Yulia Kustova, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA20749 Issued in CA

Practice address

2121 S San Pedro St Ste E
Los Angeles, CA 90011-1161

Phone

(213) 742-0300

NPI assigned

Aug 11, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florence Western Medical Clinic IncGroup PAC ID 1850485962, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Florence Western Medical Clinic Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1154347797
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1003121203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 HAWTHORN AVE APT 304",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900286963",
            "telephone_number": "323-350-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S SAN PEDRO ST STE E",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900111161",
            "telephone_number": "213-742-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20440 Sherman Way",
            "address_purpose": "LOCATION",
            "city": "Canoga Park",
            "state": "CA",
            "postal_code": "913063110",
            "country_code": "US",
            "telephone_number": "818-346-2395",
            "fax_number": "818-346-4591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUSTOVA",
        "first_name": "YULIA",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-11",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Kushnick
• Alisa Kusolvisitkul, PHARMD
• Melanie Kusonruksa, M.D.
• Steven Russell Kussman, M.D.
• Liza Kustantin
• Jehuda David Kusuma
• Sydney Kusumoputro, MD
• Ruvy Rose Dayrit Kutilek, NP
• Sean K Kutlay, D.D.S.
• Sarah Jane Cella Kutrumbos, LMFT

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.