Janesri de Silva M.D. a Prof Corp

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A88991 Issued in CA

Legal business name

JANESRI DE SILVA M.D. A PROF CORP

Doing business as

Kids & Teens Medical Group

Practice address

504 S Sierra Madre Blvd
Pasadena, CA 91107-5240

Phone

(818) 361-5437

Fax

(626) 406-1800

NPI assigned

Jul 22, 2009

Last updated

Jun 15, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Janesri Wijayangani De Silva, M.DNPI 1568502953

Title

President

Phone

(818) 361-5437

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• KIDS & TEENS MEDICAL GROUP Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Janesri de Silva MD a Prof Corp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Janesri de Silva M.D. a Prof Corp

  dba Kids& Teens Medical Group

  • Pediatrics Physician
  • Mission Hills, CA
  • NPI 1548493315
  NPD tax ID
• Janesri de Silva, MD a Prof Corp

  dba Kids & Teens Medical Group

  • Pediatrics Physician
  • Van Nuys, CA
  • NPI 1114253671
  NPD tax ID

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Janesri W De Silva, M.D.

  • Pediatrics Physician
  • Mission Hills, CA
  • NPI 1568502953
  Medicare reassignment NPD Authorized official
• Benjamin Behroozan, M.D.

  • Family Medicine Physician
  • Santa Monica, CA
  • NPI 1750440681
  Medicare reassignment NPD
• Trish Balolong Reyes, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Westlake Village, CA
  • NPI 1972002228
  Medicare reassignment NPD
• Marek Zdarzyl, M.D.

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1386618270
  Medicare reassignment NPD
• Hilma Benjamin, M.D.

  • Pediatrics Physician
  • Mission Hills, CA
  • NPI 1609088269
  NPD (past)
• Faiza Iram, MD

  • Pediatrics Physician
  • Bloomington, CA
  • NPI 1063773141
  NPD (past)
• Rena Keynigshteyn, M.D.

  • General Practice Physician
  • Culver City, CA
  • NPI 1316980535
  NPD (past)
• Lourdes F Mosqueda, MD

  • Pediatrics Physician
  • South Pasadena, CA
  • NPI 1962557108
  NPD (past)
• Helen Pensanti, MD

  • General Practice Physician
  • Santa Ana, CA
  • NPI 1659707586
  NPD (past)
• Leore Marcel Slavick, PA

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1114740602
  NPD (past)
• Carolina Mae Ungs, MD

  • Pediatrics Physician
  • Pasadena, CA
  • NPI 1205398039
  NPD (past)
• Qiona Latreaste Young, PA-C

  • Surgical Physician Assistant
  • San Francisco, CA
  • NPI 1043330210
  NPD (past)

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1326278490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 S SIERRA MADRE BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911075240",
            "telephone_number": "818-361-5437",
            "fax_number": "626-406-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 S SIERRA MADRE BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911075240",
            "telephone_number": "818-361-5437",
            "fax_number": "626-406-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1442 Foothill Blvd",
            "address_purpose": "LOCATION",
            "city": "LA Canada Flintridge",
            "state": "CA",
            "postal_code": "910112107",
            "country_code": "US",
            "telephone_number": "818-361-5437 x105",
            "fax_number": "626-406-1801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JANESRI DE SILVA M.D. A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-22",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "DE SILVA",
        "authorized_official_first_name": "JANESRI",
        "authorized_official_middle_name": "WIJAYANGANI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-361-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A88991",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "A88991",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A889910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIDS & TEENS MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KIDS & TEENS MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kamari James
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• Jane Mathews Services
• Janelle Litwak, MFT
• Barbara Louise Janetzke, PH.D.
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• Krysta Janis
• J Michael Jann, D.D.S.
• Christine Marie Jansen-Gillum, MFT

• Pediatrics Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.