Individual provider Active NPI

Karah Grace Gong, PA-C

  • Physician Assistant
  • Visalia, CA
National Provider Identifier
1407556624
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
63410 Issued in CA
Practice address
2300 W Sunnyside Ave
Visalia, CA 93277-7287
Phone
(559) 731-2009
NPI assigned
Mar 7, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 63410 CA Primary

Addresses

Primary practice location

2300 W Sunnyside Ave
Visalia, CA 93277-7287

Mailing address

2300 W Sunnyside Ave
Visalia, CA 93277-7287
Phone (559) 731-2009

Other practice location 1

115 Mall Dr
Hanford, CA 93230-5786
Phone (559) 582-9000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240111004418 CA Practitioner - Physician Assistant 1759732928 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
63410CAMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Dec 1, 2023 Accepting new patients
Cep America - California CurrentSince Dec 1, 2023 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

115 Mall Dr
Hanford, CA 93230
Phone (559) 537-0550

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

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": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1407556624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 W SUNNYSIDE AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932777287",
            "telephone_number": "559-731-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W SUNNYSIDE AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932777287",
            "telephone_number": "559-731-2009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Mall Dr",
            "address_purpose": "LOCATION",
            "city": "Hanford",
            "state": "CA",
            "postal_code": "932305786",
            "country_code": "US",
            "telephone_number": "559-582-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONG",
        "first_name": "KARAH",
        "middle_name": "GRACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-07",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "63410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Visalia, CA

Sources for this page

Verify at the official NPI Registry.