MEDICARE: IAN A LEVIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	C43357	CA
2	2085N0700X	Neuroradiology Physician	C43357	CA
3	2085N0904X	Nuclear Radiology Physician	C43357	CA
4	2085P0229X	Pediatric Radiology Physician	C43357	CA
5	2085R0202X	Diagnostic Radiology Physician	C43357	CA
6	2085R0204X	Vascular & Interventional Radiology Physician	C43357	CA
7	2085U0001X	Diagnostic Ultrasound Physician	C43357	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033227640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN A LEVIN M.D.

Provider Business Mailing Address
First Line	:	DEPT LA 21559
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-1559
Country	:	US
Telephone Number	:	949-263-8620
Fax Number	:	949-263-8620

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BOULEVARD
Second Line	:	SUITE 1120
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-549-3030
Fax Number	:	323-549-3049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	03/07/2023

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Directions to “ IAN A LEVIN M.D.” Practice Location

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