Individual provider Active NPI

Jeniffer Won

  • Family Nurse Practitioner
  • Huntington Beach, CA
National Provider Identifier
1740810613
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95026724 Issued in CA
Practice address
7677 Center Ave Ste 214
Huntington Beach, CA 92647-9102
Phone
(949) 313-8766
NPI assigned
Jan 20, 2020
Last updated
Feb 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95026724 CA Primary

Addresses

Primary practice location

7677 Center Ave Ste 214
Huntington Beach, CA 92647-9102

Mailing address

5 Palacio
Aliso Viejo, CA 92656-7031
Phone (623) 776-5880

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
I20231201002717 CA Practitioner - Nurse Practitioner 0042633612 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95026724CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rebecca a Prostko MD PA CurrentSince Apr 12, 2020 Accepting new patients
Concertocare Medical Group of California, P.C. CurrentSince Oct 6, 2023 Accepting new patients

Locations

7677 Center Ave
Huntington Beach, CA 92647
Phone (714) 766-6560

7677 Center Ave
Ste 214
Huntington Beach, CA 92647
Phone (310) 433-9507

938 SW Martin Downs Blvd
Palm City, FL 34990
Phone (772) 221-7620

816 SE Ocean Blvd
Stuart, FL 34994
Phone (772) 260-5066

811 Main St
#7
Kansas City, MO 64105

Organizations & group practices 2

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": "1579478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1740810613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 PALACIO",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926567031",
            "telephone_number": "623-776-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7677 CENTER AVE STE 214",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926479102",
            "telephone_number": "949-313-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WON",
        "first_name": "JENIFFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-20",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95026724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.