Sanusi Hambali Umar, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A067317 Issued in CA

Practice address

819 N Harbor Dr
Suite 400
Redondo Beach, CA 90277-2006

Phone

(310) 480-0490

Fax

(310) 318-1590

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• County of Los Angeles

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228953600000",
    "number": "1982797593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 N HARBOR DR",
            "address_2": "SUITE 400",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902772006",
            "telephone_number": "310-480-0490",
            "fax_number": "310-318-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 N HARBOR DR",
            "address_2": "SUITE 400",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902772006",
            "telephone_number": "310-480-0490",
            "fax_number": "310-318-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UMAR",
        "first_name": "SANUSI",
        "middle_name": "HAMBALI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A067317",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A067317",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE LICENSE",
            "identifier": "A067317",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antanissha Tyler
• Steven P Tyssee, DPT
• Lyssa Lynn Uchida, MT
• Mahendra C Udani, MD
• Bernard L Ullman, MD
• Sherilynn Umayam
• Unbridled Chances Psychotherapy Professional Corporation
• Sokmom Lim Ung, FNP
• Destiny Uriarte
• Jimmy Urizar

• Dermatology Physician in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; 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.