MEDICARE: MIYA SUMII LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	27993	CA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1215441860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIYA SUMII LCSW

Provider Business Mailing Address
First Line	:	1146 S LUCERNE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-6841
Country	:	US
Telephone Number	:	323-493-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 BAUCHET ST STE 204
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2544
Country	:	US
Telephone Number	:	323-493-3690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	02/02/2021

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