Individual provider Active NPI

So Yun Ahn

  • Family Nurse Practitioner
  • Visalia, CA
National Provider Identifier
1306248703
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95000876 Issued in CA
Practice address
627 S Garden St Apt C
Visalia, CA 93277-2851
Phone
(714) 581-3222
NPI assigned
Sep 17, 2014
Last updated
Apr 20, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP95000876 CA Primary

Addresses

Primary practice location

627 S Garden St Apt C
Visalia, CA 93277-2851

Mailing address

627 S Garden St Apt C
Visalia, CA 93277-2851
Phone (714) 581-3222

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
I20150805007696 CA Practitioner - Nurse Practitioner 2365756202 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SC Medical, Inc.Group PAC ID 6305001439, 10 clinicians

Practice addresses (Care Compare)

19042 Soledad Canyon Rd
Santa Clarita, CA 91351-3362
Phone (661) 251-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95000876CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kaweah Delta Health Care District Current Accepting new patients
SC Medical, Inc. CurrentSince Feb 1, 2025 Accepting new patients
Kaweah Delta Health Care District CurrentSince Jun 1, 2015 Accepting new patients
Kaweah Delta Health Care District CurrentSince Jun 26, 2015 Accepting new patients
Kaweah Delta Health Care District CurrentSince Jun 1, 2015 Accepting new patients
SC Medical, Inc. CurrentSince Feb 1, 2025 Accepting new patients

Locations

19042 Soledad Canyon Rd
Santa Clarita, CA 91351
Phone (661) 251-6300

27550 Newhall Ranch Rd
Ste 203
Valencia, CA 91355
Phone (661) 251-6300

1633 S Court St
Visalia, CA 93277
Phone (559) 624-6090

400 W Mineral King Ave
Visalia, CA 93291
Phone (559) 624-2001

840 S Akers St
Visalia, CA 93277
Phone (559) 624-3700

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, 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": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1306248703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 S GARDEN ST APT C",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932772851",
            "telephone_number": "714-581-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 S GARDEN ST APT C",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932772851",
            "telephone_number": "714-581-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHN",
        "first_name": "SO YUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-17",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95000876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Visalia, CA

Sources for this page

Verify at the official NPI Registry.