Tae Yoon Won, NURSE PRACTITIONER

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95022157 Issued in CA

Practice address

12362 Beach Blvd Ste 10
Stanton, CA 90680-3944

Phone

(714) 248-9500

NPI assigned

Jun 8, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FCDCDA/Endpoint/FCDCDA

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.

• Livingstone Community Development Corporation

  • Federally Qualified Health Center (FQHC)
  • Stanton, CA
  • NPI 1952662686
  Medicare reassignment NPD
• Livingstone Community Development Corporation

  • Federally Qualified Health Center (FQHC)
  • Fullerton, CA
  • NPI 1881210318
  NPD

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

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1356035653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD STE 10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803944",
            "telephone_number": "714-248-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD STE 10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803944",
            "telephone_number": "714-248-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WON",
        "first_name": "TAE",
        "middle_name": "YOON",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95022157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Lee Weber, ACSW
• Katherine West
• Western Pacific Med-Corp
• Angela Wilson
• Esther Jeehyun Won
• Alex Wong
• Kelly Wong
• Worldwide Hospice Care
• Jianyong Wu
• Amber Nicole Yado

• Nurse Practitioner in Stanton, CA
• Providers in Stanton, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.