Provider Demographics
NPI:1992974471
Name:KERNDT, PETER REYNOLDS (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:REYNOLDS
Last Name:KERNDT
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 1:2615 S GRAND AVE
Mailing Address - Street 2:RM 507H
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2608
Mailing Address - Country:US
Mailing Address - Phone:213-745-0811
Mailing Address - Fax:213-743-4864
Practice Address - Street 1:2615 S GRAND AVE
Practice Address - Street 2:RM 507H
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2608
Practice Address - Country:US
Practice Address - Phone:213-745-0811
Practice Address - Fax:213-743-4864
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine