Active NPI
Susan K. Boudakian, DO
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1982808010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 20A6939
- Practice address
- 6041 Cadillac Ave
Los Angeles, CA 90034-1702 - Phone
- (323) 857-2000
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 20A6939 | CA | Primary |
Addresses
Primary practice location
6041 Cadillac Ave
Los Angeles, CA 90034-1702
Mailing address
6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone (323) 857-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6939 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222128000000",
"number": "1982808010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6041 CADILLAC AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900341702",
"telephone_number": "323-857-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6041 CADILLAC AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900341702",
"telephone_number": "323-857-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDAKIAN",
"first_name": "SUSAN",
"middle_name": "K.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-13",
"last_updated": "2008-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "20A6939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.