NPIMap

Organization Active NPI

Superior Multi Specialty Medical Clinic Inc.

  • General Practice Physician
  • Los Angeles, CA
National Provider Identifier
1770774366
Registry record updated Feb 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SUPERIOR MULTI SPECIALTY MEDICAL CLINIC INC.
Practice address
11600 Venice Blvd
Los Angeles, CA 90066-4014
Phone
(310) 390-9551
Fax
(310) 390-9296
NPI assigned
Aug 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2010

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

Authorized official

Name
Reza Ray Ehsan, M.D.
Title
Medical Director
Phone
(310) 390-9551

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Emergency Care Clinic/Center 261QE0002X A50372 CA
Multi-Specialty Clinic/Center 261QM1300X A50372 CA
Medical Specialty Clinic/Center 261QM2500X A50372 CA
Pain Clinic/Center 261QP3300X A50372 CA
Urgent Care Clinic/Center 261QU0200X A50312 CA

Addresses

Primary practice location

11600 Venice Blvd
Los Angeles, CA 90066-4014

Mailing address

11600 Venice Blvd
Los Angeles, CA 90066-4014
Phone (310) 390-9551

Other identifiers 1

IdentifierTypeStateIssuer
1770774366MedicaidCA

Other names 1

  • Superior Medical Clinic Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266796800000",
    "number": "1770774366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11600 VENICE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900664014",
            "telephone_number": "310-390-9551",
            "fax_number": "310-390-9296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11600 VENICE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900664014",
            "telephone_number": "310-390-9551",
            "fax_number": "310-390-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR MULTI SPECIALTY MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2010-02-22",
        "status": "A",
        "authorized_official_last_name": "EHSAN",
        "authorized_official_first_name": "REZA",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "310-390-9551",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "CA",
            "license": "A50372",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "A50372",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "A50372",
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "CA",
            "license": "A50372",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "A50312",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770774366",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.