Active NPI
Jane Bork, M.D.
- Pediatrics Physician
- Loma Linda, CA
National Provider Identifier
1386759017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G46632
- Practice address
- 11370 Anderson St
Ste B-100
Loma Linda, CA 92354-3450 - Phone
- (909) 558-2848
- NPI assigned
- Aug 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G46632 | CA | Primary |
Addresses
Primary practice location
11370 Anderson St
Ste B-100
Loma Linda, CA 92354-3450
Mailing address
54701 File Number
Los Angeles, CA 90074-4701
Phone (909) 558-3111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G466320 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G46632 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386759017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54701 FILE NUMBER",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900744701",
"telephone_number": "909-558-3111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11370 ANDERSON ST",
"address_2": "STE B-100",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543450",
"telephone_number": "909-558-2848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORK",
"first_name": "JANE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G46632",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G466320",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.