Brentwood Medical Group a Professional Medical Corp

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

20A6273 Issued in CA

Legal business name

BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP

Practice address

11645 Wilshire Blvd
Suite 745
Los Angeles, CA 90025-1708

Phone

(310) 696-0101

NPI assigned

Nov 19, 2012

Last updated

Feb 26, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Javid Tavari, D.O.NPI 1669400602

Title

President

Phone

(310) 696-0101

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Javid D Tavari, D.O.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1669400602
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519603200000",
    "number": "1720322415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD",
            "address_2": "SUITE 745",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251708",
            "telephone_number": "310-696-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD",
            "address_2": "SUITE 745",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251708",
            "telephone_number": "310-696-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-19",
        "last_updated": "2018-02-26",
        "status": "A",
        "authorized_official_last_name": "TAVARI",
        "authorized_official_first_name": "JAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-696-0101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A6273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brentview Medical Inc. (Brentview Medical Urgent Care)
• Brentwood - Eating Disorder Center of California, LLC (Eating Disorder Center of California)
• Brentwood Ambulatory Surgical Medical Center
• Brentwood Center for Advanced Medicine, PC (Bernhoft Center for Advanced Medicine)
• Brentwood Dermatology Medical Group Inc
• Brentwood Orthopedic and Spine Surgery LLC
• Brentwood Physical Therapy Inc
• Brentwood Surgery Center Inc.
• Heather Jeanne Bresett
• David Bresler II, M.D.

• Internal Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.