Unknown Individual – Adult Medicine Physician, NPI 1104933456

Unknown Individual is a healthcare provider. based in West hollywood, California. specializing in Adult Medicine Physician. They hold a License No. CA20A3999 (CA). The NPI Number for Unknown Individual is 1104933456

Main info

Organization
Inactive
53 Years Of Experience
Name
Unknown Individual
NPI
1104933456
Phone
(310) 360-0280
Address
8733 BEVERLY BLVD
Deactivation Date
22 January 2021

Doctor Profile

Medical School Name
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
-
Graduation Year
1973 (53 years ago)
PAC ID
0446207583
Professional Enrollment ID
I20050401000283
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 8733, Beverly Boulevard, West Hollywood, Los Angeles County, California, 90048, United States

    #408

    WEST HOLLYWOOD, CA 90048

    Phone: (310) 360-0280

    Fax: (310) 360-0955

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 90048)

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Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1104933456 in the public NPI dataset.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Adult Medicine Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is West Hollywood, California in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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