Individual provider Active NPI

Khoa Ba Nguyen

  • Dermatology Physician
  • Santa Monica, CA
National Provider Identifier
1073139630
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A186255 Issued in CA
Practice address
2020 Santa Monica Blvd Ste 510
Santa Monica, CA 90404-2131
Phone
(310) 917-3376
NPI assigned
Jun 19, 2020
Last updated
Oct 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A186255 CA Primary

Addresses

Primary practice location

2020 Santa Monica Blvd Ste 510
Santa Monica, CA 90404-2131

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-8707

Other practice location 1

100 W California Blvd
Pasadena, CA 91105-3010
Phone (714) 931-1440

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231109002962 CA Practitioner - Dermatology 7113325473 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Florida College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Regents of the University of CaliforniaGroup PAC ID 8426956160, 33 clinicians

Practice addresses (Care Compare)

100 Medical Plaza
Suite 216
Los Angeles, CA 90095-0001
Phone (310) 206-8662

100 Moody CT
Suite 200
Thousand Oaks, CA 91360-6082
Phone (805) 418-3500

200 Medical Plaza
Los Angeles, CA 90095-0001
Phone (310) 825-6911

2001 Santa Monica Blvd
Suite 1070
Santa Monica, CA 90404-2202
Phone (310) 917-3376

2020 Santa Monica Blvd
Suite 210
Santa Monica, CA 90404-2139
Phone (310) 458-2381

2020 Santa Monica Blvd
Suite 510
Santa Monica, CA 90404-2131
Phone (310) 582-6360

700 W 7TH St
S270 D
Los Angeles, CA 90017-3768
Phone (213) 896-0010

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.51 of 100Reported as group
Quality
79.37
Promoting interoperability
100
Improvement activities
40
Cost
73.65

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions391
Removal of nail tissue1-10
Removal or shaving of skin growth176
Skin biopsy52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A186255CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Aug 28, 2023 Accepting new patients
The Regents of the University of California CurrentSince Oct 1, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 28, 2023 Accepting new patients
The Regents of the University of California Dermatology CurrentSince Mar 1, 2025 Accepting new patients
The Regents of the University of California CurrentSince Oct 1, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
UCLA Medical Group Dermatology Past Accepting new patients

Locations

24302 Paseo de Valencia
Ste 200
Laguna Hills, CA 92653
Phone (949) 458-8252

200 Medical Plz
Ste 465
Los Angeles, CA 90095
Phone (310) 825-5510

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

700 W 7th St
Ste S270D
Los Angeles, CA 90017
Phone (213) 988-8339

File 55737
Los Angeles, CA 90074

892 Aerovista Pl
Ste 240
San Luis Obispo, CA 93401
Phone (805) 541-8252

2001 Santa Monica Blvd
Ste 1070
Santa Monica, CA 90404
Phone (310) 315-7900

2001 Santa Monica Blvd
Ste 1090
Santa Monica, CA 90404
Phone (310) 582-7474

2020 Santa Monica Blvd
Ste 210
Santa Monica, CA 90404
Phone (310) 458-2381

2020 Santa Monica Blvd
Ste 510
Santa Monica, CA 90404
Phone (310) 633-8400

100 Moody Ct
Ste 110
Thousand Oaks, CA 91360
Phone (805) 418-3500

100 Moody Ct
Ste 200
Thousand Oaks, CA 91360
Phone (805) 418-3500

Interoperability endpoints

  • Direct secure messaging: knguyen624923@direct.uclahealth.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1073139630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 SANTA MONICA BLVD STE 510",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042131",
            "telephone_number": "310-917-3376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 W California Blvd",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911053010",
            "country_code": "US",
            "telephone_number": "714-931-1440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KHOA",
        "middle_name": "BA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-19",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A186255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.