Dr. Jadah Marie Sun Petty, Ph.D.
Psychologist, Clinical in Los Angeles, CA. Individual provider (NPI-1).
NPI number1760069769
StatusActive
Last updated in NPPESMar 25, 2021
Details
- NPI
- 1760069769
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jadah Marie Sun Petty
- Credential
- Ph.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 25, 2021
- Certification date
- Mar 25, 2021
- Last updated
- Mar 25, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- Medicare opt-out
- Sep 23, 2025 to Sep 23, 2027
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | 32461 | CA | Yes |
Practice location
351 E Temple StLos Angeles, CA 90012-3328
Phone 213-253-2677
Mailing address
4208 Tujunga Ave Apt 103Studio City, CA 91604-2900
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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