Active NPI
King Myron Mendelsohn, M.D.
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1063594919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A174690
- Practice address
- 11980 San Vicente Blvd Ste 711
Los Angeles, CA 90049-6605 - Phone
- (310) 475-3949
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A174690 | CA | Primary |
Addresses
Primary practice location
11980 San Vicente Blvd Ste 711
Los Angeles, CA 90049-6605
Mailing address
862 N Norman PL
Los Angeles, CA 90049-1546
Phone (310) 475-3949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5381216 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A174690 | CA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696550400000",
"number": "1063594919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "862 N NORMAN PL",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900491546",
"telephone_number": "310-475-3949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11980 SAN VICENTE BLVD STE 711",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900496605",
"telephone_number": "310-475-3949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDELSOHN",
"first_name": "KING",
"middle_name": "MYRON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2023-10-06",
"certification_date": "2023-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A174690",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5381216",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.