Individual provider Active NPI

Larry DO Nguyen, PT

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1396239075
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
37957 Issued in CA
Practice address
4647 Zion Ave
San Diego, CA 92120-2507
Phone
(415) 600-6680
NPI assigned
Jun 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 37957 CA Primary

Addresses

Primary practice location

4647 Zion Ave
San Diego, CA 92120-2507

Mailing address

11509 Rocoso Rd
Lakeside, CA 92040-1242
Phone (916) 690-2417

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181012002555 CA Practitioner - Physical Therapist in Private Practice 6103178512 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4510 Viewridge Ave
San Diego, CA 92123-1637
Phone (619) 528-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Aug 13, 2018 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Aug 21, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 13, 2018 Accepting new patients

Locations

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

4510 Viewridge Ave
San Diego, CA 92123
Phone (858) 502-1350

Organizations & group practices 4

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": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1396239075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11509 ROCOSO RD",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920401242",
            "telephone_number": "916-690-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4647 ZION AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921202507",
            "telephone_number": "415-600-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "LARRY",
        "middle_name": "DO",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "37957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.