Healthcare Provider Details

I. General information

NPI: 1285368381
Provider Name (Legal Business Name): KANELL & ZHU, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10323 SANTA MONICA BLVD STE 103
LOS ANGELES CA
90025-5056
US

IV. Provider business mailing address

2708 WILSHIRE BLVD # 362
SANTA MONICA CA
90403-4706
US

V. Phone/Fax

Practice location:
  • Phone: 323-553-2112
  • Fax: 909-365-2225
Mailing address:
  • Phone: 323-553-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KANELL
Title or Position: CFO
Credential: MD
Phone: 323-553-2112