MK Jefferson MD Anesthesia Servics, Inc.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G68903C Issued in CA

Legal business name

MK JEFFERSON MD ANESTHESIA SERVICS, INC.

Practice address

18300 Roscoe Blvd
Northridge, CA 91325-4105

Phone

(818) 885-8500

NPI assigned

Dec 3, 2007

Last updated

Dec 3, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael K. Jefferson, MD

Title

President

Phone

(818) 885-8500

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1871775783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10076",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914100076",
            "telephone_number": "805-578-8300",
            "fax_number": "805-578-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18300 ROSCOE BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254105",
            "telephone_number": "818-885-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK JEFFERSON MD ANESTHESIA SERVICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-03",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-885-8500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G68903C",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "G68903C",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G689030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in Northridge, CA
• Providers in Northridge, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.

Verify at the official NPI Registry.