Active NPI
Vivian Tanudjaja
- Athletic Trainer
- Long Beach, CA
National Provider Identifier
1831692086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 6481 Atlantic Ave Apt 135
Long Beach, CA 90805-2339 - Phone
- (562) 612-5696
- NPI assigned
- Mar 14, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | CA | Primary |
Addresses
Primary practice location
6481 Atlantic Ave Apt 135
Long Beach, CA 90805-2339
Mailing address
6481 Atlantic Ave Apt 135
Long Beach, CA 90805-2339
Phone (562) 612-5696
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520985600000",
"number": "1831692086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6481 ATLANTIC AVE APT 135",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908052339",
"telephone_number": "562-612-5696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6481 ATLANTIC AVE APT 135",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908052339",
"telephone_number": "562-612-5696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANUDJAJA",
"first_name": "VIVIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-14",
"last_updated": "2018-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.