Individual provider Active NPI

Ngan Nhu Doan

  • Gerontology Nurse Practitioner
  • Costa Mesa, CA
National Provider Identifier
1497931125
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
95012646 Issued in CA
Practice address
2995 Red Hill Ave Ste 200
Costa Mesa, CA 92626-5984
Phone
(949) 279-6519
NPI assigned
Jan 11, 2008
Last updated
Jan 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 95012646 CA Primary

Addresses

Primary practice location

2995 Red Hill Ave Ste 200
Costa Mesa, CA 92626-5984

Mailing address

507 S Euclid St SPC 10
Santa Ana, CA 92704-1068
Phone (714) 423-4031

Other identifiers 1

IdentifierTypeStateIssuer
10D0539932OtherCAMSI

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
I20210122001759 CA Practitioner - Nurse Practitioner 7315351970 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95012646CAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Medical Clinic, Inc Current Accepting new patients
Riverside Medical Clinic, Inc CurrentSince Sep 24, 2020 Accepting new patients
Riverside Medical Clinic, Inc CurrentSince Sep 24, 2020 Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
Hoag Hospital Past Accepting new patients

Locations

3660 Arlington Ave
Riverside, CA 92506
Phone (951) 782-3789

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1497931125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 S EUCLID ST SPC 10",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927041068",
            "telephone_number": "714-423-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 RED HILL AVE STE 200",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265984",
            "telephone_number": "949-279-6519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOAN",
        "first_name": "NGAN",
        "middle_name": "NHU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-11",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95012646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MSI",
            "identifier": "10D0539932",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.