Healthcare Provider Details

I. General information

NPI: 1467399139
Provider Name (Legal Business Name): NEXLIFE MEDICAL GROUP NJ P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NEWPORT CENTER DR
NEWPORT BEACH CA
92660-7520
US

IV. Provider business mailing address

260 NEWPORT CENTER DR
NEWPORT BEACH CA
92660-7520
US

V. Phone/Fax

Practice location:
  • Phone: 949-818-8000
  • Fax: 949-385-5458
Mailing address:
  • Phone: 949-818-8000
  • Fax: 949-385-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM KENNAH
Title or Position: CEO
Credential: MD
Phone: 949-818-8000