Organization Active NPI

Lincoln Heights Family and Industrial Medical Clinic

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1942309497
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 13853 Issued in CA
Legal business name
LINCOLN HEIGHTS FAMILY AND INDUSTRIAL MEDICAL CLINIC
Practice address
2409 N Broadway
Los Angeles, CA 90031-2218
Phone
(323) 225-8038
Fax
(323) 225-2106
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Kelly Hong Vo
Title
Office Manager
Phone
(323) 225-8038

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X A53847 CA
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X A35695 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A53847 CA
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X A33894 CA
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA 13853 CA Primary

Addresses

Primary practice location

2409 N Broadway
Los Angeles, CA 90031-2218

Mailing address

2409 N Broadway
Los Angeles, CA 90031-2218
Phone (323) 225-8038

Other identifiers 1

IdentifierTypeStateIssuer
GR0056500MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1942309497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2409 N BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900312218",
            "telephone_number": "323-225-8038",
            "fax_number": "323-225-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 N BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900312218",
            "telephone_number": "323-225-8038",
            "fax_number": "323-225-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN HEIGHTS FAMILY AND INDUSTRIAL MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "VO",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "HONG",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "323-225-8038"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A53847",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "CA",
            "license": "A35695",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A53847",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A33894",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 13853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0056500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.