Individual provider Active NPI

Len Umayam

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1710594916
Registry record updated Jan 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95017737 Issued in CA
Practice address
12301 Wilshire Blvd Ste 512
Los Angeles, CA 90025-1053
Phone
(888) 684-2779
Fax
(323) 366-2966
NPI assigned
Sep 30, 2020
Last updated
Jan 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95017737 CA Primary

Addresses

Primary practice location

12301 Wilshire Blvd Ste 512
Los Angeles, CA 90025-1053

Mailing address

PO Box 643
Big Bear City, CA 92314-0643

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220906001901 CA Practitioner - Nurse Practitioner 5890179170 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mellow Medical Inc a Professional CorporationGroup PAC ID 3375767403, 30 clinicians

Practice addresses (Care Compare)

12301 Wilshire Blvd
Suite 512
Los Angeles, CA 90025-1053
Phone (888) 684-2779

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95017737CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mellow Medical Inc a Professional Corporation CurrentSince Aug 23, 2022 Accepting new patients
Ehab Yacoub MD Inc. CurrentSince Jul 25, 2022 Accepting new patients
Hlca, Inc. PastSince Sep 8, 2019 Accepting new patients

Locations

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

12301 Wilshire Blvd
Ste 512
Los Angeles, CA 90025
Phone (833) 427-3566

4685 MacArthur Ct
Ste 340
Newport Beach, CA 92660
Phone (949) 424-4544

17075 Devonshire St
Ste 204
Northridge, CA 91325
Phone (818) 368-8929

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

8235 Santa Monica Blvd
Ste 302
West Hollywood, CA 90046
Phone (310) 892-4284

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4
  • Direct secure messaging: len.umayam.1@9357.direct.athenahealth.com
  • Direct secure messaging: len.umayam.2@9357.direct.athenahealth.com
  • Direct secure messaging: len.umayam.3@9357.direct.athenahealth.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": "1601424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674864000000",
    "number": "1710594916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 643",
            "city": "BIG BEAR CITY",
            "state": "CA",
            "postal_code": "923140643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 WILSHIRE BLVD STE 512",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251053",
            "telephone_number": "888-684-2779",
            "fax_number": "323-366-2966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UMAYAM",
        "first_name": "LEN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-30",
        "last_updated": "2023-01-28",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95017737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.