Active NPI
Amy Ruth Vandiver
- Dermatology Physician
- Los Angeles, CA
National Provider Identifier
1740716190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- A158695
- Practice address
- 200 UCLA Medical PLZ Ste 450
Los Angeles, CA 90095-1233 - Phone
- (310) 825-6911
- NPI assigned
- May 4, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | A158695 | CA | Primary |
Addresses
Primary practice location
200 UCLA Medical PLZ Ste 450
Los Angeles, CA 90095-1233
Mailing address
5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-8707
Other practice location 1
2020 Santa Monica Blvd Ste 510
Santa Monica, CA 90404-2131
Phone (310) 917-3376
Other practice location 2
2001 Santa Monica Blvd Ste 1070
Santa Monica, CA 90404-2202
Phone (310) 301-8707
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A158695 | CA | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| UCLA Medical Group | Dermatology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696204800000",
"number": "1740716190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5767 W CENTURY BLVD STE 400",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455631",
"telephone_number": "310-301-8707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 UCLA MEDICAL PLZ STE 450",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951233",
"telephone_number": "310-825-6911"
}
],
"practiceLocations": [
{
"address_1": "2020 Santa Monica Blvd Ste 510",
"address_purpose": "LOCATION",
"city": "Santa Monica",
"state": "CA",
"postal_code": "904042131",
"country_code": "US",
"telephone_number": "310-917-3376",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2001 Santa Monica Blvd Ste 1070",
"address_purpose": "LOCATION",
"city": "Santa Monica",
"state": "CA",
"postal_code": "904042202",
"country_code": "US",
"telephone_number": "310-301-8707",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VANDIVER",
"first_name": "AMY",
"middle_name": "RUTH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-04",
"last_updated": "2023-10-02",
"certification_date": "2022-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "A158695",
"primary": true
}
],
"identifiers": [],
"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 Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.