Provider Demographics
NPI:1821004797
Name:KANEL, GARY CRAIG (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:CRAIG
Last Name:KANEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-2582
Mailing Address - Fax:323-442-2588
Practice Address - Street 1:2011 ZONAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089
Practice Address - Country:US
Practice Address - Phone:323-442-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39010207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA220012280OtherMEDICARE RAILROAD
CA00G390100OtherBLUE SHIELD
CA00G390100Medicaid
CA1952325565OtherGROUP NPI
CA220012280OtherMEDICARE RAILROAD
CA00G390100Medicaid
CAWG39010AMedicare PIN
CAE97499Medicare UPIN
CAW7801BMedicare PIN
CA1952325565OtherGROUP NPI
CAHW7801AMedicare PIN