KCCC-AMITY (NPI# 1407378458) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407378458 |
| Entity Type | Organization |
| Organization Name | KCCC-AMITY |
| Practice Address |
3745 S Grand Ave Los Angeles CA 90007-4332 |
| Mailing Address |
4211 Avalon Blvd Los Angeles CA 90011-5622 |
| Practice Telephone | 3232330425 |
| Mailing Telephone | 3232330425 |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2017-07-12 |
| Authorized Official Name | DR. EARLE CHARLES (CHIEF INFORMATION OFFICER) |
| Authorized Official Telephone | 3234325093 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | KEDREN COMMUNITY HEALTH CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Street Address |
3745 S GRAND AVE |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90007-4332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174957518 | Tanyna B Sosa-williams | Social Worker | 3745 S Grand Ave, Los Angeles, CA 90007 | 2013-08-21 |
| 1285261685 | Juan Perez Tapia | Counselor | 3745 S Grand Ave, Los Angeles, CA 90007-4332 | 2020-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093278632 | St. John's Well Child and Family Center, Inc. | Clinic/Center | 1060 West Exposition Blvd., Los Angeles, CA 90007 | 2019-04-10 |
| 1639690803 | Michelle Pittman | Registered Nurse | 2829 South Grand Ave., H. Claude Hudson Chc, Los Angeles, CA 90007 | 2017-06-28 |
| 1568983773 | Debbie Sharon Gillett | Registered Nurse | 2829 South Grand Avenue, H. Claude Hudson Health Center, Los Angeles, CA 90007 | 2017-06-28 |
| 1043749435 | Tamika Brown | Driver | 2947 Van Buren Place, Los Angeles, CA 90007 | 2017-06-08 |
| 1356891857 | Eli Gendler | General Practice | 2501 South Hill St., Los Angeles, CA 90007 | 2016-10-07 |
| 1770037715 | Jennifer R Knutson | Nurse Practitioner | 2409 S. Vermont Ave., Los Angeles, CA 90007 | 2016-08-08 |
| 1386006088 | Matthew Welzenbach | Internal Medicine | St. John's Well Child, 1910 Magnolia Ave #101, Los Angeles, CA 90007 | 2016-03-22 |
| 1316315765 | Gary L Nollins | Counselor | 145 W 22ns Street, Los Angeles, CA 90007 | 2015-09-02 |
| 1861882698 | Tarlan, P. Akhavan Dds A Prof Corp | Dentist | 2407 South Vermont Ave, Los Angeles, CA 90007 | 2015-02-02 |
| 1316341258 | Jessica Huang | Student in an Organized Health Care Education/Training Program | 854 West Adams Blvd, Los Angeles, CA 90007 | 2014-10-21 |
| Find all providers in zip 90007 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184224156 | Via Care Community Health Center | Clinic/Center | 400 West Washington Blvd., The Hub D3-room 107, Los Angeles, CA 90015 | 2020-10-29 |
| 1649896903 | Jwch Institute, Inc. | Clinic/Center | 964 N Vermont Ave, Los Angeles, CA 90029-3529 | 2020-06-23 |
| 1306461074 | Jwch Institute, Inc | Clinic/Center | 855 N Vermont Ave, Los Angeles, CA 90029-3516 | 2020-06-09 |
| 1578186144 | Universal Community Health Center | Clinic/Center | 5460 E Beverly Blvd, Los Angeles, CA 90022-2208 | 2020-05-18 |
| 1114556263 | Arm 4 Arm Foundation | Clinic/Center | 231 W Vernon Ave., Suite 101, 201, Los Angeles, CA 90037 | 2020-04-01 |
| 1225673262 | Complete Care Community Health Center, Inc | Clinic/Center | 1300 N Vermont Ave Ste 606, Los Angeles, CA 90027-6088 | 2019-11-13 |
| 1811548712 | Jwch Institute, Inc | Clinic/Center | 1670 E 120 Street, West Support Bldg #14 Fl 2, Los Angeles, CA 90059-3026 | 2019-09-23 |
| 1902453731 | Altamed Health Services Corp | Clinic/Center | 2100 W 3rd St Ste 400, Los Angeles, CA 90057-2290 | 2019-08-26 |
| 1992269757 | Los Angeles Christian Health Centers | Clinic/Center | 325 7th Street, Los Angeles, CA 90014 | 2019-01-25 |
| 1083132849 | Altamed Health Services Corp | Clinic/Center | 2100 W 3rd St Ste 220, Los Angeles, CA 90057-1993 | 2017-08-31 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90007 |
Please comment or provide details below to improve the information on KCCC-AMITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.