Neil D Fagen, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

G29304 Issued in CA

Practice address

18411 Clark St Ste 204
Tarzana, CA 91356-3535

Phone

(818) 996-4796

Fax

(818) 996-4793

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Neil D. Fagen,M.D.,Inc.

  • Gastroenterology Physician
  • Tarzana, CA
  • NPI 1023311008
  NPD (past) Authorized official
• Specialty Surgical Center of Encino LP

  • Ambulatory Surgical Clinic/Center
  • Encino, CA
  • NPI 1588679179
  NPD (past)

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289260800000",
    "number": "1700878428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18411 CLARK ST STE 204",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563535",
            "telephone_number": "818-996-4796",
            "fax_number": "818-996-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18411 CLARK ST STE 204",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563535",
            "telephone_number": "818-996-4796",
            "fax_number": "818-996-4793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGEN",
        "first_name": "NEIL",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2010-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "G29304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G293040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariga Eyvazi
• Ezlinkmeds Pharmacy, Inc.
• Joseph Ezra, MD
• Alexander Ezzati, LAC
• Nazanin Ezzati, DDS
• Jeremy Fain
• Azita Fakheri, MD
• Amita Firouzi Fakhimi, PSY.D.
• Sayel S. Fakhoury, D.C.
• Family and Individual Therapy, Inc.

• Gastroenterology Physician in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; 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.