Californiacarecorp

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

A91343 Issued in CA

Legal business name

CALIFORNIACARECORP

Practice address

127 S Brand Blvd # 241
Glendale, CA 91204-1342

Phone

(818) 551-0026

NPI assigned

Jun 21, 2010

Organization subpart

Yes

Parent organization

CALIFORNIACARECORPAs reported in NPPES

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

Authorized official

Name

Michael Ming-Ta Su, M.D.

Title

Provider

Phone

(818) 551-0026

Specialties & licenses 1

Addresses

Part of

California Care Corp

Locations

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

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277078400000",
    "number": "1407177785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S BRAND BLVD # 241",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041342",
            "telephone_number": "818-551-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S BRAND BLVD # 241",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041342",
            "telephone_number": "818-551-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIACARECORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CALIFORNIACARECORP",
        "enumeration_date": "2010-06-21",
        "last_updated": "2010-06-21",
        "status": "A",
        "authorized_official_last_name": "SU",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "MING-TA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "818-551-0026",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "A91343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Glendale, CA
• Providers in Glendale, CA by specialty
• Preferred Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2010; 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.