CHDP Provider Roster by Zip Code new - Department of Public ...
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5/6/2013 1:50:54 PM<br />
County <strong>of</strong> Los Angeles - <strong>Department</strong> <strong>of</strong> <strong>Public</strong> Health<br />
<strong>Public</strong> Health - Childrens Medical Services<br />
Child Health And Disability Prevention Program<br />
Active <strong>Provider</strong>s <strong>by</strong> Alphabet<br />
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
A DIOP FAMILY CARE MEDICAL<br />
GROUP<br />
AAA COMPREHENSIVE<br />
HEALTHCARE<br />
1023145240 2710 W. MANCHESTER<br />
BLVD., STE A<br />
INGLEWOOD 90305 (323) 778-4310 12 4 8 3 10/23/2002<br />
1396067500 18607 VENTURA BLVD.,<br />
SUITE 101<br />
TARZANA 91356 (818) 758-8282 25 4 2 1 10/21/2010<br />
AASTHA INC 1700171105 1902 ROYALTY DRIVE, STE.<br />
225<br />
POMONA 91767 (909) 231-6181 13 4 3 2 10/20/2011<br />
ABDEL- MALEK, SHAHIRA S. MD<br />
INC<br />
1508088840 3100 E FLORENCE AVE.<br />
STE. 1<br />
HUNTINGTON PA 90255 (323) 583-4115 12 4 7 2 9/24/1997<br />
ABRAHAM, GIZEL A., M.D. 1033144704 1510 S. CENTRAL AVE STE<br />
510<br />
GLENDALE 91204 (818) 502-2181 13 4 2 1 5/6/1999<br />
ABRAHAMIAN, AZNIV A., M.D. 1033270293 12507 VICTORY BLVD NORTH HOLLYW 91606 (818) 769-7540 13 4 2 1 3/26/1999<br />
ACTIVE HEALTHCARE MEDICAL<br />
GROUP INC.<br />
1699955575 512 S. GLENDORA AVE. WEST COVINA 91790 (626) 337-2888 13 4 3 2 9/22/2003<br />
ADHAMI, AFSHIN S., M.D. 1104991686 3030 TYLER AVE EL MONTE 91731 (626) 350-9540 13 4 3 2 8/15/2000<br />
ADHAMI, SHAWN A., MD INC 1932315827 1000 W. WHITTIER BLVD. MONTEBELLO 90640 (323) 346-0555 12 4 7 2 10/18/2005<br />
ADVANCED FAMILY CARE MED<br />
GRP<br />
ADVANCED FAMILY MEDICAL<br />
GROUP<br />
ADVENTIST HEALTH<br />
PHYSICIANS NETWORK<br />
1033267216 1201 E FLORENCE AVE LOS ANGELES 90001 (323) 588-0084 12 4 6 3 12/3/1998<br />
1588778930 16415 S. COLORADO<br />
AVENUE #304<br />
PARAMOUNT 90723 (562) 531-4171 13 4 6 3 9/28/1978<br />
1427310648 801 S. CHEVY CHASE DRIVE<br />
# 200<br />
GLENDALE 91205 (818) 637-7980 12 4 2 1 4/30/2013<br />
AFSHIN, AKHAVAN DO APC 1821210329B 530 E. WASHINGTON BLVD. LOS ANGELES 90015 (213) 747-2626 12 4 4 3 7/21/2011<br />
AGHAPY MEDICAL GROUP INC. 1194960799 2542 E. FLORENCE AVE.,<br />
STE. B<br />
WALNUT PARK 90255 (323) 584-8700 12 4 7 2 4/27/2009<br />
AGUILUZ, JACQUELINE B, D.O.<br />
INC,<br />
1851306724 21508 S. NORWALK BLVD. HAWAIIAN GARD 90716 (562) 865-5214 13 4 7 2 8/31/2004<br />
AINTABLIAN, IGHIA, M.D. INC 1548358369 1510 S. CENTRAL AVE STE<br />
450<br />
GLENDALE 91204 (818) 500-8822 13 4 2 1 8/25/1989<br />
AIYEGBUSI & BRAIMAH AMC 1710084959 21350 HAWTHORNE BLVD<br />
STE 157<br />
TORRANCE 90503 (310) 540-7240 12 4 8 3 4/1/2013<br />
AKHANJEE, NARGIS R. MD 1508843699 2105 BEVERLY BLVD STE<br />
217A<br />
LOS ANGELES 90057 (213) 483-5430 13 4 4 3 7/2/2001<br />
AKHAVAN, AFSHIN DO, APC 1821210329A 3009 S. VERMONT AVE. LOS ANGELES 90007 (323) 730-1663 12 4 4 3 9/20/2005<br />
Monday, May 06, 2013 Page 1 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
ALBURY, DENISE A., M.D. 1417053257 644 E. REGENT STREET,<br />
SUITE 104<br />
INGLEWOOD 90301 (310) 419-2223 13 4 8 3 2/24/2009<br />
ALFRED LAVI, D.O.,<br />
PROFESSIONAL CORP<br />
ALFRED LAVI, DO<br />
PROFESSIONAL CORP<br />
ALHAMBRA FAMILY MEDICAL<br />
CENTER INC, AMPC<br />
1629198791B 1835 S. LA CIENEGA BLVD<br />
STE. 205 & 215<br />
LOS ANGELES 90035 (310) 836-2273 12 4 6 3 12/26/2012<br />
1629198791 2324 W. PICO BLVD LOS ANGELES 90006 (213) 383-3600 12 4 4 3 3/24/2005<br />
1851324206 801 W. VALLEY BLVD. , STE.<br />
204<br />
ALHAMBRA 91803 (626) 281-2232 12 4 3 2 1/5/2006<br />
ALI, ALIYA I., M.D. 1962513846 12826 E. PHILADELPHIA<br />
STREET SUITE A<br />
WHITTIER 90601 (562) 789-9908 13 4 7 2 6/27/1996<br />
ALIANZA MEDICAL CENTER 1073675385 6907 SEVILLE AVE HUNTINGTON PA 90255 (323) 588-1100 12 4 7 2 3/12/1998<br />
ALICIA G. NUGAS, MD 1730298407 22408 NORWALK BLVD.. HAWAIIAN GARD 90716 (562) 421-2188 13 4 7 2 11/15/2010<br />
ALL CARE MEDICAL GROUP. INC. 1720055429 2675 E. SLAUSON AVE. HUNTINGTON PA 90255 (323) 589-6681 12 4 7 2 8/18/2006<br />
ALL FAMILY NEIGHBORHOOD<br />
MED. CLINIC & WELLNESS CTR.<br />
ALL FOR HEALTH, HEALTH FOR<br />
ALL INC<br />
ALL FOR HEALTH, HEALTH FOR<br />
ALL INC.<br />
1760698740 874 W. MARTIN LUTHER<br />
KING JR.BLVD.<br />
LOS ANGELES 90037 (323) 238-0800 12 4 6 3 4/9/2008<br />
1568567220B 437 SOUTH PACIFIC AVE GLENDALE 91204 (818) 409-3020 25 4 2 1 3/14/2012<br />
1568567220A 519 E. BROADWAY GLENDALE 91205 (818) 409-3022 22 4 2 1 10/21/2005<br />
ALL VALLEY PEDIATRICS 1942219167 14901 RINALDI STREET,<br />
SUITE 300<br />
MISSION HILLS 91345 (818) 365-7783 12 4 2 1 10/23/2003<br />
ALONSO, LAZARO V,<br />
MD/ALONSO MED GRP<br />
ALONSO, LAZARO V,<br />
MD/ALONZO MED GROUP<br />
ALTAMED COMM HLTH CLINIC-<br />
EL MONTE<br />
1700065901B 11349 SATICOY STREET SUN VALLEY 91352 (818) 982-5750 12 4 2 1 3/25/1998<br />
1700065901A 15216 VANOWEN ST. VAN NUYS 91405 (818) 785-7875 12 4 2 1 3/2/1998<br />
1982814745 10418 VALLEY BLVD SUITE B EL MONTE 91731 (626) 453-8466 22 4 3 2 10/27/1996<br />
ALTAMED HEALTH GROUP-BELL 1518171016 6901 S. ATLANTIC AVE. BELL 90201 (323) 562-6700 22 4 7 2 6/30/2004<br />
ALTAMED HEALTH SERV. CORP-<br />
EAST LA 1ST STREET<br />
ALTAMED HEALTH SERVICES<br />
CORP<br />
ALTAMED HEALTH SERVICES<br />
CORP.<br />
ALTAMED HEALTH SERVICES<br />
CORP./ ALTAMED MED GRP W.<br />
COVINA<br />
ALTAMED HEALTH<br />
SERVICES/ALTAMED MOBIL<br />
HEALTH CL<br />
1134492937 2219 E. 1ST STREET LOS ANGELES 90033 (323) 269-0421 22 4 4 4 7/22/2009<br />
1396959060 5427 E. WHITTIER BLVD LOS ANGELES 90022 (323) 869-1900 22 4 7 2 8/1/1991<br />
1710191283 9436 SLAUSON AVE. PICO RIVERA 90660 (562) 949-6069 22 4 7 2 8/1/1991<br />
1730481318 1300 S SUNSET AVE WEST COVINA 91790 (626) 338-3991 22 4 3 2 6/25/2012<br />
1396959060STA 5427 E. WHITTIER BLVD. LOS ANGELES 90022 (323) 889-7890 22 4 7 2 10/8/1999<br />
Monday, May 06, 2013 Page 2 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
ALTAMED MED & DNTL GRP-<br />
RAMONA GARDENS<br />
ALTAMED MED.& DNTL GRP -<br />
WILLIAM MEAD<br />
ALTAMED MED.& DNTL. GRP -<br />
ESTRADA COURTS<br />
ALTAMED MEDICAL & DENTAL<br />
GRP-WHITTIER WEST<br />
ALTAMED MEDICAL GRP<br />
HEALTH SVS/CHILDRENS HOSP<br />
PEDIATRICS<br />
AMAVI A PROFESSIONAL<br />
MEDICAL CORP.<br />
AMERICAN INDIAN HEALING<br />
CENTER<br />
1255542601STA 1424 Crusado Lane Unit 168 LOS ANGELES 90033 (323) 265-1998 22 4 4 3 10/15/2007<br />
1255542601STC 268 BLOOM ST. UNIT 322 LOS ANGELES 90012 (323) 265-1998 22 4 4 4 12/19/2007<br />
1255542601STB 1305 S. CONCORD ST.. #18 LOS ANGELES 90023 (323) 265-1998 22 4 4 3 10/15/2007<br />
1255542601 3945 WHITTIER BLVD. LOS ANGELES 90023 (323) 265-1998 22 4 4 3 8/26/2004<br />
1629283197 4650 W. SUNSET BLVD # 76 LOS ANGELES 90027 (323) 669-2113 22 4 4 3 5/17/2006<br />
1598984288 2705 WHITTIER BLVD. LOS ANGELES 90023 (323) 263-3861 12 4 4 3 2/12/1992<br />
1558541771 12456 WASHINGTON BLVD WHITTIER 90602 (562) 693-4325 25 4 7 2 10/4/2006<br />
AMG, A PROFESSIONAL CORP. 1558306266 925 S GARFIELD AVE ALHAMBRA 91801 (626) 282-0282 12 4 3 2 12/23/1996<br />
AMINI, MASSOUD, M.D. 1609930858 7143 SEVILLE AVE. HUNTINGTON PA 90255 (323) 587-0145 12 4 7 2 12/3/1998<br />
AN PANG CHIENG MD INC / EL<br />
SERENO MED GRP.<br />
ANGELES COMPREHENSIVE<br />
COMM CLINIC INC<br />
1336189117 3301 N. EASTERN AVE LOS ANGELES 90032 (323) 225-2351 12 4 4 3 1/25/1993<br />
1457470684 3920 EAGLE ROCK BLVD<br />
STE A.<br />
LOS ANGELES 90065 (323) 255-5225 25 4 4 3 8/12/2008<br />
ANNIE LIM & KHENG LIM, MD 1932299930 9209 S COLIMA RD., STE<br />
4200<br />
WHITTIER 90605 (562) 698-6388 12 4 7 2 1/14/2002<br />
ANTELOPE VALLEY COMM<br />
CLINIC<br />
ANTELOPE VALLEY COMM.<br />
CLINIC MOBILE 1 HLTH. CTR.<br />
ANTELOPE VALLEY COMMUNITY<br />
CLINIC - MOBILE HEALTH CLINIC<br />
II<br />
ANTELOPE VALLEY COMMUNITY<br />
CLINIC- LANCASTER<br />
ANWAR & VASSEMA ARASTU<br />
MD INC<br />
1730499872 45104 10TH STREET WEST LANCASTER 93534 (661) 942-2391 22 4 1 1 5/25/2011<br />
1710199674 45074 10TH STREET, SUITE<br />
109<br />
LANCASTER 93534 (661) 942-2391 22 4 1 1 9/18/2001<br />
1619290624 45074 10TH STREET WEST,<br />
STE. 109<br />
LANCASTER 93534 (661) 942-2391 22 4 1 1 2/18/2010<br />
1609199934 45074 10TH STREET WEST,<br />
STE., 109<br />
LANCASTER 93534 (661) 942-2391 22 4 1 1 9/18/2001<br />
1831493394 12675 LA MIRADA BLVD STE<br />
200<br />
LA MIRADA 90638 (562) 941-9853 13 4 7 2 6/28/1988<br />
APAIT HEALTH CENTER 1912292285 1730 W OLYMPIC BLVD.,<br />
STE. 150<br />
LOS ANGELES 90015 (213) 553-1830 25 4 4 4 2/28/2013<br />
ARCEO, RUTH N., M.D. 1427150093 904 E PACIFIC COAST HWY. LONG BEACH 90806 (562) 591-2785 13 4 8 3 4/7/2000<br />
ARDMORE MEDICAL GROUP INC 1578624672 3564 SANTA ANITA AVE<br />
STE. A<br />
EL MONTE 91731 (626) 350-8101 12 4 3 2 6/24/1993<br />
ARDMORE MEDICAL GROUP INC 1235299637 2765 E. FLORENCE AVENUE HUNTINGTON PA 90255 (323) 588-6888 12 4 7 2 8/19/1995<br />
Monday, May 06, 2013 Page 3 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
ARDMORE MEDICAL GROUP INC 1124189212 3518 W. 8TH STREET LOS ANGELES 90005 (213) 384-9949 12 4 4 3 5/27/1993<br />
ARDMORE MEDICAL GROUP INC. 1770649097 3500 E. WHITTIER BLVD.<br />
STE#105<br />
LOS ANGELES 90023 (323) 262-8100 12 4 4 3 5/27/1993<br />
ARDMORE MEDICAL GROUP INC. 1992873947 5953 ATLANTIC BLVD. MAYWOOD 90270 (323) 562-6170 12 4 7 2 8/30/2004<br />
ARMINE NAZARYAN MD<br />
MEDICAL CLINIC INC., APC<br />
ARROYO VISTA FAMILY HEALTH<br />
CENTER<br />
ARROYO VISTA FAMILY HEALTH<br />
CENTER<br />
ARROYO VISTA FAMILY HEALTH<br />
CENTER/MOBILE II<br />
ARROYO VISTA FAMILY HEALTH<br />
FOUNDATION<br />
ARROYO VISTA FAMILY HLTH<br />
CTR<br />
ARROYO VISTA FAMILY HLTH.<br />
CTR. / LOMA DRIVE<br />
ARSLANIAN, ZAVEN M., M.D. /<br />
ARSLANIAN MEDICAL CLINIC<br />
ARUTYOUNIAN, NARIN,<br />
MD/WEST COAST DOCTOR'S<br />
MED GR<br />
1689715070 221 SOUTH GLENDALE AVE GLENDALE 91205 (818) 500-0716 13 4 2 1 11/10/2009<br />
1316088479 4815 VALLEY BLVD., UNIT C LOS ANGELES 90032 (323) 222-1134 22 4 4 3 12/28/2001<br />
1174665905 2411 N. BROADWAY LOS ANGELES 90031 (323) 987-2000 22 4 4 3 3/24/2006<br />
1891837621 6000 N. FIGUEROA ST. LOS ANGELES 90042 (323) 254-5221 22 4 4 3 1/19/2006<br />
1821302027 4837 HUNTINGTON<br />
DR.NORTH<br />
LOS ANGELES 90032 (323) 225-0024 22 4 4 3 4/30/2013<br />
1447353701 6000 N. FIGUEROA STREET LOS ANGELES 90042 (323) 254-5221 22 4 4 3 1/6/1992<br />
1346200342 303 S. LOMA DRIVE, STE. 202 LOS ANGELES 90017 (213) 201-5800 22 4 4 3 6/11/2008<br />
1174545651 633 NORTH CENTRAL AVE<br />
STE 107<br />
GLENDALE 91203 (818) 244-6633 13 4 2 1 9/15/1998<br />
1467648329 814 E. BROADWAY ST<br />
SUITE# 1<br />
GLENDALE 91205 (818) 265-5040 13 4 2 1 5/30/2006<br />
ARUTYUNYAN, VARDUI, MD 1841235223 1030 S. GLENDALE AVE #309 GLENDALE 91205 (818) 553-1020 13 4 2 1 3/9/2011<br />
ASIAN PACIFIC HEALTH CARE<br />
INC<br />
ASIAN PACIFIC HEALTH CARE<br />
VENTURE INC./ APHCV- EL<br />
MONTE/ ROSEMEAD HLTH<br />
ASIAN PACIFIC HEALTH CARE<br />
VENTURE, INC<br />
ASIAN PACIFIC HEALTH CARE<br />
VENTURE, INC<br />
ASSUTA FAMILY MEDICAL<br />
GROUP<br />
1003951708 3939 TRACY STREET LOS ANGELES 90027 (323) 665-1129 22 4 4 3 10/10/2006<br />
1609147743 9960 BALDWIN PLACE EL MONTE 91731 (626) 774-2988 25 4 3 2 12/20/2012<br />
1811129091 1575 WEST 2ND STREET LOS ANGELES 90026 (323) 644-3885 25 4 4 3 3/25/2011<br />
1336208255 1530 HILLHURST AVE., STE<br />
200<br />
LOS ANGELES 90027 (323) 644-3880 22 4 3 3 9/10/2002<br />
1639400260 12922 VICTORY BLVD N HOLLYWOOD 91606 (818) 760-2800 12 4 2 1 5/19/2010<br />
ASWANI, MOHINI, M.D. 1811006943 3737 MARTIN LUTHER KING<br />
JR BLVD STE 205<br />
LYNWOOD 90262 (310) 604-0105 13 4 6 3 11/30/1982<br />
ATEIA, SAMIA MD INC 1376615401 14135 FRANCISQUITO AVE#<br />
106<br />
BALDWIN PARK 91706 (626) 960-3753 13 4 3 2 5/18/2009<br />
ATLURI, RAO L., MD INC. 1699828848 14051 E. RAMONA PKWY. BALDWIN PARK 91706 (626) 338-7338 13 4 3 2 7/31/2009<br />
Monday, May 06, 2013 Page 4 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
AUSTIN, EDWARD, M.D. 1245383488 1331 E. COMPTON BLVD. COMPTON 90221 (310) 763-4250 13 4 6 3 8/7/1998<br />
AUTUMN MEDICAL GROUP 1881746022 9200 COLIMA RD # 207 WHITTIER 90605 (562) 945-0252 12 4 7 2 12/6/2010<br />
AVALON MEDICAL CLINIC 1346250347 100 FALLS CANYON ROAD,<br />
BOX 1563<br />
AVALON 90704 (310) 510-0700 22 4 8 3 8/21/1991<br />
AWADA, ALI M MD 1356531297 12301 S. HAWTHORNE BLVD. HAWTHORNE 90250 (310) 355-0054 13 4 8 3 4/4/2006<br />
AXMINSTER MEDICAL GROUP<br />
INC<br />
AXMINSTER MEDICAL GROUP,<br />
INC<br />
AXMINSTER MEDICAL GROUP,<br />
INC.<br />
1821099227 4314 W. SLAUSON AVE LOS ANGELES 90043 (310) 675-5370 12 4 6 4 12/3/2012<br />
1942293279 11539 HAWTHORNE BLVD<br />
6TH FLOOR<br />
HAWTHORNE 90250 (310) 675-5370 12 4 8 4 12/13/2012<br />
1801897368 8540 S. SEPULVEDA BLVD<br />
STE 818<br />
LOS ANGELES 90045 (310) 675-5370 12 4 5 4 11/26/2012<br />
AZADI-RAD, AYAT, MD 1154593929 7232 VAN NUYS BLVD.<br />
SUITE 201<br />
VAN NUYS 91405 (818) 373-4999 13 4 2 1 11/1/2010<br />
AZER, NAGWA L., MD 1891864070 931 BUENA VISTA ST. SUITE DUARTE<br />
503<br />
91010 (626) 357-2269 13 4 3 2 9/20/2005<br />
AZINGE-OBASI, MEZIA O MD 1659379634 3450 W. 43RD ST. STE 106 LOS ANGELES 90008 (323) 290-2832 13 4 6 3 3/11/2010<br />
AZIZ-ZADEH, NASSER, M.D. 1093723371 1141 W. REDONDO BEACH<br />
BLVD. #407<br />
GARDENA 90247 (310) 527-5554 13 4 8 3 7/1/1992<br />
AZUL MEDICAL CLINIC, INC. 1679626436 6517 EASTERN AVE. BELL GARDENS 90201 (323) 773-8295 12 4 7 2 10/27/2004<br />
AZURIN, ELEANOR, MD 1538278270 7700 PACIFIC BLVD. WALNUT PARK, 90255 (323) 585-7320 13 4 7 2 3/13/2002<br />
AZURIN, NARCISO M., M.D. 1659479269 4075 TWEEDY BLVD SOUTH GATE 90280 (323) 566-4111 12 4 7 2 1/1/1984<br />
BADYMOGHADDAM, YAGHOUB<br />
MD.<br />
1932225208 5726 E OLYMPIC BLVD COMMERCE 90022 (323) 727-7000 13 4 7 2 1/24/2008<br />
BAEZ, ALFONSO M., M.D. 1134295132 14127 S. VERMONT AVE GARDENA 90247 (310) 532-1650 13 4 8 3 4/25/1994<br />
BAI, EUNG KOO, M.D. 1962412536 12017 E. ROSECRANS AVE. NORWALK 90650 (562) 868-2027 13 4 7 2 3/7/1991<br />
BALETTE, LILY C., MD 1902960388 1141 W. REDONDO BEACH<br />
BLVD SUITE 211<br />
GARDENA 90247 (310) 327-0245 13 4 8 3 6/2/2009<br />
BALLOU, NICOLETTE L., M.D. 1457420077 8920 WILSHIRE BLVD. STE<br />
604<br />
BEVERLY HILLS 90211 (310) 659-7867 13 4 5 3 7/16/1986<br />
BALTAIAN, LILIT MD 1154552305 741 E ALTADENA DR ALTADENA 91001 (626) 794-8133 13 4 3 2 3/19/2012<br />
BANSAL, JAGAN N., MD INC. 1043392962 5540 N. FIGUEROA ST. LOS ANGELES 90042 (323) 478-1101 12 4 4 3 5/20/2005<br />
BANSUAN, RAINER, M.D. 1336258037 10305 GARVEY AVENUE S. EL MONTE 91733 (626) 455-0982 13 4 3 2 9/11/1998<br />
BANTA, DANTE A., M.D. 1215100417 875 N. WESTERN AVE LOS ANGELES 90029 (323) 461-0777 13 4 4 3 12/21/1994<br />
BAQUIRAN, PAULINA M., M.D. 1518041359 1321 N. VERMONT AVE STE<br />
C<br />
LOS ANGELES 90027 (323) 666-2304 13 4 4 3 6/3/1991<br />
BARKODAR, JOHN M., M.D. 1467558734 3314 FIRESTONE BLVD. SOUTH GATE 90280 (323) 567-4483 13 4 7 2 3/27/1989<br />
Monday, May 06, 2013 Page 5 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
bartz altadonna community<br />
HEALTH CENTER<br />
1811279763 43322 gingham ave., suite 104<br />
& 105<br />
lancaster 93535 (661) 874-4050 25 4 2 1 12/31/2012<br />
BASILIOS, MAGED Z, MD 1225021462 4505 SLAUSON AVE., STE E. MAYWOOD 90270 (323) 771-0080 13 4 7 2 11/23/2004<br />
BASS, BRENDA G. MD 1477627248 9201 SUNSET BLVD. STE 408 LOS ANGELES 90069 (310) 273-7401 13 4 4 3 11/13/1981<br />
BATRES , ERIC R. , MD MEDICAL<br />
CORPORATION<br />
1083735203 5101 E. FLORENCE AVE.<br />
STE. #4<br />
BELL 90201 (323) 560-4673 13 4 7 2 12/10/2004<br />
BAUTISTA, DAISY I., M.D. 1689691537 328 S. ALVARADO STREET LOS ANGELES 90057 (213) 483-3968 13 4 4 3 7/3/1996<br />
BAYLON, PAUL M., MD 1003824020 3118-3120 E. FLORENCE AVE HUNTINGTON PA 90255 (323) 587-1616 13 4 7 2 5/12/2011<br />
BAZEL, MICHAEL, M.D. 1598712978 4001 E. FLORENCE AVENUE BELL 90201 (323) 562-0595 13 4 7 2 6/5/2001<br />
BEESLEY, ELLIS N JR, M.D. 1063470219 1127 WILSHIRE BLVD. STE<br />
707<br />
LOS ANGELES 90017 (213) 482-4830 13 4 4 3 11/20/1992<br />
BEHARIE, CARLOS MD<br />
MEDICAL GROUP, INC.<br />
BELL GARDENS FAMILY<br />
MEDICAL CENTER<br />
1538156708 10050 GARVEY AVE., SUITE<br />
111<br />
EL MONTE, 91733 (626) 652-0790 12 4 3 2 3/23/2005<br />
1720115033 6501 GARFIELD AVE. BELL GARDENS 90201 (562) 928-9600 22 4 7 2 11/17/2003<br />
BENDANA, RAUL J., M.D. 1285752832 1619 1/2 W. PICO BLVD. LOS ANGELES 90015 (213) 487-0615 13 4 4 3 4/5/1996<br />
BENDITO PEDIATRIC, INC 1144596966 22030 sherman way ste.210 CANOGA PARK 91303 (818) 857-5991 13 4 2 1 1/23/2013<br />
BENEVOLENCE INDUSTRIES INC 1578763207 3631 CRENSHAW BLVD.,<br />
STE. 109<br />
LOS ANGELES 90016 (323) 732-0100 25 4 6 4 12/31/2012<br />
BENEVOLENCE INDUSTRIES INC<br />
/ CENTRAL MEDICAL CLINIC<br />
1376761940 3533 W. PICO BLVD LOS ANGELES 90019 (323) 734-1600 25 4 4 3 12/6/2010<br />
BENJAMIN BEHROOZAN MD INC. 1639234362 2221 LINCOLN BLVD. #200 SANTA MONICA 90405 (310) 396-9999 13 4 5 3 4/24/1985<br />
BENMAR MEDICAL INC. 1891724910 2020 N. GLENOAKS BLVD BURBANK 91504 (818) 845-2491 12 4 2 1 11/29/2011<br />
BERGANZA, JOSE D., M.D. INC 1962560896 14514 RAMONA BLVD.<br />
SUITE# 3<br />
BALDWIN PARK 91706 (626) 337-0424 12 4 3 2 2/20/1998<br />
BERGMAN MEDICAL GROUP 1639177520 15111 E. WHITTIER BLVD.,<br />
STE 102<br />
WHITTIER 90603 (562) 945-6440 12 4 7 2 8/10/1998<br />
BERNALES, GEORGE A., M.D. 1235107491 2766 E. FLORENCE AVENUE HUNTINGTON PA 90255 (323) 583-2718 13 4 7 2 5/4/1994<br />
BIENVENIDOS CHILDREN'S<br />
CENTER, INC<br />
1124153820 507 SOUTH ATLANTIC<br />
BOULEVARD<br />
LOS ANGELES 90022 (323) 268-9191 25 4 7 2 9/11/2012<br />
BLESA, MARTA MD INC 1881614378 5821 TEMPLE CITY BLVD TEMPLE CITY 91780 (626) 287-8261 13 4 7 2 9/8/2010<br />
BROOKDALE MEDICAL CORP.<br />
INC.<br />
1265572903 2809 TWEEDY BLVD. SOUTH GATE 90280 (323) 567-9909 12 4 7 2 10/30/2006<br />
BROOMAND, BEHROUZ, M.D. 1528226073 6056 LANKERSHIM BLVD. NORTH HOLLYW 91606 (818) 761-2300 13 4 2 1 2/29/1988<br />
BROUKHIM, BIJAN MD., INC. 1205877354 6330 VAN NUYS BLVD. VAN NUYS 91401 (818) 994-9822 12 4 2 1 6/2/2008<br />
Monday, May 06, 2013 Page 6 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
BROUKHIM, BIJAN, M.D. INC 1982641734 7400 VAN NUYS BLVD.<br />
STE#120<br />
VAN NUYS 91405 (818) 782-9892 12 4 2 1 3/1/2005<br />
BRUECKMANN, JOSEPH, DO 1730257379 15651 E. IMPERIAL HWY,<br />
STE 102<br />
LA MIRADA 90638 (562) 947-8646 13 4 7 2 4/5/1994<br />
BURSTEIN, MARINA,<br />
MD/BURSTEIN MD, APC<br />
CALIFONIA PRIMARY HEALTH,<br />
PROTACIO, RODOLFO B., M.D.,<br />
CALIFORNIA FAMILY<br />
CARE/NORTHEAST COMMUNITY<br />
CLINIC<br />
CALIFORNIA HEALTH MEDICAL<br />
GROUP<br />
1093808933 24013 VENTURA BLVD.,<br />
SUITE 101<br />
CALABASAS, 91302 (818) 222-2443 13 4 2 1 7/21/2005<br />
1154583193 1510 S. CENTRAL AVE, #540 GLENDALE 91204 (818) 500-8739 13 4 2 1 8/13/1998<br />
1689885907 1414 S. GRAND AVE., STE<br />
200<br />
LOS ANGELES 90015 (213) 743-9000 22 4 4 3 10/27/2006<br />
1700069705 2721 WEST 6TH STREET LOS ANGELES 90057 (213) 386-0010 12 4 4 3 12/2/1997<br />
CARCAMO, ERICK F., M.D. 1457594939 4070 STERLING WAY BALDWIN PARK 91706 (626) 337-0676 13 4 3 2 10/18/1995<br />
CARIGMA, CECILIA S. MD /<br />
MIGHTY KIDZ PEDIATRICS<br />
CARLOS BEHARIE MD MEDICAL<br />
GROUP INC / CLINICA DE<br />
MATERNIDAD GINECOLOGIA Y<br />
PEDIATRIA MED GRP<br />
CARLOS BEHARIE MD MEDICAL<br />
GROUP INC/ CLINICA DE<br />
MATERNIDAD GINECOLOGIA Y<br />
PEDIATRIA MED GRP<br />
CASABAR, RUBEN S. MD., INC./<br />
SANTANA MED. CLINIC<br />
1174719058 18821 PIONEER BLVD., STE.<br />
D<br />
CERRITOS 90701 (562) 403-0400 13 4 7 2 12/6/2011<br />
1568762037 13742 AMAR RD LA PUENTE 91746 (626) 916-0400 12 4 3 2 8/30/2012<br />
1013212349 4126 N. MAINE AVE BALDWIN PARK 91706 (626) 653-0800 12 4 3 2 8/30/2012<br />
1104910629A 2426 W. 8TH STREET SUITE<br />
105<br />
LOS ANGELES 90057 (213) 388-4415 13 4 4 3 1/4/2008<br />
CASABAR, RUBEN S., M.D., INC 1104910629B 6017 ATLANTIC BLVD. MAYWOOD 90270 (323) 560-8880 13 4 7 2 12/3/1992<br />
CEDARS-SINAI MED CTR<br />
(C.O.A.C.H. FOR KIDS PROG I)<br />
CEDARS-SINAI MED CTR<br />
C.O.A.C.H. FOR KIDS PROGRAM<br />
II<br />
CEDARS-SINAI MEDICAL<br />
CENTER<br />
1639172372STA 8700 BEVERLY BLVD., TSB<br />
210<br />
LOS ANGELES 90048 (310) 423-9585 2 4 4 3 12/17/1987<br />
1639172372STB 8700 BEVERLY BLVD. TSB<br />
210<br />
LOS ANGELES 90048 (310) 423-9585 2 4 4 3 5/16/2002<br />
1639172372 8700 BEVERLY BLVD., RM<br />
1473<br />
LOS ANGELES 90048 (310) 423-6321 2 4 4 3 12/17/1987<br />
CELERINA B. MEDINA, MD INC. 1972749216 4149 TWEEDY BLVD. # B SOUTH GATE 90280 (323) 564-4545 12 4 7 2 4/7/1994<br />
CENTRAL CITY COMMUNITY<br />
HEALTH CENTER<br />
CENTRAL NEIGHBORHOOD<br />
HEALTH FOUNDATION<br />
CENTURY MEDICAL CENTER,<br />
APC<br />
1235283094 5970 S CENTRAL AVE. LOS ANGELES 90001 (323) 234-3280 22 4 6 3 8/1/2003<br />
1639336803 2707 SOUTH CENTRAL AVE. LOS ANGELES 90011 (323) 234-5000 22 4 6 3 4/7/1980<br />
1528270147 3451 WEST CENTURY BLVD.<br />
B-1<br />
INGLEWOOD 90303 (310) 677-9400 12 4 8 3 11/2/2004<br />
Monday, May 06, 2013 Page 7 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
CENTURY WOMEN MEDICAL<br />
GROUP<br />
CENTURY WOMEN MEDICAL<br />
GROUP INC.<br />
CESAR VELEZ MEDICAL GROUP<br />
IN.<br />
1285753723 2030 W PICO BLVD LOS ANGELES 90006 (213) 389-4544 12 4 4 3 5/20/2008<br />
1295854701 3710 E. CESAR CHAVEZ<br />
AVE. 2ND. FLOOR<br />
LOS ANGELES 90063 (323) 980-8404 12 4 7 2 2/6/2006<br />
1730231523 1411 W. SUNSET BLVD., STE<br />
203<br />
LOS ANGELES 90026 (312) 482-8313 12 4 4 3 4/7/2006<br />
CHAMBI, RICARDO E., M.D. 1902080708 4347 E. SLAUSON AVE MAYWOOD 90270 (323) 773-3137 13 4 7 2 9/25/1996<br />
CHAN, CHOA, MD INC. 1992831671 1530 E. CHEVY CHASE DR.,<br />
#202<br />
GLENDALE 91206 (818) 244-9595 13 4 2 1 3/8/2002<br />
CHAN, CONSTANT KEE SEIN<br />
M.D.<br />
1225347438 10007 STATE STREET LYNWOOD 90262 (323) 566-3157 13 4 6 3 10/25/1984<br />
CHAN, EVA YEE-FUN, M.D. 1508953894 19745 E. COLIMA RD, STE 11 ROWLAND HEIGH 91748 (909) 594-3382 13 4 3 2 1/25/1993<br />
CHANG, BONG S. M.D. 1427131150 3671 W. 6TH STREET LOS ANGELES 90020 (213) 383-8496 13 4 4 3 6/10/1983<br />
CHANG, JYH C MD., PROF CORP 1316168636 4318 N. MAINE AVE., UNIT A BALDWIN PARK, 91706 (626) 962-5141 12 4 3 2 2/18/1997<br />
CHAPARRAL MEDICAL GROUP,<br />
INC<br />
1528020112 790 EAST BONITA AVE. 2ND<br />
FLOOR<br />
POMONA 91767 (909) 447-8585 12 4 3 2 11/10/2010<br />
CHARCHIAN, DAVID M., M.D. 1114902822 1030 S. GLENDALE AVE<br />
STE. 305<br />
GLENDALE 91205 (818) 241-0220 13 4 2 1 8/22/1997<br />
CHEN, CHARLES C., M.D. 1912922246 210 N. GARFIELD AVE STE<br />
306<br />
MONTEREY PAR 91754 (626) 571-6811 13 4 3 2 9/14/1983<br />
CHEN, CRISPINA A., M.D. 1558464107 10802 RAMONA BLVD. EL MONTE 91731 (626) 443-8918 13 4 3 2 8/17/1989<br />
CHEN, LULU L MD INC 1649426990 1318 E. FLORENCE AVE LOS ANGELES 90001 (323) 584-9525 12 4 6 3 9/29/2010<br />
CHENG, GEORGE Y., M.D. 1770621641 1239 N. AVALON BLVD. STE<br />
B<br />
WILMINGTON 90744 (310) 513-1591 13 4 8 3 10/29/1996<br />
CHILDREN & ADULTS MED GRP,<br />
Inc<br />
CHILDREN'S COMPREHENSIVE<br />
MED GRP<br />
1841337532 9246 E. VALLEY BLVD., STE.<br />
A<br />
ROSEMEAD 91770 (626) 571-6908 13 4 3 2 6/12/2006<br />
1386850592 3756 SANTA ROSALIA DR<br />
STE 600<br />
LOS ANGELES 90008 (323) 299-3200 12 4 6 3 5/21/1975<br />
Childrens Hospital <strong>of</strong> Los Angeles 1124073366 5000 W. Sunset Blvd., 4th floor Los Angeles 90027 (323) 361-2153 2 4 4 3 3/7/2011<br />
CHINATOWN SERVICE CENTER<br />
FAMILY HC<br />
1427046754 767 N. HILL ST., STE 200 LOS ANGELES 90012 (213) 808-1718 22 4 4 3 1/5/2006<br />
CHO, DON, M.D. 1922036870 13818 PIONEER BLVD. NORWALK 90650 (562) 868-3775 13 4 7 2 8/16/1996<br />
CHOI, SUNG S., M.D. 1417034257 3323 W. OLYMPIC BLVD. LOS ANGELES 90019 (323) 733-0127 13 4 4 3 12/26/1995<br />
CHOICE PROVIDERS MEDICAL<br />
GROUP<br />
CHOICE PROVIDERS MEDICAL<br />
GROUP INC.<br />
1114947058C 11631 VICTORY BLVD. SUITE NORTH HOLLYW<br />
101<br />
91606 (818) 764-8838 12 4 2 1 8/20/2007<br />
1114947058B 17709 CHATSWORTH ST GRANADA HILLS 91344 (818) 363-8176 12 4 2 1 1/29/2007<br />
CHOW,THICK GONG-WING, M.D. 1447282876 817 S. VERMONT AVE. LOS ANGELES 90005 (213) 385-0029 13 4 4 3 10/21/1999<br />
Monday, May 06, 2013 Page 8 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
CHU, JAE S., M.D. 1063400745 12610 S. WESTERN AVE LOS ANGELES 90047 (323) 757-1853 13 4 6 3 6/9/1992<br />
CHUANG, LILIAN S., M.D. 1326068354 3111 W. BEVERLY BLVD. MONTEBELLO 90640 (323) 728-0671 13 4 7 2 9/1/1981<br />
CHUATECO, CAROUCEL K. MD 1841216223 1663 BEVERLY BLVD., STE.<br />
101<br />
LOS ANGELES 90026 (213) 250-0235 13 4 4 3 7/25/2005<br />
CISCO MEDICAL GROUP INC. 1053408989 18518 SHERMAN WAY RESEDA 91335 (818) 757-0954 12 4 2 1 4/5/2007<br />
CITIZEN'S MEDICAL GROUP 1528148566 11560 W PICO BLVD LOS ANGELES 90064 (310) 477-8285 12 4 5 3 5/2/1979<br />
CLINICA DE LOS ANGELES<br />
MEDICAL GROUP<br />
Clinica de los Angeles Medical<br />
Group Inc.<br />
CLINICA DE SALUD FAM MED<br />
CLINIC<br />
CLINICA DEL SOCORRO<br />
MEDICAL GROUP INC<br />
1184754996 4301 S. FIGUEROA ST., STE.<br />
F<br />
LOS ANGELES 90037 (323) 231-7700 13 4 6 3 11/30/2004<br />
1245524578 2098 S. Central Ave. Los Angeles 90011 (213) 744-9494 12 4 6 3 8/23/2012<br />
1427113463 12610 GLENOAKS BLVD. SYLMAR 91340 (818) 361-4111 12 4 2 1 11/9/1989<br />
1215263827 1061 E. VERNON AVE # F LOS ANGELES 90011 (323) 233-9686 12 4 6 3 12/6/2011<br />
CLINICA FAMILIAR SAN LUCAS 1043462443 11017 S. ATLANTIC BLVD. LYNWOOD 90262 (310) 635-3800 12 4 6 3 4/21/2009<br />
CLINICA LA VICTORIA, AMG 1184777922 5950 SANTA FE AVE HUNTINGTON PA 90255 (323) 588-5500 12 4 7 2 8/14/2003<br />
CLINICA MEDICA ABC 1518161629 10510 VICTORY BLVD., STE.<br />
102<br />
NORTH HOLLYW 91606 (818) 505-0492 13 4 2 1 8/24/2009<br />
CLINICA MEDICA AMERICANA<br />
MEDICAL CTR INC.<br />
CLINICA MEDICA LA SAGRADA<br />
FAMILIA<br />
1942312715 4075 E. WHITIER BLVD. LOS ANGELES 90023 (323) 264-4924 12 4 6 3 4/3/2006<br />
1578567038 15955 PARAMOUNT BLVD.<br />
UNIT A<br />
PARAMOUNT 90723 (562) 531-9806 12 4 6 3 5/16/1995<br />
CLINICA MEDICAL CUZCATLAN 1821215914 3559 E. GAGE AVE. BELL 90201 (323) 581-8485 12 4 7 2 3/3/2003<br />
CLINICA MSR OSCAR A ROMERO 1275629495 123 S ALVARADO STREET LOS ANGELES 90057 (213) 989-7700 22 4 4 3 3/20/2001<br />
CLINICA MSR OSCAR ROMERO 1316033533 2032 MARENGO ST LOS ANGELES 90033 (323) 987-1030 22 4 4 3 7/18/2006<br />
CLINICA MSR. OSCAR A.<br />
ROMERO<br />
CLINICA PACIFICA MEDICAL<br />
GROUP<br />
1558524264 201 S. ALVARADO STREET,<br />
STE. 100<br />
LOS ANGELES 90057 (213) 201-8300 22 4 4 4 9/25/2009<br />
1316111933 2550 E. SLAUSON AVE.<br />
SUITE G<br />
HUNTINGTON PA 90255 (323) 581-0791 12 4 7 2 8/4/1994<br />
CLINICA SANTA MARTA MED 1366699027 3742 WHITTIER BLVD LOS ANGELES 90023 (323) 780-4100 12 4 4 3 5/22/2009<br />
CO OF L.A. - ANTELOPE VALLEY<br />
HEALTH CENTER<br />
CO OF L.A. - BELLFLOWER<br />
HEALTH CENTER<br />
CO OF L.A. - DOLLARHIDE<br />
HEALTH CENTER<br />
CO OF L.A. - EL MONTE<br />
COMPREHENSIVE HC<br />
1336152578 335-B AVENUE , K-6 LANCASTER 93535 (661) 723-4640 21 4 1 1 3/24/2003<br />
1518973940 10005 E. FLOWER STREET BELLFLOWER 90706 (562) 804-8112 21 4 7 2 6/26/2002<br />
1235247578 1108 N. OLEANDER STREET COMPTON 90222 (310) 763-2244 22 4 6 3 9/19/2005<br />
1972516631 10953 RAMONA BLVD. EL MONTE 91731 (800) 383-4600 21 4 3 2 3/10/2004<br />
Monday, May 06, 2013 Page 9 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
CO OF L.A. - HARBOR-UCLA<br />
PEDIATRIC MANAGED CARE<br />
CLINIC<br />
CO OF L.A. - HARBOR-UCLA FAM<br />
HC/COMM HLTH PLAN<br />
CO OF L.A. - HARBOR-UCLA<br />
MED CTR ATTN: PEDS DEPT.<br />
CO OF L.A. - HARBOR-UCLA<br />
MEDICAL CTR/K.I.D.S. HUB<br />
CLINIC<br />
CO OF L.A. - HIGH DESERT<br />
HEALTH SYSTEMS<br />
CO OF L.A. - HIGH DESERT<br />
HTH. SYST. SCAN / HUB CLINIC<br />
CO OF L.A. - HUDSON<br />
COMPREHENSIVE HEALTH<br />
CO OF L.A. - HUMPHREY<br />
COMPREHENSIVE HC<br />
CO OF L.A. - LA PUENTE<br />
SUBCENTER<br />
CO OF L.A. - LAC+USC EAST<br />
SAN GABRIEL VALLEY<br />
CO OF L.A. - LAKE LA<br />
COMMUNITY CLINIC<br />
CO OF L.A. - LITTLEROCK COMM<br />
CLINIC<br />
1407878150STA 21840 NORMANDIC AVE.<br />
SUITE350<br />
TORRANCE 90502 (310) 222-1220 1 4 8 3 9/22/1999<br />
1407878150STB 1403 W LOMITA BLVD 2ND<br />
FLOOR<br />
HARBOR CITY 90710 (310) 534-7600 10 4 8 3 11/21/1991<br />
1407878150 1000 CARSON STREET L-4 TORRANCE 90509 (310) 222-2300 1 4 8 3 5/5/1975<br />
1407878150STD 1000 W. CARSON STREET<br />
BOX 460<br />
TORRANCE 90509 (310) 222-6504 21 4 8 4 8/25/2010<br />
1003929829A 44900 N. 60TH ST. WEST LANCASTER 93536 (661) 945-8368 22 4 1 1 10/5/2005<br />
1003929829B 44900 N. 60TH STREET WEST LANCASTER 93536 (661) 945-8461 21 4 1 1 12/12/2006<br />
1144233800 2829 S GRAND AVE. LOS ANGELES 90007 (213) 744-3895 21 4 6 3 12/31/2006<br />
1982611919 5850 S. MAIN ST. LOS ANGELES 90003 (323) 346-4447 22 4 6 3 12/31/2006<br />
1770596439 15930 CENTRAL AVE. LA PUENTE 91744 (626) 968-3711 21 4 3 2 7/25/2005<br />
1316187255 4024 N. DURFEE AVE. EL MONTE 91732 (626) 450-8930 22 4 3 2 5/11/2011<br />
1821101643 16921 EAST AVENUE O,<br />
SPACE G<br />
PALMDALE 93591 (661) 945-8444 22 4 1 1 1/23/2004<br />
1467565283 8201 PEARBLOSSOM<br />
HIGHWAY<br />
LITTLEROCK 93543 (661) 945-8508 22 4 1 1 10/29/2009<br />
CO OF L.A. - LONG BEACH CHC 1518971241 1333 CHESTNUT AVENUE LONG BEACH 90813 (562) 599-8636 21 4 8 3 4/29/1987<br />
CO OF L.A. - MARTIN LUTHER<br />
KING JR. /DREW MEDICAL CTR<br />
MAAC<br />
CO OF L.A. - MID VALLEY COMP<br />
HC<br />
CO OF L.A. - MID VALLEY COMP<br />
HC<br />
CO OF L.A. - OLIVE VIEW -UCLA<br />
MED. CTR.- PEDIATRICS<br />
CO OF L.A. - ROYBAL<br />
COMPREHENSIVE HEALTH<br />
CO OF L.A. - SAN FERNANDO<br />
HC/VAUGHN SCHOOL BASED<br />
H.C.<br />
CO OF L.A. - SAN FERNANDO<br />
HEALTH CENTER<br />
1245343052 12021 WILMINGTON AVENUE LOS ANGELES 90059 (310) 668-8763 22 4 6 3 5/5/1975<br />
1467465641STA 7515 VAN NUYS BLVD VAN NUYS 91405 (818) 947-4026 21 4 2 1 12/30/2005<br />
1467465641 7515 VAN NUYS BLVD. VAN NUYS 91405 (818) 947-4026 21 4 2 1 12/30/2005<br />
1316969934 14445 OLIVE VIEW DR. SYLMAR 91342 (818) 364-3184 22 4 2 1 11/19/1975<br />
1982617692 245 S. FETTERLY AVE. LOS ANGELES 90022 (323) 780-2442 21 4 7 2 9/16/2004<br />
1558379990STA 13330 VAUGHN ST. SAN FERNANDO 91340 (818) 834-9405 21 4 2 1 12/29/2005<br />
1558379990 1212 PICO ST. SAN FERNANDO 91340 (818) 837-6969 21 4 2 1 12/29/2005<br />
Monday, May 06, 2013 Page 10 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
CO OF L.A. - SOUTH VALLEY<br />
HEALTH CENTER<br />
CO OF L.A. - WILMINGTON<br />
HC/COMMUNITY HEALTH PLAN<br />
CO OF L.A. - WILMINGTON<br />
HEALTH CENTER<br />
COMPLETE CARE COMMUNITY<br />
HEALTH CENTER, INC<br />
COMPREHENSIVE COMM.<br />
HEALTH CENTERS<br />
COMPREHENSIVE COMMUNITY<br />
H.C./NO. HOLLYWOOD<br />
COMPREHENSIVE COMMUNITY<br />
HEALTH CTRS /EAGLE ROCK<br />
COMPREHENSIVE COMMUNITY<br />
HLTH CTRS/HIGHLAND PARK<br />
COMPREHENSIVE MEDICAL<br />
CENTER, INC<br />
COMPREHENSIVE MEDICAL<br />
CTR. INC.<br />
COMPTON CENTRAL HEALTH<br />
CLINIC<br />
CONSULTORIO MEDICO LATINO<br />
MED CTR<br />
CORONEL-PEREY, ANNETTE A.,<br />
MD INC<br />
1649383464 38350 40TH STREET EAST,<br />
STE 100<br />
PALMDALE 93550 (661) 272-5000 21 4 1 1 11/20/2002<br />
1508872912A 1325 BROAD AVE. WILMINGTON 90744 (310) 518-8800 25 4 6 3 3/20/2006<br />
1508872912B 1325 BROAD AVENUE WILMINGTON 90744 (310) 518-8800 21 4 8 3 3/16/2006<br />
1215113964 2928 E. CESAR E. CHAVEZ<br />
AVE<br />
LOS ANGELES 90033 (323) 266-6700 25 4 4 4 1/3/2013<br />
1356362743 801 S. CHEVY CHASE<br />
DRIVE, SUITE # 250<br />
GLENDALE 91205 (818) 265-2264 22 4 2 1 9/12/2007<br />
1871573360 12157 VICTORY BLVD. NO. HOLLYWOOD 91606 (818) 755-8000 22 4 2 1 7/20/2004<br />
1679553192 1704 COLORADO BLVD. LOS ANGELES 90041 (323) 256-4116 22 4 4 3 9/22/2004<br />
1245210749 5059 YORK BLVD. LOS ANGELES 90042 (323) 344-4144 22 4 4 3 9/9/2004<br />
1063551257 10301 E. GARVEY AVE., STE<br />
100<br />
EL MONTE 91733 (626) 448-0468 12 4 3 2 3/9/2005<br />
1932249315 2286 S. GAREY AVE POMONA 91766 (909) 464-2818 12 4 3 2 5/14/2007<br />
1518036565 201 N. CENTRAL AVE COMPTON 90220 (310) 635-7123 25 4 6 3 10/24/2006<br />
1518996313 15730 PARAMOUNT BLVD. PARAMOUNT 90723 (562) 634-1000 12 4 6 3 2/9/1996<br />
1952670341 1045 W. REDONDO BEACH<br />
BLVD., STE. 100<br />
GARDENA 90247 (310) 532-5558 13 4 8 3 4/12/2001<br />
COSTELLO, LLOYD MD, APC 1679523468 1900 ROYALTY DR., STE 250 POMONA 91767 (909) 865-5777 12 4 3 2 8/10/2006<br />
COTING, JOSE DE GUZMAN MD<br />
INC.<br />
COVINGTON, ELIZABETH J., M.D.<br />
/ A PROF. CORP.<br />
CRENSHAW COMMUNITY<br />
HEALTH CENTER - WATTS<br />
HEALTHCARE CORP<br />
CROWN CITY MEDICAL GROUP<br />
INC<br />
CROWN CITY MEDICAL GROUP<br />
INC.<br />
CROWN CITY MEDICAL GROUP,<br />
INC<br />
1942218730 1160 N. LOGAN STREET LOS ANGELES 90026 (213) 250-7069 13 4 4 3 9/18/1988<br />
1346350386 3701 STOCKER ST, STE 101 LOS ANGELES 90008 (323) 290-2107 13 4 6 3 9/10/1996<br />
1225177751 3756 SANTA ROSALIA DR.,<br />
SUITE 400<br />
LOS ANGELES 90008 (323) 568-5460 22 4 6 3 10/8/2003<br />
1508989500 6601 RUGBY AVE. STE 300 HUNTINGTON PA 90255 (323) 582-1177 12 4 7 2 8/15/1990<br />
1619090610 3208 SANTA ANITA AVE.,<br />
STE. 200<br />
EL MONTE 91733 (626) 454-1990 12 4 3 2 3/15/1994<br />
1962525964 1542 E. FLORENCE AVE. LOS ANGELES 90001 (323) 584-0222 12 4 6 3 1/27/2005<br />
CRUZ, MARILOU G., MD 1629160155 11525 BROOKSHIRE AVE.,<br />
STE 400<br />
DOWNEY 90241 (562) 861-1245 13 4 7 2 5/11/1999<br />
Monday, May 06, 2013 Page 11 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
CUENTO, ALICIA P. MD INC. 1073880167 931 BUENA VISTA STE 100 DUARTE 91010 (626) 357-5087 13 4 3 2 4/16/1981<br />
CUIDADO LATINO MEDICAL<br />
CLINIC INC<br />
1376862607 3710 E. CESAR CHAVEZ AVE. LOS ANGELES 90063 (323) 980-7777 13 4 7 2 4/4/2012<br />
DADABHOY, SHAHIDA M., MD 1669472163 145 W. WILLOW ST POMONA 91768 (909) 865-5555 13 4 7 2 1/3/2007<br />
DAHIYA SHYAM L. MD INC 1306039300 3650 E. SOUTH ST. STE. 412 LAKEWOOD 90712 (562) 634-8001 12 4 6 2 11/18/2008<br />
DAKAK, CHAFIK 1376563957 3737 MARTIN LUTHER KING<br />
BLVD. STE 205<br />
LYNWOOD 90262 (310) 604-0105 13 4 6 3 11/17/1998<br />
DAUER, LEONARD I. MD INC. 1073647418 15215 LEFFINGWELL RD. WHITTIER 90604 (562) 946-9696 13 4 7 2 1/27/1993<br />
DAY III / THOMAS N. TWEH JR. 1720221872 1110 W. ANAHEIM ST STE.6 WILMINGTON 90744 (310) 872-3560 25 4 8 3 9/15/2010<br />
DAYANI, JILA MD 1730265703 12626 RIVERSIDE DRIVE<br />
STE 101<br />
NORTH HOLLYW 91607 (818) 766-7640 13 4 2 1 12/12/1996<br />
DE LA CRUZ, VIVIEN N. MD 1255491452 11 E ADAMS AVE ALHAMBRA 91801 (626) 281-9037 13 4 3 2 9/10/1984<br />
DE LEAVER-RUSSELL, MARGO<br />
P., MD<br />
1114061421 3831 HUGHES AVENUE STE<br />
601<br />
CULVER CITY 90232 (310) 838-4048 13 4 5 3 12/26/1986<br />
DE NOVO HEALTH CARE INC. 1972752368 803 ROSECRANS AVE COMPTON 90221 (310) 605-4800 25 4 6 3 10/20/2011<br />
DE SILVA, JANESRI , MD APC /<br />
KIDS & TEENS MED. GRP.<br />
DE SILVA, JANESRI MD APC /<br />
KIDS & TEENS MED. GR<br />
DE SILVA, JANESRI MD APC<br />
/KIDS & TEENS MEDICAL CLINIC<br />
GROUP<br />
1326278490B 10550 SEPULVEDA BLVD. MISSION HILLS 91345 (818) 361-5437 13 4 2 1 4/3/2008<br />
1326278490D 18433 ROSCOE BLVD. SUITE<br />
106<br />
NORTHRIDGE 91325 (818) 349-3225 13 4 2 1 5/25/2011<br />
1326278490A 14608 VICTORY BLVD. VAN NUYS 91411 (818) 901-1600 13 4 2 1 1/15/2010<br />
DEBNATH, SHEILA MD 1952625303 1220 S. CENTRAL AVE, STE<br />
105<br />
GLENDALE 91204 (818) 545-9539 13 4 2 1 2/3/1995<br />
DEL CARMEN MED. CTR.<br />
COMPREMED MED. GRP. INC.<br />
1386757086 19234 VANOWEN STREET RESEDA 91335 (818) 705-1157 12 4 2 1 1/30/1997<br />
DEL ROSARIO MEDICAL INC. 1659419307 3400 E. FLORENCE AVE HUNTINGTON PA 90255 (323) 589-9384 12 4 7 2 8/22/1996<br />
Desai, jitendra N MD 1215979141 14624 sherman way suite 401 van nuys 91405 (818) 786-1200 13 4 2 1 6/13/2011<br />
DESAI, PRITI N., MD 1932235587 315 N. THIRD AVE # 205 COVINA 91723 (626) 332-4543 13 4 3 2 1/29/2010<br />
DI SARLI, RICARDO. MD AMC 1487605721 1568 N ORANGE GROVE AVE POMONA 91767 (909) 868-6666 13 4 3 2 3/25/1999<br />
DIAZ-GOMEZ, MARIO A., MD 1427003300 2001 N GAREY AVE STE 101 POMONA 91767 (909) 624-2242 13 4 3 2 3/10/2008<br />
DIEGO MEDICAL CORPORATION 1225060643 23517 S. MAIN ST STE 101 CARSON 90745 (310) 549-2840 12 4 8 3 5/19/1978<br />
DING, LEI MD, A PROFESSIONAL<br />
CORP.<br />
1689677684 1661 HANOVER ROAD STE.<br />
101<br />
INDUSTRY 91748 (626) 581-4298 13 4 3 2 12/3/2003<br />
DOAN, YEN, MD 1861587172 1663 BEVERLY BLVD STE 201 LOS ANGELES 90026 (213) 413-4845 13 4 4 3 10/10/1984<br />
Monday, May 06, 2013 Page 12 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
DOROTHY MAE MEDICAL CLINIC<br />
INC.<br />
1669533907 8880 S. BROADWAY LOS ANGELES 90003 (323) 750-1196 12 4 6 3 5/3/2000<br />
DR TRAN MEDICAL OFFICE INC 1629242532 7900 GARVEY AVE ROSEMEAD 91770 (626) 307-1050 12 4 3 2 2/10/2011<br />
DURFEE FAMILY CARE MEDICAL<br />
GROUP<br />
EAST FAMILY MEDICAL CLINIC /<br />
EAST LA PAZ MED. INC.<br />
EAST LOS ANGELES CLINICA<br />
MEDICA GEN MED CTR<br />
1972828085 2006 DURFEE AVE EL MONTE 91733 (626) 442-5015 13 4 3 2 11/27/1996<br />
1881616761 3712 WHITTIER BLVD. LOS ANGELES 90023 (323) 268-8347 12 4 4 3 10/29/2007<br />
1053368530 6125 WHITTIER BLVD. LOS ANGELES 90022 (323) 887-0000 12 4 7 2 10/29/1998<br />
EAST VALLEY COMMUNITY HC 1649324443 680 FAIRPLEX DRIVE POMONA 91768 (909) 620-8088 22 4 3 2 3/12/1998<br />
EAST VALLEY COMMUNITY<br />
HEALTH CTR, INC.<br />
EAST VALLEY COMMUNITY<br />
HLTH CTR INC.<br />
1831243625STA 17840 VILLA CORTA STREET LA PUENTE 91744 (626) 919-4333 22 4 3 2 7/5/2012<br />
1831243625 420 S. GLENDORA AVE WEST COVINA 91790 (626) 919-4333 22 4 3 2 11/4/1997<br />
EBRAHIMI, ABDOLRASOOL, M.D. 1114933314 575 E. HARDY STREET STE<br />
221<br />
INGLEWOOD 90301 (310) 677-9131 13 4 8 3 6/13/1985<br />
EGARI, ROY MD, MEDICAL<br />
CLINIC<br />
EISNER PEDIATRIC AND FAMILY<br />
MEDICAL CTR.<br />
El Dorado Community Service<br />
Center<br />
EL DORADO COMMUNITY SVCS<br />
CTR<br />
EL MONTE CLINICA MED GEN<br />
MEDI CTR INC.<br />
EL MONTE FAMILY MEDICAL<br />
GROUP INC.<br />
EL PROYECTO DEL BARRIO<br />
FAMILY HLTH CARE CL<br />
1871603829 18011 PIONEER BLVD. ARTESIA 90701 (562) 402-0711 12 4 7 2 9/25/1991<br />
1316044522 1530 S. OLIVE ST. LOS ANGELES 90015 (213) 747-5542 22 4 4 3 12/1/2002<br />
1821167305 21507 Norwalk Blvd. Hawaiian Gardens 90716 (562) 916-7581 25 4 7 2 6/11/2008<br />
1396814893 6265 SEPULVEDA BLVD STE. VAN NUYS<br />
9<br />
91411 (818) 779-0555 25 4 2 1 5/10/2012<br />
1093762593 11026 VALLEY MALL EL MONTE 91731 (626) 443-4300 12 4 3 2 9/17/1999<br />
1073680757 11227 VALLEY BLVD. EL MONTE 91731 (626) 442-7077 12 4 3 2 4/22/1999<br />
1083624423 8902 WOODMAN AVENUE<br />
2ND FLOOR<br />
ARLETA 91331 (818) 830-7033 25 4 2 1 8/1/1992<br />
EL PROYECTO DEL BARRIO INC. 1538130893 20800 SHERMAN WAY CANOGA PARK 91306 (818) 883-2273 22 4 2 1 3/22/2000<br />
EL PROYECTO DEL BARRIO INC.<br />
/ AZUSA HEALTH CENTER<br />
ELDESSOUKY, AMANI A<br />
MD/NUEVA ESPERANZA<br />
HEALTHCARE INC.<br />
1770696023 150 N. AZUSA AVE. AZUSA 91702 (626) 969-7885 22 4 7 2 6/25/2007<br />
1528074044 1704 W MANCHESTER AVE #<br />
109<br />
LOS ANGELES 90047 (323) 778-8485 13 4 6 3 6/22/2006<br />
ESPINOZA, MARIA A , MD INC. 1134320716 2151 W. 6TH ST. LOS ANGELES 90057 (213) 483-2222 13 4 4 3 2/13/2006<br />
ESSILFIE, WILLIAM MD 1588744627 1141 W. REDONDO BLVD.<br />
#307<br />
GARDENA 90247 (310) 715-6100 13 4 8 3 4/19/1996<br />
EZELL, JIMMY L, MD 1770661613 7500 S. WESTERN AVENUE LOS ANGELES 90047 (323) 971-2250 13 4 6 3 6/5/1998<br />
Monday, May 06, 2013 Page 13 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
EZRA, ESHAGH, MD INC. 1790797835 15424 NORDHOFF ST SUITE<br />
B<br />
NORTH HILLS 91343 (818) 891-5500 13 4 2 1 10/15/2007<br />
FAMILIA SANA MEDICAL GROUP,<br />
INC<br />
1669783122 15211 VANOWEN ST. SUITE<br />
# 206<br />
VAN NUYS 91405 (818) 787-8473 12 4 2 1 3/30/2011<br />
FAMILY PLANNING CENTER 1811032436 22310 WARDHAM AVE. HAWAIIAN GARD 90716 (562) 420-2433 25 4 7 2 9/22/2006<br />
FAMILY PRACTICE OF<br />
GLENDALE INC<br />
FAMILY PRACTICE OF<br />
GLENDALE, INC. A MEDICAL<br />
GROUP<br />
1801851043A 801 S. CHEVY CHASE DR.<br />
STE 230<br />
GLENDALE 91205 (818) 500-5586 12 4 2 1 1/1/1990<br />
1801851043B 1818 VERDUGO BLVD. SUITE GLENDALE<br />
200<br />
91208 (818) 790-1088 12 4 2 1 6/11/2003<br />
FAN, BUNCHEN R 1588665657 4124 N ROSEMEAD BLVD.,<br />
STE. A<br />
ROSEMEAD 91770 (626) 285-2477 13 4 3 2 2/17/1998<br />
FARFALLA INC. 1750575916 3655 LOMITA BLVD. #211 TORRANCE 90505 (310) 406-3818 13 4 8 3 3/13/2009<br />
FARLEY, MARLON M.<br />
MD/INGLEWOOD FAMILY<br />
MEDICAL CLINIC<br />
1750325098 3215 W. IMPERIAL HWY INGLEWOOD 90303 (310) 677-3595 13 4 6 3 12/2/2005<br />
FARROHI, FAREADEH 1669487435 18546 ROSCOE BLVD, STE<br />
211<br />
NORTHRIDGE 91324 (818) 885-8040 13 4 2 1 11/29/2000<br />
FATIMA MEDICAL CLINIC<br />
MEDICAL GROUP<br />
FCS MEDICAL CORP/FAM CARE<br />
SPEC<br />
1487659116 820 S. ALVARADO STREET<br />
#A<br />
LOS ANGELES 90057 (213) 384-0604 12 4 4 3 10/13/1994<br />
1942255195 1701 E. CESAR CHAVEZ<br />
AVE., #230<br />
LOS ANGELES 90033 (323) 226-1100 12 4 4 3 12/29/1992<br />
FCS MEDICAL CORPORATION 1740233725 815 W. WASHINGTON BLVD. MONTEBELLO 90640 (323) 728-3955 12 4 7 2 8/22/1996<br />
FCS MEDICAL CORPORATION 1649223777 1701 CESAR CHAVEZ AVE.,<br />
STE 402<br />
LOS ANGELES 90033 (323) 317-9200 12 4 4 3 11/30/2001<br />
FCS MEDICAL CORPORATION 1982657029 5823 YORK BLVD STE 1 LOS ANGELES 90042 (323) 255-1575 12 4 4 3 12/16/1991<br />
FELDMAN, ROCHELLE C., M.D. 1053368167 18520 VIA PRINCESSA,<br />
SUITE C2<br />
CANYON COUNT 91387 (661) 424-9000 13 4 2 1 5/19/2008<br />
FERAS & HISHAM AMC / ST.<br />
JOHN MED CLINIC INC.<br />
1700055274 2112 S. GAREY AVE. # C POMONA 91766 (909) 464-0520 12 4 3 2 8/30/1999<br />
FIGUEROA, MANUEL I. MD 1770679102 816 S. INDIANA ST. LOS ANGELES 90023 (323) 262-5432 13 4 4 3 12/21/1994<br />
FLAIR PARK MEDICAL CLINIC 1275721896 1730 S. SAN GABRIEL BLVD.<br />
STE. B<br />
SAN GABRIEL 91776 (626) 573-1252 13 4 3 2 8/13/1993<br />
FLEISCHMAN, HORACIO S., MD 1619083615 4036 WHITTIER BLVD., STE<br />
200<br />
LOS ANGELES 90023 (323) 796-0500 13 4 7 3 2/14/1992<br />
FLORENCE MEDICAL CENTER<br />
INC.<br />
FLORENCE WESTERN MEDICAL<br />
CLINIC INC<br />
1013932979 1557 E. FLORENCE AVE LOS ANGELES 90001 (323) 584-1490 12 4 6 3 2/18/1999<br />
1154347797 7301 S. WESTERN AVE. LOS ANGELES 90047 (323) 778-2131 12 4 6 3 6/28/2006<br />
Monday, May 06, 2013 Page 14 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
FOOTHILL COMMUNITY MED<br />
CORP/SAN RAFAEL COMM MED<br />
1881811404 647 E. ARROW HIGHWAY AZUSA 91702 (626) 858-5199 12 4 3 2 2/6/2002<br />
GABBITA, GEETHA V. 1881602175 14568 WHITTIER BLVD WHITTIER 90605 (562) 698-8263 13 4 7 2 5/19/1994<br />
GAGE MEDICAL CENTER 1891904686 2719 E. GAGE AVE. HUNTINGTON PA 90255 (323) 277-0272 12 4 7 2 10/18/2005<br />
GALDAMEZ, LUIS MD 1225168024 2955 E. FLORENCE AVENUE HUNTINGTON PA 90255 (323) 585-0732 12 4 7 2 3/12/1996<br />
GALDAMEZ, LUIS, MD/CLINICA<br />
MEDICA VIRGEN DE GUADAL<br />
1033240650 6831 SEVILLE AVE. HUNTINGTON PA 90255 (323) 581-8234 12 4 7 2 12/2/2005<br />
GANATA, JOSE R., M.D. 1730107293 625 W. COLLEGE ST #105 LOS ANGELES 90012 (213) 617-9157 13 4 4 3 10/1/1983<br />
GARCIA, ANTONIO M., MD 1821177833 586 E MISSION BLVD POMONA 91766 (909) 622-6240 13 4 3 2 11/20/1997<br />
GARCIA, GAYDA Y. MD 1750541322 123 EAST F STREET UNIT F. Wilmington 90744 (310) 835-6500 13 4 8 3 4/21/2006<br />
GARDENS MEDICAL CENTER<br />
INC.<br />
1891839270 7218 GARFIELD AVE BELL GARDENS 90201 (562) 927-1111 13 4 7 2 9/24/2008<br />
GARFIELD HEALTH CENTER 1760480610 210 N GARFIELD AVE SUITE<br />
203<br />
MONTEREY PAR 91754 (626) 307-7397 25 4 3 2 10/31/2005<br />
gaw, brian k md., inc 1932409257 1669 west avenue j suite 304 lancaster 93534 (661) 951-7888 13 4 1 1 8/2/2011<br />
GERKE,THOMAS J MD 1265585061 4055 E. OLYMPIC BLVD., STE LOS ANGELES<br />
207<br />
90023 (323) 262-0599 13 4 4 3 4/14/1999<br />
GHALILI, SAMAN, MD 1891724993 648 E. 21st Street LOS ANGELES 90011 (213) 749-7110 12 4 6 3 10/29/2007<br />
GHALILI, SOLEIMAN H., MD 1255493128 648 E. 21 st STREET LOS ANGELES 90011 (213) 749-7110 13 4 6 3 4/14/1988<br />
GHALILI, STEVEN S. MD 1669546453 648 E. 21ST STREET LOS ANGELES 90011 (213) 749-7110 13 4 6 3 9/13/2000<br />
GHIYA, DINESH C 1306959333 15141 E WHITTIER BLVD<br />
STE 350<br />
WHITTIER 90603 (562) 698-7761 13 4 7 2 9/2/1986<br />
GIDOWSKI, ROSA MARIA, MD 1689742702 368 W. BADILLO COVINA 91723 (626) 915-5161 13 4 3 2 11/22/2004<br />
GILL, CADRIN E. MD 1891851861 231 W. VERNON AVE. #201 LOS ANGELES 90037 (323) 231-5181 13 4 6 3 5/1/1987<br />
GIVELBER, ANNA I., MD 1174698534 7531 SANTA MONICA BLVD.<br />
STE 201<br />
LOS ANGELES 90046 (323) 850-1177 13 4 5 3 12/8/1983<br />
GODOY, IGNATIUS P., MD 1972789188 16660 PARAMOUNT BLVD., #<br />
206<br />
PARAMOUNT 90723 (562) 634-9433 12 4 6 3 10/14/1997<br />
GOLBARI, ABRAHAM MD 1396047775 14030 CRENSHAW BLVD. GARDENA 90249 (310) 327-8746 13 4 8 3 5/29/2003<br />
GOMEZ, HAROLD A 1083619753 1220 S. GLENDORA AVENUE WEST COVINA 91790 (626) 919-3800 14 4 3 2 3/13/2012<br />
GONZALEZ, BERTHA 1932295680 3106 W. BEVERLY BLVD. MONTEBELLO 90640 (323) 728-1274 13 4 7 2 5/5/1999<br />
GONZALEZ, ENRIQUE J., MD 1023161684 4755 E. CESAR CHAVEZ<br />
AVE, STE. A<br />
LOS ANGELES 90022 (323) 262-4194 13 4 7 2 6/1/2005<br />
GONZALEZ, JAIME MD INC. 1588730162 350 VINTON AVE STE. 204 POMONA 91767 (909) 622-3353 13 4 3 2 9/24/2007<br />
Monday, May 06, 2013 Page 15 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
GOODFAITH FAMILY MEDICAL<br />
CLINIC<br />
1952323800 7540 E. GARVEY AVE STE C ROSEMEAD 91770 (626) 307-4785 12 4 3 2 5/19/2001<br />
GOODMAN, CHARLES D MD, INC 1336163807 18350 ROSCOE BLVD., STE<br />
706<br />
NORTHRIDGE 91325 (818) 993-1614 13 4 2 1 11/4/1997<br />
GRACE MEDICAL GROUP OF<br />
THE VALLEY INC<br />
1215965223 2740 N. GAREY AVE, STE.<br />
100<br />
POMONA 91767 (909) 392-3230 12 4 3 2 2/10/2004<br />
GREAT CARE MEDICAL GROUP 1194949180 5255 W SUNSET BLVD. 1ST<br />
FLR<br />
LOS ANGELES 90027 (323) 463-7262 12 4 4 3 9/10/1987<br />
GROVER, RAHUL MD., INC 1497970115 8733 BEVERLY BLVD STE<br />
200<br />
WEST HOLLYWO 90048 (310) 652-3981 12 4 4 3 8/24/2009<br />
GUERRERO, DAVID A. MD/<br />
COMPTON FAMILY MED.<br />
1023147717 2210 E. COMPTON BLVD. COMPTON 90221 (310) 635-1852 13 4 6 3 2/27/2008<br />
HA,TAM THI MD 1205896206 756 E. HOLT AVENUE POMONA 91767 (909) 623-5369 13 4 3 2 8/17/1989<br />
HABIB, SHEHNAZ N., M.D. / A<br />
PROF. CORP.<br />
HABTEZGHI, HAGOS MD FAM &<br />
COMM MED CLINIC<br />
1346569217 14860 ROSCOE BLVD., # 300 VAN NUYS 91402 (818) 782-0604 13 4 2 1 7/17/1998<br />
1235289679 9901 SOUTH COMPTON<br />
AVENUE<br />
LOS ANGELES 90002 (323) 835-8401 13 4 6 3 1/18/2000<br />
HAKIMIAN, EBRAHIM MD 1568481174 14649 VICTORY BLVD. STE<br />
22<br />
VAN NUYS 91411 (818) 909-9868 13 4 2 1 8/8/1996<br />
HAMDAN, SALEH H MD, INC 1982795068 5817 TEMPLE CITY BLVD. TEMPLE CITY 91780 (626) 285-1254 13 4 3 2 5/2/1979<br />
HANAA N. HANNA, MD INC. 1003954942 858 W. 9TH ST., SUITE #101 SAN PEDRO 90731 (310) 547-0887 13 4 8 3 4/28/2008<br />
HANJAN, HARBHAJAN K. MD 1336227594 906 S. SUNSET AVENUE<br />
#103<br />
WEST COVINA 91790 (626) 962-4474 13 4 3 2 8/18/1983<br />
HARBOR FREE CLINIC 1467490425 593 W. 6TH ST. SAN PEDRO 90731 (310) 732-5887 25 4 8 3 3/15/2006<br />
HARBOR FREE<br />
CLINIC/PEDIATRIC CENTER<br />
1467490425STA 731 S. BEACON ST. SAN PEDRO 90731 (310) 732-5887 25 4 8 3 4/4/2006<br />
HASHEMI, ZIA, MD 1538203971A 4750 GAGE AVENUE BELL 90201 (323) 562-1100 13 4 7 2 6/18/2002<br />
HAWTHORNE MORNINGSIDE<br />
MEDICAL CLINIC<br />
HEALTH ALLIANCE MEDICAL<br />
GROUP<br />
HEALTHCARE MEDICAL CLINIC<br />
OF POMONA INC<br />
HEALTHY HEARTS MEDICAL<br />
GROUP INC.<br />
1477692408 12954 S. HAWTHORNE<br />
BLVD.,STE. 104<br />
HAWTHORNE 90250 (310) 679-0269 12 4 8 3 3/23/2004<br />
1124248570 17170 COLIMA RD. STE. G HACIENDA HEIG 91745 (626) 810-0706 12 4 3 2 5/27/1993<br />
1205961034 822 N. GAREY AVE POMONA 91767 (909) 524-0555 12 4 3 2 5/5/2010<br />
1417189341 8727 VAN NUYS BLVD STE<br />
101-102<br />
PANORAMA CITY 91402 (818) 899-5555 12 4 2 1 8/23/1999<br />
HEKMAT, FARAH L., MD 1073655841 9301 WILSHIRE BLVD. #402 BEVERLY HILLS 90210 (310) 276-0541 13 4 5 3 12/5/2008<br />
HEKMAT, VAHID MD 1609851187 23101 SHERMAN PL., STE.<br />
407<br />
WEST HILLS 91307 (818) 999-3800 13 4 2 1 11/3/2011<br />
Monday, May 06, 2013 Page 16 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
HERALD CHRISTIAN HEALTH<br />
CENTER<br />
1033390273 923 S. SAN GABRIEL BLVD. SAN GABRIEL 91776 (626) 286-8700 25 4 3 2 8/5/2009<br />
HERNANDEZ, MARIA C.A. MD 1316135742 4530 S. ROSEMEAD BLVD. PICO RIVERA 90660 (562) 692-0621 13 4 7 2 9/7/1999<br />
HERNANDEZ, VALENTIN MD 1871520320 13440 S. Hawthorne Blvd. Hawthorne 90250 (310) 219-0941 13 4 8 3 7/30/2010<br />
HETHUMUNI, STEPHANEE MD.<br />
INC.<br />
HIGH DESERT MEM. MED CTR<br />
INC./ CLINICA SANTA MARIA -<br />
ECHO PARK<br />
HIGH DESERT WOMENS MEM /<br />
HUNTINGTON PARK CLINICA<br />
1639226202 101 E. BEVERLY BLVD.<br />
SUITE 404<br />
MONTEBELLO 90640 (323) 722-6861 13 4 7 2 5/14/2008<br />
1033304894 1517 W. SUNSET BLVD LOS ANGELES 90026 (213) 482-4400 12 4 4 3 7/6/2011<br />
1023203882 2638 E. FLORENCE AVE HUNTINGTON PA 90255 (323) 581-4665 12 4 7 2 7/21/2011<br />
HMAYAKYAN, SAMVEL, MD 1538168174 1133 S. CENTRAL AVE GLENDALE 91204 (818) 244-0400 13 4 2 1 9/18/2002<br />
HOANG, KHANG V, DO 1952397937 13672 HAWTHORNE BLVD. HAWTHORNE 90250 (310) 644-5097 13 4 8 3 9/20/1995<br />
HOGAN, ANJANETTE, MD, INC 1457447393 1141 W. REDONDO BEACH<br />
BLVD. SUITE# 409<br />
GARDENA 90247 (310) 532-0308 13 4 6 3 6/28/2006<br />
HOLLYWOOD CROSS MEDICAL<br />
CLINIC INC<br />
HOLLYWOOD SUNSET FREE<br />
CLINIC<br />
1649209743 1110 N. WESTERN AVE.,<br />
STE. 201<br />
LOS ANGELES 90029 (323) 463-6881 12 4 4 3 4/7/1995<br />
1679691810 3324 SUNSET BLVD. LOS ANGELES 90026 (323) 660-7959 25 4 4 3 3/19/1986<br />
HONG, SUNG JEEN, MD 1235155151 3000 W. OLYMPIC BLVD.,<br />
STE 304<br />
LOS ANGELES 90006 (323) 733-1122 13 4 4 3 10/3/1980<br />
HONG, WEN SHIANG MD 1770675621 18403 PIONEER BLVD STE<br />
207<br />
ARTESIA 90701 (562) 860-0381 13 4 7 2 9/26/1977<br />
HUANG, CHING-CHIH D. 1033139647 160 E ARTESIA ST., STE. 235 POMONA 91767 (909) 397-5205 13 4 3 2 10/29/1990<br />
HUANG, HELEN CHE-MIN, MD 1053322743 1850 S. AZUSA AVE SUITE<br />
209<br />
HACIENDA HEIG 91745 (626) 810-8688 13 4 3 2 2/13/1996<br />
HUANG, LIH- SYH, MD 1790719854 612 W DUARTE ROAD STE<br />
203<br />
ARCADIA 91007 (626) 447-4342 13 4 3 2 5/5/1999<br />
HUNTINGTON PARK CLINICA<br />
MEDICA GENERAL A MED. CTR.<br />
1942256094 6347 PACIFIC BLVD. HUNTINGTON PA 90255 (323) 583-8383 12 4 7 2 10/20/1997<br />
HUSSAIN, RIZWANA B., MD 1548472574 18750 COLIMA RD ROWLAND HEIGH 91748 (626) 912-9345 13 4 3 2 11/22/2011<br />
HWEE, THOMAS NI, MD 1245553932 993 N. BROADWAY, SUITE A LOS ANGELES 90012 (213) 625-7995 13 4 4 3 11/2/1984<br />
INDIANA FIRST MED GRP. 1063591584 4082 E. WHITTIER BLVD. ,<br />
STE. 103<br />
LOS ANGELES 90023 (323) 268-5598 13 4 4 3 3/26/1982<br />
INGLEWOOD MENTAL HEALTH<br />
SERVICES<br />
INTEGRATED HEALTHCARE<br />
MED GRP INC.<br />
1700882156 4450 W, CENTURY BLVD. INGLEWOOD 90304 (310) 671-0555 25 4 8 3 1/31/2003<br />
1801805056A 2850 ARTESIA BLVD. STE<br />
105<br />
REDONDO BEAC 90278 (310) 214-8000 12 4 8 3 12/13/1999<br />
Monday, May 06, 2013 Page 17 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
INTEGRATED HLTHCARE MED<br />
GRP INC<br />
INTERCOMMUNITY FAMILY MED.<br />
ASSOC/SATELLITE.<br />
INTERCOMMUNITY FAMILY<br />
MEDICAL ASSOC. INC<br />
1801805056B 1762 WESTWOOD BLVD #<br />
300<br />
LOS ANGELES 90024 (310) 441-2000 12 4 5 3 12/7/2000<br />
1831251610STA 10750 S. LAUREL AVE. WHITTIER 90605 (562) 903-4194 12 4 7 2 10/25/2004<br />
1831251610 12291 WASHINGTON BLVD.,<br />
STE. 500<br />
WHITTIER 90606 (562) 698-2541 12 4 7 2 10/25/2004<br />
ISKANDER, MONA Y. MD 1679580880 4477 W. 118TH ST, SUITE 301 HAWTHORNE 90250 (310) 978-8026 13 4 8 3 11/30/1987<br />
ISKAROUS, RAGAA Z, MD INC 1215035274 11003 LAKEWOOD BLVD.<br />
#201<br />
DOWNEY 90241 (562) 869-1038 13 4 7 2 6/13/2002<br />
ITCHON, LIDEIA N, MD, INC 1336240217 25835 NARBONNE AVE., STE<br />
260<br />
LOMITA 90717 (310) 517-0977 13 4 8 3 3/23/2004<br />
J & L DE LEON MEDICAL GROUP 1760407621 16660 PARAMOUNT BLVD.,<br />
STE 211<br />
PARAMOUNT 90723 (562) 633-5438 12 4 6 3 6/22/2005<br />
JARAMILLO, JORGE I.<br />
MD/CITRUS VALLEY FAMILY MED<br />
JAYASINGHE MEDICAL GROUP<br />
INC/LOS ANGELES MEDICAL<br />
CENTER<br />
1598833469 1400 N. HACIENDA BLVD. LA PUENTE 91744 (626) 931-2200 13 4 3 2 6/21/2004<br />
1457460503 319 N.SOTO STREET LOS ANGELES 90033 (323) 266-6730 12 4 4 3 10/14/1983<br />
JAZAYERI, AZAM 1972523728 3831 HUGHES AVE., STE. 502 CULVER CITY 90232 (310) 558-8895 13 4 5 3 1/26/1994<br />
JEYARANJAN, T. MD 1669589644 284 S. ATLANTIC BLVD. LOS ANGELES 90022 (323) 780-5884 13 4 7 2 2/17/1980<br />
JHS MEDICAL CENTER INC. 1265564496 1030 S. GLENDALE AVE.,<br />
STE 404<br />
GLENDALE 91205 (818) 240-9911 13 4 2 1 1/18/2000<br />
JIANG, SIMON MD 1447363692 1314 WILSHIRE BLVD LOS ANGELES 90017 (213) 384-5132 13 4 4 3 1/22/2007<br />
JIMENEZ, FRANCISCO A., MD 1972696573 1000 W. WHITTIER BLVD. MONTEBELLO 90640 (323) 728-7353 13 4 7 2 12/5/2007<br />
JIMSHER MEDICAL GROUP 1912033622 8001 LAUREL CANYON<br />
BLVD, #109<br />
NORTH HOLLYW 91605 (818) 767-4728 12 4 2 1 12/8/1994<br />
JOCELYN C. ZUNIGA, MD. INC 1386682623 11525 BROOKSHIRE<br />
AVE.SUITE 302<br />
DOWNEY, 90241 (562) 904-2821 13 4 7 2 11/7/2007<br />
JOHNSON-CHAVIS, TONI, MD,<br />
INC<br />
1083728190B 11868 ROSECRANS AVE NORWALK 90650 (562) 864-3113 13 4 7 2 9/23/2003<br />
JOHNSON-CHAVIS,TONI D. 1083728190A 403 S. LONG BEACH BLVD.<br />
STE B<br />
COMPTON 90221 (323) 774-6551 13 4 6 3 12/5/1988<br />
JOHNTIN MEDICAL GROUP INC. 1992861058 1722 DESIRE AVE., STE. 208 ROWLAND HEIGH 91748 (626) 913-1888 12 4 3 2 10/30/1992<br />
JONAH MEDICAL GROUP INC. 1942591847 3545 Wilshire Blvd., Ste 202 Los Angeles 90010 (213) 388-5144 12 4 4 3 4/11/2011<br />
JONES, JOHN K MD INC. 1386862308 3580 E. IMPERIAL HWY.,<br />
STE. A<br />
LYNWOOD 90262 (310) 763-3075 12 4 6 3 12/19/2011<br />
JORGE, CAMILO S., M.D., INC. 1740511369 16415 COLORADO AVE STE<br />
102<br />
PARAMOUNT 90723 (562) 531-1946 13 4 6 3 1/27/1999<br />
Monday, May 06, 2013 Page 18 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
JOSHUA INTERNATIONAL MED<br />
GRP<br />
JWCH INSTITUTE INC/BELL<br />
GARDENS COMMUNITY HEALTH<br />
CENTER<br />
1215150529 17370 NORWALK BLVD. CERRITOS 90703 (562) 809-5674 12 4 7 2 9/22/1994<br />
1295829109 6912 AJAX AVE. BELL GARDENS 90201 (323) 562-5813 22 4 7 2 9/6/2005<br />
JWCH INSTITUTE, INC 1538342704 14371 CLARK AVE. BELLFLOWER 90706 (562) 867-6006 25 4 7 2 10/2/2012<br />
JWCH INSTITUTE, INC. 1386708634 12360 FIRESTONE BLVD. NORWALK 90650 (562) 281-0305 22 4 7 2 2/20/2007<br />
KAAKIJIAN, SARKIS ARSIN 1992801906 1500 S. CENTRAL AVENUE<br />
#318<br />
GLENDALE 91204 (818) 548-5437 13 4 2 1 12/12/1996<br />
KAGWA-NYANZI J PEDIATRICS<br />
CLINIC INC<br />
KAMILA COMPREHENSIVE HLTH<br />
CTR, INC<br />
1073741039 117 W. WILLOW ST. STE. B POMONA 91768 (909) 865-5519 13 4 3 2 1/17/2002<br />
1831232677 5831 FIRESTONE BLVD.<br />
SUITE E.<br />
SOUTH GATE 90280 (562) 806-7545 25 4 4 2 4/8/2003<br />
KARAMEDIN, FRANGIS 1275600249 3680 E. IMPERIAL HWY STE.<br />
306<br />
LYNWOOD 90262 (310) 609-1500 13 4 6 3 8/4/1997<br />
KASHANI, ATA M MD/RESEDA<br />
MED CL<br />
1740349851 18355 SHERMAN WAY RESEDA 91335 (818) 343-0964 13 4 2 1 11/4/1997<br />
KATIRAIE, SEPEHR, MD 1508136326 2625 E FLORENCE BLVD<br />
STE D<br />
HUNTINGTON PA 90255 (323) 588-3800 13 4 7 2 11/2/2000<br />
KAYEKJIAN, GARABED, MD INC 1306026034 18250 ROSCOE BLVD., # 130 NORTHRIDGE 91325 (818) 998-8097 13 4 2 1 11/18/1997<br />
KEDIA, MRIDULA MD 1598860645 4201 TORRANCE BLVD. STE<br />
380<br />
TORRANCE 90503 (310) 540-5676 13 4 8 3 6/24/1999<br />
KERAMATI, SHAHNAZ, MD 1619001245 10507 HAWTHORNE BLVD. LENNOX 90304 (310) 672-9851 13 4 8 3 2/7/2005<br />
KEVORKIAN, VICTOR A. M.D. 1952496663 14111 S. VAN NESS AVE #4 GARDENA 90249 (310) 516-9152 13 4 8 3 7/7/1982<br />
KEYNIGSHTEYN RENA Y MD 1285711937A 6200 WILSHIRE BLVD. STE<br />
1708<br />
LOS ANGELES, C 90048 (310) 856-9377 13 4 4 3 8/26/2008<br />
KHAMIS, SHERIF MD, INC. 1225302789 7257 OWENSMOUTH AVE<br />
STE A<br />
CANOGA PARK 91303 (818) 347-0065 13 4 2 1 12/20/2002<br />
KHAN, DEANNA Y., MD 1255488821 101 E. BEVERLY BLVD., STE.<br />
404<br />
MONTEBELLO 90640 (323) 722-6861 13 4 7 2 5/14/2008<br />
KHAN, HAMEED MD., INC. 1710986740 21350 HAWTHORNE BLVD.<br />
#259<br />
TORRANCE 90503 (310) 540-5464 13 4 8 3 5/19/1997<br />
KHUDATYAN, HRACH MD 1720050032 610 N. CENTRAL AVE.<br />
STE.209<br />
GLENDALE 91203 (818) 662-8858 13 4 2 1 12/27/2010<br />
KIDS DOC APMC/WEST COVINA<br />
KIDS DOC<br />
1376676403 933 S. SUNSET AVE., STE.<br />
101<br />
WEST COVINA 91790 (626) 919-5437 12 4 3 2 11/1/2006<br />
KIM, CHUNG W. 1841363793 4082 E WHITTIER BLVD STE<br />
102<br />
LOS ANGELES 90023 (323) 261-2111 13 4 4 3 6/17/1997<br />
KIM, JANET S., MD INC 1265764955 500 S. VIRGIL AVE # 204 LOS ANGELES 90020 (213) 388-7828 13 4 4 3 10/5/2010<br />
Monday, May 06, 2013 Page 19 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
KIM, JI BAIK 1356481915 2405 W. 8TH STREET #101 LOS ANGELES 90057 (213) 381-5577 13 4 4 3 4/30/1992<br />
KIM, JUNG H MD 1902914773 18614 SHERMAN WAY RESEDA 91335 (818) 996-9497 13 4 2 1 8/18/1983<br />
KIM, KUM SON, MD 1306905112 1433 W MERCED AVENUE<br />
STE 217<br />
WEST COVINA 91790 (626) 917-1924 13 4 3 2 1/3/1984<br />
KIM, KUNG SOO, MD 1467415455 18102 PIONEER BLVD. STE<br />
201<br />
ARTESIA 90701 (562) 865-8537 13 4 7 2 8/10/1990<br />
KIM, KYU MD 1013001379 15211 VANOWEN ST., STE.<br />
300<br />
VAN NUYS 91405 (818) 786-4910 13 4 2 1 8/29/1995<br />
KIM, MILAN, MD 1588761233 18895 COLIMA ROAD, STE. A. ROWLAND HEIGH 91748 (626) 581-2332 13 4 3 2 4/7/2000<br />
KIM, YOUNG SOON 1669476206 17507 CRENSHAW BLVD. TORRANCE 90504 (310) 324-4443 13 4 8 3 7/3/1985<br />
KOH, SANDY S. MD., INC. 1134364748 2727 N. PECK RD. EL MONTE 91733 (626) 350-2196 13 4 3 2 11/22/1982<br />
KOH, SANDY S., MD INC 1083726905 3419 N. TYLER AVE. EL MONTE 91731 (626) 350-2197 13 4 3 2 7/30/2007<br />
KOHANZADEH, SHAHLA, MD 1649338914 803 S. ALVARADO ST. . LOS ANGELES 90057 (213) 381-1117 13 4 4 3 5/15/2007<br />
KOLDHEKAR, VAIJAYANTI S.,<br />
MD, INC<br />
1386730919 931 BUENA VISTA STREET<br />
#302<br />
DUARTE 91010 (626) 303-2541 13 4 3 2 9/14/2005<br />
KONG, ARTHUR, MD 1790835338 1048 S GARFIELD AVE, STE<br />
100<br />
ALHAMBRA 91801 (626) 282-7585 13 4 3 2 10/25/1977<br />
KONG-THEIN, LORNA , MD 1396828554 207 S. SANTA ANITA AVE.<br />
SUITE # 330<br />
SAN GABRIEL 91776 (626) 458-1888 13 4 3 2 8/15/2003<br />
KOO, ERLINDA L., MD 1114936812 223 N GARFIELD AVE., STE.<br />
201<br />
MONTEREY PAR 91754 (626) 573-4330 13 4 3 2 5/15/1980<br />
KOO, HELEN S, MD 1477596864 265 E BEVERLY BLVD 2ND<br />
FL<br />
MONTEBELLO 90640 (323) 721-4922 13 4 7 2 12/27/1984<br />
KOREAN HEALTH<br />
EDUCATION/KHEIR HEALTH SVS<br />
CTR<br />
1437377454 3727 W 6TH ST., STE. 200 LOS ANGELES, 90020 (213) 637-1070 25 4 4 3 10/19/2006<br />
KOTOYAN, MARCOS, MD 1841367091 1300 N. VERMONT AVE. #804 LOS ANGELES 90027 (323) 662-9711 13 4 4 3 6/1/1983<br />
KPADUWA, JULIUS C. MD. AMC 1790975258 9573 GARVEY AVE. SUITE 17 SO. EL MONTE 91733 (626) 454-1801 12 4 3 2 1/28/2008<br />
KPADUWA, JULIUS C. MD,<br />
MEDICAL CORP.<br />
1780733048 16008 AMAR ROAD CITY OF INDUST 91744 (626) 330-9535 12 4 3 2 11/10/1999<br />
KPADUWA, JULIUS C., MD, AMC 1396893723 11017 VALLEY MALL EL MONTE 91731 (626) 575-8342 12 4 3 2 10/23/2002<br />
KRIEGER, LORI R MD 1881632925 1360 W 6TH STREET, STE<br />
300<br />
SAN PEDRO 90732 (310) 514-0838 13 4 8 3 7/1/2001<br />
KULSHRESTHA, AARTI MD INC 1457608580 1433 W MERCED AVE STE<br />
112<br />
WEST COVINA 91790 (626) 502-1214 13 4 3 2 12/26/2012<br />
KUMAR, ASHA R. MD INC 1447437165 820 W SERVICE AVE WEST COVINA 91790 (626) 960-6304 13 4 3 2 1/17/1997<br />
KUMAR, KAIN MD INC 1669409025 540 WEST PALMDALE BLVD., PALMDALE<br />
STE. B<br />
93551 (661) 947-5600 13 4 1 1 11/17/2010<br />
Monday, May 06, 2013 Page 20 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
KUNNAWUTHIDEE,<br />
KAMOLTIPYA, MD<br />
1992808422 628 N VERMONT AVENUE<br />
STE 2 & 3<br />
LOS ANGELES 90004 (323) 798-5583 13 4 4 3 9/8/1982<br />
KYAN, FEE S. MD 1952469264 10230 ARTESIA BLVD., STE<br />
300<br />
BELLFLOWER 90706 (562) 804-0100 13 4 7 2 11/11/2000<br />
KYAZZE, FRED B MD INC<br />
/GALACARE MED CL<br />
L AND P MEDICAL GRP, INC/LA<br />
PAZ MEDICAL GROUP<br />
L.A. COMMUNITY CARE<br />
MEDICAL ASSOC.<br />
LA LIBERTAD MEDICAL CLINIC<br />
INC<br />
1528350014 1410 W. ALONDRA BLVD.<br />
STE. C<br />
COMPTON 90220 (310) 637-3680 13 4 6 3 8/6/1999<br />
1710077961 1107 S ALVARADO STREET # LOS ANGELES<br />
102<br />
90006 (213) 380-9999 12 4 4 3 11/13/2000<br />
1801099486 11633 S. HAWTHORNE<br />
BLVD. #103<br />
HAWTHORNE 90250 (310) 219-2929 12 4 8 3 5/4/1998<br />
1295887024 8225 LONG BEACH BLVD.<br />
STE C<br />
SOUTH GATE 90280 (323) 585-1056 13 4 7 2 5/30/1996<br />
LAC USC MEDICAL CENTER 1386655918STA 1200 N MISSION RD LOS ANGELES, C 90033 (323) 226-3683 21 4 4 3 3/31/2003<br />
LADDARAN MEDICAL GROUP 1417050782 2105 BEVERLY BLVD. STE<br />
117<br />
LOS ANGELES 90057 (213) 413-8742 12 4 4 3 9/9/1999<br />
LAGMAN, ROSARIO, MD 1053404376 1300 N VERMONT AVENUE<br />
STE 802-A<br />
LOS ANGELES 90027 (323) 660-6363 13 4 4 3 6/27/1996<br />
LAI, LAWRENCE R MD 1003996174 131 W WILLOW STREET POMONA 91768 (909) 623-8521 13 4 3 2 2/11/1989<br />
LAKESIDE MEDICAL<br />
ORGANIZATION AMG INC<br />
1831426642 1500 W. WEST COVINA<br />
PARKWAY<br />
WEST COVINA 91790 (626) 430-9992 12 4 3 2 4/10/2008<br />
LALEZARI, BAHMAN MD INC 1205137452 4944 W. PICO BLVD. LOS ANGELES 90019 (323) 939-5346 13 4 4 3 8/29/1997<br />
LANARK FAMILY MEDICAL<br />
CLINIC<br />
1124106646 8040 VAN NUYS BLVD. PANORAMA CITY 91402 (818) 373-4870 13 4 2 1 11/14/2003<br />
LAU, MAY Y. M.D., INC. 1992805550 320 S. GARFIELD AVE., STE.<br />
288<br />
ALHAMBRA 91801 (626) 607-0288 13 4 3 2 7/11/2006<br />
LAUPPE, HOLLEMBERG,<br />
AGRAWAL, KNOLL & WARREN<br />
LAUREL CANYON URGENT MED.<br />
GRP. INC.<br />
1366447781 250 W BONITA AVE., STE 200 POMONA 91767 (909) 629-5067 12 4 3 2 10/5/2010<br />
1831387620 8020 LAUREL CANYON BLVD. NORTH HOLLYW 91605 (818) 767-9623 13 4 2 1 7/27/1983<br />
LAUREL MEDICAL CENTER 1144368887 13680 VAN NUYS BLVD. PACOIMA 91331 (818) 897-7730 13 4 2 1 10/4/1996<br />
LAVIAN, DAVID MD 1770582967 14600 SHERMAN WAY, # 215 VAN NUYS, 91405 (818) 782-4300 13 4 2 1 11/10/1999<br />
LAWNDALE MEDICAL & MENTAL<br />
HEALTH SERVICES<br />
1316039241 4023 MARINE AVE LAWNDALE 90260 (310) 675-9555 25 4 8 3 5/2/2007<br />
LE, CHAU M. MD 1235135633 9206 E. VALLEY BLVD ROSEMEAD 91770 (626) 571-2763 13 4 3 2 8/14/1995<br />
LEE, CHUNG MIN MD. 1912075235 12121 CARSON ST. HAWAIIAN GARD 90716 (562) 402-1449 13 4 7 2 6/9/2009<br />
LEE, DAVID P. DO / A-ONE<br />
MEDICAL GROUP INC.<br />
LEE, DAVID P. DO / A-ONE<br />
MEDICAL GROUP INC.<br />
1306006655 1241 S. GRAND AVE., STE. E DIAMOND BAR 91765 (626) 965-1988 13 4 3 2 2/10/2009<br />
1790945632 1818 SIERRA LEONE AVE.,<br />
STE. B<br />
ROWLAND HEIGH 91748 (626) 965-1988 13 4 3 2 2/10/2009<br />
Monday, May 06, 2013 Page 21 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
LEE, HASUNG MD 1710914254 903 S. CRENSHAW BLVD.<br />
STE 104<br />
LOS ANGELES 90019 (323) 931-8177 13 4 4 3 8/7/1980<br />
LEE, JULIANNE O., MD INC. 1013159466 711 N. ALVARADO ST., STE.<br />
106<br />
LOS ANGELES 90026 (213) 413-3324 13 4 4 3 12/22/2009<br />
LEE, KIT H. MD 1518015916 3300 E. SOUTH ST., STE 204, LAKEWOOD 90711 (562) 602-1733 13 4 7 2 3/5/1984<br />
LEE, MI- JEONG MD 1568481471 2675 E. OLYMPIC BLVD.<br />
STE. 103<br />
LOS ANGELES 90006 (213) 252-0036 13 4 4 3 8/6/2001<br />
LEE, MYUNG H, MD 1821175811 14614 VICTORY BLVD. VAN NUYS 91411 (818) 787-4770 13 4 2 1 9/30/1992<br />
LEE, SEUNG M. MEDICAL INC 1962665349 2030 W. PICO BLVD. STE1 LOS ANGELES 90006 (213) 427-0667 13 4 6 3 8/22/2005<br />
LEUNG, YING-YAN MD 1275612632 3038 S HACIENDA BLVD HACIENDA HEIG 91745 (626) 961-5479 13 4 3 2 10/31/1983<br />
LEW, PO LONG, DO. A<br />
MEDICAL CORP<br />
LI, XIA, MD / SUNMOON URGENT<br />
CARE MED<br />
1558527572 9308 E VALLEY BLVD ROSEMEAD 91770 (626) 288-8881 13 4 3 2 9/29/1993<br />
1144316217 1161 1/2 LOGAN ST. LOS ANGELES 90026 (213) 484-1289 12 4 4 3 12/28/2006<br />
LIEN, THOI H., MD 1871653816 1004 E. GARVEY AVE. MONTEREY PAR 91755 (626) 280-5035 13 4 3 2 7/20/2004<br />
LII, SHYH-MINE MD 1922150267 3859 N ROSEMEAD BLVD ROSEMEAD 91770 (626) 572-4044 13 4 3 2 8/13/1998<br />
LIN, HSIN L, MD 1194752279 315 N THIRD AVENUE STE<br />
202<br />
COVINA 91723 (626) 859-2544 13 4 3 2 4/3/1992<br />
LIN, JOHN Y MD 1144392630 1148 S ROWAN AVE STE 2 LOS ANGELES 90023 (323) 261-6173 13 4 4 3 12/29/1986<br />
LIN, LIANG MU, MD 1154430296 17906 S. PIONEER BLVD STE ARTESIA<br />
101<br />
90701 (562) 402-3348 13 4 7 2 10/6/1988<br />
LIN, THOMAS H.T., MD 1033210901 790 S ATLANTIC BLVD. STE.<br />
102<br />
MONTEREY PAR 91754 (626) 576-9929 13 4 3 2 1/18/2000<br />
LINCOLN HEIGHTS FAMILY &<br />
INDUSTRIAL MED. ICAL GROUP<br />
LINCOLN HEIGHTS FAMILY AND<br />
INDUSTRIAL MEDICAL CLINIC,<br />
INC.<br />
LITTLE CO. OF MARY, LIFECARE<br />
SYSTEMS, INC.<br />
1942309497 2409 N. BROADWAY LOS ANGELES 90031 (323) 225-8038 12 4 4 3 7/11/2005<br />
1982787206 1501 E. HOLT AVE. POMONA 91767 (909) 623-3600 12 4 3 2 1/22/2007<br />
1548487143 1403 LOMITA BLVD., STE 100 HARBOR CITY 90710 (310) 784-5800 25 4 8 3 1/15/2003<br />
LIU, YEN-FU J., MD 1598982522 3250 SEPULVEDA BLVD. TORRANCE 90505 (310) 534-3231 13 4 8 3 5/11/2011<br />
LOBARBIO, MINERVA A, MD 1063589349A 13710 STUDEBAKER RD STE<br />
100<br />
NORWALK 90650 (562) 929-9625 13 4 7 2 11/9/1989<br />
LOBARBIO, MINERVA A. MD 1063589349B 16660 PARAMOUNT BLVD<br />
STE 210<br />
PARAMOUNT 90723 (562) 408-0084 13 4 6 3 6/21/1991<br />
LONG BEACH MEM MED CTR/<br />
MILLER CHILDREN'S HOSP<br />
LONG BEACH MEMORIAL<br />
MEDICAL CTR<br />
1477596583A 2801 ATLANTIC AVE LONG BEACH 90806 (562) 933-2870 2 4 8 3 5/18/2012<br />
1477596583B 3640 LOMITA BLVD STE. 205 TORRANCE 90505 (562) 933-2870 2 4 8 3 6/27/2012<br />
Monday, May 06, 2013 Page 22 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
LOPEZ, HORACIO G. MD 1659430460 2105 W. BEVERLY BLVD.<br />
STE. 129<br />
LOS ANGELES 90057 (213) 353-3600 13 4 4 3 5/16/1995<br />
LOS ANGELES CHRISTIAN PICO<br />
ALISO COMM CLINIC<br />
LOS ANGELES CLINICA MEDICA<br />
GENERAL MED. CTR. INC.<br />
LOS ANGELES COUNTY, SOUTH<br />
VALLEY PED SATELLITE CLINIC<br />
1457599631 1625 E. 4TH STREET LOS ANGELES 90033 (323) 268-8391 22 4 4 3 11/23/2009<br />
1265489751 2208 W. 7TH. STREET LOS ANGELES 90057 (213) 384-3434 12 4 4 3 7/20/2009<br />
1649383464STA 38350 40TH STREET EAST,<br />
SUITE 200<br />
PALMDALE 93552 (661) 272-5001 22 4 0 1 11/8/2012<br />
LOS NINOS CHILDREN MED. APC 1700115722A 409 E. MERCED AVE. STE. A WEST COVINA 91790 (626) 931-0901 13 4 3 2 7/28/2005<br />
LOS NINOS CHILDRENS<br />
MEDICAL CLINIC APC<br />
LOS REYES CLINICA MEDICA<br />
INC.<br />
1700115722B 1240 N HACIENDA BLVD.,<br />
STE 101<br />
LA PUENTE 91744 (626) 850-5005 13 4 3 2 1/25/2002<br />
1952461774 7934 SEVILLE AVENUE HUNTINGTON PA 90255 (323) 584-9644 12 4 7 2 6/5/2007<br />
LU, JOSEPH TSUNG-CHO 1790795185 500 N GARFIELD AVE STE<br />
202<br />
MONTEREY PAR 91754 (626) 572-8864 13 4 3 2 8/8/1996<br />
LUNA, LELANIE M., MD 1427195387 1500 S. CENTRAL AVE., STE<br />
310<br />
GLENDALE 91204 (818) 500-1331 12 4 2 1 4/14/1999<br />
MACARTHUR PARK MED. CLINIC<br />
INC<br />
1730266248 2228 W. 7TH STREET LOS ANGELES 90057 (213) 383-5773 13 4 4 3 8/28/1997<br />
MAGANA, OMAR, MD 1952464208 8338 Rosemead Blvd. PICO RIVERA 90660 (562) 942-1200 13 4 7 2 11/22/2005<br />
MAGIC JOHNSON SCHOOL<br />
BASED CLINIC<br />
1376681486 2265 E. 103RD ST. LOS ANGELES 90002 (323) 569-7183 25 4 6 3 4/1/2003<br />
MAKABALI, REYNALDO L MD INC 1306079181 2400 W. 7TH ST STE.110 LOS ANGELES 90057 (213) 389-9595 13 4 4 3 5/21/2012<br />
MALAKOOTI, HAMID, MD 1538243373 2428 W WHITTIER BLVD MONTEBELLO 90640 (323) 722-5550 13 4 7 2 8/31/1989<br />
MANGUNE, FLORENCIA M MD 1467559542 16660 PARAMOUNT BLVD., #<br />
110<br />
PARAMOUNT 90723 (562) 633-2021 13 4 6 3 10/15/1991<br />
MARCANO, BERTRAND A., MD ,<br />
INC<br />
1568734655 1700 E. CESAR E. CHAVEZ<br />
AVE STE. 3450<br />
LOS ANGELES 90033 (323) 261-0259 13 4 4 3 5/30/1979<br />
MARIA LILIBETH T. SY, MD, INC. 1609969997 8162 VAN NUYS BLVD. PANORAMA CITY 91402 (818) 787-5800 12 4 2 1 9/14/2005<br />
MAROUNI, PAYAM MD INC / ST.<br />
ANDREWS MED CTR<br />
1114255437 13750 victory blvd. van nuys 91401 (818) 988-9090 12 4 2 1 3/13/2013<br />
MARTINEZ, EDGAR I. DO INC. 1336163294 3512 E. FLORENCE AVE.,<br />
STE 102<br />
HUNTINGTON PA 90255 (323) 582-1180 13 4 7 2 1/18/2000<br />
MATEMOTJA, DANIEL MD INC 1568659563A 711 E. ROSECRANS AVE. COMPTON 90221 (310) 635-5223 12 4 6 3 12/21/2005<br />
MATEMOTJA, DANIEL MD INC./<br />
MAY FAM. MED. CLINIC<br />
1063682979 12131 CARSON ST. HAWAIIAN GARD 90716 (562) 809-0299 12 4 7 2 6/20/2008<br />
MAYER, RALPH, MD 1992845663 4972 W. PICO BLVD. STE. 201 LOS ANGELES 90019 (323) 525-2500 12 4 6 3 6/27/2005<br />
MAYER, RALPH, MD. 1194866525 2568 CLARENDON AVE. HUNTINGTON PA 90255 (323) 582-5444 12 4 7 2 6/19/2007<br />
Monday, May 06, 2013 Page 23 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
MAYWOOD FAMILY MEDICAL<br />
CTR / RAGAA Z. ISKAROUS<br />
1801184841 5920 ATLANTIC BLVD MAYWOOD 90270 (323) 562-2535 13 4 7 2 1/10/2012<br />
MCMILLAN SAMUEL , MD 1962560870 6300 FLORENCE AVE. BELL GARDENS 90201 (562) 928-9700 13 4 7 2 1/6/2010<br />
MEDEX MEDICAL GROUP INC<br />
CALIFORNIA MEDEX MEDICAL<br />
MEDICAL ASSOCIATES OF<br />
LITTLE CO. OF MARY<br />
MEDICAL GROUP OF<br />
PARAMOUNT INC./CLINICA<br />
MEDICA HISPANA MED. CORP.<br />
1063445435 616 N. GARFIELD AVE # 303 MONTEREY PAR 91754 (626) 457-8600 12 4 7 2 11/23/2010<br />
1205870391 1294 W. 6TH STREET, #104 SAN PEDRO 90731 (310) 548-9118 12 4 8 3 11/19/2001<br />
1972563617 14906 PARAMOUNT BLVD. PARAMOUNT 90723 (562) 630-1991 12 4 6 3 6/1/1994<br />
MEHRABI, YOUSEF MD 1083693915 5620 WILBUR AVE. SUITE<br />
#211<br />
TARZANA 91356 (818) 609-9997 13 4 2 1 1/18/2008<br />
MENDOZA, JOSE E, MD 1588712541 5750 DOWNEY AVENUE STE LAKEWOOD<br />
#204<br />
90712 (562) 531-4362 13 4 7 2 4/22/1983<br />
MENDOZA, MANUEL F. MD, INC. 1942416045 16323 CLARK AVE BELLFLOWER 90706 (562) 925-7716 12 4 7 2 3/6/2006<br />
MENENDEZ INTEGRAL<br />
PEDIATRICS INC.<br />
1922289495 1510 S. CENTRAL AVE # 350 GLENDALE 91204 (818) 552-2100 13 4 2 1 6/24/2008<br />
MENG, SHERRY F, MD INC 1346252483 18391 E. COLIMA ROAD, STE<br />
210<br />
ROWLAND HEIGH 91748 (626) 581-2188 13 4 3 2 6/26/2002<br />
MERCADER, ROLANDO S. MD<br />
INC.<br />
1033223409 166 S. ALVARADO STREET<br />
STE. 106<br />
LOS ANGELES 90057 (213) 484-6694 13 4 4 3 5/3/1993<br />
MERCADO, SATURNINA D., MD 1386866093 10230 E. ARTESIA BLVD.,<br />
STE 207<br />
BELLFLOWER 90706 (562) 863-3474 13 4 7 2 9/10/1990<br />
MERCY MEDICAL CENTER 1104014414 16444 PARAMOUNT BLVD.<br />
#103<br />
PARAMOUNT 90723 (562) 531-7790 12 4 6 3 7/26/1993<br />
MICHAEL GITTER MD INC. /<br />
CENTRO MEDICO MACARTHUR<br />
PARK<br />
1265668784 2011 WILSHIRE BLVD. LOS ANGELES 90057 (213) 484-1244 12 4 4 3 2/16/2010<br />
MICHAEL, MAHFOUZ M MD 1104045210 1437 S ATLANTIC BLVD. LOS ANGELES 90022 (323) 268-9900 12 4 7 2 4/7/1998<br />
MICHAEL, MAHFOUZ M<br />
MD/CLINICA MED SAN MIGUEL<br />
1508085515 7542 LAUREL CANYON BLVD NORTH HOLLYW 91605 (818) 765-0503 12 4 2 1 4/22/1998<br />
MICHAEL, MAHFOUZ M, M.D. 1104045061 7128 PACIFIC BLVD., FLOOR<br />
2, STE. A<br />
HUNTINGTON PA 90255 (323) 583-9700 12 4 7 2 1/22/2001<br />
MICHAEL, MAHFOUZ M. M.D. 1609095660 825 N. PARK AVE. POMONA 91768 (909) 622-9988 12 4 3 2 4/2/1998<br />
MICHAEL, MAHFOUZ M. MD /<br />
CLINICA MED. SAN MIGUEL<br />
MICHAEL, MAHFOUZ M.<br />
MD/CLINICA MED SAN MIGUEL<br />
MICHAEL, MAHFOUZ M., MD.,<br />
INC.<br />
1861611899 115 E. WASHINGTON BLVD LOS ANGELES, C 90015 (213) 234-5520 12 4 4 3 3/27/2007<br />
1881627057 8781 VAN NUYS BLVD. PANORAMA CITY 91402 (818) 892-8349 12 4 2 1 4/22/1998<br />
1659591832 954 N. VERMONT AVENUE LOS ANGELES 90029 (323) 666-6866 12 4 4 3 11/10/2003<br />
Monday, May 06, 2013 Page 24 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
MINASSIAN, GUIRAGOS MD 1871681817A 5620 WILBUR AVE STE 212 TARZANA 91356 (818) 708-8044 13 4 2 1 11/22/2000<br />
MINASSIAN, GUIRAGOS S MD 1871681817B 5000 SUNSET BLVD., STE 640 LOS ANGELES 90027 (323) 666-6202 13 4 4 3 6/27/1996<br />
MISSION CITY COMM NETWRK 1306017603 9919 LAUREL CANYON BLVD. PACOIMA 91331 (818) 686-4243 22 4 2 1 11/23/2010<br />
MISSION CITY COMMUNITY<br />
NETWORK INC<br />
MLS CLINICAL & MEDICAL<br />
CORPORATION<br />
1760409791 15206 PARTHENIA ST. NORTH HILLS 91343 (818) 895-3100 22 4 2 1 5/14/1992<br />
1912146887 7340 FLORENCE AVE.<br />
STE.109<br />
DOWNEY 90240 (562) 928-4642 13 4 7 2 8/23/2005<br />
MOAS, OVI MD 1427123504 7444 LANKERSHIM BLVD. NORTH HOLLYW 91605 (818) 765-4917 13 4 2 1 2/1/1996<br />
MOCEGA, JUAN A. MD JR INC. 1093954018 1141 W. REDONDO BEACH<br />
STE. 308<br />
GARDENA 90247 (310) 807-9477 12 4 8 3 1/21/2010<br />
MODERN CONCEPTS MED GRP 1790738243 1217 W. WHITTIER BLVD. MONTEBELLO 90640 (323) 728-6070 12 4 7 2 3/29/2011<br />
MODERN CONCEPTS MEDICAL<br />
GROUP INC.<br />
1386859619 1701 CESAR CHAVEZ AVE.,<br />
STE 354<br />
LOS ANGELES 90033 (323) 221-5366 12 4 4 3 9/27/2002<br />
MODI, KANAN A., MD INC. 1881704898 1305 W. ARROW HWY., STE.<br />
104<br />
SAN DIMAS 91773 (909) 394-9004 13 4 3 2 4/27/2009<br />
MOGHADAM, MEHDI A., MD 1679625222 7232 VAN NUYS BLVD., Ste.<br />
201<br />
VAN NUYS 91405 (818) 373-4999 13 4 2 1 12/11/2001<br />
MOJTAHEDIAN, EMMANUEL MD,<br />
INC<br />
MOLINA, JOSEPH M. MD /<br />
MOLINA MED GRP OF SO<br />
CALIFORNIA<br />
MOLINA, JOSEPH M. MD PROF<br />
CORP / MOLINA MED GRP OF<br />
SO CALIFORNIA<br />
1609899087 6425 E. WHITTIER BLVD. LOS ANGELES 90022 (323) 728-0101 13 4 7 2 10/30/1992<br />
1982976692 445 E. ANAHEIM ST. # H WILMINGTON 90744 (310) 233-7796 12 4 8 3 8/16/1985<br />
1629340336 887 E. SECOND STREET POMONA 91766 (909) 620-7769 12 4 3 2 9/11/1989<br />
MONTAZERI, EHSAN , M.D. INC. 1871645184 1231 N. AVALON BLVD. WILMINGTON 90744 (310) 835-7215 12 4 8 3 6/1/1999<br />
MONTEBELLO PEDIATRIC<br />
MEDICAL GROUP<br />
1437270014 101 BEVERLY BLVD. STE<br />
207<br />
MONTEBELLO 90640 (323) 726-1400 13 4 7 2 7/31/1978<br />
MONTES MEDICAL GROUP INC 1982873162 11822 E. FLORAL DRIVE WHITTIER 90601 (562) 908-4355 12 4 7 2 2/8/1985<br />
MONTES MEDICAL GROUP INC 1700055746 13820 SAN ANTONIO DR. NORWALK 90650 (562) 944-2181 12 4 7 2 3/17/2003<br />
MONTES MEDICAL GROUP INC. 1093809592 832 S. GREVILLEA AVE. INGLEWOOD 90301 (310) 419-4354 12 4 8 3 2/24/1988<br />
MONTES MEDICAL GROUP, INC 1437487956 321 S. MEDNIK AVE. LOS ANGELES 90022 (323) 266-7888 12 4 7 2 8/4/2010<br />
MORADI, HAMID MD INC 1982982401 14350 VICTORY BLVD UNIT 3 VAN NUYS 91401 (818) 786-8396 13 4 2 1 6/11/2012<br />
MORENO SHURA MD APC 1740406255 7301 STATE ST HUNTINGTON PA 90255 (323) 581-5120 12 4 7 2 4/18/2006<br />
MORNINGSIDE PRIMARY CARE 1730299157 617 W MANCHESTER AVE. LOS ANGELES 90044 (323) 750-9715 12 4 8 3 3/23/2006<br />
MOSAIC FAMILY CARE MEDICAL<br />
GROUP<br />
1891830568 4857 HUNTINGTON DR.<br />
NORTH<br />
LOS ANGELES 90032 (323) 226-9042 12 4 4 3 10/17/2002<br />
Monday, May 06, 2013 Page 25 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
MOSSAHEBI, ABDOLSAMAD,MD 1487712550 1300 N VERMONT AVE STE<br />
701<br />
LOS ANGELES 90027 (323) 665-1287 13 4 4 3 2/3/1992<br />
MOY, ENG WEI, MD 1255384525 4301 TWEEDY BLVD. SOUTH GATE 90280 (323) 566-5129 13 4 7 2 11/19/1999<br />
MULTI HEALTH CARE MEDICAL<br />
GROUP INC<br />
1861418576 3175 E. FIRESTONE BLVD. SOUTH GATE 90280 (323) 567-8910 12 4 7 2 4/1/2003<br />
MUNGCAL, RENATO V MD 1003886847 133 S. VERMONT AVENUE LOS ANGELES 90004 (213) 480-0748 13 4 4 3 1/4/1993<br />
MURTIDJAJA, WILLY, MD 1174620041 1175 UNRUH AVENUE LA PUENTE 91744 (626) 918-8210 13 4 3 2 3/19/1992<br />
N. ROSTAMI MEDICAL GROUP<br />
INC./ SAN JUDAS MED. GRP<br />
WEST<br />
NABIL & JANET F SOLIMAN<br />
CENTRO MEDICAL INC.<br />
1033256573 1080 N. WESTERN AVE. LOS ANGELES 90029 (323) 957-8787 12 4 4 3 3/1/1996<br />
1497776322 11946 S HAWTHORNE BLVD. HAWTHORNE 90250 (310) 675-1136 13 4 8 3 1/13/2004<br />
NAMATALLA, GALAL S., MD 1629136544 5985 FLORENCE AVE, UNIT N BELL GARDENS 90201 (323) 562-2900 13 4 7 2 9/22/2003<br />
NARAYANAN, B MD. INC. 1174610380 101 E. BEVERLY BLVD. STE.,<br />
306<br />
MONTEBELLO 90640 (323) 888-8646 13 4 7 2 8/22/2005<br />
NAT NARINDAR K. ,MD 1255393682 27141 HIDAWAY AVE. SUITE<br />
200<br />
CANYON COUNT 91351 (661) 251-8400 13 4 2 1 4/2/2007<br />
NAVARRETE, JOSE C, MD 1447326855 6043 ATLANTIC BLVD. MAYWOOD 90270 (323) 771-9680 13 4 7 2 6/16/1994<br />
NEGUSSIE SUZANNA S MD 1326188210 3717 S LA BREA AVE STE 201 LOS ANGELES 90016 (323) 292-5600 13 4 6 3 9/24/2008<br />
Neighborhood Medical Clinic 1235286436 723 E. Manchester Ave. Los Angeles 90001 (323) 750-2325 13 4 6 3 7/2/2010<br />
NEJAT ROSTAMI MEDICAL 1609913441 3377 WILSHIRE BLVD.,<br />
SUITE 101<br />
LOS ANGELES 90010 (213) 484-0000 12 4 4 3 3/5/1993<br />
NERCESSIAN, ARMEN Y<br />
MD/SUNSHINE FAMILY MEDICAL<br />
NG, LIONEL P. MD - CHILDREN<br />
FIRST PED. GRP. OF DUARTE<br />
1679534374 561 S. AZUSA WAY LA PUENTE 91744 (626) 964-9111 13 4 3 2 6/26/1998<br />
1295935203 2329 E Huntington Dr. DUARTE 91010 (626) 357-4600 12 4 3 2 4/25/2003<br />
NGUYEN FRANKLIN C. DO 1316009418 9251 GARVEY AVE SUITE F S EL MONTE 91733 (626) 350-8338 13 4 7 2 10/12/2007<br />
NGUYEN, ANH V MD 1720205768 3250 SEPULVEDA BVLD TORRANCE 90505 (310) 534-3231 12 4 8 3 4/23/2008<br />
NGUYEN, CHI T. MD. INC. 1265492771 933 S. SUNSET AVE # 201 WEST COVINA, 91790 (626) 962-0030 13 4 3 2 11/25/2002<br />
NGUYEN, CUONG V, MD 1730193889 14921 S. PRAIRIE AVE STE 1 LAWNDALE 90260 (310) 676-8000 13 4 8 3 2/10/1997<br />
NGUYEN, DAVID D., MD, INC 1669553236 9817 ARKANSAS ST. BELLFLOWER 90706 (562) 867-8881 12 4 7 2 11/17/2003<br />
NGUYEN, DAVID H. DO 1437200276 633 N SPRING ST, STE 4 LOS ANGELES 90012 (213) 928-0866 13 4 4 3 10/21/2000<br />
NGUYEN, DUC V MD 1518992544 8748 E. VALLEY BLVD STE H ROSEMEAD 91770 (626) 288-3306 13 4 3 2 12/12/1990<br />
NGUYEN, HOANG D. MD 1124011952 22135 ROSCOE BLVD. STE.<br />
107<br />
CANOGA PARK 91304 (818) 481-0118 13 4 2 1 1/9/2006<br />
NGUYEN, HUNG V., MD 1104819945 7227 RESEDA BLVD. RESEDA 91335 (818) 708-7227 13 4 2 1 9/23/1988<br />
Monday, May 06, 2013 Page 26 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
NGUYEN, LIEU S. MD 1215021167 15032 S. PRAIRIE AVENUE HAWTHORNE 90250 (310) 675-7343 13 4 8 3 10/13/1988<br />
NGUYEN, QUY VAN MD 1366400145 9126 E. VALLEY BLVD., STE.<br />
B<br />
ROSEMEAD 91770 (626) 573-9003 13 4 3 2 9/11/1989<br />
NGUYEN, SAN THUY, MD 1194738849 1021 S. GARFIELD AVE ALHAMBRA 91801 (626) 282-6311 13 4 3 2 9/7/1988<br />
NGUYEN, TAN VAN, MD 1326073644 9646 E. GARVEY AVENUE<br />
#101<br />
S. EL MONTE 91733 (626) 450-0777 13 4 3 2 8/22/1996<br />
NGUYEN, TANYA T MD. INC. 1184729626 320 S. GARFIELD AVE. #288 ALHAMBRA 91801 (626) 607-0288 13 4 3 2 7/7/2006<br />
NGUYEN, TAO T, MD 1861587073 3100 E. FLORENCE AVE #9 HUNTINGTON PA 90255 (323) 583-6516 13 4 7 2 5/6/1993<br />
NGUYEN, THANG P, MD/AMC 1992729933 1271 S. UNION AVENUE LOS ANGELES 90015 (213) 386-0214 13 4 4 3 4/1/2003<br />
NGUYEN, TUAN HUU, MD 1073607446 22030 SHERMAN WAY, #211 CANOGA PARK 91303 (818) 884-7424 13 4 2 1 5/27/1981<br />
NGUYEN, VAN TUONG, MD 1053403436 600 W. MAIN STREET STE<br />
104<br />
ALHAMBRA 91801 (626) 284-3284 13 4 3 2 7/28/1980<br />
NGUYEN, VINH X., MD 1972668291 10050 E GARVEY AVE., STE<br />
115<br />
EL MONTE 91733 (626) 448-3550 13 4 3 2 10/31/2005<br />
NISAR, AZRA AFREEN MD / ANA<br />
MED. ASSOC. INC<br />
NORTHEAST COMM. CL. /<br />
WOMEN'S HEALTH CTR.<br />
1306904651 2240 PACIFIC AVE STE A Long Beach 90806 (562) 424-8199 13 4 8 3 4/11/2011<br />
1831390954 5820 N. FIGUEROA ST. LOS ANGELES 90042 (323) 255-6000 22 4 4 3 10/18/2007<br />
NORTHEAST COMMUNITY CLINIC 1538231832 5428 N. FIGUEROA ST. LOS ANGELES 90042 (323) 256-3884 22 4 4 3 5/1/1995<br />
NORTHEAST COMMUNITY CLINIC 1164672853 3751 S. HARVARD BLVD. LOS ANGELES 90018 (323) 373-9400 22 4 6 3 9/7/2006<br />
NORTHEAST COMMUNITY CLINIC 1689885428 4129 E. GAGE AVE. BELL 90201 (323) 771-8400 22 4 7 2 5/5/2004<br />
NORTHEAST COMMUNITY CLINIC 1982938213 1400 S. Grand Ave., Ste. 700 Los Angeles 90015 (213) 765-7500 25 4 4 3 1/5/2011<br />
NORTHEAST COMMUNITY CLINIC 1700097540 200 E ANAHEIM STREET WILMINGTON 90744 (310) 816-9700 22 4 8 3 2/12/2007<br />
NORTHEAST COMMUNITY CLINIC 1538231832STA 2880 E. GAGE AVE HUNTIGTON PAR 90255 (323) 826-1554 22 4 7 2 7/9/2004<br />
NORTHEAST VALLEY HEALTH -<br />
MACLAY HEALTH CENTER<br />
NORTHEAST VALLEY HEALTH<br />
CORP<br />
NORTHEAST VALLEY HEALTH<br />
CORP<br />
NORTHEAST VALLEY HEALTH<br />
CORP.<br />
NORTHEAST VALLEY HEALTH<br />
CORP. - PEDIATRIC HEALTH &<br />
HEALTH CENTER<br />
NORTHEAST VALLEY HEALTH<br />
CORP. SUN VALLEY HLTH. CTR.<br />
1053312587 12540 PIERCE AVE. PACOIMA 91331 (818) 365-7517 22 4 2 1 5/9/2002<br />
1114928595 12756 VAN NUYS BLVD. PACOIMA 91331 (818) 896-0531 22 4 2 1 1/1/1992<br />
1740281120 7107 REMMET AVENUE CANOGA PARK 91303 (818) 340-3570 22 4 2 1 10/1/1996<br />
1235130600 1600 SAN FERNANDO ROAD SAN FERNANDO 91340 (818) 365-8086 22 4 2 1 5/14/1992<br />
1093716474 7138 VAN NUYS BLVD. VAN NUYS 91405 (818) 778-6240 22 4 2 1 8/1/2000<br />
1013199264 7223 N. FAIR AVE SUN VALLEY 91352 (818) 432-4400 25 4 2 1 3/14/2008<br />
Monday, May 06, 2013 Page 27 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
NORTHEAST VALLEY HEALTH<br />
CORPORATION<br />
NORTHEAST VALLEY HLTH<br />
CORP - LAC-VALENCIA<br />
NORTHEAST VALLEY HLTH<br />
CORP./ SCHOOL BASED CLINIC<br />
NORTHRIDGE FAMILY<br />
PRACTICE MED GRP<br />
1558693655 18533 SOLEDAD CANYON<br />
ROAD<br />
SANTA CLARITA 91351 (661) 673-8800 25 4 2 1 10/21/2010<br />
1730180118 23763 VALENCIA BLVD. VALENCIA 91355 (661) 287-1551 22 4 2 1 10/4/1996<br />
1417958943 11133 O' MELVENY AVE. SAN FERNANDO 91340 (818) 365-7517 22 4 2 1 5/14/1992<br />
1285642033 18406 ROSCOE BLVD. NORTHRIDGE 91325 (818) 885-5480 12 4 2 1 1/27/1978<br />
NOURI, JAHANBAKHSH, MD 1366501629 8725 WOODMAN AVE ARLETA 91331 (818) 891-4455 13 4 2 1 12/17/1997<br />
NOURMAND, AZIZ, MD 1639180623 2001 SANTA MONICA BLVD.<br />
#865W<br />
SANTA MONICA 90404 (310) 829-3311 13 4 5 3 5/2/1990<br />
NUESTRA CLINICA INC. 1588808547 3004 WHITTIER BLVD. LOS ANGELES 90023 (323) 264-0535 12 4 4 3 6/24/2009<br />
OEY, JAMIE C. MD INC. 1962433409 10800 PARAMOUNT BLVD.,<br />
STE. 302<br />
DOWNEY 90241 (562) 861-9142 13 4 7 2 4/6/2004<br />
OKAFOR, CHRISTOPHER C. MD /<br />
CALVARY MEDICAL CLINIC<br />
1295976199 11502 S. VERMONT AVE.,<br />
STE. A<br />
LOS ANGELES 90044 (323) 757-1557 13 4 8 3 1/6/2009<br />
OKTANYAN, MARO MD 1295863124 1259 S. GLENDALE AVE,<br />
STE E<br />
GLENDALE 91205 (818) 243-0333 13 4 2 1 12/28/1998<br />
ONYEADOR, EJIKE C, MD 1699841700 555 W. COMPTON BLVD.,<br />
STE 205<br />
COMPTON 90220 (310) 223-0684 13 4 6 3 9/22/1995<br />
OO, MAUNG M. MD INC 1740299833 705 E. GARVEY AVE. MONTEREY PAR 91755 (626) 312-5488 12 4 3 2 2/1/2005<br />
OPARAH, SONNY S. 1588770408 3611 MARTIN LUTHER KING<br />
BLVD. #105<br />
LYNWOOD 90262 (310) 639-0445 13 4 6 3 3/15/1999<br />
OSEA, EDGARDO A. MD 1699795476 1310 W. SEPULVEDA BLVD. HARBOR CITY 90710 (310) 534-5765 13 4 8 3 3/2/1993<br />
PACIFIC ALLIANCE MEDICAL<br />
GROUP<br />
PAEK, WOO H. MD / ABC<br />
PEDIATRICS, INC<br />
1972551174 4837 N. HUNTINGTON DRIVE LOS ANGELES 90032 (323) 343-9461 12 4 4 3 10/7/1999<br />
1336305267 3663 W 6TH STREET, STE.<br />
301<br />
LOS ANGELES 90020 (213) 291-3228 13 4 4 3 11/4/2010<br />
PAJA MEDICAL GROUP, INC 1053367896 1800 WILSHIRE BLVD. LOS ANGELES 90057 (213) 484-9934 12 4 4 3 11/14/2005<br />
PALLIVATHUCAL, ROSALIND /<br />
SAN JUAN BOSCO MED. CLINIC<br />
1033244611B 6120 SEVILLE AVE HUNTINGTON PA 90255 (323) 357-1000 13 4 7 2 9/8/2010<br />
PALLIVATHUCAL,ROSALIND G. 1033244611A 8100 CALIFORNIA AVE STE<br />
K<br />
SOUTH GATE 90280 (323) 357-1000 13 4 7 2 2/18/1997<br />
PALMDALE PEDIATRIC CENTER 1427385525 2271 E. PALMDALE BLVD. E1 PALMDALE 93550 (661) 538-9922 13 4 1 1 8/4/2010<br />
PAMARAN, MARIA V. MD 1003913831 10230 E ARTESIA BLVD.,<br />
STE. 302<br />
BELLFLOWER 90706 (562) 461-7588 13 4 7 2 6/9/1999<br />
PANG, ARNOLD T., DO INC. 1962666156 15572 E. GALE AVE HACIENDA HEIG 91745 (626) 377-4562 13 4 3 2 8/26/2010<br />
PANGANIBAN, VIRGILIO, MD 1144475898 9604 E. ARTESIA BLVD. STE<br />
103<br />
BELLFLOWER 90706 (562) 925-7033 13 4 7 2 6/10/1998<br />
Monday, May 06, 2013 Page 28 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
PARA LATINO MEDICAL CENTER<br />
INC.<br />
1356498935 15717 PARAMOUNT BLVD. PARAMOUNT 90723 (562) 531-2231 13 4 6 3 7/23/2001<br />
PARK, HO SEONG, MD 1588723399 808 S. VERMONT AVE, STE<br />
101<br />
LOS ANGELES. 90005 (213) 382-5420 13 4 4 3 4/29/1987<br />
PARTOVY, ROBERT DO. / SAN<br />
FERNANDO MEDICAL CENTER<br />
1093933939 501 NORTH MACLAY AVE. SAN FERNANDO 91340 (818) 361-3788 13 4 2 1 9/17/2002<br />
PATEL, MAHENDRAKUMAR R MD 1356449615 4477 WHITTIER BLVD. LOS ANGELES 90022 (323) 264-2890 13 4 7 2 3/29/1989<br />
PATEL, PRATIMA R. MD 1700063773 147 W. COLLEGE ST. COVINA 91723 (626) 332-2860 13 4 3 2 5/27/1993<br />
PEACE, DE VAUGHN KENN, MD 1831103779 4326 S. WESTERN AVENUE LOS ANGELES 90062 (323) 299-9914 13 4 6 3 6/17/1986<br />
PECKSON, LOUELLA L., MD 1144516295 14624 SHERMAN WAY,<br />
SUITE 401<br />
VAN NUYS 91405 (818) 786-1200 13 4 2 1 2/27/2002<br />
PEDIATRIC & FAMILY MEDICAL<br />
CTR / USC EISNER FAMILY<br />
MEDICINE<br />
1386934875 1400 SOUTH GRAND AVE.,<br />
STE. 101<br />
LOS ANGELES 90015 (213) 747-5542 22 4 4 3 1/21/2010<br />
PEDRANO, GUADALUPE C. 1720186786 2209 SAN FERNANDO ROAD LOS ANGELES 90065 (323) 226-0511 13 4 4 3 11/28/1989<br />
PEDRO DOMINGO-FORASTE,<br />
MD., INC.<br />
1144356627 2256 WHITTIER BLVD LOS ANGELES 90023 (323) 268-8511 13 4 4 3 4/3/1997<br />
PEREZ ANGEL G MD 1295940054 1721 N. WILMINGTON BLVD. WILMINGTON 90744 (310) 835-1414 13 4 8 3 10/7/2008<br />
PEREZ, JOSE A. MD 1104991561B 1905 GAGE AVE LOS ANGELES 90001 (323) 581-8085 13 4 8 3 1/5/2011<br />
PEREZ, JOSE A., MD 1104991561A 3500 WHITTIER BLVD STE<br />
107<br />
LOS ANGELES 90023 (323) 604-0260 13 4 6 3 1/14/2011<br />
PEREZ, LUIS J., MD, APC 1225099880 716 E. MISSION BLVD. STE. D POMONA 91766 (909) 865-2332 13 4 3 2 8/31/2005<br />
PEREZ, OMAR MD, INC 1043393465 10728 E. RAMONA BLVD.<br />
STE. A<br />
EL MONTE 91731 (626) 442-9430 13 4 3 2 12/1/1992<br />
PEYMAN BANOONI MEDICAL<br />
GROUP INC<br />
1689978850 1919 W. 7TH STREET, UNIT<br />
2A<br />
LOS ANGELES 90057 (213) 413-2222 12 4 4 3 11/1/2011<br />
PHAN NGO C. MD 1043269145 330 S. GARFIELD AVE #268 ALHAMBRA 91801 (626) 281-3265 13 4 3 2 3/31/2005<br />
PICHAJ, RAISA 1669560660 5425 N. FIGUEROA ST LOS ANGELES 90042 (323) 258-0015 13 4 4 3 5/18/1990<br />
PICO CLINICA MEDICA LATINA A<br />
MED GRP INC.<br />
PICO URGENT CARE & FAM MED<br />
CTR<br />
1740329101 1600 W. PICO BLVD. LOS ANGELES 90015 (213) 386-5252 12 4 4 3 1/8/1999<br />
1598794331 6632 ROSEMEAD BLVD. PICO RIVERA 90660 (562) 654-2828 12 4 7 2 1/2/1997<br />
PILOSSYAN, VAGHARSHAK, MD 1457543076 13321 VICTORY BLVD VAN NUYS, 91401 (818) 780-0101 13 4 2 1 7/17/2008<br />
PINK LOTUS HEALTH CARE<br />
COPR<br />
1285852855 10024 S. VERMONT AVE LOS ANGELES 90044 (323) 242-0139 12 4 8 3 3/28/2011<br />
PITTS, RONALD A. 1477699486 1818 S. WESTERN AVE STE<br />
201<br />
LOS ANGELES 90006 (323) 731-8251 13 4 4 3 10/14/1980<br />
PLEITEZ, NURIA FRANCISCA, MD 1942361332 430 W. BADILLO ST COVINA 91723 (626) 859-2851 13 4 3 2 12/30/1994<br />
Monday, May 06, 2013 Page 29 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
PORRAL, AZUCENA A., MD 1881793743 5546 N. ROSEMEAD BLVD.,<br />
STE. 102<br />
TEMPLE CITY 91780 (626) 285-9600 13 4 3 2 9/15/2009<br />
PREMIER FAMILY MEDICINE<br />
ASSOCIATES INC.<br />
PREMIER FAMILY MEDICINE<br />
ASSOCIATES INC.<br />
1912907114 1770 N ORANGE GROVE<br />
AVE. STE 101<br />
POMONA 91767 (909) 469-9494 25 4 3 2 10/3/2002<br />
1164668786 1601 N. MONTE VISTA AVE.,<br />
STE. 100<br />
CLAREMONT 91711 (909) 630-7938 12 4 3 2 11/14/2011<br />
PRIETO, JOSE N, MD 1407942311 4566 EAST FLORENCE AVE.<br />
STE 2<br />
CUDAHY 90201 (323) 582-7186 13 4 7 2 5/5/1999<br />
PRIMA VIDA MEDICAL CLINIC 1407143464 8706 IMPERIAL HIGHWAY DOWNEY 90242 (562) 923-8300 13 4 7 2 2/28/2013<br />
PRIME HEALTH MEDICAL GROUP 1538256193 3228 SANTA ANITA AVE. EL MONTE 91733 (626) 444-9161 12 4 3 2 9/24/1997<br />
ProHealth Partners, A Medical Grp,<br />
Inc.<br />
1093848509 5750 downey avenue, suite 100 lakewood 90712 (562) 630-3105 12 4 7 2 4/2/2012<br />
PROSPERA GROUP CORP. 1285711937B 3831 HUGHES AVE STE 602 CULVER CITY 90232 (310) 204-6897 12 4 5 3 3/10/2009<br />
PROTESTANT CHURCH<br />
CLEAVER FAM WELLNES CL<br />
PUEBLO MEDICAL ASSOCIATE,<br />
INC<br />
QUEENSCARE FAMILY CLINIC -<br />
BRESEE<br />
QUEENSCARE FAMILY CLINIC -<br />
HOLLYWOOD<br />
QUEENSCARE FAMILY CLINIC-<br />
ECHO PARK<br />
1245248376 4368 SANTA ANITA AVE EL MONTE 91731 (626) 579-0290 25 4 3 2 4/7/2000<br />
1407033277 529 N. AZUSA AVE. AZUSA 91702 (626) 334-4061 12 4 3 2 8/26/2008<br />
1093886251 184 S. BIMINI PL. LOS ANGELES 90004 (213) 858-5126 22 4 4 3 4/9/2008<br />
1639241888 4618 FOUNTAIN AVENUE LOS ANGELES 90029 (323) 953-7191 22 4 4 3 9/24/2002<br />
1013083666 150 N RENO ST. LOS ANGELES 90026 (213) 380-7298 22 4 4 3 11/15/2002<br />
QUEENSCARE FAMILY CLINICS 1164593331 133 N. SUNOL DRIVE LOS ANGELES 90063 (323) 981-1660 25 4 7 2 8/5/2002<br />
QUEENSCARE FAMILY CLINICS 1104075282 4560 E. CESAR CHAVEZ AVE. LOS ANGELES 90022 (323) 780-4510 22 4 7 2 11/10/2010<br />
QUEENSCARE FAMILY CLINICS 1801967062 4448 YORK BLVD LOS ANGELES 90041 (323) 344-5233 25 4 4 3 11/12/2002<br />
RACHNA, RAWAL MD INC. 1295062214 14930 IMPERIAL HWY # A LA MIRADA 90638 (562) 906-1200 13 4 7 2 2/21/2006<br />
RADLEY AND COHEN AMC 1790716447 14124 FOOTHILL BLVD. STE.<br />
100<br />
SYLMAR 91342 (818) 367-1012 13 4 2 1 3/6/2003<br />
RAFAELOFF, PARVANEH, MD 1548305444 1030 S. GLENDALE AVE STE<br />
308<br />
GLENDALE 91205 (818) 265-1255 13 4 2 1 5/30/1996<br />
RAM, ASHER, M.D. CENTRO<br />
MED FAM<br />
1609803733 14547 VICTORY BLVD. VAN NUYS 91411 (818) 997-3232 13 4 2 1 4/30/1990<br />
RAMBHATLA, SAVITRI K. MD, INC 1487663837 111 W BEVERLY BLVD. STE<br />
220<br />
MONTEBELLO 90640 (323) 726-6200 13 4 7 2 8/26/1992<br />
RANGARAJAN, ALAGIA S, MD 1841382025 3131 SANTA ANITA AVE<br />
STE.102<br />
EL MONTE 91733 (626) 448-6222 13 4 3 2 9/3/1985<br />
RAQUENO, CATHERINE A. MD,<br />
INC<br />
1083722847 4566 FLORENCE AVE., STE.<br />
1<br />
CUDAHY 90201 (323) 771-1433 13 4 7 2 2/28/2002<br />
Monday, May 06, 2013 Page 30 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
REGULLANO, JOSE B., MD 1639270051 2101 W. BEVERLY BLVD.,<br />
STE 202<br />
MONTEBELLO 90640 (323) 888-2058 13 4 7 2 2/25/2002<br />
REMEDIOS, ELIZABETH MD 1639273105 423 W. COLORADO BLVD. GLENDALE 91204 (818) 507-8022 13 4 2 1 12/23/1987<br />
RESEDA FAMILY MEDICINE 1861629222 6830 RESEDA BLVD RESEDA 91335 (818) 996-4888 12 4 2 1 5/12/2010<br />
REY, MA MILDRED R. MD. 1669551891 16415 S. COLORADO AVE<br />
STE 308<br />
PARAMOUNT 90723 (562) 630-5581 13 4 6 3 12/22/1988<br />
RHEE, IN SOOK, MD 1619073806 4220 W. 3RD STREET STE<br />
205<br />
LOS ANGELES 90020 (213) 386-0183 13 4 4 3 10/25/1982<br />
RIO HONDO MEDICAL GROUP 1609972777 12444 E. WASHINGTON<br />
BLVD.<br />
WHITTIER 90602 (562) 698-0161 13 4 7 2 4/10/1978<br />
RODRIGUEZ, EVA B., MD INC. 1639266141 1403 LOMITA BLVD., STE. 305 HARBOR CITY 90710 (310) 325-4344 13 4 8 3 9/23/2010<br />
RODRIGUEZ, MARIA E., MD, INC 1023179546 2417 WHITTIER BLVD. LOS ANGELES 90023 (323) 881-1641 13 4 4 3 3/21/2001<br />
ROGECE A PROFESSIONAL<br />
MEDICAL CORP<br />
1194837518 18433 ROSCOE BLVD.,<br />
SUITE 103<br />
NORTHRIDGE 91325 (818) 734-7620 13 4 2 1 2/25/2003<br />
ROSTAMI, MIKE MD 1710073390 1119 N. WESTERN AVE.,<br />
STE. G<br />
LOS ANGELES 90029 (323) 957-9300 13 4 4 3 12/11/2008<br />
ROXAS-BUTLIG, EVANGELINE G.<br />
MD<br />
1225366305 1000 E. DOMINGUEZ ST.,<br />
STE. #110<br />
CARSON 90746 (310) 715-7755 13 4 8 3 11/30/2005<br />
ROY MEDICAL GROUP, INC 1801921952C 1543 E. PALMDALE BLVD.<br />
SUITE C<br />
PALMDALE 93550 (661) 274-1200 12 4 1 1 10/20/2008<br />
ROY, MEDICAL GROUP INC 1801921952B 21001 SHERMAN WAY STE<br />
15<br />
CANOGA PARK 91303 (818) 716-0048 12 4 2 1 3/25/1997<br />
ROY, RITA, MD 1306900832 11480 BROOKSHIRE AVE. #<br />
105<br />
DOWNEY 90241 (562) 622-1100 13 4 7 2 12/11/1981<br />
ROY, ROSALINDA, MD 1801921952A 16063 VANOWEN ST. VAN NUYS 91406 (818) 785-9989 12 4 2 1 3/25/1997<br />
RUDISON, JOSEPH C MD 1073543815 9014 S. BROADWAY LOS ANGELES 90003 (323) 755-1155 13 4 6 3 6/5/2000<br />
RUIZ, RUBEN, MD 1245261023 9201 E. WHITTIER BLVD. PICO RIVERA 90660 (562) 908-7588 12 4 7 2 1/9/1996<br />
RUSSELL, HUBERT A. MD. 1114062445 3831 HUGHES AVENUE STE<br />
601<br />
CULVER CITY 90232 (310) 204-0223 13 4 5 3 3/15/2001<br />
SABABA, LILIAN E., MD 1891806329 866 N. VERMONT AVE. # 1 LOS ANGELES 90029 (323) 660-2100 13 4 4 3 6/16/1992<br />
SABAN FREE CLINIC/ LOS<br />
ANGELES FREE CLINIC<br />
HOLLYWOOD<br />
1336281179A 5205 MELROSE AVENUE LOS ANGELES 90038 (323) 653-8622 2 4 4 3 4/1/2003<br />
SACHANI, MEHBOOB A., MD 1144268657 18433 ROSCOE BLVD. STE<br />
203<br />
NORTHRIDGE 91325 (818) 993-0506 13 4 2 1 3/31/1982<br />
SACHDEVA, REKHA, M.D. / A<br />
PROF CORP<br />
SACRED HEART FAMILY<br />
MEDICAL CLINIC, INC<br />
1255582094 3229 SANTA ANITA AVE. EL MONTE 91733 (626) 459-5420 13 4 3 2 12/21/1994<br />
1174538540 8540 ALONDRA BLVD STE B2 PARAMOUNT 90723 (562) 602-2508 12 4 6 3 5/1/2001<br />
Monday, May 06, 2013 Page 31 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
SAINT ANTHONY MEDICAL<br />
CENTER/ HOLLYWOOD CLINIC<br />
SAINT JOSEPH FAMILY<br />
MEDICAL CLINIC INC<br />
1063562130 6368 HOLLYWOOD BLVD LOS ANGELES 90028 (323) 469-5555 22 4 4 3 8/20/2012<br />
1023243193 8401 LONG BEACH BLVD SOUTH GATE 90280 (323) 277-9010 12 4 3 2 7/8/2010<br />
SAKHAI, YUSSEF MD 1518992015 6360 WILSHIRE BLVD. STE<br />
305<br />
LOS ANGELES 90048 (323) 653-3500 13 4 4 3 5/16/2000<br />
SALAZAR, TERESITA, MD INC. 1710159223 17403 WOODRUFF AVENUE BELLFLOWER 90706 (562) 804-0742 12 4 7 2 9/4/2003<br />
SALEHANI, FOAD, MD / DR. F<br />
SALEHANI PEDIATRICS<br />
SALIMPOUR PEDIATRIC MED<br />
GRP INC.<br />
SALIMPOUR PEDIATRIC<br />
MEDICAL GROUP INC.<br />
SALIMPOUR PEDIATRIC<br />
MEDICAL GROUP, INC.<br />
1669526513 922 S. ATLANTIC BLVD. LOS ANGELES 90022 (323) 262-2100 13 4 7 2 5/5/1999<br />
1871632141B 6618 VAN NUYS BLVD. VAN NUYS 91405 (818) 908-9962 12 4 2 1 8/14/1998<br />
1871632141A 15477 VENTURA BLVD.,<br />
THIRD FLOOR<br />
SHERMAN OAKS 91403 (818) 907-0322 12 4 2 1 2/18/1999<br />
1871632141C 15253 ROSCOE BLVD. PANORAMA CITY 91402 (818) 920-9947 12 4 2 1 1/8/2003<br />
SALUD DIGNA, INC 1639468325 5900 PACIFIC BLVD., STE.<br />
101<br />
HUNTINGTON PA 90255 (323) 570-0600 25 4 7 2 1/31/2013<br />
SAMUEL DIXON FAMILY HEALTH<br />
CENTER, INC.<br />
SAMUEL DIXON FAMILY HLTH<br />
CTR<br />
SAMUEL DIXON FAMILY HLTH<br />
CTR / NEWHALL HEALTH CTR<br />
1154402675B 27225 CAMP PLENTY ROAD,<br />
STE 2<br />
CANYON COUNT 91351 (661) 424-1220 25 4 2 1 8/7/2001<br />
1154402675A 30257 SAN MARTINEZ RD VAL VERDE 91384 (661) 257-4008 25 4 2 1 2/1/1991<br />
1154402675C 23772 NEWHALL AVE NEWHALL 91321 (661) 257-7892 25 4 2 1 11/22/2011<br />
SAN DIEGO ROSITA D MD 1467652602 7100 VAN NUYS BLVD STE.<br />
115<br />
VAN NUYS 91405 (818) 786-8601 13 4 2 1 11/6/2008<br />
SAN GABRIEL HEALTH CLINIC 1073534608 2630 SAN GABRIEL BLVD.,<br />
SUITE 105<br />
ROSEMEAD 91770 (626) 288-2007 12 4 3 2 9/26/2006<br />
SAN MARTIN DE PORRES MED<br />
CL<br />
SAN MARTIN DE PORRES MED<br />
CL OF SOUTH GATE<br />
SAN MATEO MEDICAL CLINIC<br />
INC<br />
1215953609 9315 TELEGRAPH RD PICO RIVERA 90660 (562) 654-6855 13 4 7 2 6/7/2001<br />
1134298318 10001 CALIFORNIA AVE SOUTH GATE 90280 (323) 564-4408 12 4 7 2 8/14/1995<br />
1881795003 4055 E. WHITTIER BLVD LOS ANGELES 90023 (323) 780-4000 12 4 4 3 1/22/1999<br />
SAN MIGUEL MEDICAL CLINIC 1801992565 8204 LONG BEACH BLVD.<br />
STE B<br />
SOUTH GATE 90280 (323) 588-3300 12 4 7 2 10/29/1995<br />
SAN PEDRO PEDIATRIC MED<br />
GRP<br />
SANATHRA, MAHENDRA G.<br />
MD/ANGEL FAM. MED.AL PRACT<br />
1255446142 1294 W. 6TH ST, STE 102 SAN PEDRO 90731 (310) 832-6487 12 4 8 3 8/4/1995<br />
1134206436 2015 E. FLORENCE AVENUE LOS ANGELES 90001 (323) 581-0000 13 4 6 3 5/16/1994<br />
SANCHEZ, DENNIS J MD 1205859733B 3529 FIRESTONE BLVD. SOUTH GATE 90280 (323) 566-1700 13 4 7 2 9/2/1998<br />
SANCHEZ, DENNIS, MD 1205859733A 9306 ALONDRA BLVD. BELLFLOWER 90706 (562) 866-9100 13 4 7 2 10/2/2003<br />
Monday, May 06, 2013 Page 32 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
SANCHEZ-BAL, VICTORIA MD 1821105610 9604 E ARTESIA BLVD STE<br />
202<br />
BELLFLOWER 90706 (562) 925-2625 13 4 7 2 5/19/1987<br />
Santa Marias Children and Family<br />
Center<br />
SANTA ROSA FAMILY CARE<br />
CTR., ANC<br />
SANTIAGO-SORIANO, SUSANA<br />
V., MD<br />
1184948598 9209 Colima rd suite 4400 whittier 90605 (562) 907-0777 25 4 3 2 10/27/2011<br />
1083836274 5015 WHITTIER BLVD. LOS ANGELES 90022 (323) 981-2930 14 4 7 2 11/7/2008<br />
1336296565 3908 BEVERLY BLVD., LOS ANGELES, 90004 (213) 388-2508 13 4 4 3 8/5/2002<br />
SANTO NINO MEDICAL CLINIC 1770685612 14427 CHASE ST PANORAMA CITY 91402 (818) 830-7751 13 4 2 1 5/29/2003<br />
SANTO TOMAS MEDICAL CLINIC 1255400669 7862 E. FIRESTONE BLVD. DOWNEY 90241 (562) 869-7007 12 4 7 2 2/10/1994<br />
SANTOSH K. GARG, MD 1598933293 1535 W. MERCED AVE.,<br />
STE., 300<br />
WEST COVINA 91790 (626) 962-8122 13 4 3 2 8/14/2001<br />
satey, fariborz d md inc 1356489629A 44215 n 15th st west suite 115 lancaster 93534 (661) 272-5656 13 4 1 1 10/3/2012<br />
SAUNDERS, JAMES E. MD INC 1104839091 3737 MARTIN LUTHER KING<br />
JR. BLVD. #204<br />
LYNWOOD 90262 (310) 537-1221 13 4 6 3 3/15/1983<br />
SEDRAK, BOTHYNA F. MD 1750472965 3650 E. SOUTH STREET STE LAKEWOOD<br />
209<br />
90712 (562) 634-1254 13 4 7 2 3/24/1983<br />
SERRA COMMUNITY MEDICAL<br />
CLINIC<br />
1275545725 9375 SAN FERNANDO ROAD SUN VALLEY 91352 (818) 768-3000 12 4 2 1 4/19/2001<br />
SEVILLA MEDICAL GROUP INC. 1871757302 2813 N. BROADWAY LOS ANGELES 90031 (323) 342-9764 12 4 4 3 4/8/2009<br />
SGHIATTI, VINCENT R. MD 1750469318 6316 Holmes Ave. LOS ANGELES 90001 (323) 583-5887 13 4 6 3 4/20/2004<br />
SHAFAI, JAMSHID, MD, INC 1467633586 7601 ATLANTIC AVENUE CUDAHY 90201 (323) 562-3500 12 4 7 2 10/28/1996<br />
Shagufta Qazi, MD, Inc. 1326216599 3655 Lomita Blvd., Ste 414 Torrance 90505 (310) 791-7400 13 4 8 3 9/28/2009<br />
SHAH, KIRITKUMAR S, MD 1942246285 3434 WHITTIER BLVD. LOS ANGELES 90023 (323) 268-6751 13 4 4 3 10/28/1991<br />
SHAHEEDY, MOHAMAD MD 1699855098 5400 BALBOA BLVD., #210 ENCINO 91316 (818) 501-7111 13 4 2 1 7/29/1983<br />
SHALABI, KAIED OTHMAN MD 1598857815 453 E. ARROW HIGHWAY<br />
STE B<br />
AZUSA 91702 (626) 915-1748 13 4 3 2 6/23/1987<br />
SHAMAAN, IHSAN N MD/CLINICA<br />
SAN JUDAS<br />
SHANE MEDICAL OFFICE CORP.<br />
DBA MAYWOOD URGENT CARE<br />
1407130883 4946 E. FLORENCE AVE. BELL 90201 (323) 773-0591 12 4 7 2 4/26/1996<br />
1548309560 4316 E. SLAUSON AVE. MAYWOOD 90270 (323) 773-2020 12 4 7 2 5/24/2005<br />
SHARYAR MANAVI, MD INC. 1578525911 214 N. CENTRAL AVE GLENDALE 91203 (818) 241-0970 12 4 2 1 9/2/2004<br />
SHENOUDA, EMILE G. MD., INC/<br />
CENTRO MEDICO<br />
GUADALUPANO PARA LA<br />
FAMILIA<br />
1760596845B 10132 CALIFORNIA AVE SOUTH GATE 90280 (323) 566-4411 13 4 7 2 9/30/2002<br />
SHENOUDA, EMILE MD 1760596845A 15340 DEVONSHIRE ST.,<br />
STE 8<br />
MISSION HILLS 91345 (818) 894-9411 13 4 2 1 11/29/2000<br />
Monday, May 06, 2013 Page 33 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
SHIH, JENNIFER LING--JIUN, MD 1750447264 4124 N. ROSEMEAD BLVD.,<br />
STE A<br />
ROSEMEAD 91770 (626) 285-2477 13 4 3 2 10/25/1995<br />
SHINE HEALTHCARE INC 1568760239 12371 IMPERIAL HIGHWAY NORWALK 90650 (562) 929-5000 12 4 7 2 1/3/2013<br />
SHOHAM, STEVEN C, MD 1841290400 10515 BALBOA BLVD. STE<br />
360<br />
GRANADA HILLS 91344 (818) 832-3322 13 4 2 1 12/15/1989<br />
SHUE, RANDALL G. DO 1679576730A 4055 E. OLYMPIC BLVD. #210 LOS ANGELES 90023 (323) 268-3491 13 4 4 2 6/2/1989<br />
SHUE, RANDALL G. DO, INC 1679576730B 11850 E. FIRESTONE BLVD<br />
STE 1.<br />
NORWALK 90650 (562) 281-1002 13 4 7 3 10/18/2002<br />
SILKA ENTERPRISES INC.<br />
SALUD FAM MED CL<br />
1952526915 5230 W. SUNSET BLVD. STE<br />
B<br />
LOS ANGELES 90027 (323) 750-7354 12 4 4 3 6/5/2000<br />
SIMONIAN, NUNE A MD 1205967916 540 N. CENTRAL AVE STE<br />
301<br />
GLENDALE 91203 (818) 242-3916 13 4 2 1 4/7/1999<br />
SINGH, PRADEEP MD INC 1295751840 44725 10TH ST, WEST # 220 LANCASTER 93534 (661) 948-7057 13 4 1 1 8/24/2010<br />
SOCAL HEALTHNET INC 1487832655 5912 Santa Monica Blvd. Los Angeles 90038 (323) 461-3888 12 4 4 3 6/26/2008<br />
SOLIMAN, TAHANI MD, INC 1902906985 6526 RUGBY AVE. HUNTINGTON PA 90255 (323) 583-2247 12 4 7 2 1/13/2005<br />
SORAYA MEDICAL GROUP INC 1285782664A 2701 FIRESTONE BLVD STE<br />
W<br />
SOUTH GATE 90280 (323) 249-6162 12 4 7 2 1/31/2000<br />
SORAYA MEDICAL GROUP INC. 1285782664B 11702 W. IMPERIAL HWY.<br />
STE 110<br />
NORWALK 90650 (562) 406-8655 12 4 7 2 2/17/2000<br />
SOTOMAYOR, SALVADOR M, MD 1265617393 5036 PASSONS BLVD.<br />
SUITE 2<br />
PICO RIVERA 90660 (562) 654-2800 12 4 7 2 5/20/1998<br />
SOUTH ATLANTIC MEDICAL<br />
GROUP<br />
SOUTH ATLANTIC MEDICAL<br />
GROUP<br />
SOUTH ATLANTIC MEDICAL<br />
GROUP<br />
SOUTH BAY FAMILY<br />
HEALTHCARE CENTER<br />
SOUTH BAY FAMILY<br />
HEALTHCARE CENTER<br />
SOUTH BAY FAMILY<br />
HEALTHCARE CENTER-<br />
INGLEWOOD<br />
SOUTH CENTRAL FAMILY<br />
HEALTH / S. MARK TAPER FNDN<br />
HEALTH<br />
SOUTH CENTRAL FAMILY<br />
HEALTH CENTER<br />
1801079728 11518 GARVEY AVENUE EL MONTE 91732 (626) 575-4584 12 4 3 2 9/2/1988<br />
1306029806 1030 W. GARDENA BLVD. GARDENA 90247 (310) 323-9999 12 4 8 3 1/21/1992<br />
1710160627 5504 E. WHITTIER BLVD. LOS ANGELES 90022 (323) 725-0167 12 4 7 2 5/22/1985<br />
1548301229 2114 ARTESIA BLVD. REDONDO BEAC 90278 (310) 318-2521 22 4 8 3 11/2/2004<br />
1871634568 742 W. GARDENA BLVD. GARDENA 90247 (310) 327-1357 22 4 8 3 11/2/2004<br />
1255472924 1091 S. LA BREA AVE. INGLEWOOD 90301 (310) 330-2960 22 4 8 3 8/31/2005<br />
1487923306 4000 S. MAIN STREET LOS ANGELES 90037 (323) 908-4200 22 4 6 3 10/26/2005<br />
1396891909 4425 S.CENTRAL AVENUE LOS ANGELES 90011 (323) 908-4200 25 4 6 3 12/1/1994<br />
Monday, May 06, 2013 Page 34 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
SOUTH CENTRAL FAMILY<br />
HEALTH CTR<br />
SOUTHERN CALIFORNIA<br />
MEDICAL CENTER, INC<br />
SOUTHERN CALIFORNIA<br />
MEDICAL CENTER, INC.<br />
SOUTHWEST TREATMENT CTR.,<br />
INC / SOUTHWEST COMM CLINIC<br />
1669799896 2680 SATURN AVE STE #<br />
110, 220 & 280<br />
HUNTINGTON PA 90255 (323) 908-4200 22 4 7 2 7/13/2012<br />
1225357114 12100 VALLEY BLVD., STE<br />
109A<br />
EL MONTE 91732 (626) 575-7500 25 4 3 2 6/7/1995<br />
1932428828 8825 WHITTIER BLVD. PICO RIVERA 90660 (562) 699-3333 25 4 7 2 7/7/1998<br />
1710268263 349 W. COMPTON BLVD. COMPTON 90220 (310) 669-9300 25 4 6 3 1/10/2013<br />
SPECIAL CARE PEDIATRICS 1457471013 19231 VICTORY BLVD. SUITE RESEDA<br />
210<br />
91335 (818) 881-8210 12 4 2 1 8/23/2006<br />
SREEDHAR CHAVA MD INC 1700023942 3580 SANTA ANITA AVE.,<br />
SUITE A<br />
EL MONTE 91731 (626) 444-2660 13 4 3 2 6/23/2009<br />
SRINIVASAN, R. S. MD INC 1780733923 941 S. ATLANTIC BLVD.,<br />
#101-102<br />
MONTEREY PAR 91754 (626) 458-8401 12 4 3 2 1/29/2002<br />
ST ANTHONY MEDICAL CENTER<br />
/ PICO CLINIC<br />
1952451031 2515 WEST PICO BLVD LOS ANGELES 90006 (213) 384-4555 22 4 4 3 8/20/2012<br />
ST. FRANCIS MEDICAL CENTER 1487697215E 3628 E. IMPERIAL HWY., STE<br />
303<br />
LYNWOOD 90262 (310) 900-7360 2 4 6 3 1/1/2002<br />
ST. FRANCIS MEDICAL CENTER<br />
(BUSINESS OFFICE)<br />
ST. FRANCIS MEDICAL<br />
CENTER/COMPTON SOUTH<br />
CLINIC<br />
ST. FRANCIS MEDICAL<br />
CENTER/DOWNEY CLINIC<br />
ST. FRANCIS MEDICAL<br />
CLINIC/HUNTINGTON PARK<br />
CLINIC<br />
St. Isabel Family Medical Clinic<br />
INC.<br />
ST. JOHN'S WELL CHILD &<br />
FAMILY CTR., INC<br />
ST. JOHNS WELL CHILD &<br />
FAMILY CENTER<br />
ST. JOHN'S WELL CHILD &<br />
FAMILY CENTER<br />
ST. JOHN'S WELL CHILD &<br />
FAMILY CENTER<br />
ST. JOHNS WELL CHILD AND<br />
FAMILY CENTER<br />
ST. JOHN'S WELL CHILD AND<br />
FAMILY CENTER INC.<br />
1487697215 3630 E. IMPERIAL HWY. LYNWOOD 90262 (310) 900-7346 2 4 6 3 1/1/2002<br />
1487697215A 457 S. LONG BEACH BLVD. COMPTON 90221 (310) 761-8461 2 4 6 3 1/1/2002<br />
1487697215C 7840 E IMPERIAL HWY., STE<br />
B<br />
DOWNEY 90242 (310) 603-6552 2 4 6 3 1/1/2002<br />
1487697215D 2700 SLAUSON AVE. HUNTINGTON PA 90255 (323) 588-8558 2 4 6 3 1/1/2002<br />
1700057981 1535 W. Lomita Blvd. Harbor City 90710 (310) 530-9300 13 4 8 3 2/18/2009<br />
1396981700 4131 S. VERMONT AVE. LOS ANGELES 90037 (323) 541-1631 22 4 6 3 6/17/2009<br />
1801028303 15301 SAN JOSE COMPTON 90221 (562) 630-6825 25 4 6 3 10/4/2012<br />
1043542111 15715 S. ATLANTIC AVE 2ND<br />
FLOOR<br />
COMPTON 90221 (310) 604-5000 22 4 6 3 11/10/2010<br />
1003068206 6505 8th AVE. Los Angeles 90043 (323) 750-9232 22 4 6 3 7/7/2009<br />
1013057371 5701 SOUTH HOOVER ST. LOS ANGELES 90037 (323) 541-1400 25 4 6 3 12/19/2007<br />
1285874826 808 WEST 58TH STREET LOS ANGELES 90037 (323) 541-1600 22 4 8 3 3/11/2010<br />
Monday, May 06, 2013 Page 35 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
ST. JOHN'S WELL CHILD CENTER 1073653630 1910 S. MAGNOLIA AVE.,<br />
STE. 101<br />
LOS ANGELES 90007 (213) 749-0947 22 4 6 3 2/14/2002<br />
ST. JOHN'S WELL CHILD<br />
CTR/COMPTON<br />
ST. JOHN'S WELL CHILD/FAMILY<br />
CENTER LINCOLN HGHTS<br />
1932249596 2115 N. WILMINGTON AVE. COMPTON 90222 (310) 603-1332 22 4 6 3 4/23/2005<br />
1932249505 2512 ALTA ST. LOS ANGELES 90031 (323) 541-1600 22 4 4 3 7/15/2005<br />
ST. PAUL MEDICAL CLINIC APC 1629142062 7400 VAN NUYS BLVD., STE.<br />
112<br />
VAN NUYS 91405 (818) 989-2406 13 4 2 1 5/1/2006<br />
ST. PAUL MEDICAL CTR. OF<br />
THE SOUTH BAY<br />
STEINBERG, DAVID N., MD INC/<br />
PICO UNION FAM. CARE<br />
1447262522 12923 INGLEWOOD AVE.,<br />
STE.1<br />
HAWTHORNE 90250 (310) 675-0395 12 4 8 3 2/26/1990<br />
1730300617 1513 S. GRAND AVE. SUITE<br />
320<br />
LOS ANGELES 90015 (213) 380-8484 13 4 4 3 9/11/2008<br />
STEWART & STEWART MDs INC 1306058565 1024 S. GARFIELD AVE. ALHAMBRA 91801 (626) 289-5181 12 4 3 2 8/5/1986<br />
SUCGANG, PAUL DO INC 1508178930 416 W LAS TUNAS DR. STE.<br />
201<br />
SAN GABRIEL 91776 (626) 389-8448 13 4 3 2 11/4/2010<br />
SULTANA, SAYEEDA MD 1497841258A 5060 ROSEMEAD BLVD. PICO RIVERA 90660 (562) 942-9895 13 4 7 2 1/6/2009<br />
SULTANA, SAYEEDA MD 1497841258B 1788 SIERRA LEONE AVE<br />
STE. 105<br />
ROWLAND HEIGH 91748 (626) 965-0150 13 4 3 2 12/21/2011<br />
SUN, JENNIFER C., MD INC 1225087836 689 W. FOOTHILL BLVD.,<br />
STE. B<br />
CLAREMONT 91711 (909) 392-3230 13 4 3 2 10/6/2006<br />
SUNDARAM FAMILY MEDICAL 1053691766 3001 E. FLORENCE AVE HUNTINGTON PA 90255 (323) 589-0927 12 4 7 2 7/5/2012<br />
SUNDARAM, JAWAHAR, MD. 1518110287 987 W. VERNON AVE. LOS ANGELES 90037 (323) 234-6300 12 4 6 3 5/9/2006<br />
SUNSHINE MEDICAL CLINIC 1386721900 555 W. COMPTON BLVD.,<br />
STE 104<br />
COMPTON 90220 (310) 639-7200 12 4 6 3 10/10/2001<br />
SUPERIOR MULTISPECIALTY<br />
MEDICAL CLINIC INC.<br />
1770774366 11600 VENICE BLVD. LOS ANGELES 90066 (310) 390-9551 12 4 5 3 7/2/1998<br />
SUPNET, MEDARDO C MD 1699923235 3585 E. IMPERIAL HWY. LYNWOOD 90262 (310) 605-4260 12 4 6 3 12/15/1993<br />
SUPNET, MEDARDO C., MD INC 1417069303 11637 THE PLAZA NORWALK 90650 (562) 864-7279 12 4 7 2 2/2/2006<br />
SURA, ANJANA S. MD 1972530418A 1336 WHITTIER BLVD. MONTEBELLO 90640 (323) 726-2255 13 4 7 2 10/12/1979<br />
SUYAT, GEORGE U, M.D. 1023047669 2105 BEVERLY BLVD. #131 LOS ANGELES 90057 (213) 413-8836 13 4 4 3 2/9/1999<br />
SWANSON, WILLIAM D., MDc 1568521938 4200 NO. PECK RD, STE B EL MONTE 91732 (626) 350-5073 13 4 3 2 11/15/2004<br />
SWEENY, ALFREDO MD INC 1962538173 4719 SOUTH BROADWAY LOS ANGELES 90037 (323) 231-9983 12 4 6 3 9/29/2001<br />
SWEENY, ALFREDO E MD 1598836108 3706 SUNSET BLVD. LOS ANGELES 90026 (323) 669-1036 13 4 4 3 3/17/1992<br />
T.H.E. CLINIC AT RUTH TEMPLE<br />
H C<br />
1023287679 3834 S. WESTERN AVENUE LOS ANGELES 90062 (323) 730-1920 25 4 6 3 6/5/1998<br />
T.H.E. CLINIC INC 1023287679STA 10223 FIRMONA AVE LENNOX 90304 (323) 730-1920 4 8 4 4/22/2013<br />
Monday, May 06, 2013 Page 36 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
TABIB, MONA 1801990239 16661 VENTURA BLVD. #211 ENCINO 91436 (818) 789-7893 13 4 2 1 9/28/1993<br />
TADROS, GEORGETTE 1598869018 931 BUENA VISTA DRIVE<br />
#202<br />
DUARTE 91010 (626) 301-1515 13 4 3 2 11/7/1989<br />
TALBERT MEDICAL<br />
CORPORATION<br />
1720171325 3650 E SOUTH ST SUITE 303 LAKEWOOD 90712 (562) 633-9734 12 4 7 2 7/20/2009<br />
TALBERT MEDICAL GROUP 1326049800 818 W. ALONDRA BLVD.. COMPTON 90220 (310) 537-1337 12 4 6 3 1/8/2001<br />
TALBERT MEDICAL GROUP INC. 1225039704 8311 FLORENCE AVE. DOWNEY 90240 (562) 923-4911 12 4 7 2 3/6/2001<br />
TAMARI, MANSOUR, MD 1720269194 9146 SEPULVEDA BLVD. NORTH HILLS 91343 (818) 920-1133 13 4 2 1 7/20/1999<br />
TAMHANE, SHRIKANT K. DO. /<br />
SOUTH BAY FAM. MED. CLINIC<br />
TAN, TERENCE TZ MD/TERENCE<br />
T Z TAN MD INC<br />
1497868251 23517 S. Main St., Ste. 103 Carson 90745 (310) 834-5388 13 4 8 3 1/12/2009<br />
1699822239 3301 BEECHWOOD AVENUE LYNWOOD 90262 (310) 638-5188 13 4 6 3 12/8/1992<br />
TAN, TERESITA E. 1396835633 244 S. OXFORD AVE, STE 9 LOS ANGELES 90004 (213) 382-1770 13 4 4 3 10/5/1984<br />
TARZANA TREATMENT CENTER,<br />
FAMILY MEDICAL CLINIC<br />
TARZANA TREATMENT<br />
CENTER/FAMILY MED CLINIC<br />
TAVARUA MEDICAL & MENTAL<br />
SERVICES<br />
TAY, EMERALD S., MD A PROF<br />
CORP<br />
1881710861 907 W. LANCASTER BLVD. LANCASTER 93534 (661) 723-4829 12 4 1 1 8/20/2001<br />
1427043389 8330 RESEDA BLVD. NORTHRIDGE 91324 (818) 534-1820 25 4 2 1 8/22/2002<br />
1427127174 8207 WHITTIER BLVD. PICO RIVERA 90660 (562) 692-2522 25 4 7 2 1/1/1991<br />
1023143344 222 E. VALLEY BLVD. SAN GABRIEL 91776 (626) 307-8636 13 4 3 2 10/23/2009<br />
TEPERSON, ANDREW L, MD 1598705170 1224 E. AVE S ,STE .A PALMDALE 93550 (661) 274-8666 13 4 1 1 6/8/2005<br />
TERESA MEDICAL CENTER INC. 1205056033B 326 N. VERMONT AVE LOS ANGELES 90004 (323) 660-5900 12 4 4 3 8/5/2009<br />
TERESA MEDICAL CENTER, INC. 1205056033A 2631 W. OLYMPIC BLVD. LOS ANGELES 90006 (213) 383-9955 12 4 4 3 6/29/2002<br />
THE NORTHEAST COMMUNITY<br />
CLINIC<br />
THE NORTHEAST COMMUNITY<br />
CLINIC / ELIZABETH HLTH CTR<br />
1891028171 4455 W. 117TH ST., STE. #300 HAWTHORNE 90250 (310) 645-0444 25 4 8 3 11/23/2010<br />
1881987576 4811 ELIZABETH CTR CUDAHY 90201 (323) 923-1900 22 4 7 2 4/30/2012<br />
THE SABAN FREE CLINIC 1235271065 6043 HOLLYWOOD BLVD. LOS ANGELES 90028 (323) 653-8622 25 4 6 3 3/10/2003<br />
THE VALLEY CLINICA MED GEN<br />
MED CTR INC<br />
THENAPPAN, ANNAPOORANI<br />
MD. INC<br />
1962459479 6511 VAN NUYS BLVD. VANNUYS 91401 (818) 901-9090 12 4 2 1 3/9/2012<br />
1982959243 1701 E. CESAR E. CHAVEZ<br />
AVE. STE. 128<br />
LOS ANGELES 90033 (323) 223-2338 13 4 4 3 8/29/2006<br />
TOMASSIAN, VRISH, M.D. 1134292519 607 N. CENTRAL AVE., STE.,<br />
#307<br />
GLENDALE 91203 (818) 242-9370 13 4 2 1 5/11/1990<br />
TON, HOANG T. M.D. 1750480158 642 N. BROADWAY #2 LOS ANGELES 90012 (213) 620-1720 13 4 4 3 9/22/1983<br />
TOOMARI, TAJAV DO INC 1871880500 7100 VAN NUYS BLVD STE<br />
113<br />
VAN NUYS 91405 (818) 205-1666 13 4 2 1 6/4/2012<br />
Monday, May 06, 2013 Page 37 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
TOOMARI, TAJAV DO INC. 1326372830 16661 VENTURA BLVD., STE.<br />
504<br />
ENCINO 91436 (818) 205-1666 13 4 2 1 2/15/2011<br />
TRAN, KIET T., M.D. 1285636209 815 W. CESAR CHAVEZ AVE<br />
#201<br />
LOS ANGELES 90012 (213) 617-8246 13 4 4 3 9/6/1990<br />
TRAN, NGOC-MAI, MD 1467470823 3968 E. WHITTIER BLVD LOS ANGELES 90023 (323) 415-6100 13 4 7 2 4/3/2006<br />
TROMPETA, BELLAFLOR V.,<br />
M.D., A MEDICAL CORP.<br />
1922137272 18433 ROSCOE BLVD., STE.<br />
#104<br />
NORTHRIDGE 91325 (818) 993-9555 13 4 2 1 3/29/1980<br />
TRUONG, CAROLINE N. MD 1679579809 9014 E. GARVEY AVE #I ROSEMEAD 91770 (626) 572-3955 13 4 3 2 9/22/2005<br />
TSAI, MARK C. MD 1225033111 16415 SOUTH COLORADO<br />
AVE. #101<br />
PARAMOUNT 90723 (562) 634-6341 13 4 6 3 6/9/2011<br />
TWEETY FAMILY CLINIC INC. 1962685966 3050 TWEETY BLVD SOUTH GATE 90280 (323) 357-0700 12 4 7 2 3/17/2008<br />
UC REGENTS UCLA FHC LES<br />
KELLEY CENTER<br />
UCLA DEPT. OF PEDS. GROUP<br />
PRACTICE<br />
UCLA SCHOOL OF NURSING<br />
HEALTH CTR<br />
UNIVERSAL COMMUNITY<br />
HEALTH<br />
1275591802 1920 COLORADO AVENUE SANTA MONICA 90404 (310) 319-4700 12 4 5 3 6/28/2002<br />
1982667663 200 UCLA MED PLAZA<br />
CHILDRENS HLTH CTR #265<br />
LOS ANGELES 90095 (310) 825-0867 12 4 5 3 12/24/1992<br />
1710972351 545 S SAN PEDRO ST LOS ANGELES 90013 (213) 673-4849 25 4 4 2 8/6/2012<br />
1093023277 1005 E. WASHINGTON BLVD.<br />
STE. A<br />
LOS ANGELES 90021 (213) 745-3636 13 4 4 3 9/9/2004<br />
Universal Medical Clinic, INC 1760671077 18701 Sherman Way, Suite # 4 Reseda 91335 (818) 881-8989 12 4 2 1 7/29/2008<br />
UNIVERSAL PRIMARY CARE 1154386209 1560 E. CHEVY CHASE DR.<br />
STE. 245<br />
GLENDALE 91206 (818) 246-5900 12 4 2 1 3/17/2005<br />
UNIVERSAL PRIMARY CARE 1255396248 801 S CHEVY CHASE DR<br />
STE. 200<br />
GLENDALE 91204 (818) 637-7980 12 4 2 1 1/2/2002<br />
UNIVERSITY MUSLIM MED<br />
UMMA COMMUNITY CLINIC<br />
URGENT CARE AMERICA<br />
MEDICAL CLINIC INC.<br />
1720171242 711 W. FLORENCE AVE LOS ANGELES 90044 (323) 789-5610 22 4 8 3 4/10/2006<br />
1568663573 13470 TELEGRAPH ROAD WHITTIER 90605 (562) 906-7766 12 4 7 2 5/26/1998<br />
URIBE, DANIEL, M.D. 1922049279 13307 SAN ANTONIO DR NORWALK 90650 (562) 863-0124 13 4 7 2 2/10/1989<br />
USC CARE MEDICAL GROUP,<br />
INC.<br />
1902846306A 1520 SAN PABLO STREET,<br />
STE. 1300<br />
LOS ANGELES 90033 (323) 442-5900 12 4 4 3 12/22/2009<br />
UY, JIMMY TI, M.D. INC 1659561488 2011 W. BEVERLY BLVD. LOS ANGELES 90057 (213) 413-4777 13 4 4 3 9/29/1989<br />
VALLEY COMMUNITY CLINIC 1588740989 6801 COLDWATER CANYON<br />
AVE.<br />
NORTH HOLLYW 91605 (818) 763-8836 22 4 2 1 8/1/2002<br />
VALLEY COMMUNITY CLINIC 1588740989STA 11254 GOTHIC AVE ROOM<br />
S104<br />
GRANADA HILLS 91344 (818) 763-1718 22 4 2 1 3/16/2010<br />
VALLEY MISSION MEDICAL A<br />
MED CORP<br />
1942343785 220 N. MACLAY AVE., STE. 2 SAN FERNANDO 91340 (818) 837-1355 12 4 2 1 10/22/1994<br />
Monday, May 06, 2013 Page 38 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
VALLEY MISSION MEDICAL A<br />
MED CORP<br />
VALLEY PEDIATRICS A<br />
PMC/PREMIER PEDIATRICS<br />
MED. GRP INC<br />
VAN DINH NGUYEN MEDICAL<br />
CORPORATION<br />
1699818278 6410 VAN NUYS BLVD. STE B VAN NUYS 91401 (818) 908-2300 12 4 2 1 10/17/1997<br />
1043423460 14901 RINALDI ST., STE 330 MISSION HILLS 91345 (818) 365-7778 12 4 2 1 9/11/2002<br />
1063458503 7128 SEVILLE AVENUE HUNTINGTON PA 90255 (323) 588-2186 12 4 7 2 2/6/1998<br />
VARMA, USHA K., M.D. 1457362527 316 E. LAS TUNAS DRIVE<br />
STE 206<br />
SAN GABRIEL 91776 (626) 285-9705 13 4 3 2 1/6/1998<br />
VASHISTHA, KRISHAN K., M.D. 1629062005 27141 HIDAWAY AVE #105 CANYON COUNT 91351 (661) 251-4783 13 4 2 1 5/13/1983<br />
VASQUEZ, JULIO N. MD, APC 1467612820 14860 ROSCOE BLVD., STE.<br />
304<br />
PANORAMA CITY 91402 (818) 904-1055 13 4 2 1 3/3/2009<br />
VAYUVEGULA, BHARATHI MD 1801820857B 635 S. WESTLAKE AVE LOS ANGELES 90057 (213) 484-8703 12 4 4 3 4/12/2011<br />
VAYUVEGULA, BHARATHI MD<br />
PHD INC. / ANANDA MEDICAL<br />
GRP.<br />
1801820857A 130 W. ROUTE 66, STE 212 GLENDORA 91740 (626) 914-0174 13 4 3 2 7/11/2006<br />
VAZQUEZ, CAROLINA MD APC 1780974410 6501 EASTERN AVE., STE. A BELL GARDENS 90201 (323) 771-0145 13 4 7 2 7/5/2012<br />
VELASCO, ERLINDA C, MD 1891949319 711 N. ALVARADO STREET<br />
#106<br />
LOS ANGELES 90026 (213) 413-3324 13 4 4 3 3/20/1985<br />
VENEGAS, CARLOS A. MD 1467654590 4225 TWEEDY BLVD SOUTH GATE 90280 (323) 564-6464 13 4 7 2 12/11/2007<br />
VENICE FAMILY CLINIC 1669418513 604 ROSE AVE. VENICE 90291 (310) 392-8630 22 4 5 3 12/18/1991<br />
VENICE FAMILY CLINIC / COLEN<br />
FAMILY HEALTH CTR.<br />
VENICE FAMILY CLINIC /<br />
SIMMS/MANN HEALTH &<br />
WELLNESS CTR.<br />
1003842360 4700 INGLEWOOD BLVD STE<br />
102<br />
CULVER CITY 90230 (310) 392-8636 22 4 5 3 10/18/2007<br />
1558397067 2509 PICO BLVD. SANTA MONICA 90405 (310) 664-7662 22 4 5 3 1/22/1997<br />
VILLARICA, SHIRLEY R, MD 1851371595A 1535 W. MERCED, STE. 301 WEST COVINA 91790 (626) 814-8800 12 4 3 2 6/14/2000<br />
VILLATORO, PAULINO A MD 1922291228 1532 E. SAN BERNARDINO<br />
AVE. STE. A2<br />
POMONA, CA 91767 (909) 624-0392 13 4 3 2 8/28/1995<br />
VO, HUU D. M.D. 1811941909 1182 E. HOLT AVE., STE B POMONA 91767 (909) 623-8502 13 4 3 2 6/7/1992<br />
VO, TRI MINH, M.D. 1407907744 10107 E. VALLEY BLVD. EL MONTE 91731 (626) 443-9050 13 4 3 2 9/8/1989<br />
VUONG-DAC, MAN, MD. INC. 1043246317 3649 E. FLORENCE AVE. BELL 90201 (323) 583-6333 13 4 7 2 2/5/2002<br />
WALK-IN MEDICAL CARE 1437375953 18326 PIONEER BLVD ARTESIA 90701 (562) 860-5599 12 4 7 2 10/11/2007<br />
WALTER JAYASINGHE MD<br />
APC/L.A. MEDICAL CENTER.<br />
WALTER JAYASINGHE,M.D. APC<br />
LOS ANGELES MEDICAL CENTER<br />
1730282286 2010 WILSHIRE BLVD. 2ND<br />
FL.<br />
LOS ANGELES 90057 (213) 483-9209 12 4 4 3 12/4/1990<br />
1538177811 679 S. WESTLAKE AVE. LOS ANGELES 90057 (213) 413-4141 12 4 4 3 8/31/2010<br />
Monday, May 06, 2013 Page 39 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
WANG, DAVID W, MD 1912905787A 711 W. COLLEGE ST STE.<br />
328<br />
LOS ANGELES 90012 (213) 626-5143 13 4 4 3 10/30/1989<br />
WANG, DAVID W., M.D. 1912905787B 210 N. GARFIELD AVENUE<br />
STE 300<br />
MONTEREY PAR 91754 (626) 307-9009 13 4 3 2 7/31/1998<br />
WANG, MAY M., M.D. 1538108139 11803 E. CARSON ST HAWAIIAN GARD 90716 (562) 924-4455 13 4 7 2 10/28/1993<br />
WANG, YONG, M.D. 1326056888 11245 LOWER AZUSA RD EL MONTE 91731 (626) 579-9541 13 4 3 2 2/8/2000<br />
WATCHI, RALPH, M.D. 1003846189 1300 N. VERMONT AVE STE<br />
901<br />
LOS ANGELES 90027 (323) 912-9221 13 4 4 3 1/15/1999<br />
WATTS HEALTH CENTER 1477649119 10300 COMPTON AVE LOS ANGELES 90002 (323) 564-4331 25 4 6 3 7/28/2003<br />
WE CARE MORE II FAMILY 1962683938 2110 A. N SANTA FE AVE COMPTON 90222 (310) 637-7131 12 4 6 3 9/16/2008<br />
WESTERN UNIVERSITY OF<br />
HEALTH SCIENCES<br />
WESTSIDE FAMILY HEALTH<br />
CENTER<br />
WHITE MEMORIAL PEDIATRIC<br />
MED. GRP.<br />
1679515217 795 E. SECOND STREET.<br />
SUITE 5<br />
POMONA 91766 (909) 865-2565 12 4 3 2 12/2/2003<br />
1831287978 1711 OCEAN PARK BLVD. SANTA MONICA 90405 (310) 450-2191 22 4 5 3 8/10/1992<br />
1851497002 1701 E. CESAR CHAVEZ<br />
AVE. # 456<br />
LOS ANGELES 90033 (323) 987-1200 12 4 4 3 11/21/1984<br />
WHITTIER PEDIATRIC GROUP 1750463014 8522 S. PAINTER AVE. WHITTIER 90602 (562) 698-6266 12 4 7 2 6/5/2006<br />
WIJESEKERA, STANLEY, M.D. 1215001987 101 E. BEVERLY BLVD. #305 MONTEBELLO 90640 (323) 888-8981 13 4 7 2 8/7/1989<br />
WILMINGTON COMMUNITY<br />
CL/MARY B HENRY<br />
TELEMEDICINE CTR<br />
WILMINGTON COMMUNITY<br />
CLINIC<br />
1932194586STA 10901 S. VERMONT AVE. LOS ANGELES 90044 (323) 241-6717 22 4 8 3 9/16/2004<br />
1932194586 1009 N. AVALON BLVD. WILMINGTON 90744 (310) 549-5760 22 4 8 3 8/16/2004<br />
WONG, HANSON P., M.D. 1073725768 10230 ARTESIA BLVD., STE.<br />
201<br />
BELLFLOWER 90706 (562) 804-7223 13 4 7 2 5/18/1998<br />
WONG, KAI Y., M.D. 1376656967 711 W. COLLEGE ST, STE 208 LOS ANGELES 90012 (213) 625-3182 13 4 4 3 2/6/1997<br />
WONG, SHI-YIN MD INC 1902986920 407 W. College Street Los Angeles 90012 (213) 626-3589 13 4 4 4 8/9/2010<br />
WONG, TAN L. MD 1790728749 2187 FOOTHILL BLVD STE. B LA VERNE 91750 (909) 596-1941 13 4 3 2 6/2/2005<br />
WOSK, SAMUEL MD / LA<br />
PROVIDENCIA MED INC<br />
1609061431 3412 WHITTIER BLVD. LOS ANGELES 90023 (323) 264-4006 13 4 4 3 11/3/2008<br />
WU, KONG-TAY, M.D. 1790989267 1818 N. ORANGE GROVE<br />
AVE STE 200<br />
POMONA 91767 (909) 622-6433 13 4 3 2 2/11/1992<br />
WU, TAI-HING MD/ NEW VALLEY<br />
MEDICAL GRP INC<br />
YACOUB MED INC. DRS.<br />
URGENT CARE MED. GRP<br />
1417963661 415 W. VALLEY BLVD., STE C SAN GABRIEL 91776 (626) 943-9240 13 4 3 2 3/11/1992<br />
1477698512 120 S. MONTEBELLO BLVD. MONTEBELLO 90640 (323) 726-0533 12 4 7 2 3/23/1999<br />
YACOUB, NADER M., MD 1194848580 14282 AMAR ROAD LA PUENTE 91746 (626) 917-4481 13 4 3 2 3/23/2005<br />
YALZADEH, PARVIZ MD 1821076134 23560 MADISON ST STE 206 TORRANCE 90505 (310) 534-4990 13 4 8 3 8/1/1981<br />
Monday, May 06, 2013 Page 40 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
YBPC MEDICAL CLINIC INC /<br />
YOVANA BRUNO PED CARE INC<br />
1760689426B 1750 HUNTINGTON DRIVE<br />
SUITE B<br />
DUARTE 91010 (626) 930-1600 13 4 3 2 3/11/2010<br />
YEHOWA MEDICAL SERVICES 1093095192 1039 W. FLORENCE AVE LOS ANGELES 90044 (323) 776-1500 25 4 8 4 1/3/2013<br />
YERZINKIAN, SUSANNA M., M.D. 1578672788 540 N. CENTRAL AVE #301 GLENDALE 91203 (818) 242-3916 13 4 2 1 5/5/1986<br />
YI, DONG J., M.D. 1023176229 1058 S. VERMONT AVE STE<br />
227<br />
LOS ANGELES 90006 (213) 368-6025 13 4 4 3 8/22/1996<br />
YNCHAUSTI, RAQUEL M., M.D. 1033279609 1840 N. HACIENDA BLVD.<br />
SUITE 4<br />
LA PUENTE 91744 (626) 850-5056 13 4 3 2 8/25/1989<br />
YOO, KYUNG SOO, M.D. 1346467461 15446 PARTHENIA ST NORTH HILLS 91343 (818) 891-1616 13 4 2 1 1/30/1996<br />
YOON, SAM H, M.D. 1538272802 4177 REDONDO BEACH<br />
BLVD.<br />
LAWNDALE 90260 (310) 214-1407 13 4 8 3 9/17/1982<br />
YOUNG, HARDING G., MD INC. 1154415925 3628 E. Imperial Hwy. #302 Lynwood 90262 (310) 631-2660 13 4 6 3 8/13/2008<br />
YU CARE MEDICAL GROUP INC. 1639177587 210 N. GARFIELD AVE. #316 MONTEREY PAR 91754 (626) 307-7397 12 4 3 2 6/17/1997<br />
YU CARE MEDICAL GRP INC 1235317561 1722 S. DESIRE AVE., STE<br />
102<br />
ROWLAND HEIGH 91748 (626) 581-0700 12 4 3 2 9/3/2008<br />
YU, EDWIN T. MD 1134220544 2101 W. BEVERLY BLVD,<br />
STE 202<br />
MONTEBELLO 90640 (323) 888-2058 13 4 7 2 2/25/2002<br />
YU, KING YEE, M.D. 1043300809 1902 ROYALTY DRIVE, STE<br />
100P<br />
POMONA 91767 (909) 620-4048 13 4 3 2 10/27/1999<br />
YUJUICO-DANGANAN, IMELDA<br />
MD INC<br />
1255401139 16904 BELLFLOWER BLVD. BELLFLOWER 90706 (562) 866-8046 13 4 7 2 11/30/2001<br />
YUN, EUN MI, M.D. 1609987486 819 S. ALVARADO STREET<br />
#101<br />
LOS ANGELES 90057 (213) 388-6000 13 4 4 3 8/6/1991<br />
ZACOALCO MEDICAL GROUP<br />
INC.<br />
1750442836 1414 E. FLORENCE AVENUE LOS ANGELES 90001 (323) 588-1383 12 4 6 3 3/30/1998<br />
ZAFARANCHI, MOJDEH, M.D, INC. 1306936687 22110 ROSCOE BLVD., #303 CANOGA PARK 91304 (818) 887-5515 13 4 2 1 8/13/1993<br />
ZARET, PHILLIP D., DO 1235129354 15090 IMPERIAL HWY. LA MIRADA 90638 (562) 943-8444 13 4 7 2 8/23/2005<br />
ZARGARIAN, VIGEN, M.D. 1609981091 540 N. CENTRAL AVE, # 105 GLENDALE 91203 (818) 244-2224 13 4 2 1 5/6/1999<br />
ZARRABI MEDICAL<br />
CORPORATION<br />
1255323408 3175 TWEEDY BOULEVARD SOUTH GATE 90280 (323) 567-7722 12 4 7 2 7/15/1994<br />
ZARRABI, MANOOCHEHR, MD 1699767517 6355 ATLANTIC AVE BELL 90201 (323) 773-3000 12 4 7 2 9/4/2003<br />
ZEBALLOS, EDWIN W M/SANTA<br />
ROSA DE LIMA<br />
1821139205 6915 SEVILLE AVENUE HUNTINGTON PA 90255 (323) 588-9800 13 4 7 2 9/26/1997<br />
Monday, May 06, 2013 Page 41 <strong>of</strong> 42
SiteName NPI- ID# Address City <strong>Zip</strong> Telephone Type Category SPA Region Date Activated<br />
Total Active <strong>Provider</strong> Sites:<br />
Category Desc:<br />
922<br />
1.Health Assessment Only<br />
3.Laboratory Services Only<br />
4.(CC) provider who will accept <strong>new</strong> referrals<br />
5.(CC) provider who will not accept <strong>new</strong> referrals<br />
Monday, May 06, 2013 Page 42 <strong>of</strong> 42
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