Healthcare Provider Details

I. General information

NPI: 1346560455
Provider Name (Legal Business Name): KENTON HOWARD FIBEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TERRACE 100, 125, 400
LOS ANGELES CA
90045-9004
US

IV. Provider business mailing address

535 E 70TH ST ATTENTION: KENTON FIBEL, MD
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7200
  • Fax: 646-714-6376
Mailing address:
  • Phone: 646-714-6323
  • Fax: 646-714-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA118684
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number268986
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: