Executive Medical Group LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

EXECUTIVE MEDICAL GROUP LLC

Practice address

1115 Aqua Vista St
Unit 405
North Hollywood, CA 91602

Phone

(310) 381-9093

NPI assigned

Dec 15, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Jean-Claude KiarashNPI 1922719418

Title

Ceo

Phone

(310) 381-9093

Specialties & licenses 5

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jean-Claude Kiarash

  • Personal Care Attendant
  • West Hollywood, CA
  • NPI 1922719418
  NPD Authorized official

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1194437707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8605 SANTA MONICA BLVD",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900694109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 AQUA VISTA ST",
            "address_2": "UNIT 405",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91602",
            "telephone_number": "310-381-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-15",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A",
        "authorized_official_last_name": "KIARASH",
        "authorized_official_first_name": "JEAN-CLAUDE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-381-9093",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.