Irene Koolwijk, M.D.

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

A121627 Issued in CA

Practice address

300 UCLA Medical PLZ Ste 3300
Los Angeles, CA 90095-6062

Phone

(310) 825-0867

Fax

(310) 206-4855

NPI assigned

Jun 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children's Hospital Los Angeles Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1265530653

  Pediatrics

  Medicare reassignment NPD
• UC Regents

  dba UCLA Dept of Pediatric Grp Practice

  • Pediatrics Physician
  • Los Angeles, CA
  • NPI 1982667663
  Medicare reassignment NPD
• Childrens Hospital of Los Angeles

  • Children's Hospital
  • Los Angeles, CA
  • NPI 1124073366
  NPD (past)
• Regents Univ of Calif Los Angeles

  dba Resnick Neuropsychiatric Hospital at UCLA

  • Psychiatric Hospital
  • Los Angeles, CA
  • NPI 1952308363
  NPD (past)
• UCLA Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1043427248

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1518164706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8707",
            "fax_number": "310-301-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UCLA MEDICAL PLZ STE 3300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900956062",
            "telephone_number": "310-825-0867",
            "fax_number": "310-206-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOLWIJK",
        "first_name": "IRENE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A121627",
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "CA",
            "license": "A121627",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CA",
            "license": "A121627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Koo
• John J Koo, MD
• Kyungjoo Koo
• Matthew Koo, MD
• Yoona Koo, PHARM.D., BCGP
• Mary Jane Koon, FNP
• Christina Koonce
• Laura Koonce, LMFT
• Nicole Koontz
• Crystal Dawn Koop

• Developmental - Behavioral Pediatrics Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Developmental - Behavioral Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.

Verify at the official NPI Registry.