MEDICARE: KENDEL THIRLBENNY PA-C

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	363AM0700X	Medical Physician Assistant	PA 16098	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01272662/DU4032	OTHER	CA	RAILROAD MEDICARE
4	P01273082	OTHER	CA	RAILROAD MEDICARE-DU4032-WILMINGTON

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942358221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDEL THIRLBENNY PA-C

Provider Business Mailing Address
First Line	:	200 OCEANGATE
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4302
Country	:	US
Telephone Number	:	562-499-6191
Fax Number	:	877-469-3649

Provider Business Practice Location Address
First Line	:	540 E ARTESIA BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1476
Country	:	US
Telephone Number	:	562-423-3383
Fax Number	:	877-469-3649

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	04/16/2015

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Directions to “ KENDEL THIRLBENNY PA-C” Practice Location

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