Individual provider Active NPI

Hrak Ray Jalian, M.D.

  • Procedural Dermatology Physician
  • Santa Monica, CA
National Provider Identifier
1023260346
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
A106413 Issued in CA
Practice address
2020 Santa Monica Blvd Ste 570
Santa Monica, CA 90404-2131
Phone
(310) 917-3376
NPI assigned
Oct 17, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology Physician 207NS0135X A106413 CA Primary

Addresses

Primary practice location

2020 Santa Monica Blvd Ste 570
Santa Monica, CA 90404-2131

Mailing address

2020 Santa Monica Blvd Ste 570
Santa Monica, CA 90404-2131
Phone (310) 917-3376

Other identifiers 1

IdentifierTypeStateIssuer
1023260346MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130401000233 CA Practitioner - Dermatology 4385801570 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
106413CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Rebecca Fitzgerald M.D. , Inc. Procedural Dermatology CurrentSince Jan 14, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 15, 2017 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 15, 2017 Accepting new patients

Locations

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

321 N Larchmont Blvd
Ste 9
Los Angeles, CA 90004
Phone (323) 464-8046

321 N Larchmont Blvd
Ste 906
Los Angeles, CA 90004
Phone (323) 464-8046

393 E Walnut St
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 4

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": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1023260346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 SANTA MONICA BLVD STE 570",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042131",
            "telephone_number": "310-917-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 SANTA MONICA BLVD STE 570",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042131",
            "telephone_number": "310-917-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JALIAN",
        "first_name": "HRAK",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-17",
        "last_updated": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A106413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023260346",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.