Active NPI
Kandy Sue Ah Puck
- Licensed Vocational Nurse
- Riverside, CA
National Provider Identifier
1891952909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- VN197916
- Practice address
- 2782 Woodbine St
Riverside, CA 92507-5665 - Phone
- (951) 684-5957
- NPI assigned
- May 18, 2008
- 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 |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | VN197916 | CA | Primary |
Addresses
Primary practice location
2782 Woodbine St
Riverside, CA 92507-5665
Mailing address
2782 Woodbine St
Riverside, CA 92507-5665
Phone (951) 684-5957
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VN197916 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211068800000",
"number": "1891952909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2782 WOODBINE ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925075665",
"telephone_number": "951-684-5957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2782 WOODBINE ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925075665",
"telephone_number": "951-684-5957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AH PUCK",
"first_name": "KANDY",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-18",
"last_updated": "2008-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "VN197916",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.