MEDICARE: KEVIN J. PELTON MD, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1922721976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN J. PELTON MD, INC.

Provider Business Mailing Address
First Line	:	1700 E CESAR E CHAVEZ AVE STE 2200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2476
Country	:	US
Telephone Number	:	323-264-7600
Fax Number	:	323-261-8027

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 408
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3905
Country	:	US
Telephone Number	:	323-271-4173
Fax Number	:	213-621-9584

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN JEFFREY PELTON
Credential	:	MD
Telephone Number	:	323-264-7600

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	05/08/2024

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