NPIMap

Organization Active NPI

Elite Oncology Medical Group

  • Specialist
  • Los Angeles, CA
National Provider Identifier
1346302114
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A026479 Issued in CA
Legal business name
ELITE ONCOLOGY MEDICAL GROUP
Practice address
12099 W Washington Blvd Ste 304
Los Angeles, CA 90066-2621
Phone
(310) 398-0013
Fax
(310) 398-4470
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Nazar Al-Bussam, M.D.
Title
Director of Medical Oncology
Phone
(310) 397-8654

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A026479 CA Primary

Addresses

Primary practice location

12099 W Washington Blvd Ste 304
Los Angeles, CA 90066-2621

Mailing address

12405 Venice Blvd # 2
Los Angeles, CA 90066-3803
Phone (310) 397-8654

National Provider Directory

National Provider Directory
Tax ID family
Elite Oncology Medical Group3 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.

Locations

12099 W Washington Blvd
Ste 304
Los Angeles, CA 90066
Phone (310) 397-8654

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346302114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12405 VENICE BLVD # 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900663803",
            "telephone_number": "310-397-8654",
            "fax_number": "310-398-4470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12099 W WASHINGTON BLVD STE 304",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900662621",
            "telephone_number": "310-398-0013",
            "fax_number": "310-398-4470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE ONCOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AL-BUSSAM",
        "authorized_official_first_name": "NAZAR",
        "authorized_official_title_or_position": "DIRECTOR OF MEDICAL ONCOLOGY",
        "authorized_official_telephone_number": "310-397-8654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A026479",
            "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 Aug 22, 2020; 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.