Individual provider Active NPI

Evelyn Le Nguyen

  • Physician Assistant
  • Tustin, CA
National Provider Identifier
1184149064
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA59228 Issued in CA
Practice address
2552 Walnut Ave Ste 200
Tustin, CA 92780-6983
Phone
(714) 406-4461
NPI assigned
Aug 11, 2017
Reactivated
Jan 18, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA59228 CA Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

2552 Walnut Ave Ste 200
Tustin, CA 92780-6983

Mailing address

2552 Walnut Ave Ste 200
Tustin, CA 92780-6983

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
I20210426001664 CA Practitioner - Physician Assistant 2567870892 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pih Health PhysiciansGroup PAC ID 8426951328, 616 clinicians

Practice addresses (Care Compare)

12675 La Mirada Blvd
Suite 201And401
La Mirada, CA 90638-2200
Phone (562) 903-7339

15725 Whittier Blvd
Whittier, CA 90603-2347
Phone (562) 947-1669

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.61 of 100Reported as group
Quality
58.7
Improvement activities
40
Cost
75.08

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA59228CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pih Health Physicians CurrentSince Nov 10, 2022 Accepting new patients
Complete Care Community Health Center, Inc CurrentSince Apr 12, 2021 Accepting new patients
Pih Health Physicians CurrentSince Nov 10, 2022 Accepting new patients
Complete Care Community Health Center, Inc CurrentSince Apr 12, 2021 Accepting new patients

Locations

12675 La Mirada Blvd
Ste 201401
La Mirada, CA 90638
Phone (562) 903-7339

2928 E Cesar E Chavez Ave
Los Angeles, CA 90033
Phone (323) 266-6700

941 S Atlantic Blvd
Ste 101
Monterey Park, CA 91754
Phone (626) 458-8401

15725 Whittier Blvd
Ste 500
Whittier, CA 90603
Phone (562) 448-1350

Interoperability endpoints

  • Direct secure messaging: evelynnguyen@pihh.allscriptsdirect.net

Organizations & group practices 6

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1184149064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2552 WALNUT AVE STE 200",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2552 WALNUT AVE STE 200",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806983",
            "telephone_number": "714-406-4461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "EVELYN",
        "middle_name": "LE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-11",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "deactivation_date": "2020-12-29",
        "reactivation_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA59228",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.