Individual provider Active NPI

Kraig L Golden, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1689713380
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
60099 Issued in CA
Practice address
4618 Fountain Ave
Los Angeles, CA 90029-1977
Phone
(323) 953-7170
NPI assigned
Feb 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A60099 CA
Internal Medicine Physician 207R00000X 60099 CA Primary

Addresses

Primary practice location

4618 Fountain Ave
Los Angeles, CA 90029-1977

Mailing address

950 S Grand Ave FL 2
Los Angeles, CA 90015-3999
Phone (323) 669-4346

Other identifiers 1

IdentifierTypeStateIssuer
00A600990MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100927001335 CA Practitioner - Family PracticePractitioner - Internal Medicine 7911023973 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
60099CAMDInternal Medicine Physician
A60099CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gracelight Community Health CurrentSince Dec 7, 2019 Accepting new patients
Children's Hospital Los Angeles Mental Health Past Accepting new patients

Locations

950 S Grand Ave
Fl 2
Los Angeles, CA 90015

150 N Reno St
Los Angeles, CA 90026
Phone (213) 380-7298

950 S Grand Ave
Los Angeles, CA 90015
Phone (323) 681-1792

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kraig.golden.p1@direct.lakeside.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1689713380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 S GRAND AVE FL 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153999",
            "telephone_number": "323-669-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4618 FOUNTAIN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291977",
            "telephone_number": "323-953-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDEN",
        "first_name": "KRAIG",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A60099",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "60099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A600990",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.