Basic Information
| Provider Information | |||||||||
| NPI: | 1033227640 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEVIN | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT LA 21559 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911851559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492638620 | ||||||||
| FaxNumber: | 9492638620 | ||||||||
| Practice Location | |||||||||
| Address1: | 5455 WILSHIRE BOULEVARD | ||||||||
| Address2: | SUITE 1120 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900364201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235493030 | ||||||||
| FaxNumber: | 3235493049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | C43357 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | C43357 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | C43357 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | C43357 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | C43357 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | C43357 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | C43357 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | BL6846476 | 01 | CA | DEA | OTHER | 00C433570 | 05 | CA | MEDICAID |