NPIMap

Organization Active NPI

Gastroenterology Associates of Southern California

  • Medical Specialty Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1457563629
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
GASTROENTEROLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
Practice address
1701 Cesar Chavez Blvd.
Suite 307
Los Angeles, CA 90033
Phone
(213) 483-5940
Fax
(213) 483-9084
NPI assigned
May 3, 2007
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
Mordo Suchov, M.D.
Title
Managing Partner
Phone
(213) 483-5940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

1701 Cesar Chavez Blvd.
Suite 307
Los Angeles, CA 90033

Mailing address

201 S. Alvarado St.
Suite 707
Los Angeles, CA 90057-2320
Phone (213) 483-5940

Other identifiers 1

IdentifierTypeStateIssuer
GR0064560MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Gastroenterology Associates of Southern California6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457563629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S. ALVARADO ST.",
            "address_2": "SUITE 707",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572320",
            "telephone_number": "213-483-5940",
            "fax_number": "213-483-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CESAR CHAVEZ BLVD.",
            "address_2": "SUITE 307",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90033",
            "telephone_number": "213-483-5940",
            "fax_number": "213-483-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY ASSOCIATES OF SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SUCHOV",
        "authorized_official_first_name": "MORDO",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "213-483-5940",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0064560",
            "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 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.