Organization Active NPI

Wireless Diagnostic

  • Gastroenterology Physician
  • Los Angeles, CA
National Provider Identifier
1821164070
Registry record updated Aug 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A61044 Issued in CA
Legal business name
WIRELESS DIAGNOSTIC
Practice address
2080 Century Park East #1206
Los Angeles, CA 90067
Phone
(310) 282-0525
Fax
(310) 201-0662
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2015

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

Authorized official

Name
Nicholas Karyotakis, MDNPI 1922072826
Title
Owner
Phone
(310) 282-0525

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X A61044 CA Primary

Addresses

Primary practice location

2080 Century Park East #1206
Los Angeles, CA 90067

Mailing address

9589 Stuart Lane
Beverly Hills, CA 90210
Phone (310) 282-0525

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150731014917 CA Part B Supplier - Clinic/Group Practice 2961716113 Receives reassigned benefits from 1 practitioner
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438905600000",
    "number": "1821164070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9589 STUART LANE",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "90210",
            "telephone_number": "310-282-0525",
            "fax_number": "310-201-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CENTURY PARK EAST #1206",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90067",
            "telephone_number": "310-282-0525",
            "fax_number": "310-201-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIRELESS DIAGNOSTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-08-07",
        "status": "A",
        "authorized_official_last_name": "KARYOTAKIS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-282-0525",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A61044",
            "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 Aug 7, 2015; 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.