NPIMap

Organization Active NPI

Convalescent Podiatry Care a Professional Corporation

  • Podiatrist
  • Lakewood, CA
National Provider Identifier
1306606579
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
CONVALESCENT PODIATRY CARE A PROFESSIONAL CORPORATION
Practice address
5445 Del Amo Blvd Ste 102
Lakewood, CA 90712-2761
Phone
(562) 867-0811
Fax
(562) 866-4046
NPI assigned
Mar 22, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Jooyoung Han, DPMNPI 1023540325
Title
President
Phone
(657) 200-5680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X Primary

Addresses

Primary practice location

5445 Del Amo Blvd Ste 102
Lakewood, CA 90712-2761

Mailing address

5445 Del Amo Blvd Ste 102
Lakewood, CA 90712-2761
Phone (562) 867-0811

Other names 1

  • Convalescent Podiatry Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241101001221 CA Part B Supplier - Clinic/Group Practice 7315470036 Receives reassigned benefits from 11 practitioners
Practice locations: Lakewood, CA; San Bernardino, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1306606579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 DEL AMO BLVD STE 102",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907122761",
            "telephone_number": "562-867-0811",
            "fax_number": "562-866-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 DEL AMO BLVD STE 102",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907122761",
            "telephone_number": "562-867-0811",
            "fax_number": "562-866-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVALESCENT PODIATRY CARE A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "HAN",
        "authorized_official_first_name": "JOOYOUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "657-200-5680",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Convalescent Podiatry Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.