NPIMap

Individual provider Active NPI

Pennie Khong, NP

  • Family Nurse Practitioner
  • Federal Way, WA
National Provider Identifier
1770192924
Registry record updated Sep 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61090460 Issued in WA
Practice address
33501 1St Way S
Federal Way, WA 98003-6208
Phone
(253) 838-2400
Fax
(253) 874-1637
NPI assigned
Jul 23, 2020
Last updated
Sep 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2026

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 AP61090460 WA Primary

Addresses

Primary practice location

33501 1St Way S
Federal Way, WA 98003-6208

Mailing address

PO Box 741515
Los Angeles, CA 90074-1515

Other practice location 1

3505 Spangler Ln Ste 400
Copperopolis, CA 95228-9424
Phone (209) 785-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210618000665 CA Practitioner - Nurse Practitioner 4789084344 Reassigns benefits to 1 organization
I20260323000390 WA Practitioner - Nurse Practitioner 4789084344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virginia Mason Medical CenterGroup PAC ID 9830002617, 867 clinicians

Practice addresses (Care Compare)

33501 1St Way S
Federal Way, WA 98003-6208
Phone (253) 838-2400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP61090460WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Mar 8, 2021 Accepting new patients
Mark Twain Medical Center Past Accepting new patients

Locations

3505 Spangler Ln
Copperopolis, CA 95228
Phone (209) 785-7000

3505 Spangler Ln
Ste 400
Copperopolis, CA 95228
Phone (209) 785-7000

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

Organizations & group practices 3

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790553600000",
    "number": "1770192924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741515",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900741515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33501 1ST WAY S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036208",
            "telephone_number": "253-838-2400",
            "fax_number": "253-874-1637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3505 Spangler Ln Ste 400",
            "address_purpose": "LOCATION",
            "city": "Copperopolis",
            "state": "CA",
            "postal_code": "952289424",
            "country_code": "US",
            "telephone_number": "209-785-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHONG",
        "first_name": "PENNIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61090460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.