NPIMap

Organization Active NPI

Image M.D.

  • General Practice Physician
  • N Hollywood, CA
National Provider Identifier
1104978766
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G74582 Issued in CA
Legal business name
IMAGE M.D.
Practice address
12805 Victory Blvd
N Hollywood, CA 91606-3012
Phone
(818) 506-5906
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Clarence Sutton, M.D.
Title
Physician Owner
Phone
(818) 506-5906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X G74582 CA Primary

Addresses

Primary practice location

12805 Victory Blvd
N Hollywood, CA 91606-3012

Mailing address

12805 Victory Blvd
N Hollywood, CA 91606-3012
Phone (818) 506-5906

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104978766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12805 VICTORY BLVD",
            "city": "N HOLLYWOOD",
            "state": "CA",
            "postal_code": "916063012",
            "telephone_number": "818-506-5906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12805 VICTORY BLVD",
            "city": "N HOLLYWOOD",
            "state": "CA",
            "postal_code": "916063012",
            "telephone_number": "818-506-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGE M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "818-506-5906",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G74582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in N Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.