Active NPI
Kathryn Underwood
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1093945792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA55934
- Practice address
- 311 Winston St
Los Angeles, CA 90013-1519 - Phone
- (213) 215-2804
- NPI assigned
- Jul 16, 2009
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 013380 | NY | |
| Medical Physician Assistant | 363AM0700X | |||
| Physician Assistant | 363A00000X | PA55934 | CA | Primary |
Addresses
Primary practice location
311 Winston St
Los Angeles, CA 90013-1519
Mailing address
8700 Beverly Blvd
West Hollywood, CA 90048-1804
Phone (310) 423-5000
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55934 | CA | MD | Dentist |
| PA55934 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bimc Faculty Practice | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592352000000",
"number": "1093945792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8700 BEVERLY BLVD",
"city": "WEST HOLLYWOOD",
"state": "CA",
"postal_code": "900481804",
"telephone_number": "310-423-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 WINSTON ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900131519",
"telephone_number": "213-215-2804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "KATHRYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-16",
"last_updated": "2020-06-17",
"certification_date": "2020-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "013380",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA55934",
"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, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.