Magnolia Wellness Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MAGNOLIA WELLNESS INC.

Practice address

4295 Gesner St Ste 3F
San Diego, CA 92117-6667

Phone

(858) 956-0514

NPI assigned

May 29, 2023

Organization subpart

No

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

Authorized official

Name

Kaili Ji Shumilak, DONPI 1831489855

Title

President

Phone

(858) 956-0514

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kaili Ji Shumilak, D.O.

  • Family Medicine Physician
  • Northridge, CA
  • NPI 1831489855
  NPD Authorized official

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

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1346933181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3365 29TH STREET",
            "address_2": "1/2",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92104",
            "telephone_number": "619-887-0987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4295 GESNER ST STE 3F",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921176667",
            "telephone_number": "858-956-0514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA WELLNESS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-29",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A",
        "authorized_official_last_name": "SHUMILAK",
        "authorized_official_first_name": "KAILI",
        "authorized_official_middle_name": "JI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-956-0514",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Magnett, L.C.S.W.
• Joana Lynn Vicencio Magno, FNP
• Khareza Magno
• Laura Magno
• Rochelle Magno
• Sarah Magnon, SLP
• Jessica Lynn Magnus, SLP
• Kara A Magnusen, FNP-C
• Anna Magnuson, OT
• Joshua David Magnuson, APRN, CRNA, MS

• Family Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.