Ly Kong Pheng Jalao

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

NP95009751 Issued in CA

Practice address

2200 Del Paso Blvd
Sacramento, CA 95815-3102

Phone

(916) 642-1890

NPI assigned

Sep 12, 2018

Sex

Male

Sole proprietor

Yes

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 CA

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

Nurse Practitioner

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Health and Life Organization, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1427715515
  NPD (past)
• Health and Life Organization, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1538180245
  NPD (past)

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

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1952884124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6817 E LANE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937275814",
            "telephone_number": "209-613-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 DEL PASO BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958153102",
            "telephone_number": "916-642-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JALAO",
        "first_name": "LY KONG PHENG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-12",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "NP95009751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rohit Jaiswal, M.D.
• George Gbubemi Jaja
• Ankita Jakhu
• Christopher Jakle, MD
• Tahmina Jalal
• Hector Angel Jam
• Roshni Jamadar, FNP-C
• Jamal Adams Licensed Professional Clinical Counselor Inc
• Jamal Mujaddid Mohammed, M.D., Inc.
• Ala Zeyad Jamal, MD

• Primary Care Nurse Practitioner in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.