California Interventional Medical Group

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

G88795 Issued in CA

Legal business name

CALIFORNIA INTERVENTIONAL MEDICAL GROUP

Practice address

11601 Wilshire Blvd
5TH Floor
Los Angeles, CA 99025

Phone

(630) 725-2737

NPI assigned

Oct 17, 2012

Last updated

Oct 17, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Lee Worthington-Kirsch, M.D.

Title

Physician

Phone

(630) 725-2700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1588917322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 BUTTERFIELD RD.",
            "address_2": "SUITE 220",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151279",
            "telephone_number": "630-725-2700",
            "fax_number": "630-725-2783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11601 WILSHIRE BLVD",
            "address_2": "5TH FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "99025",
            "telephone_number": "630-725-2737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA INTERVENTIONAL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "WORTHINGTON-KIRSCH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "630-725-2700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "CA",
            "license": "G88795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Phlebology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Phlebology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.