Active NPI
Kasanu Patthanadettrakul
- Massage Therapist
- Van Nuys, CA
National Provider Identifier
1386397974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 243
- Practice address
- 15511 Sherman Way Apt 43
Van Nuys, CA 91406-4156 - Phone
- (949) 524-2555
- NPI assigned
- Feb 2, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 243 | CA | Primary |
Addresses
Primary practice location
15511 Sherman Way Apt 43
Van Nuys, CA 91406-4156
Mailing address
15511 Sherman Way Apt 43
Van Nuys, CA 91406-4156
Phone (949) 524-2555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10431980 | Other | CA | LA CARE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | text | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 243 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711929600000",
"number": "1386397974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15511 SHERMAN WAY APT 43",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914064156",
"telephone_number": "949-524-2555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15511 SHERMAN WAY APT 43",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914064156",
"telephone_number": "949-524-2555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTHANADETTRAKUL",
"first_name": "KASANU",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-02",
"last_updated": "2024-04-01",
"certification_date": "2024-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "243",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA CARE",
"identifier": "10431980",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "text",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"contentOtherDescription": "1",
"address_1": "15511 Sherman Way Apt 43",
"city": "Van Nuys",
"state": "CA",
"country_code": "US",
"postal_code": "914064156",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Van Nuys, CA
- Heather Michelle Patin, M.A., BCBA
- Patricia Arroyo D.D.S. Corporation
- Patrick P Sassani, MD, Medical Corporation (Lux Eye & Retina - Ophthalmology Specialists Of The Valley)
- Patrick Sogbein (Debs Medical Distributor)
- Jack Patterson, M.D.
- Daisha Patton
- Frances Pauken
- Marissa Pavone
- Payam Barzivand, D.D.S., Inc. (Affordable Gentle Dental)
- Payam Marouni MD, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.