NPIMap

Organization Active NPI

Hollenberg Agrawal Knoll Warren Hong Fung Tillis Kaushal MDS

  • Pediatrics Physician
  • Pomona, CA
National Provider Identifier
1366447781
Registry record updated Jul 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
HOLLENBERG AGRAWAL KNOLL WARREN HONG FUNG TILLIS KAUSHAL MDS
Practice address
250 W Bonita Ave
#200
Pomona, CA 91767-1850
Phone
(909) 620-1935
Fax
(909) 865-7688
NPI assigned
Jun 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2014

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

Authorized official

Name
Mr. Jim Hollenberg
Title
Staff/It
Phone
(909) 620-1935

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

250 W Bonita Ave
#200
Pomona, CA 91767-1850

Mailing address

250 W Bonita Ave
#200
Pomona, CA 91767-1850
Phone (909) 620-1935

Other identifiers 1

IdentifierTypeStateIssuer
GR0066720OtherCAMEDI CAL GROUP NUMBER

Other names 1

  • Pomona Pediatrics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0677550Hollenberg, Agrawal, Knoll, Warren, Hong,250 W Bonita Ave Ste 200, Pomona, CA 91767Certificate of waiverMar 2, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406678400000",
    "number": "1366447781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W BONITA AVE",
            "address_2": "#200",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671850",
            "telephone_number": "909-620-1935",
            "fax_number": "909-865-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W BONITA AVE",
            "address_2": "#200",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671850",
            "telephone_number": "909-620-1935",
            "fax_number": "909-865-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLENBERG AGRAWAL KNOLL WARREN HONG FUNG TILLIS KAUSHAL MDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2014-07-30",
        "status": "A",
        "authorized_official_last_name": "HOLLENBERG",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "STAFF/IT",
        "authorized_official_telephone_number": "909-620-1935",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI CAL GROUP NUMBER",
            "identifier": "GR0066720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pomona Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.