Active NPI
Kelsey Koga
- Speech-Language Pathologist
- Long Beach, CA
National Provider Identifier
1174090567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22086
- Practice address
- 3620 Long Beach Blvd
Long Beach, CA 90807-4022 - Phone
- (562) 595-0912
- NPI assigned
- Oct 24, 2018
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22086 | CA | Primary |
Addresses
Primary practice location
3620 Long Beach Blvd
Long Beach, CA 90807-4022
Mailing address
1484 Via Latina Dr
Camarillo, CA 93012-9288
Phone (805) 402-4642
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22086 | Medicaid | CA |
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 |
|---|---|---|---|
| 22086 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1174090567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1484 VIA LATINA DR",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930129288",
"telephone_number": "805-402-4642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3620 LONG BEACH BLVD",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908074022",
"telephone_number": "562-595-0912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOGA",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-24",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "22086",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "22086",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.