Kristi Jo Diehl, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA18019 Issued in CA

Practice address

15361 Central Ave
Chino, CA 91710-7608

Phone

(909) 393-7171

Fax

(909) 393-7676

NPI assigned

Mar 13, 2007

Last updated

Jan 10, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kristi Jo Gough Former name

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

Physician Assistant

State licenses

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.

• Moreno Family Medical and Associates Inc

  dba Chino Hills Family Medical Group

  • Family Medicine Physician
  • Chino, CA
  • NPI 1043615610
  Medicare reassignment

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1417080052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16441 CYAN CT",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917094601",
            "telephone_number": "909-393-8082",
            "fax_number": "909-606-9599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15361 CENTRAL AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917107608",
            "telephone_number": "909-393-7171",
            "fax_number": "909-393-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEHL",
        "first_name": "KRISTI",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA18019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTI",
            "last_name": "GOUGH",
            "middle_name": "JO",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jose Adalberto Dheming, MD
• Michael Dia
• Diana Lee DDS, Inc.
• Jose J Diaz, M.D.
• Farid Didari
• Melissa Dinh
• Ivy Kamille Pineda Dino
• Jaina R DO, DPT
• Julie DO, FNP-C
• Lan DO

• Medical Physician Assistant in Chino, CA
• Providers in Chino, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; 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.