Kathryn Taraneh Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

52802 Issued in CA

Practice address

1115 S Sunset Ave Ste 200
West Covina, CA 91790-3940

Phone

(626) 732-8390

NPI assigned

Sep 25, 2015

Sex

Female

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Emanate Health Medical Care Foundation

  • Multi-Specialty Clinic/Center
  • West Covina, CA
  • NPI 1467195073
  Medicare reassignment
• Emanate Health Medical Group

  • Family Medicine Physician
  • Glendora, CA
  • NPI 1326582743
  Medicare reassignment
• Indus Healthcare, Inc.

  • Family Medicine Physician
  • Pomona, CA
  • NPI 1508907874
  Medicare reassignment
• Citrus Valley Physician Partners

  • Specialist
  • West Covina, CA
  • NPI 1043703150
  NPD
• Emanate Health Medical Group

  • General Practice Physician
  • Covina, CA
  • NPI 1881054997
  NPD

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1982074548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 S CYPRESS AVE",
            "address_2": "APT. D",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917624913",
            "telephone_number": "714-612-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 S SUNSET AVE STE 200",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903940",
            "telephone_number": "626-732-8390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1532 E. San Bernardino Ave",
            "address_2": "Suite A2",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917624913",
            "country_code": "US",
            "telephone_number": "909-623-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATHRYN",
        "middle_name": "TARANEH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-25",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jonathan J Tye, MD a Professional Corp

• Physician Assistant in West Covina, CA
• Providers in West Covina, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.