Indravadan a Dave MD Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

C41876 Issued in CA

Legal business name

INDRAVADAN A DAVE MD INC

Practice address

274 One and Half S Rampart Blvd
Los Angeles, CA 90057-1404

Phone

(213) 389-5570

Fax

(213) 389-5578

NPI assigned

Feb 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Indravadan A Dave, M.D.NPI 1497799944

Title

Owner Pres

Phone

(213) 389-5570

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Indravadan Dave, MD

  • General Practice Physician
  • New Hyde Park, NY
  • NPI 1497799944
  NPD (past) Authorized official

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609916048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 ONE AND HALF S RAMPART BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571404",
            "telephone_number": "213-389-5570",
            "fax_number": "213-389-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 ONE AND HALF S RAMPART BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571404",
            "telephone_number": "213-389-5570",
            "fax_number": "213-389-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDRAVADAN A DAVE MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVE",
        "authorized_official_first_name": "INDRAVADAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER PRES",
        "authorized_official_telephone_number": "213-389-5570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "C41876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "C41876",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.