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SYDNEY KUSUMOPUTRO MD
NPI 1770384158
Student in an Organized Health Care Education/Training Program in Los Angeles, CA

Active since March 21, 2025PECOS Enrolled
1200 N STATE ST STE A7D, LOS ANGELES, CA 90089(323) 409-7556 Get Directions Write a Review

NPPES record last updated: March 21, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Sydney Kusumoputro Md NPPES

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

SYDNEY KUSUMOPUTRO MD (NPI 1770384158) is an individual student in an organized health care education/training program in Los Angeles, California and active in the NPI registry since March 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1770384158
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSYDNEY KUSUMOPUTROCredential: MD
Location Address1200 N STATE ST STE A7DLos Angeles, CA 90089-1001
Mailing Address1200 N State St Ste A7dLos Angeles, CA 90089-1001
Phone(323) 409-7556
Sole ProprietorNo
Enumeration DateMarch 21, 2025
NPPES CertifiedMarch 21, 2025
✔ NPI 1770384158 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.
1200 N STATE ST STE A7D, Los Angeles, CA 90089
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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)

Sydney Kusumoputro 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.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ISHANI D PREMARATNE MD
Plastic Surgery
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-6225
DIVYA MULCHANDANI MD
Student in an Organized Health Care Education/Training Program
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-5707
YEKTA RAHIMI ASHTIANI MD
Student in an Organized Health Care Education/Training Program
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-7556
DAVID VASCONCELLOS
Student in an Organized Health Care Education/Training Program
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-7556
CATHERINE POTIN
Student in an Organized Health Care Education/Training Program
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-7556
JUSTIN VU
Student in an Organized Health Care Education/Training Program
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-7556
ASHLEY KWON
Student in an Organized Health Care Education/Training Program
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-7556
PRANAV BHAMIDIPATI
Student in an Organized Health Care Education/Training Program
1200 N STATE ST STE A7D
LOS ANGELES, CA 90089
Los Angeles County (323) 409-7556

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 Sydney Kusumoputro's NPI number?

The NPI number for Sydney Kusumoputro is 1770384158. It was assigned to this individual provider in the NPPES registry on March 21, 2025.

Where is Sydney Kusumoputro located?

Sydney Kusumoputro practices at 1200 N State St Ste A7d, Los Angeles, CA 90089. The listed phone number is (323) 409-7556.

What is Sydney Kusumoputro's specialty?

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

Is Sydney Kusumoputro enrolled in Medicare?

Yes. Sydney Kusumoputro is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Sydney Kusumoputro was last updated on March 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.