Individual provider Active NPI

Michelle D Henry, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1952479339
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
G74047 Issued in CA
Practice address
1401 S Grand Ave
Los Angeles, CA 90015-3010
Phone
(213) 742-5716
Fax
(213) 742-5731
NPI assigned
Dec 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X G74047 CA Primary

Addresses

Primary practice location

1401 S Grand Ave
Los Angeles, CA 90015-3010

Mailing address

21021 Tomlee Ave
Torrance, CA 90503-4064
Phone (310) 818-1989

Other practice location 1

3330 Lomita Blvd
Torrance, CA 90505-5002
Phone (310) 325-9110

Other identifiers 1

IdentifierTypeStateIssuer
00G740470MedicaidCA

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
I20180209001637 CA Practitioner - Other (Physician)Practitioner - Pediatric Medicine 4486914561 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G74047CAMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 5, 2018 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 5, 2018 Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Feb 1, 2024 Accepting new patients
Children'S Hospital Los Angeles Medical Group, Inc. CurrentSince Jan 9, 2018 Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients

Locations

8635 W 3rd St
Ste 465W
Los Angeles, CA 90048
Phone (310) 423-0674

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

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

18321 Clark St
Tarzana, CA 91356
Phone (310) 423-6744

4140 W 190th St
Torrance, CA 90504
Phone (310) 967-1780

3330 Lomita Blvd
Torrance, CA 90505
Phone (310) 517-4675

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

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": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1952479339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21021 TOMLEE AVE",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034064",
            "telephone_number": "310-818-1989",
            "fax_number": "213-742-5731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S GRAND AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153010",
            "telephone_number": "213-742-5716",
            "fax_number": "213-742-5731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3330 Lomita Blvd",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905055002",
            "country_code": "US",
            "telephone_number": "310-325-9110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENRY",
        "first_name": "MICHELLE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "G74047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G740470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.