Missak Kltchian MD Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A52368 Issued in CA

Legal business name

MISSAK KLTCHIAN MD INC.

Practice address

4645 Hollywood Blvd Ste 2/4
Los Angeles, CA 90027-5455

Phone

(323) 661-4500

Fax

(323) 661-3260

NPI assigned

Jul 2, 2018

Last updated

Jul 2, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Missak Kltchian, MDNPI 1255359840

Title

MD / President

Phone

(323) 661-4500

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Missak Kltchian, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1255359840
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530489600000",
    "number": "1932695079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 HOLLYWOOD BLVD STE 2/4",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275455",
            "telephone_number": "323-661-4500",
            "fax_number": "323-661-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 HOLLYWOOD BLVD STE 2/4",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275455",
            "telephone_number": "323-661-4500",
            "fax_number": "323-661-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSAK KLTCHIAN MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-02",
        "last_updated": "2018-07-02",
        "status": "A",
        "authorized_official_last_name": "KLTCHIAN",
        "authorized_official_first_name": "MISSAK",
        "authorized_official_title_or_position": "MD / PRESIDENT",
        "authorized_official_telephone_number": "323-661-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A52368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1255359840",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A52368",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1578901237",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Erin Mispagel
• Monali Misra, M.D.
• Sasmita Misra, M.D.
• Miss Stevens for Lingerie (Leslie Diane Vaughn)
• Bahareh Missaghi, DC
• Mary Guinevere Missig, AMFT
• Mission Behavioral Health, Inc.
• Mission City Community Network Inc
• Mission City Community Network Inc
• Mission City Community Network, Inc.

• Internal Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, 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 Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.