MEDICARE: DR. KENYON S LUO 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	A33917	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114020500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENYON S LUO MD

Provider Business Mailing Address
First Line	:	4418 VINELAND AVE
Second Line	:	SUITE 118
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2159
Country	:	US
Telephone Number	:	818-769-0995
Fax Number	:	818-762-0988

Provider Business Practice Location Address
First Line	:	4418 VINELAND AVE
Second Line	:	SUITE 118
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2159
Country	:	US
Telephone Number	:	818-769-0995
Fax Number	:	818-762-0988

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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