Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Audreyandra Lucia Imansjah, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1710481858

Audreyandra Lucia Imansjah, DO is a Family Practice in San Ramon, California. Qualified in 2018, 8 years ago. Practices with Permanente Medical Group Inc, a 10,941-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
8
Licensed in
CA
In the registry since
2018
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

2300 Camino Ramon
San Ramon, CA 94583-1354
Phone: (925) 244-7400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 17597 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1710481858
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorYes
NPI enumeratedMarch 22, 2018
Last updated in NPPESApril 21, 2022
Certification dateApril 21, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Permanente Medical Group Inc — 10941 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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