Individual provider Active NPI

Ilan Bazak, DPM

  • Podiatrist
  • Los Angeles, CA
National Provider Identifier
1932153970
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E3741 Issued in CA
Practice address
1121 N Fairfox Ave
Los Angeles, CA 90046
Phone
(323) 650-6363
Fax
(323) 650-4377
NPI assigned
May 22, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E3741 CA Primary

Addresses

Primary practice location

1121 N Fairfox Ave
Los Angeles, CA 90046

Mailing address

1121 N Fairfox Ave
Los Angeles, CA 90046
Phone (323) 650-6363

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101021000771 CA Practitioner - Podiatry 2668582560 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1121 N Fairfax Ave
West Hollywood, CA 90046-5306
Phone (323) 650-6363

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue112
Removal of skin lesions28
Removal of nail tissue649
Removal or shaving of skin growth535

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E3741CAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vascular Intervention Specialists Inc Podiatrist CurrentSince Mar 1, 2019 Accepting new patients
Ilan Bazak DPM Professional Corp Podiatrist CurrentSince Mar 5, 2004 Accepting new patients
Cha Hollywood Medical Center, LP PastSince Jul 14, 2010 Accepting new patients

Locations

19231 Victory Blvd
Ste 155
Reseda, CA 91335
Phone (818) 457-4512

18375 Ventura Blvd
Tarzana, CA 91356
Phone (818) 422-5322

1121 N Fairfax Ave
West Hollywood, CA 90046
Phone (213) 650-6363

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1932153970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 N FAIRFOX AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90046",
            "telephone_number": "323-650-6363",
            "fax_number": "323-650-4377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 N FAIRFOX AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90046",
            "telephone_number": "323-650-6363",
            "fax_number": "323-650-4377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZAK",
        "first_name": "ILAN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E3741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.