Somsupha Kanjanauthai, M.D.

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

A103083 Issued in CA

Practice address

1300 N Vermont Ave
Los Angeles, CA 90027-6098

Phone

(323) 913-4200

Fax

(510) 281-0766

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

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

Specialty

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacifica Foundation LLCGroup PAC ID 0648624718, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hollywood Presbyterian Medical Center Hospital, Los Angeles, CA, CCN 050063
• Pih Health Good Samaritan Hospital Hospital, Los Angeles, CA, CCN 050471

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pacificafoundation.somsuphakanjanauthai@157113.advancedmd-direct.com
• Direct secure messaging: skanjanauthai1787816@ehrdirect.mayoclinicmsg.org

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.

• Pacifica Foundation LLC.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Los Angeles, CA
  • NPI 1386352466
  Medicare reassignment Care Compare group
• Usc Care Medical Group, Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902846306

  Internal Medicine

  Medicare reassignment NPD
• Usc Care Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Pasadena, CA
  • NPI 1427937390
  NPD
• Keck Medical Center of Usc

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1417554528
  NPD (past)
• Usc University Hospital, Inc.

  • Psychiatric Hospital Unit
  • Los Angeles, CA
  • NPI 1790718500
  NPD (past)
• Usc Verdugo Hills Hospital, LLC

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1265875207
  NPD (past)
• Ascension Via Christi Hospitals Wichita Inc.

  • Psychiatric Hospital Unit
  • Wichita, KS
  • NPI 1902893415
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • General Acute Care Hospital
  • Eau Claire, WI
  • NPI 1629027578
  NPD (past)
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Eau Claire, WI
  • NPI 1972552909
  NPD (past)
• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  • Community/Retail Pharmacy
  • La Crosse, WI
  • NPI 1174509046
  NPD (past)
• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Sparta, WI
  • NPI 1275510596
  NPD (past)
• Mayo Clinic Hospital-Rochester

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rochester, MN
  • NPI 1710953286
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cha Hollywood Medical Center, LP

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1922033547
  Care Compare affiliation
• Pih Health Good Samaritan Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1508859323
  Care Compare affiliation

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1285843979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276098",
            "telephone_number": "323-913-4200",
            "fax_number": "510-281-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276098",
            "telephone_number": "323-913-4200",
            "fax_number": "510-281-0766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3731 Wilshire Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900102830",
            "country_code": "US",
            "telephone_number": "323-913-4200",
            "fax_number": "510-281-0766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANJANAUTHAI",
        "first_name": "SOMSUPHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A103083",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A103083",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A103083",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "22647",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201073310A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maggie Schweig Kanin, MD
• Maralee Rachel Kanin
• Kanishka Wijegunaratne, MD Inc
• Rabih Kanj, PHARMD
• Vachirawit Kanjanapunchoke
• Jason Kanji, MD
• Joanna Elizabeth Kanji, MSW, ACSW
• Rahim Amirali Kanji, D.C.
• Rehan Amin Kanji, M.D.
• Shrey Kanjiya, M.D.

• Interventional Cardiology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Interventional Cardiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.