Active NPI
Sunil M Dissanayake, M.D.
- Family Medicine Physician
- Rowland Heights, CA
National Provider Identifier
1942290093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A 39447
- Practice address
- 1612 Nogales St
Rowland Heights, CA 91748-2257 - Phone
- (626) 965-1646
- Fax
- (626) 965-4697
- NPI assigned
- Oct 27, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A 39447 | CA | Primary |
Addresses
Primary practice location
1612 Nogales St
Rowland Heights, CA 91748-2257
Mailing address
1612 Nogales St
Rowland Heights, CA 91748-2257
Phone (626) 965-1646
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HA39447A | Other | MEDICARE PIN #2 | |
| 00A394470 | Medicaid | CA | |
| AO763Z | Other | MEDICARE PIN #3 |
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 |
|---|---|---|---|
| A 39447 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229990400000",
"number": "1942290093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1612 NOGALES ST",
"city": "ROWLAND HEIGHTS",
"state": "CA",
"postal_code": "917482257",
"telephone_number": "626-965-1646",
"fax_number": "626-965-4697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1612 NOGALES ST",
"city": "ROWLAND HEIGHTS",
"state": "CA",
"postal_code": "917482257",
"telephone_number": "626-965-1646",
"fax_number": "626-965-4697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISSANAYAKE",
"first_name": "SUNIL",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-27",
"last_updated": "2008-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A 39447",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PIN #2",
"identifier": "HA39447A",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A394470",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PIN #3",
"identifier": "AO763Z",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Rowland Heights, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.