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PACIFICA FOUNDATION LLC.
NPI 1386352466
Orthopaedic Surgery - Adult Reconstructive Orthopaedic Surgery in Los Angeles, CA

Active since November 08, 2022CLIA 05D2280130 · Waiver
1300 N VERMONT AVE STE 407, LOS ANGELES, CA 90027(323) 913-4524(323) 913-4826 Get Directions Write a Review

NPPES record last updated: May 1, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 1, 2026, Aug 29, 2023, Mar 17, 2023 and 1 more (4 updates tracked since 2022).

About Pacifica Foundation Llc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PACIFICA FOUNDATION LLC. (NPI 1386352466), doing business as Pacifica Foundation Llc, is a healthcare organization registered as an adult reconstructive orthopaedic surgery in Los Angeles, California and active in the NPI registry since November 2022. The organization holds a CLIA Waiver certificate valid through April 12, 2027, maintains 2 additional practice locations, and lists Douglas Long, President, as its authorized official.

NPPES Registry Identity

NPI1386352466
Entity TypeOrganization
Primary Taxonomy207XS0114X
Legal Business NamePACIFICA FOUNDATION LLC.
Location Address1300 N VERMONT AVE STE 407Los Angeles, CA 90027-6086
Mailing Address1300 N Vermont Ave Ste 407Los Angeles, CA 90027-6086 · (323) 913-4524 · Fax (800) 245-0808
Phone(323) 913-4524
Fax(323) 913-4826
Organization SubpartNo
Authorized OfficialDouglas LongPresident · (323) 913-4914
Enumeration DateNovember 8, 2022
Last NPPES UpdateMay 1, 20264 updates tracked since enumeration
NPPES CertifiedMay 1, 2026
✔ NPI 1386352466 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyOrthopaedic Surgery · Adult Reconstructive Orthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207XS0114X
Definition
Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures.
Also ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedOrthopaedic Surgery · Orthopaedic Surgery of the SpineTaxonomy 207XS0117X
1300 N VERMONT AVE STE 407, Los Angeles, CA 90027
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Other Names 1

Former Legal Business NamePacifica Foundation Llc

Secondary Practice Locations 2

Location 11300 N Vermont Ave Ste 100Los Angeles, CA 90027-6098 · Phone (323) 913-4300 · Fax (800) 245-0408
Location 2600 N Garfield Ave Ste 106Monterey Park, CA 91754-1168 · Phone (626) 280-3781 · Fax (800) 245-0408

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pacifica Foundation Llc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Pacifica Foundation LLC., which bills Medicare for the services they deliver. Of these, 3 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

William Long, M.D.
Orthopedic Surgery
NPI 1023067055
1300 N VERMONT AVE STE 100
Los Angeles, CA 90027
(323) 913-4300
✔ PECOS✔ Accepts MedicareSame address
Somsupha Kanjanauthai, M.D.
Interventional Cardiology
NPI 1285843979
1300 N VERMONT AVE
Los Angeles, CA 90027
(323) 913-4200
✔ PECOS✔ Accepts MedicareSame address
H Michael Mynatt, MD
Orthopedic Surgery
NPI 1326100207
1300 N VERMONT AVE DOCTORS TOWER -- SUITE 100
Los Angeles, CA 90027
(323) 913-4300
✔ PECOSSame address
Tae Shin, M.D.
Orthopedic Surgery
NPI 1750483723
1245 WILSHIRE BLVD., SUITE 400
Los Angeles, CA 90017
(213) 482-2992
✔ PECOS✔ Accepts Medicare3.2 mi
Ben Ha, M.D.,
Obstetrics/Gynecology
NPI 1043305774
711 W COLLEGE ST SUITE 540
Los Angeles, CA 90012
(213) 626-5151
✔ PECOS✔ Accepts Medicare3.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2280130

Pacifica Foundation, LLC · Monterey Park, CA
Active · expires Apr 12, 2027
CLIA Number05D2280130
Laboratory TypeCommunity Clinic
Certificate Effective DateApril 13, 2025
Certificate Expiration DateApril 12, 2027
Laboratory DirectorBen Ha
Laboratory Phone(323) 913-4200
Laboratory LocationPacifica Foundation, LLC600 N Garfield Ave Ste 106, Monterey Park, CA 91754
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pacifica Foundation LLC.'s NPI number?

The NPI number for Pacifica Foundation LLC. is 1386352466. It was assigned to this organization in the NPPES registry on November 8, 2022. The provider was formerly known as Pacifica Foundation LLC.

Where is Pacifica Foundation LLC. located?

Pacifica Foundation LLC. is located at 1300 N Vermont Ave Ste 407, Los Angeles, CA 90027. The listed phone number is (323) 913-4524.

What is Pacifica Foundation LLC.'s specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Adult Reconstructive Orthopaedic Surgery, with taxonomy code 207XS0114X.

Is Pacifica Foundation LLC. enrolled in Medicare?

Yes. Pacifica Foundation LLC. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pacifica Foundation LLC.?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 3 Medicare specialties reassign their Medicare billing to Pacifica Foundation LLC.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Orthopedic Surgery (3), Interventional Cardiology (1) and Obstetrics/Gynecology (1). Of these, 3 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Pacifica Foundation LLC. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2280130) is associated with this NPI, valid through April 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pacifica Foundation LLC. was last updated on May 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.