Active NPI
Jedidah W Kiema, REGISTERED NURSE
- Administrator Registered Nurse
- Eastvale, CA
National Provider Identifier
1144755638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 504041
- Practice address
- 6387 Pomegranate CT
Eastvale, CA 92880-7203 - Phone
- (626) 488-9787
- NPI assigned
- Apr 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 504041 | CA | Primary |
Addresses
Primary practice location
6387 Pomegranate CT
Eastvale, CA 92880-7203
Mailing address
6387 Pomegranate CT
Eastvale, CA 92880-7203
Phone (626) 488-9787
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 504041 | CA | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492819200000",
"number": "1144755638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6387 POMEGRANATE CT",
"city": "EASTVALE",
"state": "CA",
"postal_code": "928807203",
"telephone_number": "626-488-9787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6387 POMEGRANATE CT",
"city": "EASTVALE",
"state": "CA",
"postal_code": "928807203",
"telephone_number": "626-488-9787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIEMA",
"first_name": "JEDIDAH",
"middle_name": "W",
"name_prefix": "Mrs.",
"credential": "REGISTERED NURSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-22",
"last_updated": "2017-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "CA",
"license": "504041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eastvale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.