Unknown Individual – Emergency Medicine Physician, NPI 1124073382

Unknown Individual is a healthcare provider. based in Burbank, California. specializing in Emergency Medicine Physician. They hold a License No. A37107 (CA). The NPI Number for Unknown Individual is 1124073382

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124073382
Phone
(818) 557-0135
Address
2550 NORTH HOLLYWOOD WAY
Deactivation Date
25 January 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3237851204
Graduation Year
1969 (57 years ago)
PAC ID
3779486758
Group Practice PAC ID
8820304462
Professional Enrollment ID
I20040128000557
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • North Hollywood Way, Burbank, Los Angeles County, California, 91522, United States

    SUITE 204

    BURBANK, CA 915055040

    Phone: (818) 557-0135

    Fax: (818) 557-1394

    Type: Mailing

  • Los Angeles Community Hospital, 4081, East Olympic Boulevard, East Los Angeles, Los Angeles County, California, 90023, United States

    LOS ANGELES, CA 900233330

    Phone: (323) 881-2666

    Fax: (323) 267-4530

    Type: Location

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 91505)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8820304462View full group profile
NameSpecialtyState
Emergency MedicineTX
Emergency MedicineCA
Emergency MedicineCA
-CA
Emergency Medicine, Internal MedicineCA
Emergency Medicine, Internal MedicineCA
Nurse PractitionerCA
-CA
Emergency MedicineCA
Emergency MedicineTX

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1124073382 for Unknown Individual, then check state licensing separately.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Burbank, California in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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