Healthcare Provider Details

I. General information

NPI: 1649267071
Provider Name (Legal Business Name): KENNETH T ABJELINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23700 CAMINO DEL SOL
TORRANCE CA
90505-5017
US

IV. Provider business mailing address

PO BOX 2490
PALOS VERDES PENINSULA CA
90274-8490
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-1151
  • Fax:
Mailing address:
  • Phone: 424-400-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA64789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: