Individual provider Active NPI

Kevin Jun-Pay Fang, M.D.

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1922499714
Registry record updated Feb 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A134401 Issued in CA
Practice address
4650 W Sunset Blvd # 68
Los Angeles, CA 90027-6062
Phone
(323) 361-2122
NPI assigned
Feb 15, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A134401 CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd # 68
Los Angeles, CA 90027-6062

Mailing address

1520 Rodney Dr Apt 314
Los Angeles, CA 90027-5323
Phone (301) 529-9959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20161021002112 CA Practitioner - Pediatric Medicine 0648558858 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A134401CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Los Angeles Medical Group, Inc. Pediatrics CurrentSince Aug 1, 2017 Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients

Locations

4650 W Sunset Blvd
#76
Los Angeles, CA 90027
Phone (323) 669-2113

4650 W Sunset Blvd
#68
Los Angeles, CA 90027
Phone (323) 361-2122

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kevin.fangmd.p1@direct.plannedparenthoodla.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1423958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423958400000",
    "number": "1922499714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 RODNEY DR APT 314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275323",
            "telephone_number": "301-529-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD # 68",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANG",
        "first_name": "KEVIN",
        "middle_name": "JUN-PAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-15",
        "last_updated": "2015-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A134401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.