Healthcare Provider Details

I. General information

NPI: 1134336811
Provider Name (Legal Business Name): KEDREN COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 E 60TH ST
LOS ANGELES CA
90001-1017
US

IV. Provider business mailing address

4211 AVALON BLVD
LOS ANGELES CA
90011-5622
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-0425
  • Fax: 323-233-5186
Mailing address:
  • Phone: 323-432-5093
  • Fax: 323-233-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number930000028
License Number StateCA

VIII. Authorized Official

Name: HILDA RODRIGUEZ
Title or Position: DIRECTOR OF BILLING SERVICES
Credential:
Phone: 323-802-0264