| Martin Luther King, Jr. Outpatient Center | |
|
1670 E 120th St Los Angeles CA 90059-3026 | |
| (310) 668-5201 | |
| Not Available |
| Full Name | Martin Luther King, Jr. Outpatient Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1670 E 120th St, Los Angeles, California |
| Authorized Official Name and Position | Cynthia Oliver (ADMINISTRATOR) |
| Authorized Official Contact | 4243381001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martin Luther King, Jr. Outpatient Center 1670 E 120th St Los Angeles CA 90059-3026 Ph: (310) 668-5201 | Martin Luther King, Jr. Outpatient Center 1670 E 120th St Los Angeles CA 90059-3026 Ph: (310) 668-5201 |
| NPI Number | 1780877613 |
|---|---|
| Provider Enumeration Date | 08/23/2007 |
| Last Update Date | 05/14/2020 |
| Medicare PECOS PAC ID | 1850296534 |
|---|---|
| Medicare Enrollment ID | O20090713000358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780877613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | (* (Not Available)) | Secondary |
| Provider Name | Juan C Esteva |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1700961489 PECOS PAC ID: 8628977154 Enrollment ID: I20040105000361 |
| Provider Name | Susan M Partovi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134312812 PECOS PAC ID: 7416841523 Enrollment ID: I20040210000895 |
| Provider Name | Satya N Vashishtha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588731350 PECOS PAC ID: 4587655113 Enrollment ID: I20040521000277 |
| Provider Name | Raymond W Chyu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689615312 PECOS PAC ID: 2961484068 Enrollment ID: I20040602001620 |
| Provider Name | Denise D Brathwaite |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1770524605 PECOS PAC ID: 7315921194 Enrollment ID: I20040617001133 |
| Provider Name | Walter R Bush |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437191566 PECOS PAC ID: 7618956608 Enrollment ID: I20040714000887 |
| Provider Name | James Pagano |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003855826 PECOS PAC ID: 8820063043 Enrollment ID: I20040901001145 |
| Provider Name | Liberata G Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154458347 PECOS PAC ID: 5092782656 Enrollment ID: I20040913001284 |
| Provider Name | Antoine Roberts |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1114911880 PECOS PAC ID: 7719948652 Enrollment ID: I20041022001133 |
| Provider Name | Ellsworth R Grant |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1043233760 PECOS PAC ID: 6507829736 Enrollment ID: I20041109000696 |
| Provider Name | Hermenegildo Ocampo |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1245331297 PECOS PAC ID: 4688637788 Enrollment ID: I20041109001256 |
| Provider Name | Galust G Halajyan |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1629161385 PECOS PAC ID: 8729042213 Enrollment ID: I20041115000846 |
| Provider Name | Sheilah Clayton |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538265673 PECOS PAC ID: 9436115276 Enrollment ID: I20041203000527 |
| Provider Name | Stanley H Hsia |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1841300647 PECOS PAC ID: 5193781730 Enrollment ID: I20041206001011 |
| Provider Name | George L Marks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578589602 PECOS PAC ID: 6800852344 Enrollment ID: I20041206001043 |
| Provider Name | Golriz Jafari |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1174629166 PECOS PAC ID: 5799743423 Enrollment ID: I20041228000969 |
| Provider Name | Susan Claster |
|---|---|
| Provider Type | Practitioner - Hematology |
| Provider Identifiers | NPI Number: 1659471829 PECOS PAC ID: 4284686833 Enrollment ID: I20050211000534 |
| Provider Name | Michelle C Banks |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1356365654 PECOS PAC ID: 7719933803 Enrollment ID: I20050322000708 |
| Provider Name | Alexander Y Nemirovsky |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1568410520 PECOS PAC ID: 7719924513 Enrollment ID: I20050413000657 |
| Provider Name | Ramon Narciso Guadiz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003998147 PECOS PAC ID: 1153319553 Enrollment ID: I20050414000794 |
| Provider Name | Jean-claude Henry |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1215022561 PECOS PAC ID: 6608814983 Enrollment ID: I20050418001030 |
| Provider Name | Joseph L Thomas |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568641660 PECOS PAC ID: 6709826043 Enrollment ID: I20050505001243 |
| Provider Name | Neerja Puri |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073700472 PECOS PAC ID: 7113968843 Enrollment ID: I20050512000681 |
| Provider Name | Stephen C Lui |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1891770384 PECOS PAC ID: 4385672534 Enrollment ID: I20050729000566 |
| Provider Name | Jose S Tandoc |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366413387 PECOS PAC ID: 0840221446 Enrollment ID: I20050823001128 |
| Provider Name | Brian M Lee |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1558457556 PECOS PAC ID: 4880610575 Enrollment ID: I20051021000465 |
| Provider Name | Andrew L Katz |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1780661900 PECOS PAC ID: 2567480536 Enrollment ID: I20051108000666 |
| Provider Name | Ruth Oren |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1821123696 PECOS PAC ID: 6103850706 Enrollment ID: I20051108000830 |
| Provider Name | Sony A. Ta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740200914 PECOS PAC ID: 1355360686 Enrollment ID: I20051116000553 |
| Provider Name | Ahmad S Khalifa |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1902954837 PECOS PAC ID: 9931120359 Enrollment ID: I20051213000878 |
| Provider Name | Farhad Motamedi |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1891887287 PECOS PAC ID: 9234152794 Enrollment ID: I20060110001177 |
| Provider Name | Leena A Zopey |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1801838594 PECOS PAC ID: 6608880489 Enrollment ID: I20060131000957 |
| Provider Name | Mark A Ghaly |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578637898 PECOS PAC ID: 4486669207 Enrollment ID: I20060215000783 |
| Provider Name | Anthony R Mccloud |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1437242716 PECOS PAC ID: 4981612637 Enrollment ID: I20060322000637 |
| Provider Name | Lori Hobbs |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1104831866 PECOS PAC ID: 9830196146 Enrollment ID: I20061030000522 |
| Provider Name | Jina Chung |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1558450668 PECOS PAC ID: 1658378732 Enrollment ID: I20061102000363 |
| Provider Name | Rodrigo J Torres |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1578651584 PECOS PAC ID: 0840220117 Enrollment ID: I20061113000268 |
| Provider Name | Hayward Lynn Eubanks |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1023039815 PECOS PAC ID: 5890795108 Enrollment ID: I20070111000130 |
| Provider Name | Merlyn M Asuncion |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679656193 PECOS PAC ID: 1355250820 Enrollment ID: I20070402000433 |
| Provider Name | Sebhat Afework |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891821666 PECOS PAC ID: 3375641863 Enrollment ID: I20070606000741 |
| Provider Name | Florence B Chong |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295950160 PECOS PAC ID: 2062511264 Enrollment ID: I20070629000165 |
| Provider Name | Shalu Gupta |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1518187202 PECOS PAC ID: 5799878716 Enrollment ID: I20070907000290 |
| Provider Name | Kim V Fouche |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275573669 PECOS PAC ID: 2567557374 Enrollment ID: I20071008000605 |
| Provider Name | Thomas M Ohearn |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1912104720 PECOS PAC ID: 6103912472 Enrollment ID: I20071017000844 |
| Provider Name | Shashank Sharma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184803892 PECOS PAC ID: 9436249711 Enrollment ID: I20071227000145 |
| Provider Name | Kenneth D Lewis |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1629154745 PECOS PAC ID: 5496835795 Enrollment ID: I20071227000366 |
| Provider Name | Michael H Owens |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275728388 PECOS PAC ID: 7315027489 Enrollment ID: I20071231000575 |
| Provider Name | Lucilene F Tolentino |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1710079603 PECOS PAC ID: 8123100096 Enrollment ID: I20080130000817 |
| Provider Name | Celina M Nadelman |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1437259595 PECOS PAC ID: 2365527207 Enrollment ID: I20080317000394 |
| Provider Name | Joy Brotherton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194731604 PECOS PAC ID: 3173522851 Enrollment ID: I20081030000178 |
| Provider Name | Kanagal L Satyanarayana |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487721486 PECOS PAC ID: 0244399343 Enrollment ID: I20081104000592 |
| Provider Name | Ellen L Rothman |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1649371261 PECOS PAC ID: 1759441116 Enrollment ID: I20081115000196 |
| Provider Name | Bharti H Nachnani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841326477 PECOS PAC ID: 2769544477 Enrollment ID: I20081215000169 |
| Provider Name | Karen R. Sun |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1083877534 PECOS PAC ID: 9739242520 Enrollment ID: I20090105000445 |
| Provider Name | Ruth N Arceo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427150093 PECOS PAC ID: 6406919729 Enrollment ID: I20090113000716 |
| Provider Name | Koko Myat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417099060 PECOS PAC ID: 7315095452 Enrollment ID: I20090429000683 |
| Provider Name | Esther Chung |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1356598288 PECOS PAC ID: 3870645534 Enrollment ID: I20090710000407 |
| Provider Name | Carleton Allen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205975208 PECOS PAC ID: 6507910197 Enrollment ID: I20090817000419 |
| Provider Name | Rachel A Feit-leichman |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1306047394 PECOS PAC ID: 1951496454 Enrollment ID: I20091013000580 |
| Provider Name | Ray Zhao |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558595967 PECOS PAC ID: 7416094065 Enrollment ID: I20091030000172 |
| Provider Name | Alam N.m Syed |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1316956279 PECOS PAC ID: 2567461601 Enrollment ID: I20091113000238 |
| Provider Name | Alexandria Booth |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1588872352 PECOS PAC ID: 6305904087 Enrollment ID: I20100216000815 |
| Provider Name | Zoetania N Dantas |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1265565774 PECOS PAC ID: 6901941582 Enrollment ID: I20100308000148 |
| Provider Name | Tiffany E Hill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174756241 PECOS PAC ID: 6305981762 Enrollment ID: I20100310000120 |
| Provider Name | Anita J Horner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215038229 PECOS PAC ID: 2860527694 Enrollment ID: I20100318000833 |
| Provider Name | Miguel A Unzueta |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1023040714 PECOS PAC ID: 5799811816 Enrollment ID: I20100329000451 |
| Provider Name | Alan M Heilpern |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649219080 PECOS PAC ID: 0143127001 Enrollment ID: I20100519000210 |
| Provider Name | Mark Volpicelli |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1083786636 PECOS PAC ID: 5395766679 Enrollment ID: I20100909000950 |
| Provider Name | Ronald J Oudiz |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316957228 PECOS PAC ID: 3476749821 Enrollment ID: I20101124000177 |
| Provider Name | Richard Casey |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1609890797 PECOS PAC ID: 6901709310 Enrollment ID: I20110105000017 |
| Provider Name | Barbara S Yates |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1164616686 PECOS PAC ID: 9234282567 Enrollment ID: I20110202000391 |
| Provider Name | Melanie A Osby |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1154413045 PECOS PAC ID: 8022299023 Enrollment ID: I20110224000057 |
| Provider Name | Doron Nazarian |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1841503174 PECOS PAC ID: 4880877927 Enrollment ID: I20110523000210 |
| Provider Name | Daniel J Furoy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669671319 PECOS PAC ID: 9133304470 Enrollment ID: I20110805000556 |
| Provider Name | Leroy William Vaughn |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1528149036 PECOS PAC ID: 4688846314 Enrollment ID: I20110930000471 |
| Provider Name | Dana N Scott |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1114109626 PECOS PAC ID: 4789856964 Enrollment ID: I20111012000341 |
| Provider Name | Lisa M Garcia |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1134396419 PECOS PAC ID: 5092982694 Enrollment ID: I20120123000709 |
| Provider Name | Sandeep K Khanna |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1366514044 PECOS PAC ID: 0042258444 Enrollment ID: I20120201000244 |
| Provider Name | John A Uyanne |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871635243 PECOS PAC ID: 7911165725 Enrollment ID: I20120224000776 |
| Provider Name | Theodore C Friedman |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1972669125 PECOS PAC ID: 6204097520 Enrollment ID: I20120413000271 |
| Provider Name | Glenda A Lindsey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437298585 PECOS PAC ID: 3577724806 Enrollment ID: I20120413000374 |
| Provider Name | Priya Pillutla |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255453171 PECOS PAC ID: 5890957989 Enrollment ID: I20120508000097 |
| Provider Name | Carla E Herriford |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1114910163 PECOS PAC ID: 3375616436 Enrollment ID: I20120514000519 |
| Provider Name | Jennifer B Galindo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568683175 PECOS PAC ID: 8224291810 Enrollment ID: I20120517000545 |
| Provider Name | Maria D Navar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821124462 PECOS PAC ID: 1759544000 Enrollment ID: I20120523000616 |
| Provider Name | Halline U Overby |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912062001 PECOS PAC ID: 4981868643 Enrollment ID: I20120607000703 |
| Provider Name | Anika A Russell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629396213 PECOS PAC ID: 9537316013 Enrollment ID: I20120906000456 |
| Provider Name | Jane Mary Mcgarvey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376657148 PECOS PAC ID: 7618975368 Enrollment ID: I20121018000395 |
| Provider Name | Sandra I Vizireanu |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205060449 PECOS PAC ID: 1355593393 Enrollment ID: I20121220000208 |
| Provider Name | Jennifer A Kwok |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497989636 PECOS PAC ID: 4284871351 Enrollment ID: I20130508000534 |
| Provider Name | Parissa Moradi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043448731 PECOS PAC ID: 8123266277 Enrollment ID: I20130530000623 |
| Provider Name | Allen S Funnye |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306956107 PECOS PAC ID: 2062650195 Enrollment ID: I20130601000063 |
| Provider Name | Marynell Jelinek |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487687828 PECOS PAC ID: 4587804968 Enrollment ID: I20130708000551 |
| Provider Name | Sophia Monica Soni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346564101 PECOS PAC ID: 9830332949 Enrollment ID: I20130821000254 |
| Provider Name | Shobita Rajagopalan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205041779 PECOS PAC ID: 4789818139 Enrollment ID: I20131018000180 |
| Provider Name | Pandora F Mcdaniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972639508 PECOS PAC ID: 0345475927 Enrollment ID: I20131107000840 |
| Provider Name | Riza G Nielsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174956064 PECOS PAC ID: 4789811803 Enrollment ID: I20131217001843 |
| Provider Name | Stanley Frencher |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1124341086 PECOS PAC ID: 5395977516 Enrollment ID: I20140422001045 |
| Provider Name | Frederick Rutherford |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1346359973 PECOS PAC ID: 3971738691 Enrollment ID: I20140620001446 |
| Provider Name | Sandy Wang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154562551 PECOS PAC ID: 2769538230 Enrollment ID: I20150119000196 |
| Provider Name | Aram L Shemmassian |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578889069 PECOS PAC ID: 2769707249 Enrollment ID: I20150203002043 |
| Provider Name | Jaquelyn L Macaraeg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326380643 PECOS PAC ID: 7810208188 Enrollment ID: I20150613000099 |
| Provider Name | Ashley Mcilhenny |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528215720 PECOS PAC ID: 0042521833 Enrollment ID: I20150619002068 |
| Provider Name | Aseem Hemmad |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1659686111 PECOS PAC ID: 9931413358 Enrollment ID: I20150729009395 |
| Provider Name | Judy H Chen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659531044 PECOS PAC ID: 7810205820 Enrollment ID: I20150924001181 |
| Provider Name | Uma I Bhaskara |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1548635428 PECOS PAC ID: 5193028033 Enrollment ID: I20160126002443 |
| Provider Name | Perlita Amada Perez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174810972 PECOS PAC ID: 8628205804 Enrollment ID: I20160211000889 |
| Provider Name | Carmen Morales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154733012 PECOS PAC ID: 8921303777 Enrollment ID: I20160216002680 |
| Provider Name | Heidi Louise Behforouz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073579736 PECOS PAC ID: 9537348271 Enrollment ID: I20160223002516 |
| Provider Name | Lauren P Daskivich |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1225284714 PECOS PAC ID: 0941442859 Enrollment ID: I20160229001572 |
| Provider Name | Veronica Marbella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770906984 PECOS PAC ID: 8325344302 Enrollment ID: I20160317001061 |
| Provider Name | Jean I James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902932700 PECOS PAC ID: 8022315399 Enrollment ID: I20160331001301 |
| Provider Name | Deisy Nava |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487082822 PECOS PAC ID: 0547569451 Enrollment ID: I20160427001924 |
| Provider Name | Aki Niihara |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1114286952 PECOS PAC ID: 9537483870 Enrollment ID: I20161026000964 |
| Provider Name | Ma Jasmin F Binas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578909404 PECOS PAC ID: 3870874035 Enrollment ID: I20161229001553 |
| Provider Name | Aydin H Pooli |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1548558067 PECOS PAC ID: 9133351026 Enrollment ID: I20170223001028 |
| Provider Name | Olivia C Almeida Hunt |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1376842880 PECOS PAC ID: 2668756602 Enrollment ID: I20170310001624 |
| Provider Name | Tasha M Dixon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295175099 PECOS PAC ID: 8426332461 Enrollment ID: I20170310001867 |
| Provider Name | Timothy P Fox |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1568805471 PECOS PAC ID: 5395012637 Enrollment ID: I20170517001000 |
| Provider Name | Aditi S Jani |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1366880395 PECOS PAC ID: 0547537805 Enrollment ID: I20170517001986 |
| Provider Name | Frances F Crisostomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770902413 PECOS PAC ID: 6103193313 Enrollment ID: I20170518000915 |
| Provider Name | Bernadette Manalo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245677293 PECOS PAC ID: 1052688686 Enrollment ID: I20170601001449 |
| Provider Name | Marc H Huh |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1316387715 PECOS PAC ID: 6901023258 Enrollment ID: I20170905002159 |
| Provider Name | Maria Guadalupe Hurtado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366833741 PECOS PAC ID: 7719243112 Enrollment ID: I20171116002324 |
| Provider Name | Maria A Berumen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003207739 PECOS PAC ID: 2567728967 Enrollment ID: I20171116002672 |
| Provider Name | Revery P Barnes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669812467 PECOS PAC ID: 9638438666 Enrollment ID: I20180118002704 |
| Provider Name | Natalie C Arias |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801316492 PECOS PAC ID: 8426314485 Enrollment ID: I20180515002862 |
| Provider Name | Amy K Yetasook |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1982028130 PECOS PAC ID: 2769786938 Enrollment ID: I20181015003165 |
| Provider Name | Karla Anel Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609263623 PECOS PAC ID: 4183962061 Enrollment ID: I20190219002859 |
| Provider Name | Jessica I Schneider |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902223332 PECOS PAC ID: 0345589974 Enrollment ID: I20190226003182 |
| Provider Name | Lisa N Gantz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679968887 PECOS PAC ID: 2062754443 Enrollment ID: I20190506000738 |
| Provider Name | Safari M Sekiyoba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275006686 PECOS PAC ID: 0345574695 Enrollment ID: I20190620002327 |
| Provider Name | Theodore Tso |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1285040980 PECOS PAC ID: 2769716521 Enrollment ID: I20190627001949 |
| Provider Name | Niousha Moini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073829735 PECOS PAC ID: 0749538072 Enrollment ID: I20200213000872 |
| Provider Name | Emily Herron Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679967996 PECOS PAC ID: 8921371865 Enrollment ID: I20210108002189 |
| Provider Name | Khanhphong D Trinh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871818906 PECOS PAC ID: 0941441893 Enrollment ID: I20210129002190 |
| Provider Name | Atul Nakhasi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104261924 PECOS PAC ID: 0648684498 Enrollment ID: I20210205002395 |
| Provider Name | Lynda Basile Stack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659405306 PECOS PAC ID: 6305251984 Enrollment ID: I20210211002200 |
| Provider Name | Kim Marie Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487916250 PECOS PAC ID: 5597171470 Enrollment ID: I20210302000993 |
| Provider Name | Angeli Bueno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982066411 PECOS PAC ID: 0143636571 Enrollment ID: I20210310001471 |
| Provider Name | Scott Gilmore |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457705642 PECOS PAC ID: 8628360062 Enrollment ID: I20210524001233 |
| Provider Name | Joyce A Sutedja |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1366974743 PECOS PAC ID: 0547593568 Enrollment ID: I20210816002520 |
| Provider Name | Ryan A Gleber |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013470384 PECOS PAC ID: 5890190474 Enrollment ID: I20210819001695 |
| Provider Name | Perla M Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528580438 PECOS PAC ID: 6103222757 Enrollment ID: I20210907001236 |
| Provider Name | Ignacio D Velazquez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972923290 PECOS PAC ID: 0446665095 Enrollment ID: I20211118002062 |
| Provider Name | Eric R Crum |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1285825307 PECOS PAC ID: 9133442270 Enrollment ID: I20220204001597 |
| Provider Name | Yazeed Ali Samara |
|---|---|
| Provider Type | Practitioner - Hematology |
| Provider Identifiers | NPI Number: 1528419355 PECOS PAC ID: 3274968219 Enrollment ID: I20220209002282 |
| Provider Name | Zaki Elmaghraby |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1659392785 PECOS PAC ID: 8729069778 Enrollment ID: I20220308002690 |
| Provider Name | Charito Chalie Salasac Franco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295487163 PECOS PAC ID: 8022404896 Enrollment ID: I20220404000839 |
| Provider Name | Apollonia Godoy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730573395 PECOS PAC ID: 3476837535 Enrollment ID: I20220405001579 |
| Provider Name | Anna L Yap |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265935092 PECOS PAC ID: 4688081235 Enrollment ID: I20220411000690 |
| Provider Name | Jong Joon Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306812532 PECOS PAC ID: 8921150749 Enrollment ID: I20220422002156 |
| Provider Name | Deborah Me |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1225482516 PECOS PAC ID: 8426398348 Enrollment ID: I20220425000691 |
| Provider Name | James Refaat Habashy |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1659682565 PECOS PAC ID: 1456639731 Enrollment ID: I20220428000979 |
| Provider Name | Robert C Gutierrez |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730146374 PECOS PAC ID: 0749268985 Enrollment ID: I20220506000885 |
| Provider Name | Yvonne Danae Camper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265779094 PECOS PAC ID: 6406235837 Enrollment ID: I20220615001905 |
| Provider Name | Robin Ravind Chand |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1811253495 PECOS PAC ID: 0547494346 Enrollment ID: I20221115002475 |
| Provider Name | Jennifer L Bailey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992332845 PECOS PAC ID: 2860866175 Enrollment ID: I20230327002928 |
| Provider Name | Omowunmi M Abioro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891399820 PECOS PAC ID: 6608233622 Enrollment ID: I20230607001195 |
| Provider Name | Teena P Tran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184234577 PECOS PAC ID: 7315304151 Enrollment ID: I20230719003905 |
| Provider Name | Kristian James |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982224978 PECOS PAC ID: 1951756311 Enrollment ID: I20231005000575 |
| Provider Name | Charmaine Elouise Dorsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932638665 PECOS PAC ID: 7618324286 Enrollment ID: I20231103003203 |
| Provider Name | Francis Lim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003236415 PECOS PAC ID: 7810261369 Enrollment ID: I20240419001186 |
Joseph I Kang Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3755 Beverly Blvd, Ste 301, Los Angeles, CA 90004 Phone: 323-664-7777 | |
Clinica Virgen De Guadalupe Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 985 W Vernon Ave, Los Angeles, CA 90037 Phone: 323-234-6300 | |
Ssg San Pedro Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5811 S San Pedro St, Los Angeles, CA 90011 Phone: 213-553-1800 | |
John L Sherman Md Amc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8635 W 3rd St Ste 485w, Los Angeles, CA 90048 Phone: 310-855-8081 Fax: 310-855-0438 | |
Altamed Medical Group Eapc Prop 99 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Citadel Dr, Ste 490, Los Angeles, CA 90040 Phone: 323-725-8751 Fax: 323-889-7399 | |
Altamed Health Services Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5425 Pomona Blvd, Los Angeles, CA 90022 Phone: 323-832-7527 Fax: 323-832-7599 | |
Apla Health & Wellness - David Geffen Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 611 S Kingsley Dr, Los Angeles, CA 90005 Phone: 213-201-1623 Fax: 213-201-1595 |