Individual provider Active NPI

Jane Yoon, MD

  • Pediatrics Physician
  • Fountain Valley, CA
National Provider Identifier
1912249913
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A174872 Issued in CA
Practice address
18035 Brookhurst Street, Ste 2100
Fountain Valley, CA 92708
Phone
(657) 241-9090
Fax
(714) 665-4603
NPI assigned
Mar 18, 2013
Last updated
Apr 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 290787 NY
Pediatrics Physician 208000000X A174872 CA Primary

Addresses

Primary practice location

18035 Brookhurst Street, Ste 2100
Fountain Valley, CA 92708

Mailing address

3091 Sage View CT
Fullerton, CA 92833-5511

Other names 1

  • Jae Won Yoon Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210930002740 CA Practitioner - Pediatric Medicine 3971739962 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A174872CAMDPediatrics Physician
290787NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgecrest Regional Hospital CurrentSince Apr 1, 2023 Accepting new patients
Memorialcare Medical Foundation Pediatrics CurrentSince May 1, 2023 Accepting new patients
Ridgecrest Regional Hospital CurrentSince Apr 1, 2023 Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

18035 Brookhurst St
Ste 2100
Fountain Valley, CA 92708
Phone (657) 241-9090

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

1081 N China Lake Blvd
Ridgecrest, CA 93555
Phone (760) 446-0616

1111 N China Lake Blvd
Ridgecrest, CA 93555
Phone (760) 446-4571

1111 N China Lake Blvd
#190
Ridgecrest, CA 93555
Phone (760) 499-3855

Organizations & group practices 4

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": "1363564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1912249913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3091 SAGE VIEW CT",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928335511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18035 BROOKHURST STREET, STE 2100",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "92708",
            "telephone_number": "657-241-9090",
            "fax_number": "714-665-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOON",
        "first_name": "JANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-18",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "290787",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A174872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JAE WON",
            "last_name": "YOON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.