Provider Demographics
NPI:1316049620
Name:KYNARD, ANDREA (MD, NP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:KYNARD
Suffix:
Gender:F
Credentials:MD, NP
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 56316
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-0029
Mailing Address - Country:US
Mailing Address - Phone:310-714-3888
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 56316
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-0029
Practice Address - Country:US
Practice Address - Phone:310-714-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361376363LF0000X
PR021571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP34726Medicare UPIN