Active NPI
Philip Matin, M.D.
- In Vivo & In Vitro Nuclear Medicine Physician
- Granite Bay, CA
National Provider Identifier
1881995678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Vivo & In Vitro Nuclear Medicine Physician
- License
- G15173
- Practice address
- 8782 Bronson Dr
Granite Bay, CA 95746-6907 - Phone
- (916) 791-1947
- NPI assigned
- Nov 9, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G15173 | CA | |
| In Vivo & In Vitro Nuclear Medicine Physician | 207UN0903X | G15173 | CA | Primary |
Addresses
Primary practice location
8782 Bronson Dr
Granite Bay, CA 95746-6907
Mailing address
PO Box 2609
Granite Bay, CA 95746-2609
Phone (916) 791-1947
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289260800000",
"number": "1881995678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2609",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957462609",
"telephone_number": "916-791-1947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8782 BRONSON DR",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957466907",
"telephone_number": "916-791-1947"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATIN",
"first_name": "PHILIP",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-09",
"last_updated": "2010-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G15173",
"primary": false
},
{
"code": "207UN0903X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, In Vivo & In Vitro Nuclear Medicine",
"state": "CA",
"license": "G15173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite Bay, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.