Active NPI
Jelena Nikolic, MD
- Family Medicine Physician
- Harbor City, CA
National Provider Identifier
1639379795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A84334
- Practice address
- 25825 Vermont Ave
Harbor City, CA 90710-3518 - Phone
- (310) 325-5111
- Fax
- (626) 405-6768
- NPI assigned
- Jul 18, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A84334 | CA | Primary |
Addresses
Primary practice location
25825 Vermont Ave
Harbor City, CA 90710-3518
Mailing address
393 E Walnut St
3Rd Floor - PHR Systems
Pasadena, CA 91188-0001
Phone (626) 405-7914
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A843340 | Other | CA | MEDICAL PIN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A84334 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184716800000",
"number": "1639379795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "393 E WALNUT ST",
"address_2": "3RD FLOOR - PHR SYSTEMS",
"city": "PASADENA",
"state": "CA",
"postal_code": "911880001",
"telephone_number": "626-405-7914",
"fax_number": "626-405-6768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25825 VERMONT AVE",
"city": "HARBOR CITY",
"state": "CA",
"postal_code": "907103518",
"telephone_number": "310-325-5111",
"fax_number": "626-405-6768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKOLIC",
"first_name": "JELENA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-18",
"last_updated": "2007-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A84334",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL PIN",
"identifier": "00A843340",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harbor City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.