NPIMap

Organization Active NPI

Irradiance Medical Group Inc

  • Procedural Dermatology Physician
  • Los Angeles, CA
National Provider Identifier
1740213198
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
G77152 Issued in CA
Legal business name
IRRADIANCE MEDICAL GROUP INC
Practice address
420 E 3Rd St Ste 805
Los Angeles, CA 90013-1646
Phone
(213) 687-3214
Fax
(213) 687-0622
NPI assigned
Jul 9, 2006
Last updated
Sep 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Authorized official

Name
Dr. Christopher Tsung Lung Ho, M.D.NPI 1679507537
Title
Owner
Phone
(213) 687-3214

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X G77152 CA Primary
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X A55242 CA

Addresses

Primary practice location

420 E 3Rd St Ste 805
Los Angeles, CA 90013-1646

Mailing address

420 E 3Rd St Ste 805
Los Angeles, CA 90013-1646
Phone (213) 687-3214

Other identifiers 1

IdentifierTypeStateIssuer
00G771521MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100128000298 CA Part B Supplier - Clinic/Group Practice 2860534864 Receives reassigned benefits from 7 practitioners
Practice locations: Los Angeles, CA; Torrance, CA

National Provider Directory

National Provider Directory

Locations

4000 Hollywood Blvd
Ste 215
Hollywood, FL 33021

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1740213198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 3RD ST STE 805",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900131646",
            "telephone_number": "213-687-3214",
            "fax_number": "213-687-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E 3RD ST STE 805",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900131646",
            "telephone_number": "213-687-3214",
            "fax_number": "213-687-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRRADIANCE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "HO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "TSUNG LUNG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-687-3214",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G77152",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A55242",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G771521",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.