Provider Demographics
NPI:1124120787
Name:KANENGISER, LEWIS RINGEL (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:RINGEL
Last Name:KANENGISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:SUITE #550
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-315-0188
Mailing Address - Fax:310-315-0235
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE #550
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-315-0188
Practice Address - Fax:310-315-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92568Medicare UPIN
CAG45287Medicare ID - Type Unspecified