Active NPI
Devaughn Peace, MD
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1831103779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G29868
- Practice address
- 4326 S Western Ave
Los Angeles, CA 90062-1648 - Phone
- (213) 299-9914
- Fax
- (213) 292-3254
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G29868 | CA | Primary |
Addresses
Primary practice location
4326 S Western Ave
Los Angeles, CA 90062-1648
Mailing address
4326 S Western Ave
Los Angeles, CA 90062-1648
Phone (213) 299-9914
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G298680 | Medicaid | CA |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G29868 | CA | MD | Pediatrics Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1831103779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4326 S WESTERN AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900621648",
"telephone_number": "213-299-9914",
"fax_number": "213-292-3254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4326 S WESTERN AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900621648",
"telephone_number": "213-299-9914",
"fax_number": "213-292-3254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACE",
"first_name": "DEVAUGHN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G29868",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G298680",
"state": "CA"
}
],
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.