Active NPI
Annie Kanchanasuwan, RN, GNP, GCNS-BC
- Gerontology Nurse Practitioner
- Pasadena, CA
National Provider Identifier
1609832385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 15980
- Practice address
- 988 S Fair Oaks Ave
Pasadena, CA 91105-2626 - Phone
- (626) 799-4193
- NPI assigned
- Apr 22, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 15980 | CA | Primary |
Addresses
Primary practice location
988 S Fair Oaks Ave
Pasadena, CA 91105-2626
Mailing address
3731 Revere Ave
Los Angeles, CA 90039-1818
Phone (323) 662-3007
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
- Credentials
- Registered Nurse
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201651200000",
"number": "1609832385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3731 REVERE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900391818",
"telephone_number": "323-662-3007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "988 S FAIR OAKS AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052626",
"telephone_number": "626-799-4193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANCHANASUWAN",
"first_name": "ANNIE",
"name_prefix": "Ms.",
"credential": "RN, GNP, GCNS-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-22",
"last_updated": "2008-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "CA",
"license": "15980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.