Active NPI
Nasim Rezakhah Khadem, M.D.
- Diagnostic Radiology Physician
- Los Angeles, CA
National Provider Identifier
1649539263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- A129623
- Practice address
- 1500 San Pablo St FL 2
Los Angeles, CA 90033-5313 - Phone
- (323) 442-8541
- Fax
- (323) 442-8755
- NPI assigned
- May 16, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Diagnostic Radiology Physician | 2085R0202X | A129623 | CA | Primary |
Addresses
Primary practice location
1500 San Pablo St FL 2
Los Angeles, CA 90033-5313
Mailing address
PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-8541
Other practice location 1
400 N Pepper Ave
Colton, CA 92324-1801
Phone (909) 580-3367
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 |
|---|---|---|---|
| A129623 | CA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shin Imaging LLC | Past | Accepting new patients | |
| Shin MRI LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Radiology Clinic/Center
- Fullerton, CA
- NPI 1235689175
-
- Radiology Clinic/Center
- Los Angeles, CA
- NPI 1295841377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1649539263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31309",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900310309",
"telephone_number": "323-442-8541",
"fax_number": "323-442-8755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 SAN PABLO ST FL 2",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900335313",
"telephone_number": "323-442-8541",
"fax_number": "323-442-8755"
}
],
"practiceLocations": [
{
"address_1": "400 N Pepper Ave",
"address_purpose": "LOCATION",
"city": "Colton",
"state": "CA",
"postal_code": "923241801",
"country_code": "US",
"telephone_number": "909-580-3367",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KHADEM",
"first_name": "NASIM",
"middle_name": "REZAKHAH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-16",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CA",
"license": "A129623",
"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 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.