NPI |
1073126447 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Entity Type Code |
2 |
The date that a record was last updated or changed. |
Employer Identification Number EIN |
|
The code designating the provider’s gender if the provider is a person. |
Provider Organization Name Legal Business Name |
KAC FOR SENIORS, INC. |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider First Line Business Practice Location Address |
4872 VENICE BLVD |
|
Provider Business Practice Location Address City Name |
LOS ANGELES |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Provider Business Practice Location Address State Name |
CA |
|
Provider Business Practice Location Address Postal Code |
900195662 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2137125700 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
8/26/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
8/26/2020 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
HENKIN |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
RICHARD |
The first name of the authorized official. |
Authorized Official Middle Name |
ERIC |
The middle name of the authorized official. |
Authorized Official Title or Position |
TREASURER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
2137125700 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
251E00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
NPI Certification Date |
8/26/2020 |
|