MEDICARE: KBS MEDICAL CALIFORNIA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1871475715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KBS MEDICAL CALIFORNIA PC

Provider Business Mailing Address
First Line	:	169 MADISON AVE STE 15824
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5101
Country	:	US
Telephone Number	:	909-442-4965
Fax Number	:	844-440-2410

Provider Business Practice Location Address
First Line	:	145 S FAIRFAX AVE STE 200&300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2166
Country	:	US
Telephone Number	:	909-442-4965
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	LISA KENNEDY
Credential	:
Telephone Number	:	909-679-3482

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	04/16/2026

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