NPIMap

Organization Active NPI

Advanced Hematology Oncology Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1083142376
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ADVANCED HEMATOLOGY ONCOLOGY MEDICAL GROUP INC
Practice address
6221 Wilshire Blvd Ste 504
Los Angeles, CA 90048-5223
Phone
(323) 965-9995
Fax
(323) 965-5678
NPI assigned
May 31, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Roman Kleynberg, MDNPI 1700103298
Title
President
Phone
(323) 965-9995

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

6221 Wilshire Blvd Ste 504
Los Angeles, CA 90048-5223

Mailing address

6221 Wilshire Blvd Ste 504
Los Angeles, CA 90048-5223
Phone (323) 965-9995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171205002504 CA Part B Supplier - Clinic/Group Practice 3779840459 Receives reassigned benefits from 11 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1083142376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 WILSHIRE BLVD STE 504",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485223",
            "telephone_number": "323-965-9995",
            "fax_number": "323-965-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 WILSHIRE BLVD STE 504",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485223",
            "telephone_number": "323-965-9995",
            "fax_number": "323-965-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED HEMATOLOGY ONCOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KLEYNBERG",
        "authorized_official_first_name": "ROMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-965-9995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.