Organization Active NPI

Jittima Jirasetpatana

  • Podiatrist
  • Glendale, CA
National Provider Identifier
1992903710
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E4442 Issued in CA
Legal business name
JITTIMA JIRASETPATANA
Practice address
1510 S Central Ave
Suite 120
Glendale, CA 91204-2500
Phone
(818) 242-3668
Fax
(818) 242-2425
NPI assigned
Jul 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Jittima Jirasetpatana, DPMNPI 1114021789
Title
Owner
Phone
(818) 242-3668

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X E4442 CA Primary

Addresses

Primary practice location

1510 S Central Ave
Suite 120
Glendale, CA 91204-2500

Mailing address

1510 S Central Ave Ste 120
Glendale, CA 91204-2576
Phone (818) 242-3668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040514001239 CA Part B Supplier - Clinic/Group Practice 8022008606 Receives reassigned benefits from 1 practitioner
Practice locations: Glendale, CA

National Provider Directory

National Provider Directory

Locations

1127 Wilshire Blvd
Ste 112
Los Angeles, CA 90017
Phone (213) 240-5996

855 N Lark Ellen Ave
Ste H
West Covina, CA 91791
Phone (626) 331-0725

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1992903710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE STE 120",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042576",
            "telephone_number": "818-242-3668",
            "fax_number": "818-242-2425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE",
            "address_2": "SUITE 120",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042500",
            "telephone_number": "818-242-3668",
            "fax_number": "818-242-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JITTIMA JIRASETPATANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "JIRASETPATANA",
        "authorized_official_first_name": "JITTIMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-242-3668",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.