Individual provider Active NPI

Khanh-Van T Le-Bucklin, MD

  • Hospitalist Physician
  • Orange, CA
National Provider Identifier
1750461893
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
000000A69311 Issued in CA
Practice address
Uci Medical Center
101 The City Drive South
Orange, CA 92868
Phone
(714) 456-8978
NPI assigned
Oct 16, 2006
Last updated
Feb 13, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 000000A69311 CA Primary

Addresses

Primary practice location

Uci Medical Center
101 The City Drive South
Orange, CA 92868

Mailing address

Primary Care Medical Group
PO Box 513620
Los Angeles, CA 90051-3620
Phone (714) 456-6369

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081219000289 CA Practitioner - Pediatric MedicinePractitioner - Hospitalist 1658449244 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
000000A69311CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Regents of the University of California-Irvine Hospitalist CurrentSince Oct 14, 2010 Accepting new patients
Pediatric Subspecialty Faculty, Inc. Past Accepting new patients

Locations

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

Organizations & group practices 2

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202860800000",
    "number": "1750461893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PRIMARY CARE MEDICAL GROUP",
            "address_2": "PO BOX 513620",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900513620",
            "telephone_number": "714-456-6369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UCI MEDICAL CENTER",
            "address_2": "101 THE CITY DRIVE SOUTH",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "92868",
            "telephone_number": "714-456-8978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE-BUCKLIN",
        "first_name": "KHANH-VAN T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2008-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "000000A69311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.