Provider Demographics
NPI:1003135989
Name:SARDJONO, NATALIE MAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:MAYA
Last Name:SARDJONO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAYA
Other - Middle Name:SARDJONO
Other - Last Name:HSIEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12665 VILLAGE LN APT 3327
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2847
Mailing Address - Country:US
Mailing Address - Phone:562-933-7880
Mailing Address - Fax:
Practice Address - Street 1:2810 LONG BEACH BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1558
Practice Address - Country:US
Practice Address - Phone:562-933-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1307252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology