Individual provider Active NPI

Paul Namkoong, PA-C

  • Physician Assistant
  • San Jose, CA
National Provider Identifier
1265160931
Registry record updated Feb 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2784 Issued in NV
Practice address
1246 Quail Creek Cir
San Jose, CA 95120-4151
Phone
(408) 821-4868
NPI assigned
Aug 10, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2023

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
Physician Assistant 363A00000X PA2784 NV Primary

Addresses

Primary practice location

1246 Quail Creek Cir
San Jose, CA 95120-4151

Mailing address

1246 Quail Creek Cir
San Jose, CA 95120-4151
Phone (408) 821-4868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20230224002509 NV Practitioner - Physician Assistant 3375916166 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fremont Emergency Services Scherr LTD Physician Assistant CurrentSince Mar 1, 2023 Accepting new patients

Locations

3100 N Tenaya Way
Las Vegas, NV 89128
Phone (702) 225-5025

10770 Las Vegas Blvd S
Las Vegas, NV 89183
Phone (702) 916-9002

3186 S Maryland Pkwy
Ste 410
Las Vegas, NV 89109

9300 W Sunset Rd
Las Vegas, NV 89148
Phone (702) 880-2100

3325 S Fort Apache Rd
Las Vegas, NV 89117
Phone (702) 962-0500

7207 Aliante Pkwy
North Las Vegas, NV 89084
Phone (702) 962-5100

Organizations & group practices 2

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": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1265160931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 QUAIL CREEK CIR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951204151",
            "telephone_number": "408-821-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 QUAIL CREEK CIR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951204151",
            "telephone_number": "408-821-4868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAMKOONG",
        "first_name": "PAUL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-10",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA2784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.