Active NPI
Yevgeniy Glukhovsky
- Adult Health Nurse Practitioner
- Tarzana, CA
National Provider Identifier
1013566520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 95012495
- Practice address
- 18425 Burbank Blvd
Tarzana, CA 91356-2806 - Phone
- (855) 690-0565
- NPI assigned
- Sep 6, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 95012495 | CA | Primary |
Addresses
Primary practice location
18425 Burbank Blvd
Tarzana, CA 91356-2806
Mailing address
18425 Burbank Blvd
Tarzana, CA 91356-2806
Phone (855) 690-0565
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240620000430 | CA | Practitioner - Nurse Practitioner | 2365985249 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95012495 | CA | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minghsun Liu, M.D., PC | Current | Accepting new patients | |
| WT Health of California LLC | Current | Accepting new patients |
Locations
11103 Venice Blvd
Los Angeles, CA 90034
Phone (310) 734-8526
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567728000000",
"number": "1013566520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18425 BURBANK BLVD",
"city": "TARZANA",
"state": "CA",
"postal_code": "913562806",
"telephone_number": "855-690-0565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18425 BURBANK BLVD",
"city": "TARZANA",
"state": "CA",
"postal_code": "913562806",
"telephone_number": "855-690-0565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLUKHOVSKY",
"first_name": "YEVGENIY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-06",
"last_updated": "2019-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "CA",
"license": "95012495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tarzana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.