NPIMap

Individual provider Active NPI

Jungmin Kang, AG-ACNP

  • Nurse Practitioner
  • Palo Alto, CA
National Provider Identifier
1538694914
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95007388 Issued in CA
Practice address
300 Pasteur Dr # A160
Palo Alto, CA 94305-2200
Phone
(650) 725-4672
NPI assigned
Apr 24, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95007388 CA Primary
Acute Care Nurse Practitioner 363LA2100X 95007388 CA
Registered Nurse 163W00000X 717640 CA

Addresses

Primary practice location

300 Pasteur Dr # A160
Palo Alto, CA 94305-2200

Mailing address

300 Pasteur Dr
Stanford, CA 94305

Other practice location 1

2000 Mowry Ave
Fremont, CA 94538-1716
Phone (510) 791-1111

Other names 1

  • Jung Min Kang Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171031001223 CA Practitioner - Nurse Practitioner 2163798562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.53 of 100Reported as group
Quality
87.08
Promoting interoperability
100
Improvement activities
40
Cost
69.51

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
717640CAMDRegistered Nurse
95007388CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Oct 24, 2017 Accepting new patients
LPCH Medical Group Div of Lucile CurrentSince Oct 24, 2017 Accepting new patients
Stanford Health Care Current Accepting new patients
Stanford Health Care CurrentSince Oct 24, 2017 Accepting new patients

Locations

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

300 Pasteur Dr
#A160
Stanford, CA 94305
Phone (650) 725-4672

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1538694914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "94305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR # A160",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-725-4672"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Mowry Ave",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "945381716",
            "country_code": "US",
            "telephone_number": "510-791-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANG",
        "first_name": "JUNGMIN",
        "credential": "AG-ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95007388",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95007388",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "717640",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUNG",
            "last_name": "KANG",
            "middle_name": "MIN",
            "credential": "AG-ACNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.