NPIMap

Organization Active NPI

Wayne S. Gradman, MD Inc

  • Vascular Surgery Physician
  • Los Angeles, CA
National Provider Identifier
1487831046
Registry record updated Mar 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
G17696 Issued in CA
Legal business name
WAYNE S. GRADMAN, MD INC
Practice address
2080 Century Park E
Suite #803
Los Angeles, CA 90067-2001
Phone
(310) 277-4868
Fax
(310) 277-4869
NPI assigned
Jan 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2013

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

Authorized official

Name
Dr. Wayne Stuart Gradman, M.D.
Title
President
Phone
(310) 277-4868

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X G17696 CA Primary

Addresses

Primary practice location

2080 Century Park E
Suite #803
Los Angeles, CA 90067-2001

Mailing address

2080 Century Park E
Suite #803
Los Angeles, CA 90067-2001
Phone (310) 277-4868

Other identifiers 1

IdentifierTypeStateIssuer
GR0040310MedicaidCA

Other names 1

  • BEVERLY HILLS VEINS CENTER Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364169600000",
    "number": "1487831046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 CENTURY PARK E",
            "address_2": "SUITE #803",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900672001",
            "telephone_number": "310-277-4868",
            "fax_number": "310-277-4869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CENTURY PARK E",
            "address_2": "SUITE #803",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900672001",
            "telephone_number": "310-277-4868",
            "fax_number": "310-277-4869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE S. GRADMAN, MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-25",
        "last_updated": "2013-03-25",
        "status": "A",
        "authorized_official_last_name": "GRADMAN",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-277-4868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "G17696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0040310",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEVERLY HILLS VEINS CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 25, 2013; 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.