Active NPI
Kaitlyn Phuong Nguyen, P.A.C.
- Medical Physician Assistant
- Fountain Valley, CA
National Provider Identifier
1043590250
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective May 20, 2018.
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA21641
- Practice address
- 17220 Newhope St
#125
Fountain Valley, CA 92708-4272 - Phone
- (714) 435-0600
- NPI assigned
- Aug 18, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA21641 | CA | Primary |
Addresses
Primary practice location
17220 Newhope St
#125
Fountain Valley, CA 92708-4272
Mailing address
17220 Newhope St
#125
Fountain Valley, CA 92708-4272
Phone (714) 435-0600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21641 | CA | MD | General Practice Dentistry |
| PA21641 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336003200000",
"number": "1043590250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17220 NEWHOPE ST",
"address_2": "#125",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084272",
"telephone_number": "714-435-0600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17220 NEWHOPE ST",
"address_2": "#125",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084272",
"telephone_number": "714-435-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "KAITLYN",
"middle_name": "PHUONG",
"credential": "P.A.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-18",
"last_updated": "2012-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA21641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.