NPIMap

Organization Active NPI

Glendale Community Medical Group, Inc.

  • Nephrology Physician
  • Glendale, CA
National Provider Identifier
1679564934
Registry record updated Feb 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
23056633 Issued in CA
Legal business name
GLENDALE COMMUNITY MEDICAL GROUP, INC.
Practice address
801 S Chevy Chase Dr
Suite 105
Glendale, CA 91205-4431
Phone
(818) 265-2204
Fax
(818) 265-2201
NPI assigned
Nov 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2011

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

Authorized official

Name
Dr. Duc Cong Bui, M.D.
Title
President
Phone
(818) 265-2204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X 23056633 CA Primary

Addresses

Primary practice location

801 S Chevy Chase Dr
Suite 105
Glendale, CA 91205-4431

Mailing address

801 S Chevy Chase Dr
Suite 105
Glendale, CA 91205-4431
Phone (818) 265-2204

Other identifiers 1

IdentifierTypeStateIssuer
00A459580MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Glendale Community Medical Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

801 S Chevy Chase Dr
Ste 105
Glendale, CA 91205
Phone (818) 242-5299

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297209600000",
    "number": "1679564934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S CHEVY CHASE DR",
            "address_2": "SUITE 105",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912054431",
            "telephone_number": "818-265-2204",
            "fax_number": "818-265-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S CHEVY CHASE DR",
            "address_2": "SUITE 105",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912054431",
            "telephone_number": "818-265-2204",
            "fax_number": "818-265-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE COMMUNITY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2011-02-09",
        "status": "A",
        "authorized_official_last_name": "BUI",
        "authorized_official_first_name": "DUC",
        "authorized_official_middle_name": "CONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-265-2204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "23056633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A459580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; 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.