Individual provider Active NPI

Kammi Yap Sayaseng, NP

  • Pediatric Nurse Practitioner
  • Fresno, CA
National Provider Identifier
1962573063
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
NP11636 Issued in CA
Practice address
4770 W Herndon Ave
Suite 108
Fresno, CA 93722-8401
Phone
(559) 256-7990
Fax
(559) 256-7991
NPI assigned
Nov 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NP11636 CA Primary
Nurse Practitioner 363L00000X NP11636 CA
Registered Nurse 163W00000X RN508617 CA

Addresses

Primary practice location

4770 W Herndon Ave
Suite 108
Fresno, CA 93722-8401

Mailing address

4770 W Herndon Ave
Suite 108
Fresno, CA 93722-8401
Phone (559) 256-7990

Other identifiers 1

IdentifierTypeStateIssuer
RN508617MedicaidCA

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100526000505 CA Practitioner - Nurse Practitioner 9830228006 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN508617CAMDRegistered Nurse
NP11636CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Partners CurrentSince Mar 19, 2024 Accepting new patients
Sierra View Local Health Care District PastSince Aug 1, 2016 Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2066 E Copper Ave
Ste 102
Fresno, CA 93730
Phone (559) 299-2997

2066 E Copper Ave
Ste 104
Fresno, CA 93730
Phone (559) 299-2997

45 E River Park Pl W
Ste 104
Fresno, CA 93720
Phone (559) 320-0550

2823 Fresno St
Fresno, CA 93721
Phone (559) 459-3965

2335 E Kashian Ln
Ste 410
Fresno, CA 93701
Phone (559) 266-4100

805 W Acequia Ave
Ste 2D
Visalia, CA 93291
Phone (559) 622-8687

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1962573063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 W HERNDON AVE",
            "address_2": "SUITE 108",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937228401",
            "telephone_number": "559-256-7990",
            "fax_number": "559-256-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 W HERNDON AVE",
            "address_2": "SUITE 108",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937228401",
            "telephone_number": "559-256-7990",
            "fax_number": "559-256-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAYASENG",
        "first_name": "KAMMI",
        "middle_name": "YAP",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-11",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "NP11636",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP11636",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN508617",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN508617",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.