Healthcare Provider Details

I. General information

NPI: 1720721798
Provider Name (Legal Business Name): KAYSEN LEE MCCARTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 W GOLDLEAF CIR STE 295
LOS ANGELES CA
90056-1292
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 160
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 310-241-3687
  • Fax:
Mailing address:
  • Phone: 805-404-6348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: