Active NPI
Lynn Yvonne Dewgarde, M.D.
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1497851489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G79134
- Practice address
- 10300 Compton Ave
Los Angeles, CA 90002-3628 - Phone
- (323) 357-6658
- Fax
- (323) 563-1636
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G79134 | CA | Primary |
Addresses
Primary practice location
10300 Compton Ave
Los Angeles, CA 90002-3628
Mailing address
10300 Compton Ave
Los Angeles, CA 90002-3628
Phone (323) 357-6658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251121003607 | CA | Order and Referring Only - Pediatric Medicine | 1850282690 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G79134 | CA | MD | Pediatrics Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1497851489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10300 COMPTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900023628",
"telephone_number": "323-357-6658",
"fax_number": "323-563-1636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10300 COMPTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900023628",
"telephone_number": "323-357-6658",
"fax_number": "323-563-1636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWGARDE",
"first_name": "LYNN",
"middle_name": "YVONNE",
"name_prefix": "Ms.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G79134",
"primary": true
}
],
"identifiers": [],
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.