Individual provider Active NPI

Sin Wee Koh-Gale, AGPCNP

  • Adult Health Nurse Practitioner
  • Rancho Mirage, CA
National Provider Identifier
1174989875
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
95003233 Issued in CA
Practice address
35400 Bob Hope Dr Ste 210
Rancho Mirage, CA 92270-1774
Phone
(760) 202-0686
Fax
(760) 770-4563
NPI assigned
Jan 11, 2016
Last updated
Nov 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 95003233 CA Primary

Addresses

Primary practice location

35400 Bob Hope Dr Ste 210
Rancho Mirage, CA 92270-1774

Mailing address

35400 Bob Hope Dr Ste 210
Rancho Mirage, CA 92270-1774
Phone (760) 202-0686

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200611001902 CA Order and Referring Only - Nurse Practitioner 6406278894

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95003233CAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Syed F Azam Medical Associates Inc CurrentSince Dec 5, 2021 Accepting new patients

Locations

35400 Bob Hope Dr
Ste 210
Rancho Mirage, CA 92270
Phone (760) 202-0686

Interoperability endpoints

  • Direct secure messaging: sin.wee.koh-gale.1@11678.direct.athenahealth.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1174989875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35400 BOB HOPE DR STE 210",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701774",
            "telephone_number": "760-202-0686",
            "fax_number": "760-770-4563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35400 BOB HOPE DR STE 210",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701774",
            "telephone_number": "760-202-0686",
            "fax_number": "760-770-4563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOH-GALE",
        "first_name": "SIN WEE",
        "name_prefix": "Mr.",
        "credential": "AGPCNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-11",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95003233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

Verify at the official NPI Registry.