NPIMap

Organization Active NPI

Crown City Medical Group, Inc.

  • Family Medicine Physician
  • Pasadena, CA
National Provider Identifier
1073512836
Registry record updated Jul 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CROWN CITY MEDICAL GROUP, INC.
Practice address
2661 E Washington Blvd
Pasadena, CA 91107-1412
Phone
(626) 798-4952
Fax
(626) 296-1403
NPI assigned
Jul 14, 2005
Last updated
Jul 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2014

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

Authorized official

Name
Kevin B. Tyson, M.D.NPI 1194723874
Title
Midical Director
Phone
(626) 798-8792

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CA Primary

Addresses

Primary practice location

2661 E Washington Blvd
Pasadena, CA 91107-1412

Mailing address

2661 E Washington Blvd
Pasadena, CA 91107-1412
Phone (626) 798-8792

National Provider Directory

National Provider Directory

Locations

3208 Santa Anita Ave
Ste 200
El Monte, CA 91733
Phone (626) 454-1990

1542 E Florence Ave
Los Angeles, CA 90001
Phone (323) 584-0222

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406505600000",
    "number": "1073512836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2661 E WASHINGTON BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071412",
            "telephone_number": "626-798-8792",
            "fax_number": "626-296-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2661 E WASHINGTON BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071412",
            "telephone_number": "626-798-4952",
            "fax_number": "626-296-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN CITY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2014-07-28",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MIDICAL DIRECTOR",
        "authorized_official_telephone_number": "626-798-8792",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; 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.