NPIMap

Individual provider Active NPI

Kathleen Chak

  • Internal Medicine Physician
  • Pismo Beach, CA
National Provider Identifier
1356754659
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A14324 Issued in CA
Practice address
877 Oak Park Blvd
Pismo Beach, CA 93449-3292
Phone
(805) 474-8450
Fax
(805) 474-8454
NPI assigned
Jun 4, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 20A14324 CA
Internal Medicine Physician 207R00000X 20A14324 CA Primary

Addresses

Primary practice location

877 Oak Park Blvd
Pismo Beach, CA 93449-3292

Mailing address

877 Oak Park Blvd
Pismo Beach, CA 93449-3292
Phone (805) 474-8450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190619000179 CA Practitioner - Internal Medicine 9537493960 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

877 Oak Park Blvd
Pismo Beach, CA 93449-3292
Phone (805) 474-8450

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
14324CAMDOptometrist
20A14324CAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Central Coast Health Centers CurrentSince May 9, 2022 Accepting new patients
Pacific Central Coast Health Centers CurrentSince May 9, 2022 Accepting new patients
Healthcare Partners Affiliates Medical Group Internal Medicine CurrentSince Apr 29, 2019 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Apr 29, 2019 Accepting new patients
Pacific Central Coast Health Centers Current Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients

Locations

1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

831 E Huntington Dr
Ste 101
Monrovia, CA 91016
Phone (626) 358-0269

877 Oak Park Blvd
Pismo Beach, CA 93449
Phone (805) 473-2200

601 Torrance Blvd
#1182
Redondo Beach, CA 90277

117 W Bunny Ave
Santa Maria, CA 93458
Phone (805) 739-3474

1510 E Main St
Ste 104C
Santa Maria, CA 93454
Phone (805) 349-8514

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1356754659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 OAK PARK BLVD",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493292",
            "telephone_number": "805-474-8450",
            "fax_number": "805-474-8454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 OAK PARK BLVD",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493292",
            "telephone_number": "805-474-8450",
            "fax_number": "805-474-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAK",
        "first_name": "KATHLEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-04",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "20A14324",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A14324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pismo Beach, CA

Sources for this page

Verify at the official NPI Registry.