1427027143 NPI number — APT, GINDI, GORDON & KERMAN, M.D.'S, INC.

Table of content: DR. BRIAN EDWARD RUSAK D.M.D. (NPI 1710024443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427027143 NPI number — APT, GINDI, GORDON & KERMAN, M.D.'S, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APT, GINDI, GORDON & KERMAN, M.D.'S, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427027143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2080 CENTURY PARK EAST
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90067-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-277-2727
Provider Business Mailing Address Fax Number:
310-553-2135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 CENTURY PARK EAST
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90067-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-277-2727
Provider Business Practice Location Address Fax Number:
310-553-2135
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-277-2727

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G50780 AND C36598 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10019 . This is a "K. L. GORDON M.D. MES #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 33106001 . This is a "K.L. GORDON -DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G2080558723895 . This is a "K. L. GORDON M.D. VSP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P-11051496 . This is a "K.L. GORDON MULTI-PLAN #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0071730 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G2080559685654 . This is a "J. J. GINDI M.D. VSP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00C365980 . This is a "K.L. GORDON M.D. BL/SHLD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G210610 . This is a "J.J. GINDI BLUE SHIELD #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 26923 . This is a "SPECTERA GROUP PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 891994 . This is a "J. J. GINDI BLOCK VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA0783 . This is a "EYE MED PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 10018 . This is a "J.J. GINDI, M.D. MES #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 33106000 . This is a "J.J. GINDI - DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 891978 . This is a "K.L. GORDON BLOCK VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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