MEDICARE: DR. PETER REYNOLDS KERNDT 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	A35519	CA

General Provider Information

NPI Number	:	1992974471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER REYNOLDS KERNDT MD

Provider Business Mailing Address
First Line	:	2615 S GRAND AVE
Second Line	:	RM 507H
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2608
Country	:	US
Telephone Number	:	213-745-0811
Fax Number	:	213-743-4864

Provider Business Practice Location Address
First Line	:	2615 S GRAND AVE
Second Line	:	RM 507H
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2608
Country	:	US
Telephone Number	:	213-745-0811
Fax Number	:	213-743-4864

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	06/23/2015

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