NPIMap

Organization Active NPI

York Glen Medical Clinic, Inc

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1265686117
Registry record updated Jul 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A54189 Issued in CA
Legal business name
YORK GLEN MEDICAL CLINIC, INC
Practice address
5417 York Blvd
Los Angeles, CA 90042-2401
Phone
(323) 254-2811
Fax
(323) 254-1788
NPI assigned
Nov 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2013

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

Authorized official

Name
Mr. Ador A Bustamante, M.D.
Title
Owner
Phone
(323) 254-2811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A54189 CA Primary

Addresses

Primary practice location

5417 York Blvd
Los Angeles, CA 90042-2401

Mailing address

5417 York Blvd
Los Angeles, CA 90042-2401
Phone (323) 254-2811

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374451200000",
    "number": "1265686117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5417 YORK BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900422401",
            "telephone_number": "323-254-2811",
            "fax_number": "323-254-1788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5417 YORK BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900422401",
            "telephone_number": "323-254-2811",
            "fax_number": "323-254-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YORK GLEN MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2013-07-22",
        "status": "A",
        "authorized_official_last_name": "BUSTAMANTE",
        "authorized_official_first_name": "ADOR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-254-2811",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A54189",
            "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 Jul 22, 2013; 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.