Organization Active NPI

Irina a Urusova MD Inc

  • Medical Specialty Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1669593190
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
IRINA A URUSOVA MD INC
Practice address
6221 Wilshire Blvd Ste 220
Los Angeles, CA 90048-5226
Phone
(323) 954-9369
Fax
(323) 954-1160
NPI assigned
Apr 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Authorized official

Name
Irina A Urusova, MDNPI 1679581565
Title
President
Phone
(323) 823-3924

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

6221 Wilshire Blvd Ste 220
Los Angeles, CA 90048-5226

Mailing address

6221 Wilshire Blvd Ste 220
Los Angeles, CA 90048-5226
Phone (323) 954-9369

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070620000564 CA Part B Supplier - Clinic/Group Practice 5092814764 Receives reassigned benefits from 1 practitioner
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

5901 W Olympic Blvd
Ste 207
Los Angeles, CA 90036
Phone (323) 823-3924

18356 Clark St
#101
Tarzana, CA 91356
Phone (818) 926-2650

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1669593190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 WILSHIRE BLVD STE 220",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485226",
            "telephone_number": "323-954-9369",
            "fax_number": "323-954-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 WILSHIRE BLVD STE 220",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485226",
            "telephone_number": "323-954-9369",
            "fax_number": "323-954-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRINA A URUSOVA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "URUSOVA",
        "authorized_official_first_name": "IRINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-823-3924",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "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 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.