Active NPI
Amelia Murti Fan, MD
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1083886741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A103199
- Practice address
- 5059 York Blvd
Ms#68
Los Angeles, CA 90042-1713 - Phone
- (323) 344-4144
- Fax
- (323) 344-4146
- NPI assigned
- Apr 2, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A103199 | CA | Primary |
Addresses
Primary practice location
5059 York Blvd
Ms#68
Los Angeles, CA 90042-1713
Mailing address
801 S Chevy Chase Dr
#20
Glendale, CA 91205-4431
Phone (323) 344-4144
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 |
|---|---|---|---|
| A103199 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glendale Adventist Medical Center | Past | Accepting new patients | |
| Glendale Pediatrics, a Professional Corporation | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Skilled Nursing Facility
- Glendale, CA
- NPI 1114916293
-
- Pediatrics Physician
- Glendale, CA
- NPI 1720115660
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276732800000",
"number": "1083886741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 S CHEVY CHASE DR",
"address_2": "#20",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912054431",
"telephone_number": "323-344-4144",
"fax_number": "323-344-4146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5059 YORK BLVD",
"address_2": "MS#68",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900421713",
"telephone_number": "323-344-4144",
"fax_number": "323-344-4146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "AMELIA",
"middle_name": "MURTI",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-02",
"last_updated": "2010-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A103199",
"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 Jun 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.