Individual provider Active NPI

Nkem Shamim Elaine Asianua, PA-C

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1295481794
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA64310 Issued in CA
Practice address
5901 W Century Blvd Ste 750
Los Angeles, CA 90045-5443
Phone
(888) 880-3451
NPI assigned
Feb 23, 2022
Last updated
Jul 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA64310 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

5901 W Century Blvd Ste 750
Los Angeles, CA 90045-5443

Mailing address

604 Hacienda Dr
Camarillo, CA 93012-5212
Phone (805) 298-6355

Other practice location 1

375 S Chipeta Way
Salt Lake City, UT 84108-1260
Phone (801) 581-7766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240607003330 CA Practitioner - Physician Assistant 6608318423

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA64310CAMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1295481794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 HACIENDA DR",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125212",
            "telephone_number": "805-298-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 W CENTURY BLVD STE 750",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455443",
            "telephone_number": "888-880-3451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "375 S Chipeta Way",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841081260",
            "country_code": "US",
            "telephone_number": "801-581-7766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ASIANUA",
        "first_name": "NKEM",
        "middle_name": "SHAMIM ELAINE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA64310",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.