Individual provider Active NPI

CHI Kien Ngo, O.D.

  • Optometrist
  • Pleasanton, CA
National Provider Identifier
1174659973
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT12625T Issued in CA
Practice address
4501 Rosewood Dr
Pleasanton, CA 94588-3051
Phone
(925) 225-9036
NPI assigned
Feb 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT12625T CA Primary

Addresses

Primary practice location

4501 Rosewood Dr
Pleasanton, CA 94588-3051

Mailing address

186 Schooner CT
Richmond, CA 94804-7413

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The 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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120829000127 CA Practitioner - Optometry 5193972008 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT12625TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group, Inc CurrentSince May 16, 2016 Accepting new patients
Permanente Medical Group Inc Current Accepting new patients
Permanente Medical Group Inc CurrentSince May 16, 2016 Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

1800 Harrison St
Fl 7
Oakland, CA 94612

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

2417 Naglee Rd
Ste 8A
Tracy, CA 95304

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1174659973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 SCHOONER CT",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948047413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 ROSEWOOD DR",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945883051",
            "telephone_number": "925-225-9036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGO",
        "first_name": "CHI",
        "middle_name": "KIEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT12625T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2417 Naglee Rd Ste 8A",
            "city": "Tracy",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953047324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.