M. Bussarakum, M.D., Inc.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

A30882 Issued in CA

Legal business name

M. BUSSARAKUM, M.D., INC.

Practice address

201 S Alvarado St
Suite 603
Los Angeles, CA 90057-2320

Phone

(213) 483-0500

Fax

(213) 483-3767

NPI assigned

Mar 30, 2007

Organization subpart

No

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

Authorized official

Name

Mingquan Bussarakum, M.D.

Title

President

Phone

(213) 483-0500

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1164542536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S ALVARADO ST",
            "address_2": "SUITE 603",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572320",
            "telephone_number": "213-483-0500",
            "fax_number": "213-483-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S ALVARADO ST",
            "address_2": "SUITE 603",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572320",
            "telephone_number": "213-483-0500",
            "fax_number": "213-483-3767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M. BUSSARAKUM, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "BUSSARAKUM",
        "authorized_official_first_name": "MINGQUAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-483-0500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A30882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A308820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; 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.