Active NPI
Los Angeles Kidney Center, a Professional Medical Corporation
- Nephrology Physician
- Los Angeles, CA
National Provider Identifier
1487033353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 20A11899
- Legal business name
- LOS ANGELES KIDNEY CENTER, A PROFESSIONAL MEDICAL CORPORATION
- Practice address
- 1414 S Grand Ave Ste 100
Los Angeles, CA 90015-3071 - Phone
- (310) 927-5807
- NPI assigned
- May 26, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ardavan Mashhadian, D.O.
- Title
- Physician
- Phone
- (310) 927-5807
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 20A11899 | CA | Primary |
Addresses
Primary practice location
1414 S Grand Ave Ste 100
Los Angeles, CA 90015-3071
Mailing address
1717 Malcolm Ave PH 1
Los Angeles, CA 90024-6842
Phone (310) 927-5807
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Los Angeles Kidney Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Nephrology Physician
- Los Angeles, CA
- NPI 1790158921
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nephrology Physician
- Los Angeles, CA
- NPI 1003132523
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432598400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1724976000000",
"number": "1487033353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 MALCOLM AVE PH 1",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900246842",
"telephone_number": "310-927-5807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 S GRAND AVE STE 100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900153071",
"telephone_number": "310-927-5807"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LOS ANGELES KIDNEY CENTER, A PROFESSIONAL MEDICAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2015-05-26",
"last_updated": "2024-08-30",
"certification_date": "2024-08-30",
"status": "A",
"authorized_official_last_name": "MASHHADIAN",
"authorized_official_first_name": "ARDAVAN",
"authorized_official_title_or_position": "PHYSICIAN",
"authorized_official_telephone_number": "310-927-5807",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.O."
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "20A11899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.