NPIMap

Individual provider Active NPI

Elizabeth Allison Van Dyne, M.D.

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1235499161
Registry record updated May 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A119828 Issued in CA
Practice address
4700 W Sunset Blvd
Module 4-B
Los Angeles, CA 90027-6082
Phone
(800) 954-8000
NPI assigned
May 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A119828 CA Primary

Addresses

Primary practice location

4700 W Sunset Blvd
Module 4-B
Los Angeles, CA 90027-6082

Mailing address

4700 W Sunset Blvd
Module 4-B
Los Angeles, CA 90027-6082
Phone (800) 954-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190408000967 TX Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 6901050202 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ton San Simon Health Center CurrentSince Feb 3, 2019 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Jan 31, 2022 Accepting new patients
Ton Sells Hospital CurrentSince Feb 3, 2019 Accepting new patients
DHHS IHS Phoenix Area Current Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Jan 18, 2026 Accepting new patients
Lechee Health Facility CurrentSince Jan 18, 2026 Accepting new patients
Ton Sells Hospital Past Accepting new patients

Organizations & group practices 8

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": "1337904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337904000000",
    "number": "1235499161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 W SUNSET BLVD",
            "address_2": "MODULE 4-B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276082",
            "telephone_number": "800-954-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W SUNSET BLVD",
            "address_2": "MODULE 4-B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276082",
            "telephone_number": "800-954-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYNE",
        "first_name": "ELIZABETH",
        "middle_name": "ALLISON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-25",
        "last_updated": "2012-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A119828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.