Active NPI
Jeffrey Phommasith
- Ambulatory Care Registered Nurse
- Los Angeles, CA
National Provider Identifier
1578086195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Registered Nurse
- License
- 710651
- Practice address
- 1100 N State St
Los Angeles, CA 90033-5000 - Phone
- (323) 409-5220
- NPI assigned
- Jul 25, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Ambulatory Care Registered Nurse | 163WP2201X | 710651 | CA | Primary |
Addresses
Primary practice location
1100 N State St
Los Angeles, CA 90033-5000
Mailing address
1100 N State St
Los Angeles, CA 90033-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 710651 | CA | MD | Ambulatory Care Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500940800000",
"number": "1578086195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 N STATE ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900335000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 N STATE ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900335000",
"telephone_number": "323-409-5220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHOMMASITH",
"first_name": "JEFFREY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-25",
"last_updated": "2017-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "163WP2201X",
"taxonomy_group": "",
"desc": "Registered Nurse, Ambulatory Care",
"state": "CA",
"license": "710651",
"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 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.