Active NPI
Kimmy Nguyen, PA-C
- Physician Assistant
- Rancho Cucamonga, CA
National Provider Identifier
1154196723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 9710 19TH St
Rancho Cucamonga, CA 91737-3538 - Phone
- (909) 581-0008
- Fax
- (909) 581-0030
- NPI assigned
- Nov 23, 2023
- Last updated
- Dec 31, 2023
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
9710 19TH St
Rancho Cucamonga, CA 91737-3538
Mailing address
13632 Palomar St
Westminster, CA 92683-3022
Phone (714) 514-7259
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240515003054 | CA | Order and Referring Only - Pediatric Medicine | 1658712179 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CGEIBD/Endpoint/CGEIBD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703980800000",
"number": "1154196723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13632 PALOMAR ST",
"city": "WESTMINSTER",
"state": "CA",
"postal_code": "926833022",
"telephone_number": "714-514-7259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9710 19TH ST",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917373538",
"telephone_number": "909-581-0008",
"fax_number": "909-581-0030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "KIMMY",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-23",
"last_updated": "2023-12-31",
"certification_date": "2023-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.