Herman Sardjono MD Medical Corp

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A41793 Issued in CA

Legal business name

HERMAN SARDJONO MD MEDICAL CORP

Practice address

72 W Las Tunas Dr
Arcadia, CA 91007

Phone

(626) 821-5305

Fax

(626) 821-0141

NPI assigned

Jul 28, 2006

Organization subpart

No

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

Authorized official

Name

Herman Sardjono MD, MD PA

Title

President

Phone

(626) 821-5305

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 3

• HERMAN SARDJONO MD MED CORP Other name
• HERMAN SARDJONO MD MEDICAL CORPORAT Other name
• HERMAN SARDJONO MD MEDICAL CORPORATION Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Herman Sardjono, MD

  • Internal Medicine Physician
  • Arcadia, CA
  • NPI 1225142128
  Medicare reassignment

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1700890167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 W LAS TUNAS DR",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "91007",
            "telephone_number": "626-821-5305",
            "fax_number": "626-821-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 W LAS TUNAS DR",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "91007",
            "telephone_number": "626-821-5305",
            "fax_number": "626-821-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERMAN SARDJONO MD MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "SARDJONO MD",
        "authorized_official_first_name": "HERMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-821-5305",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A41793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A417930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HERMAN SARDJONO MD MED CORP",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "HERMAN SARDJONO MD MEDICAL CORPORAT",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "HERMAN SARDJONO MD MEDICAL CORPORATION",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Emily Tina Heng
• Jaime O Henriquez, MD
• Henry H Khin MD, Corporation
• Henry Wang Medical Inc
• James Garbis Henry, M.D
• Lee Scott Herman, M.D.
• Desiree Renae Hermosillo, LMFT
• Blanca Eimee Hernandez Ibarra
• Amy Michelle Hernandez, D.C.
• Daisy Hernandez

• Internal Medicine Physician in Arcadia, CA
• Providers in Arcadia, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.