MEDICARE: DR. KENNETH ROY KAFKA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G86040	CA

General Provider Information

NPI Number	:	1083826382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ROY KAFKA MD

Provider Business Mailing Address
First Line	:	955 CARRILLO DR STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5400
Country	:	US
Telephone Number	:	310-888-7778
Fax Number	:	323-938-1028

Provider Business Practice Location Address
First Line	:	955 CARRILLO DRIVE
Second Line	:	SUITE 210
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5400
Country	:	US
Telephone Number	:	310-888-7778
Fax Number	:	323-938-1028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	09/26/2019

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