Provider Demographics
NPI:1083866891
Name:KENSIDE MEDICAL SERVICES
Entity type:Organization
Organization Name:KENSIDE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCED PHLEBOTOMIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKENA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCOTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:NCPT
Authorized Official - Phone:213-220-5613
Mailing Address - Street 1:4833 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4810
Mailing Address - Country:US
Mailing Address - Phone:213-220-5613
Mailing Address - Fax:323-375-3217
Practice Address - Street 1:4833 10TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4810
Practice Address - Country:US
Practice Address - Phone:213-220-5613
Practice Address - Fax:323-375-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT29004246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty