Individual provider Active NPI

Kerry Sheu, M.D.

  • Pediatrics Physician
  • South Gate, CA
National Provider Identifier
1174636310
Registry record updated Jul 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
58220 Issued in CA
Practice address
4476 Tweedy Blvd
South Gate, CA 90280-6359
Phone
(323) 563-9499
Fax
(323) 563-0956
NPI assigned
Aug 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G58220 CA
Pediatrics Physician 208000000X 58220 CA Primary

Addresses

Primary practice location

4476 Tweedy Blvd
South Gate, CA 90280-6359

Mailing address

75 Remittance Dr Dept 6008
Chicago, IL 60675-6008
Phone (562) 282-1419

Other identifiers 4

IdentifierTypeStateIssuer
370020281OtherCARAILROAD MEDICARE
00G582200MedicaidCA
00G582200OtherCABLUE SHIELD
370020281OtherCAMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120105000986 CA Practitioner - Pediatric Medicine 5991971350 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G58220CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Medical Group Inc. CurrentSince Oct 10, 2011 Accepting new patients

Locations

2220 Clark Ave
Long Beach, CA 90815
Phone (562) 597-4181

4476 Tweedy Blvd
South Gate, CA 90280
Phone (323) 563-9499

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1174636310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 REMITTANCE DR DEPT 6008",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606756008",
            "telephone_number": "562-282-1419",
            "fax_number": "562-920-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4476 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806359",
            "telephone_number": "323-563-9499",
            "fax_number": "323-563-0956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEU",
        "first_name": "KERRY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G58220",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "58220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "370020281",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G582200",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G582200",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "370020281",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Gate, CA

Sources for this page

Verify at the official NPI Registry.