Individual provider Active NPI

Umakant M Khetan, M.D.

  • Specialist
  • Los Angeles, CA
National Provider Identifier
1841248549
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A38780 Issued in CA
Practice address
1245 Wilshire Blvd
Ste 306
Los Angeles, CA 90017-4803
Phone
(323) 721-9411
NPI assigned
May 4, 2006
Last updated
Oct 5, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A38780 CA Primary

Addresses

Primary practice location

1245 Wilshire Blvd
Ste 306
Los Angeles, CA 90017-4803

Mailing address

1718 Lila LN
La Canada, CA 91011-1647
Phone (818) 790-2513

Other identifiers 1

IdentifierTypeStateIssuer
00A387800MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050627000212 CA Practitioner - UrologyPractitioner - Other (Physician)Practitioner - Vascular Surgery 5597733022 Reassigns benefits to 1 organization
Practice locations: San Gabriel, CA; Monterey Park, CA; Montebello, CA; Los Angeles, CA; Alhambra, CA
I20220808000652 KY Practitioner - Urology 5597733022 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A38780CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
T J Samson Community Hospital CurrentSince Aug 1, 2022 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Sep 1, 2004 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Sep 1, 2004 Accepting new patients
Dignity Community Care Past Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients
Northeast Hospital Corporation Past Accepting new patients
Pih Health Good Samaritan Hospital Past Accepting new patients
Ahmc San Gabriel Valley Medical Past Accepting new patients
Ahmc Garfield Medical Center LP Past Accepting new patients
Ahmc Monterey Park Hospital LP Past Accepting new patients
Alhambra Hospital Medical Center, LP Past Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients

Locations

55 S Raymond Ave
Ste 200
Alhambra, CA 91801
Phone (626) 570-8005

450 E Huntington Dr
Arcadia, CA 91006
Phone (626) 254-2100

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

716 W Broadway
Glendale, CA 91204
Phone (818) 243-9999

1025 W Olympic Blvd
Los Angeles, CA 90015
Phone (213) 623-2225

2601 Via Campo
Montebello, CA 90640
Phone (323) 720-1144

880 S Atlantic Blvd
Ste 101
Monterey Park, CA 91754
Phone (626) 281-6969

900 S Atlantic Blvd
Monterey Park, CA 91754
Phone (626) 457-7450

438 W Las Tunas Dr
San Gabriel, CA 91776
Phone (626) 289-5454

1701 Santa Anita Ave
South El Monte, CA 91733
Phone (626) 350-7916

1301 N Race St
Glasgow, KY 42141
Phone (270) 651-4141

310 N L Rogers Wells Blvd
Glasgow, KY 42141
Phone (270) 651-1111

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1841248549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 LILA LN",
            "city": "LA CANADA",
            "state": "CA",
            "postal_code": "910111647",
            "telephone_number": "818-790-2513",
            "fax_number": "626-281-4536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD",
            "address_2": "STE 306",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174803",
            "telephone_number": "323-721-9411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHETAN",
        "first_name": "UMAKANT",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A38780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A387800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.