Active NPI
Kevin Chivacharoen
- Physician Assistant
- Westminster, CA
National Provider Identifier
1801442694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA57086
- Practice address
- 14371 Riverton St
Westminster, CA 92683-4692 - Phone
- (714) 728-7428
- NPI assigned
- Aug 16, 2019
- Last updated
- May 15, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA57086 | CA | Primary |
Addresses
Primary practice location
14371 Riverton St
Westminster, CA 92683-4692
Mailing address
14371 Riverton St
Westminster, CA 92683-4692
Phone (714) 728-2851
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA57086 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Careathome Medical Practice Ca PC | Past | Accepting new patients | |
| Gem Medical Group Corporation | Past | Accepting new patients |
Organizations & group practices 5
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.
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- NPI 1932640935
-
- Family Nurse Practitioner
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- NPI 1306516174
-
dba GEM Medical Group
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- NPI 1689386815
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1801442694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14371 RIVERTON ST",
"city": "WESTMINSTER",
"state": "CA",
"postal_code": "926834692",
"telephone_number": "714-728-2851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14371 RIVERTON ST",
"city": "WESTMINSTER",
"state": "CA",
"postal_code": "926834692",
"telephone_number": "714-728-7428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHIVACHAROEN",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-16",
"last_updated": "2023-05-15",
"certification_date": "2023-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA57086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westminster, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.