Maki Kusunaga, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

17529 Issued in CA

Practice address

400 W Covina Blvd
San Dimas, CA 91773-2954

Phone

(909) 592-6411

Fax

(909) 971-5841

NPI assigned

Oct 23, 2012

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

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

State licenses

Interoperability endpoints

• Direct secure messaging: mkusunaga529752@direct.uclahealth.org

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

{
    "created_epoch": "1350950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350950400000",
    "number": "1811240179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W COVINA BLVD",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W COVINA BLVD",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732954",
            "telephone_number": "909-592-6411",
            "fax_number": "909-971-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSUNAGA",
        "first_name": "MAKI",
        "name_prefix": "Miss",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-23",
        "last_updated": "2012-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "17529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divya Krishnamoorthy, MD
• Brandon Kuang, MD
• Danielle Jessica Kubanis
• Jason Kubanis
• Patrick John Kurt, MD
• La Homecare Provider Inc
• La Pharmacie, Inc
• Elvira Arlene Laguna
• Andy Lam, M.D.
• Julie Lam, O.D.

• Adult Health Nurse Practitioner in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; 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.