Active NPI
Gerald James Kavanagh, M.D.
- Specialist
- Los Angeles, CA
National Provider Identifier
1679683882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G18772
- Practice address
- 637 Lucas Ave
Suite 402
Los Angeles, CA 90017-1912 - Phone
- (213) 977-2171
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | G18772 | CA | Primary |
Addresses
Primary practice location
637 Lucas Ave
Suite 402
Los Angeles, CA 90017-1912
Mailing address
443 19TH St
Santa Monica, CA 90402-2431
Phone (310) 394-4405
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G18772 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1679683882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "443 19TH ST",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904022431",
"telephone_number": "310-394-4405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "637 LUCAS AVE",
"address_2": "SUITE 402",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171912",
"telephone_number": "213-977-2171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAVANAGH",
"first_name": "GERALD",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G18772",
"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 9, 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.