MEDICARE: KENTON E KAGY D.O.

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	2085R0202X	Diagnostic Radiology Physician	20A15777	CA
2	2085R0202X	Diagnostic Radiology Physician	DO2248	NV
3	2085R0202X	Diagnostic Radiology Physician	308951	LA

General Provider Information

NPI Number	:	1821362740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENTON E KAGY D.O.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-5138
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-4608
Country	:	US
Telephone Number	:	310-301-6800
Fax Number	:	310-794-9035

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

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	07/14/2021

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