Haggan Julijanto

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10005054A Issued in IN

Practice address

2004 W Sycamore St
Kokomo, IN 46901-4112

Phone

(574) 780-0102

NPI assigned

Oct 21, 2025

Last updated

Oct 21, 2025By the provider in NPPES

Sex

Unspecified or another gender identity

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgentchoice Care LLCGroup PAC ID 7113364423, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Urgentchoice Care LLC

  • Urgent Care Clinic/Center
  • Kokomo, IN
  • NPI 1508636945
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1761004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1871460055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14053 FOUR SEASONS WAY",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460748588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014112",
            "telephone_number": "574-780-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JULIJANTO",
        "first_name": "HAGGAN",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-10-21",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005054A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• JP Dental - Kokomo LLC
• Judith a Culver DDS LLC
• Sydnee Judy
• Amy Elizabeth Julian-Resner, FNP-C
• Julie Harrell, LCSW Counseling
• Danielle Lynn Juranovich, BCBA
• Brent Nelson Justice, MA BCBA
• Abigail Elizabeth Kaercher, DO
• Kamel Inc. (Eric J. Heathers MD)
• Aaron Kane

• Physician Assistant in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.