NPIMap

Organization Active NPI

Laddaran Medical Group

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1417050782
Registry record updated Sep 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A365070 Issued in CA
Legal business name
LADDARAN MEDICAL GROUP
Practice address
2105 Beverly Blvd
Ste 117
Los Angeles, CA 90057
Phone
(213) 413-8742
Fax
(213) 413-6482
NPI assigned
Sep 5, 2006
Last updated
Sep 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2008

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

Authorized official

Name
Anita Chua Laddaran
Title
President
Phone
(213) 413-8742

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A365070 CA Primary
Diagnostic Radiology Physician 2085R0202X A365910 CA

Addresses

Primary practice location

2105 Beverly Blvd
Ste 117
Los Angeles, CA 90057

Mailing address

2105 Beverly Blvd
Ste 117
Los Angeles, CA 90057
Phone (213) 413-8742

Other identifiers 1

IdentifierTypeStateIssuer
GR0064390MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222646400000",
    "number": "1417050782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD",
            "address_2": "STE 117",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90057",
            "telephone_number": "213-413-8742",
            "fax_number": "213-413-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD",
            "address_2": "STE 117",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90057",
            "telephone_number": "213-413-8742",
            "fax_number": "213-413-6482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LADDARAN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2008-09-29",
        "status": "A",
        "authorized_official_last_name": "LADDARAN",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "CHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-413-8742"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A365070",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A365910",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0064390",
            "state": "CA"
        }
    ],
    "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 Sep 29, 2008; 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.