Individual provider Active NPI

M. Barbara Klyde, PAC

  • Medical Physician Assistant
  • Anaheim, CA
National Provider Identifier
1740309608
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA 10707 Issued in CA
Practice address
1711 W Katella Ave
Anaheim, CA 92804-6450
Phone
(714) 400-2959
NPI assigned
Mar 29, 2007
Last updated
Feb 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 10707 CA Primary

Addresses

Primary practice location

1711 W Katella Ave
Anaheim, CA 92804-6450

Mailing address

2391 N River Trail Rd
Orange, CA 92865-2036
Phone (171) 492-1896

Other practice location 1

2391 N River Trail Rd
Orange, CA 92865-2036
Phone (171) 492-1896

Other practice location 2

27522 Antonio Pkwy Ste P3
Ladera Ranch, CA 92694-2166
Phone (949) 207-3786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1333 E Madison Ave
Suite 201
El Cajon, CA 92021-8500

5080 Spectrum Dr
Suite 1200W
Addison, TX 75001-6443

PO Box
Suite 519
Lake Forest, CA 92609-0519

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA 10707CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sun Medical Group, Inc. CurrentSince Apr 1, 2023 Accepting new patients

Locations

1711 W Katella Ave
Anaheim, CA 92804
Phone (714) 337-9393

27522 Antonio Pkwy
Ste P3
Ladera Ranch, CA 92694
Phone (949) 207-3786

Organizations & group practices 1

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": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1740309608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2391 N RIVER TRAIL RD",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928652036",
            "telephone_number": "171-492-1896",
            "fax_number": "171-463-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 W KATELLA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928046450",
            "telephone_number": "714-400-2959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2391 N River Trail Rd",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928652036",
            "country_code": "US",
            "telephone_number": "171-492-1896",
            "fax_number": "171-463-7426",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27522 Antonio Pkwy Ste P3",
            "address_purpose": "LOCATION",
            "city": "Ladera Ranch",
            "state": "CA",
            "postal_code": "926942166",
            "country_code": "US",
            "telephone_number": "949-207-3786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLYDE",
        "first_name": "M.",
        "middle_name": "BARBARA",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA 10707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.