Healthcare Provider Details

I. General information

NPI: 1508475427
Provider Name (Legal Business Name): KENNETH RYAN HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W CARSON ST
TORRANCE CA
90502-2006
US

IV. Provider business mailing address

1124 W CARSON ST
TORRANCE CA
90502-2006
US

V. Phone/Fax

Practice location:
  • Phone: 310-974-9333
  • Fax: 424-221-5903
Mailing address:
  • Phone: 310-974-9333
  • Fax: 424-221-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA208979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: