Healthcare Provider Details

I. General information

NPI: 1104436104
Provider Name (Legal Business Name): MARTHA LOUISE MCKINNEY MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 83
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD # 83
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2101
  • Fax: 323-361-1355
Mailing address:
  • Phone: 323-361-2101
  • Fax: 323-361-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberG85271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: