Eian Gallagher Prohl, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A164887 Issued in CA

Practice address

16111 Plummer St
North Hills, CA 91343-2036

Phone

(818) 891-7711

Fax

(904) 406-7123

NPI assigned

Mar 19, 2018

Last updated

Oct 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1932603776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16111 PLUMMER ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913432036",
            "telephone_number": "818-891-7711",
            "fax_number": "904-406-7123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16111 PLUMMER ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913432036",
            "telephone_number": "818-891-7711",
            "fax_number": "904-406-7123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROHL",
        "first_name": "EIAN",
        "middle_name": "GALLAGHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-19",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A164887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anatoliy Prokopets, PHYSICAL THERAPIST
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• Pure Quality Medical Supply Inc (avag karakhanyan)
• Christina Quach, PH.D.
• Melissa Quade, MFTI

• Internal Medicine Physician in North Hills, CA
• Providers in North Hills, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.