Pensri Smithedajkul

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

16190 Issued in CA

Practice address

2411 N Broadway
Los Angeles, CA 90031

Phone

(323) 987-2000

Fax

(323) 987-1448

NPI assigned

Nov 8, 2006

Last updated

Aug 3, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Community Medicine Inc.

  • Federally Qualified Health Center (FQHC)
  • Santa Ana, CA
  • NPI 1578136834
  Medicare reassignment NPD
• Community Medicine Inc

  dba Community Medical Center

  • Federally Qualified Health Center (FQHC)
  • Bellflower, CA
  • NPI 1497397806
  NPD

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533254400000",
    "number": "1528137809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 N FIGUEROA ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900424232",
            "telephone_number": "323-254-5221",
            "fax_number": "323-254-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 N BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90031",
            "telephone_number": "323-987-2000",
            "fax_number": "323-987-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITHEDAJKUL",
        "first_name": "PENSRI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2018-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "16190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "16190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Benjamin Smith, PH.D., LCSW
• William Delvan Smith, BS HSM
• Willie A Smith
• Wyatt Lombard Smith, MD
• Zoia A Smith, PT
• Gary Mark Smithson, MD, MBA
• SML Anes, P.C.
• Jan Smogorzewski
• Miroslaw Smogorzewski, M.D.
• Marta Smokler, L.C.S.W.

• Family Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.