Unknown Individual – Plastic and Reconstructive Surgery Physician, NPI 1619907078

Unknown Individual is a healthcare provider. based in Los angeles, California. specializing in Plastic and Reconstructive Surgery Physician. They hold a License No. G40132 (CA). The NPI Number for Unknown Individual is 1619907078

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619907078
Phone
(323) 442-6416
Address
1450 SAN PABLO ST
Deactivation Date
20 September 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3104235000
Graduation Year
1977 (49 years ago)
PAC ID
0749298818
Group Practice PAC ID
0446169114
Professional Enrollment ID
I20061121000728
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

  • USC Roski Eye Institute, 1450, San Pablo Street, Lincoln Heights, Los Angeles, Los Angeles County, California, 90033, United States

    SUITE 2000

    LOS ANGELES, CA 900334500

    Phone: (323) 442-6416

    Fax: (323) 442-6481

    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 90033)

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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: 0446169114View full group profile
NameSpecialtyState
Critical Care (Intensivists), General SurgeryCA
-WA
Nurse PractitionerCA
Physician AssistantCA
Clinical PsychologistCA
Nurse PractitionerCA
N E U R O S U R G E R YOH
Nurse PractitionerCA
General Surgery, Critical Care (Intensivists)CA
Internal MedicineCA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1619907078 — is the standard way to identify this listing.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Plastic and Reconstructive Surgery Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Los Angeles, California; more addresses can appear in NPPES.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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