MEDICARE: DR. KENNETH M HOUSE M.D.

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	2084P0800X	Psychiatry Physician	G14204	CA

General Provider Information

NPI Number	:	1356667521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH M HOUSE M.D.

Provider Business Mailing Address
First Line	:	10444 SANTA MONICA BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6959
Country	:	US
Telephone Number	:	310-475-1670
Fax Number	:	310-457-5649

Provider Business Practice Location Address
First Line	:	10444 SANTA MONICA BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6959
Country	:	US
Telephone Number	:	310-475-1670
Fax Number	:	310-457-5649

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

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	04/13/2010

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