Active NPI
Jacqueline Hae Yun Evans
- Physician Assistant
- Redlands, CA
National Provider Identifier
1821579335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 56203
- Practice address
- 2 W Fern Ave
Redlands, CA 92373-5916 - Phone
- (909) 793-3311
- NPI assigned
- Aug 22, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | 56203 | CA | Primary |
Addresses
Primary practice location
2 W Fern Ave
Redlands, CA 92373-5916
Mailing address
PO Box 10069
San Bernardino, CA 92423-0069
Phone (909) 335-4188
Other practice location 1
11320 Mountain View Ave Ste B
Loma Linda, CA 92354-3860
Phone (909) 300-3008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56203 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Refine Health Inc. | Current | Accepting new patients |
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 and National Provider Directory roles.
-
- Prevention Professional
- Loma Linda, CA
- NPI 1780536961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673395200000",
"number": "1821579335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10069",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924230069",
"telephone_number": "909-335-4188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 W FERN AVE",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923735916",
"telephone_number": "909-793-3311"
}
],
"practiceLocations": [
{
"address_1": "11320 Mountain View Ave Ste B",
"address_purpose": "LOCATION",
"city": "Loma Linda",
"state": "CA",
"postal_code": "923543860",
"country_code": "US",
"telephone_number": "909-300-3008",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EVANS",
"first_name": "JACQUELINE",
"middle_name": "HAE YUN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-22",
"last_updated": "2023-01-11",
"certification_date": "2023-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "56203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.