AVANTIS NEUROSCIENCE INC (NPI# 1396278321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396278321 |
| Entity Type | Organization |
| Organization Name | AVANTIS NEUROSCIENCE INC |
| Practice Address |
12401 Wilshire Blvd Ste 104 Los Angeles CA 90025-1015 |
| Mailing Address |
1807 Wilshire Blvd Ste A Santa Monica CA 90403-5678 |
| Practice Telephone | 3236820182 |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2020-01-23 |
| Authorized Official Name | DR. JEFFREY M CHUNG (CEO) |
| Authorized Official Telephone | 3236820182 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
Allopathic & Osteopathic Physicians |
| Street Address |
12401 WILSHIRE BLVD STE 104 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90025-1015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962721233 | Kevin John De Comines | Acupuncturist | 12401 Wilshire Blvd Ste 104, Los Angeles, CA 90025-1015 | 2010-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962324 | Marjan-marcia Khalitchi-alavi | Psychologist | 12400 Wilshire Blvd #230, Los Angeles, CA 90025 | 2020-11-06 |
| 1245852599 | Maureen Bridget Mcglynn | Marriage & Family Therapist | 1531 Purdue Avenue, Los Angeles, CA 90025 | 2020-05-09 |
| 1578118857 | Gregory J Bogie | Physical Therapist | 10351 Santa Monica Blvd. Suite 101, Los Angeles, CA 90025 | 2019-08-05 |
| 1518527712 | David Allen Goldstein | Marriage & Family Therapist | 12301 Wilshire Blvd., Suite 515, Los Angeles, CA 90025 | 2019-06-19 |
| 1386104875 | Kevin Meir Youssefzadeh | Student in an Organized Health Care Education/Training Program | 304 Dowlen Dr, Los Angeles, CA 90025 | 2019-03-21 |
| 1336609189 | Psychotherapy Center for Healing and Personal Growth | Psychologist | 2001 S. Barington Ave Suite 222, Los Angeles, CA 90025 | 2019-03-20 |
| 1477028819 | Flora Ma | Nurse Practitioner | 1726 Purdue Ave, Apt 2, Los Angeles, CA 90025 | 2018-10-12 |
| 1457834285 | Yeesul Yoo | Chiropractor | 2001 S. Barrington Ave Suite 101, Los Angeles, CA 90025 | 2018-09-07 |
| 1902387160 | Angelica Carmen Regalado | Behavior Technician | 7400 Pacific Blvd. Suite A & B, Walnut Park, CA 90025 | 2018-08-26 |
| 1033603378 | Craig Allen Gillett | Marriage & Family Therapist | 11847 Wilshire Blvd., #300, Los Angeles, CA 90025 | 2018-06-20 |
| Find all providers in zip 90025 | ||||
| Taxonomy Code | 2084N0600X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Clinical Neurophysiology |
| Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116877 | La Neuro Medical Group | Psychiatry & Neurology | 11843 Dorothy St Apt 2, Los Angeles, CA 90049-4456 | 2019-07-17 |
| 1780935130 | Dawn Eliashiv Md Inc. A Professional Medical Corporation | Psychiatry & Neurology | 8635 W 3rd St Ste 1080w, Los Angeles, CA 90048-6183 | 2012-09-25 |
| 1952629263 | Roger Bertoldi Md Professional Corporation | Psychiatry & Neurology | 8610 S. Sepulveda Blvd., Los Angeles, CA 90045 | 2010-05-11 |
| 1063704641 | Michael Galen Gibbs | Psychiatry & Neurology | 710 Westwood Plz, Los Angeles, CA 90095-8353 | 2011-05-13 |
| 1477877272 | David S Campion Md A Medical Corp | Psychiatry & Neurology | 10780 Santa Monica Blvd, Suite 210, Los Angeles, CA 90025-4749 | 2010-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316560378 | Green Flash Physician Oversight PC | Psychiatry & Neurology | 2868 Bayside Walk Unit C, San Diego, CA 92109-8119 | 2020-05-26 |
| 1659994739 | Jey Neuro Center, Inc | Psychiatry & Neurology | 2005 Eye Street #8-501, Bakersfield, CA 93301-4451 | 2020-05-22 |
| 1518527613 | Neuroguard Pro | Psychiatry & Neurology | 2932 N Cottonwood St Unit 16, Orange, CA 92865-1235 | 2019-06-19 |
| 1750857801 | Tms Depression Center of San Diego | Psychiatry & Neurology | 613 W Valley Pkwy Ste 102, Escondido, CA 92025-2550 | 2018-10-16 |
| 1225530637 | Iom Neuro Pro Reader | Psychiatry & Neurology | 9300 Santa Anita Ave, Suite 101, Rancho Cucamonga, CA 91730 | 2018-03-01 |
| 1437579851 | Sami Bajwa | Psychiatry & Neurology | 7240 N Van Ness Blvd, Fresno, CA 93711-0470 | 2014-04-24 |
| 1073821922 | Yuvraj Singh Grewal | Psychiatry & Neurology | 23861 Mcbean Pkwy Ste A4, Santa Clarita, CA 91355-2003 | 2010-09-14 |
| 1063686202 | Mark E Vonzastrow | Psychiatry & Neurology | 600 16th St, N212e Genentech Hall / Ucsf, San Francisco, CA 94158-2517 | 2008-04-18 |
| 1013180355 | Irving Lee Gislason | Psychiatry & Neurology | 12443 Lewis St Ste 101, Garden Grove, CA 92840-4650 | 2008-04-08 |
| 1124248844 | Baldev S Rai Md Inc | Psychiatry & Neurology | 4234 Riverwalk Pkwy Ste 280, Riverside, CA 92505-3370 | 2007-04-26 |
| Find all providers with the same taxonomy | ||||
| City | LOS ANGELES |
| Zip Code | 90025 |
Please comment or provide details below to improve the information on AVANTIS NEUROSCIENCE INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.