Van Dyke Degolia, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

G50306 Issued in CA

Practice address

11980 San Vicente Blvd
Suite 902
Los Angeles, CA 90049-5012

Phone

(310) 826-1915

Fax

(310) 826-1975

NPI assigned

Feb 6, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902945942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 SAN VICENTE BLVD",
            "address_2": "SUITE 902",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495012",
            "telephone_number": "310-826-1915",
            "fax_number": "310-826-1975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11980 SAN VICENTE BLVD",
            "address_2": "SUITE 902",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495012",
            "telephone_number": "310-826-1915",
            "fax_number": "310-826-1975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGOLIA",
        "first_name": "VAN DYKE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "G50306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mona Degan, M.D.
• Nataly Degante, MSW
• Christopher Michael Degiorgio, MD
• George Sarkis Degirmendjian
• Timothy L. Degner, MD
• Katherine Degovia
• Kayla Lauren Degracia
• Jason William Degraff, AGACNP-BC
• Alexis Capri Degrate, OTR
• Mallory Ellen Degray

• Child & Adolescent Psychiatry Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Child & Adolescent Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.