Individual provider Active NPI

Joyce Angeline Sutedja, M.D.

  • Obstetrics & Gynecology Physician
  • Orange, CA
National Provider Identifier
1366974743
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A159065 Issued in CA
Practice address
333 City Blvd W
Suite 1400
Orange, CA 92868-2903
Phone
(714) 456-5616
Fax
(714) 456-8360
NPI assigned
Apr 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X A159065 CA Primary

Addresses

Primary practice location

333 City Blvd W
Suite 1400
Orange, CA 92868-2903

Mailing address

1149 Mira Mar Ave
Long Beach, CA 90804-4139
Phone (323) 819-6021

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
I20210816002520 CA Practitioner - Obstetrics/Gynecology 0547593568 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of California, Irvine, California College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Los AngelesGroup PAC ID 1850296534, shared by 7 NPIs, 395 clinicians

Practice addresses (Care Compare)

123 W Manchester Blvd
Inglewood, CA 90301-1753
Phone (310) 419-5325

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Jul 26, 2021 Accepting new patients
County of Los Angeles Auditor Controller CurrentSince Nov 4, 2021 Accepting new patients
County of Los Angeles Current Accepting new patients
County of Los Angeles Auditor Controller CurrentSince Jul 26, 2021 Accepting new patients
County of Los Angeles Current Accepting new patients

Locations

1000 S Fremont Ave
Bldg A11
Alhambra, CA 91803
Phone (626) 457-4240

1000 S Fremont Ave
Unit 9
Alhambra, CA 91803

1108 N Oleander Ave
Compton, CA 90222
Phone (310) 763-2244

123 W Manchester Blvd
Inglewood, CA 90301
Phone (310) 419-5325

335 E Avenue I
Lancaster, CA 93535
Phone (661) 471-4000

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

Organizations & group practices 5

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1366974743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 MIRA MAR AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908044139",
            "telephone_number": "323-819-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 CITY BLVD W",
            "address_2": "SUITE 1400",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928682903",
            "telephone_number": "714-456-5616",
            "fax_number": "714-456-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTEDJA",
        "first_name": "JOYCE",
        "middle_name": "ANGELINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-03",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A159065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.