MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP-WILMINGTON AVE (NPI# 1639704323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639704323 |
| Entity Type | Organization |
| Organization Name | MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP-WILMINGTON AVE |
| Practice Address |
12021 Wilmington Ave Building 11, Suite 1000 Los Angeles CA 90059 |
| Practice Telephone | 4245296755 |
| Practice Fax Number | 4243388984 |
| Mailing Telephone | 4245296755 |
| Mailing Fax Number | 4243388984 |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-03 |
| Authorized Official Name | LAURIE GALLAGHER (DIRECTOR & ADMINISTRATOR) |
| Authorized Official Telephone | 4243388902 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | Y |
| Parent Organization Name | MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| N | 171R00000X | Interpreter | Other Service Providers | ||
| N | 172V00000X | Community Health Worker | Other Service Providers | ||
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
12021 WILMINGTON AVE BUILDING 11, SUITE 1000 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750351300 | Gangadarshni Chandramohan | Pediatrics | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2006-01-25 |
| 1114418928 | Exodus Recovery, Inc. | Community/Behavioral Health | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2018-05-29 |
| 1043759855 | Los Angeles County Department of Mental Health | Clinic/Center | 12021 Wilmington Ave, Los Angeles, CA 90059 | 2017-02-14 |
| 1053855064 | Maria Casarez-romero | Rehabilitation Practitioner | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2016-12-09 |
| 1295279453 | Kelsey Collins | Marriage & Family Therapist | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2016-12-07 |
| 1639628035 | Stella Cuomo | Student in an Organized Health Care Education/Training Program | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2016-09-26 |
| 1821443995 | Patanya Matthews | Counselor | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2016-04-26 |
| 1043677289 | Kita Stovall | Nurse Practitioner | 12021 Wilmington Ave, Los Angeles, CA 90059 | 2016-01-19 |
| 1417314741 | Noele Le Flore | Nurse Practitioner | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2016-01-18 |
| 1659757672 | Sharon Vaughn | Social Worker | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2015-07-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235759788 | Juan Jimenez Jr. | Technician, Pathology | 1860 E 120th St, Los Angeles, CA 90059 | 2020-04-24 |
| 1538717780 | Donald O Nwanze | Pharmacist | Mlk Outpatient Center (pharmacy), 1670 East 120th Street, Los Angeles, CA 90059 | 2019-08-30 |
| 1295391050 | Sheela Hoyle | Counselor | 836 East Saucer Lane, Los Angeles, CA 90059 | 2019-05-16 |
| 1750852471 | Carlos Tovar Sr. | Community Health Worker | 1720 E 120st, Los Angeles, CA 90059 | 2018-12-06 |
| 1699293910 | Amy Caryn Bolenbaugh | Recreation Therapist | 1720 E 120th Street, Los Angeles, CA 90059 | 2017-09-07 |
| 1417475757 | Scott Lee Jones | Recreation Therapist | Augustus F. Hawkins, 1720 E. 120th Street, Rm. 2196, Los Angeles, CA 90059 | 2017-09-07 |
| 1881118859 | Darlene Renee Tillman | Speech-Language Pathologist | 1670 E 120th Strret, Los Angeles, CA 90059 | 2017-08-01 |
| 1609306430 | Valda Therese Flores | Registered Nurse | 1670 E. 120th Street, Los Angeles, CA 90059 | 2017-06-14 |
| 1093244006 | Bongsill Chung | Registered Nurse | 1670 East 120th St, Los Angeles, CA 90059 | 2017-06-05 |
| 1730573395 | Apollonia Godoy | Registered Nurse | 1670 E. 120th St, 4th Floor, Module A, Los Angeles, CA 90059 | 2015-03-22 |
| Find all providers in zip 90059 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629680905 | Siavash Arani | Internal Medicine | 4524 San Pedro Pl, Los Angeles, CA 90011-3434 | 2020-08-19 |
| 1306455787 | All Health Medical Group, Inc | Internal Medicine | 1300 N Vermont Ave Ste 1008, Los Angeles, CA 90027-6096 | 2020-07-30 |
| 1912533985 | Milgrom Medical Inc. | Internal Medicine | 1555 Vine St Apt 433s, Los Angeles, CA 90028-5298 | 2020-03-20 |
| 1316582059 | Sera Ramadan, D.o., Inc | Internal Medicine | 1245 Wilshire Blvd Ste 812, Los Angeles, CA 90017-4808 | 2019-11-15 |
| 1154971018 | Del Refugio Healthcare Inc | Internal Medicine | 4800 S Central Ave Ste B, Los Angeles, CA 90011-5459 | 2019-09-12 |
| 1851957245 | Aviva Iofel, M.d., Inc. | Internal Medicine | 6234 Fountain Ave Unit B, Los Angeles, CA 90028-8214 | 2019-05-12 |
| 1588120539 | Netzah Health Corp | Internal Medicine | 866 N Vermont Ave Ste 2, Los Angeles, CA 90029-3587 | 2019-02-14 |
| 1306310495 | Baltimo Medical Center Inc | Internal Medicine | 3700 Wilshire Blvd Ste 422, Los Angeles, CA 90010-2905 | 2019-01-11 |
| 1528531316 | Dauna Marie Health Care Inc | Internal Medicine | 3755 Beverly Blvd Apt 303, Los Angeles, CA 90004-3540 | 2019-01-04 |
| 1710458005 | Equality Health Network PC | Internal Medicine | 555 W 5th St Fl 35, Los Angeles, CA 90013-1010 | 2018-12-11 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90059 |
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| 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.