KENNETH JOHAN (MD) – Internal Medicine Physician, NPI 1124690656
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
18,056 INTERNAL MEDICINE in NY
Provider Addresses for KENNETH JOHAN (MD)
234 E 149th St Ste 8-20
Bronx, NY 104515504
Phone: (718) 579-5000
Type: Location
16850 BEAR VALLEY RD STE 203
VICTORVILLE, CA 923955794
Phone: (760) 241-8000
Type: Mailing
16850 BEAR VALLEY RD
VICTORVILLE, CA 923955794
Phone: (760) 241-8000
Type: Location
21 WEST ST APT 3B
NEW YORK, NY 100062921
Phone: (312) 478-7054
Type: Mailing
234 E 149TH ST STE 8-20
BRONX, NY 104515504
Phone: (718) 579-5000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-10-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241008003993 | I | Internal Medicine | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 10451)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | CA | |
| - | CA | |
| Orthopedic Surgery | CA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CA | |
| Family Practice | CA | |
| - | CA | |
| - | CA | |
| Internal Medicine | NY | |
| Nurse Practitioner | CA | |
| General Practice | CA |
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