Matthew Richard Herzog, LCGC

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

License

GC000669 Issued in CA

Practice address

695 Charles E Young Dr S Ste 5506
Los Angeles, CA 90095-8348

Phone

(310) 210-4368

Fax

(310) 206-5699

NPI assigned

Nov 2, 2017

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509580800000",
    "number": "1043722887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 CHARLES E YOUNG DR S STE 5506",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958348",
            "telephone_number": "310-210-4368",
            "fax_number": "310-206-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 CHARLES E YOUNG DR S STE 5506",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958348",
            "telephone_number": "310-210-4368",
            "fax_number": "310-206-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "MATTHEW",
        "middle_name": "RICHARD",
        "credential": "LCGC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-02",
        "last_updated": "2017-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "CA",
            "license": "GC000669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Joseph Herzik, M.D.
• Nicholas Herzik
• Jessica Herzog, PSYD
• Lauren Marie Herzog
• Lee M. Herzog, M.B.A., PSY.D.
• Garrett David Herzon, M.D.
• Mara Elizabeth Hesed, AMFT
• Bridgette Hess, NP
• Elaine Marie Hess, PH.D.
• Karl M Hess, PHARM.D.

• Genetic Counselor (M.S.) in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Genetic Counselor (M.S.) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.