Individual provider Active NPI

Kelly Leong

  • Marriage & Family Therapist
  • Rosemead, CA
National Provider Identifier
1902295991
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
106866 Issued in CA
Practice address
9353 Valley Blvd
Rosemead, CA 91770
Phone
(626) 287-2988
NPI assigned
Jan 14, 2015
Last updated
Jun 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Marriage & Family Therapist 106H00000X 106866 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

9353 Valley Blvd
Rosemead, CA 91770

Mailing address

9353 Valley Blvd
Rosemead, CA 91770-1934

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240614000389 CA Practitioner - Marriage and Family Therapist 4688117062 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1255 W Arrow Hwy
San Dimas, CA 91773-2340
Phone (909) 394-2526

1502 W W Covina Pkwy
West Covina, CA 91790-2703
Phone (626) 960-4845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
106866CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince May 1, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince May 1, 2024 Accepting new patients

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

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.

NPI Registry JSON

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

{
    "created_epoch": "1421193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1902295991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9353 VALLEY BLVD",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917701934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9353 VALLEY BLVD",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "91770",
            "telephone_number": "626-287-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONG",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-14",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "106866",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rosemead, CA

Sources for this page

Verify at the official NPI Registry.