Jie Shi Yan, M.D.
Individual provider Active NPI Nephrology Physician · Simi Valley, CA
NPI 1396744546 · NPPES record last updated Jul 18, 2023
Key facts
- NPI
- 1396744546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- A78071 (CA)
- Practice address
- 2925 Sycamore Dr
Suite 160
Simi Valley, CA 93065-1207 - Phone
- (805) 584-0177
- Fax
- (805) 584-1179
- NPI assigned
- Jul 19, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- Stanford University School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- California Kidney Medical Group Inc
Practice addresses (Care Compare)
2925 Sycamore Dr
Suite 160
Simi Valley, CA 93065-1209
Phone (805) 584-0177
Hospital & facility affiliations
- DaVita Simi Valley Dialysis
- DaVita Moorpark Dialysis Center
- SRS-Thousand Oaks Dialysis
- Adventist Health Simi Valley
- Los Robles Hospital & Medical Center
- Northridge Hospital Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051012000616 | CA | Practitioner - Nephrology |
2860417409 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A78071 | CA | MD | Nephrology Physician |
Practice roles (6 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jonathan Nasseri MD Corp | Current |
Accepting new patients | |
| County of Ventura | Current |
Accepting new patients | |
| County of Ventura | Current |
Accepting new patients | |
| California Kidney Medical Group Inc | Current |
Accepting new patients | |
| West Coast Renal Medical Group, Inc | Nephrology | Current | Accepting new patients |
| California Kidney Medical Group, Inc | Nephrology | Current |
Accepting new patients |
Locations
14860 Roscoe Blvd
Ste 303
Panorama City, CA 91402
Phone (818) 376-4074
1227 E Los Angeles Ave
Simi Valley, CA 93065
Phone (805) 582-4000
2925 Sycamore Dr
Ste 160
Simi Valley, CA 93065
Phone (805) 584-0177
2950 Sycamore Dr
Ste 201
Simi Valley, CA 93065
Phone (805) 210-7107
2975 Sycamore Dr
Simi Valley, CA 93065
Phone (805) 522-2500
1534 N Moorpark Rd
Thousand Oaks, CA 91360
Phone (805) 497-1800
375 Rolling Oaks Dr
Ste 100
Thousand Oaks, CA 91361
Phone (805) 497-7775
227 W Janss Rd
Ste 100
Thousand Oaks, CA 91360
Phone (805) 230-2333
800 S Victoria Ave
#L4640
Ventura, CA 93009
300 Hillmont Ave
Ventura, CA 93003
Phone (805) 652-6000
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- jieshi.yan@ventura.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | A78071 | CA | Yes |
Addresses
Primary practice location
2925 Sycamore Dr
Suite 160
Simi Valley, CA 93065-1207
Mailing address
PO Box 2160
Moorpark, CA 93020-2160
Phone (818) 718-2301
Other practice location 1
1227 E Los Angeles Ave
Simi Valley, CA 93065-2871
Phone (805) 582-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A78071 | Other | CA | CALIFORNIA LICENSE NUMBER |
| 00A780710 | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jieshi.yan@ventura.cernerdirect.com | Direct |
Other providers in Simi Valley, CA
- Xpsyz
- Sahar Yaftaly
- Andrew Yaghnam
- David Ken Yamada
- Adrienne Alexis Salvador Yamamoto
- Marisela Esquer Yanez
- Yaniv Jay Dvora Chiropractic Corp
- Farida Yasmin
- Yazdan Alami DDS a Professional Dental Corporation
- Virginia Mo Keung Yeh
All providers in Simi Valley, CA · Nephrology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.