Chiaki Miura Jutabha, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A64833 Issued in CA

Practice address

2501 N Sepulveda Blvd Ste 101
Manhattan Beach, CA 90266-2722

Phone

(310) 546-8702

Fax

(310) 545-5310

NPI assigned

Aug 11, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjutabha38044@direct.uclahealth.org

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.

• UC Regents

  dba UCLA Dept of Pediatric Grp Practice

  • Pediatrics Physician
  • Los Angeles, CA
  • NPI 1982667663
  Medicare reassignment NPD
• Regents Univ of Calif Los Angeles

  dba Resnick Neuropsychiatric Hospital at UCLA

  • Psychiatric Hospital
  • Los Angeles, CA
  • NPI 1952308363
  NPD (past)
• The Regents of the University of California

  dba UCLA Dept of Medicine

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1235107566
  NPD (past)
• UCLA Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1043427248

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1760493126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD",
            "address_2": "SUITE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455632",
            "telephone_number": "310-829-9935",
            "fax_number": "310-829-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 N SEPULVEDA BLVD STE 101",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902662722",
            "telephone_number": "310-546-8702",
            "fax_number": "310-545-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUTABHA",
        "first_name": "CHIAKI",
        "middle_name": "MIURA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A64833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A648330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Johnson, LMFT
• Ann Tucker Jones, R.N.
• Elaine K Jones, MD
• Amy Jane Jonesco, PCD (POSTPARTUM CERT
• Julia R. Moen Chiropractic, Inc.
• Amy Lynn Kahn, M.A.
• Sophia Dolan Kall
• Masaaki Alexander Kamiya
• Marie Jo Kane, DC
• Christine Kao, D.O.

• Pediatrics Physician in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.