Sudarsan Kollimuttathuillam, MD

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

A169385 Issued in CA

Practice address

16300 Sand Canyon Ave Ste 207
Irvine, CA 92618-3712

Phone

(949) 333-7580

Fax

(949) 333-7599

NPI assigned

Sep 4, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hematology/Oncology

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

City of Hope Medical FoundationGroup PAC ID 3779751656, 964 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• City of Hope Helford Clinical Research Hospital Hospital, Duarte, CA, CCN 050146
• Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skollimuttathuillam81683@cityofhope.direct-ci.com
• Direct secure messaging: direct@cityofhope.direct-ci.com
• Direct secure messaging: skollimuttathuillam665465@direct.memorialcare.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• City of Hope Medical Foundation

  dba City of Hope Duarte

  • Hematology & Oncology Physician
  • Duarte, CA
  • NPI 1871886366
  Medicare reassignment Care Compare group NPD
• Pacific Shores Medical Group, Inc

  • Hematology & Oncology Physician
  • Huntington Beach, CA
  • NPI 1598814634
  Medicare reassignment NPD
• Pacific Shores Medical Group, Inc

  • Hematology & Oncology Physician
  • Irvine, CA
  • NPI 1447587050
  NPD
• Pacific Shores Medical Group, Inc.

  • Hematology & Oncology Physician
  • Glendale, CA
  • NPI 1871642991
  NPD
• Liberty Med Associates LLC

  • Foot & Ankle Surgery Podiatrist
  • Hazlet, NJ
  • NPI 1386279552
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• City of Hope National Medical Center

  • General Acute Care Hospital
  • Duarte, CA
  • NPI 1750358297
  Care Compare affiliation
• Hoag Memorial Hospital Presbyterian

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1518951300
  Care Compare affiliation

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

{
    "created_epoch": "1504483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1902324528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 512185",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900510185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE STE 207",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183712",
            "telephone_number": "949-333-7580",
            "fax_number": "949-333-7599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Main St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Huntington Beach",
            "state": "CA",
            "postal_code": "926482489",
            "country_code": "US",
            "telephone_number": "714-252-9415",
            "fax_number": "714-963-8407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Fivepoint",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926182377",
            "country_code": "US",
            "telephone_number": "949-671-4673",
            "fax_number": "949-671-4329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLLIMUTTATHUILLAM",
        "first_name": "SUDARSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-04",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A169385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@cityofhope.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "CITY OF HOPE MEDICAL FOUNDATION",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1500 Duarte Rd",
            "city": "Duarte",
            "state": "CA",
            "country_code": "US",
            "postal_code": "910103012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Davis Koh, PT, DPT
• Dongwuk Koh
• Maryam Kohanbani, RNFA,CNOR
• Diane Elizabeth Kohler, RDN
• Casey Kohn, LMFT
• Gennady Kolodenker, DPM
• Erum Kolsy
• Komi Optical, Inc.
• Komi Optical, Inc. (Pearle Vision)
• Chloe Emerson Komrosky

• Hematology & Oncology Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Hematology & Oncology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.