Provider Demographics
NPI:1386771442
Name:R. KENDRICK SLATE, M.D., INC
Entity type:Organization
Organization Name:R. KENDRICK SLATE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KENDRICK
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-303-3391
Mailing Address - Street 1:PO BOX 1607
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1607
Mailing Address - Country:US
Mailing Address - Phone:951-303-3391
Mailing Address - Fax:951-346-3627
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:CS-OCC
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44344208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF19072Medicare UPIN
CAG44344Medicare ID - Type Unspecified