Active NPI
Clark B Inderlied, PHD
- Pediatric Pathology Physician
- Los Angeles, CA
National Provider Identifier
1689773269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Pathology Physician
- License
- DR131
- Practice address
- 4650 W Sunset Blvd
Los Angeles, CA 90027-6062 - Phone
- (323) 669-4516
- Fax
- (323) 668-1047
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Pathology Physician | 207ZP0213X | DR131 | CA | Primary |
Addresses
Primary practice location
4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Mailing address
6430 W Sunset Blvd
Suite 600
Los Angeles, CA 90028-7901
Phone (323) 669-2337
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR131 | CA | MD | Pediatric Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689773269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6430 W SUNSET BLVD",
"address_2": "SUITE 600",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900287901",
"telephone_number": "323-669-2337",
"fax_number": "323-644-8488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4650 W SUNSET BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900276062",
"telephone_number": "323-669-4516",
"fax_number": "323-668-1047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INDERLIED",
"first_name": "CLARK",
"middle_name": "B",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0213X",
"taxonomy_group": "",
"desc": "Pathology, Pediatric Pathology",
"state": "CA",
"license": "DR131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.