Individual provider Active NPI

Winny Soenaryo, OT

  • Occupational Therapist
  • Los Angeles, CA
National Provider Identifier
1104483023
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT18762 Issued in CA
Practice address
1640 Marengo St Ste 500
Los Angeles, CA 90033-1061
Phone
(323) 442-3340
NPI assigned
May 27, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT18762 CA Primary

Addresses

Primary practice location

1640 Marengo St Ste 500
Los Angeles, CA 90033-1061

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-3340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220516002317 CA Practitioner - Occupational Therapist in Private Practice 2961813084 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT18762CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince May 1, 2022 Accepting new patients
Usc Care Medical Group, Inc CurrentSince May 1, 2022 Accepting new patients
Keck Medical Center of Usc Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Usc Occupational Therapy Faculty Practice, Inc. Occupational Therapist Past Accepting new patients

Locations

1031 W 34th St
Los Angeles, CA 90089
Phone (213) 740-7711

1640 Marengo St
Los Angeles, CA 90033
Phone (323) 223-4091

2250 Alcazar St
Ste 133
Los Angeles, CA 90089
Phone (323) 442-3340

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1640 Marengo St
Ste 500
Los Angeles, CA 90033
Phone (323) 442-3340

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1104483023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 MARENGO ST STE 500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331061",
            "telephone_number": "323-442-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOENARYO",
        "first_name": "WINNY",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-27",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "OT18762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.