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KEZIA IVANKA SURJANTO MD
NPI 1558066308
Student in an Organized Health Care Education/Training Program in Palo Alto, CA

Active since April 03, 2023PECOS Enrolled
780 WELCH RD RM CJ220F, PALO ALTO, CA 94304(650) 796-3912 Get Directions Write a Review

NPPES record last updated: June 20, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 20, 2024, Apr 3, 2023 (2 updates tracked since 2023).

About Kezia Ivanka Surjanto Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEZIA IVANKA SURJANTO MD (NPI 1558066308) is an individual student in an organized health care education/training program in Palo Alto, California and active in the NPI registry since April 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1558066308
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameKEZIA IVANKA SURJANTOCredential: MD
Location Address780 WELCH RD RM CJ220FPalo Alto, CA 94304-1516
Mailing Address1430 Tulane Ave # 8050New Orleans, LA 70112-2632 · (504) 988-7809 · Fax (504) 988-3971
Phone(650) 796-3912
Sole ProprietorNo
Enumeration DateApril 3, 2023
Last NPPES UpdateJune 20, 20242 updates tracked since enumeration
NPPES CertifiedJune 20, 2024
✔ NPI 1558066308 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
780 WELCH RD RM CJ220F, Palo Alto, CA 94304
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kezia Ivanka Surjanto Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kezia Surjanto's NPI number?

The NPI number for Kezia Surjanto is 1558066308. It was assigned to this individual provider in the NPPES registry on April 3, 2023.

Where is Kezia Surjanto located?

Kezia Surjanto practices at 780 Welch Rd Rm Cj220f, Palo Alto, CA 94304. The listed phone number is (650) 796-3912.

What is Kezia Surjanto's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Kezia Surjanto enrolled in Medicare?

Yes. Kezia Surjanto is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kezia Surjanto was last updated on June 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.