Southern California Permanente Medical Group

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

Practice address

17284 Slover Ave Ste 205
Fontana, CA 92337-7584

Phone

(626) 405-6942

NPI assigned

Jun 29, 2021

Last updated

Jun 29, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Khang Nguyen

Title

Director

Phone

(626) 405-6942

Specialties & licenses 1

Addresses

Tax ID family

Southern California Permanente Medical Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Kaiser Permanente

  • Clinic/Center
  • Oxnard, CA
  • NPI 1811367436
  NPD tax ID
• Rioh Medical Group

  • General Practice Physician
  • Redding, CA
  • NPI 1548205826
  NPD tax ID
• Southern California Permanente Medical Group

  • Clinical Medical Laboratory
  • Los Angeles, CA
  • NPI 1124269717
  NPD tax ID
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Pasadena, CA
  • NPI 1780309468
  NPD tax ID

Locations

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1609446814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17284 SLOVER AVE STE 205",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923377584",
            "telephone_number": "626-405-6942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17284 SLOVER AVE STE 205",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923377584",
            "telephone_number": "626-405-6942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KHANG",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "626-405-6942",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Sosa, PHARMD
• Heaven L Soto
• Jasmin A Soto, GRNA
• South Pacific Rehabilitation Services
• Southern California Permanente Medical Group
• Southern California Permanente Medical Group
• Southern California Picc Providers, Inc.
• Southridge Dental Group
• Sovereign Birth Co LLC
• Lisa Lam Sparks, NP

• Health Maintenance Organization in Fontana, CA
• Providers in Fontana, CA by specialty
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.