Active NPI
Susan J Mackensen, M.D.
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1659309896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- AFE46013
- Practice address
- 1809 Preuss Rd
Los Angeles, CA 90035-4313 - Phone
- (310) 838-3092
- Fax
- (310) 287-0656
- NPI assigned
- Jun 28, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | AFE46013 | CA | Primary |
Addresses
Primary practice location
1809 Preuss Rd
Los Angeles, CA 90035-4313
Mailing address
1809 Preuss Rd
Los Angeles, CA 90035-4313
Phone (310) 838-3092
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AFE46013 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395619200000",
"number": "1659309896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1809 PREUSS RD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900354313",
"telephone_number": "310-838-3092",
"fax_number": "310-287-0656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1809 PREUSS RD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900354313",
"telephone_number": "310-838-3092",
"fax_number": "310-287-0656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKENSEN",
"first_name": "SUSAN",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2014-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "AFE46013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.