Active NPI
Kimberly VI Nguyen, PA-C
- Physician Assistant
- Huntington Beach, CA
National Provider Identifier
1962775684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA22029
- Practice address
- 18800 Main St Ste 103
Huntington Beach, CA 92648 - Phone
- (714) 842-8100
- Fax
- (714) 842-8181
- NPI assigned
- Feb 10, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA22029 | CA | Primary |
Addresses
Primary practice location
18800 Main St Ste 103
Huntington Beach, CA 92648
Mailing address
18800 Main St Ste 103
Huntington Beach, CA 92648-1717
Phone (714) 842-8100
Other practice location 1
17100 Euclid St
Fountain Valley, CA 92708-4004
Phone (714) 966-7200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA22029 | Other | CA | CA PA LICENSE |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
11180 Warner Ave
Suite 457
Fountain Valley, CA 92708-7505
Phone (714) 486-2120
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22029 | CA | MD | Rehabilitation Psychologist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- knguyen717151@direct.memorialcare.org
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 and National Provider Directory roles.
-
dba OC Cardiovascular Care
- Interventional Cardiology Physician
- Fountain Valley, CA
- NPI 1346737905
-
- Cardiovascular Disease Physician
- Huntington Beach, CA
- NPI 1639278476
-
- Emergency Medicine Physician
- Fountain Valley, CA
- NPI 1639698475
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531094400000",
"number": "1962775684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18800 MAIN ST STE 103",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926481717",
"telephone_number": "714-842-8100",
"fax_number": "714-842-8181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18800 MAIN ST STE 103",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "92648",
"telephone_number": "714-842-8100",
"fax_number": "714-842-8181"
}
],
"practiceLocations": [
{
"address_1": "17100 Euclid St",
"address_purpose": "LOCATION",
"city": "Fountain Valley",
"state": "CA",
"postal_code": "927084004",
"country_code": "US",
"telephone_number": "714-966-7200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NGUYEN",
"first_name": "KIMBERLY",
"middle_name": "VI",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-10",
"last_updated": "2018-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA22029",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA PA LICENSE",
"identifier": "PA22029",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntington Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.