Individual provider Active NPI

Khai Nguyen, MD

  • Psychiatry Physician
  • Patton, CA
National Provider Identifier
1992102990
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A151492 Issued in CA
Practice address
3102 E Highland Ave
Patton, CA 92369-7813
Phone
(951) 840-5836
NPI assigned
Nov 19, 2014
Last updated
Apr 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A151492 CA Primary
Child & Adolescent Psychiatry Physician 2084P0804X A151492 CA

Addresses

Primary practice location

3102 E Highland Ave
Patton, CA 92369-7813

Mailing address

3870 La Sierra Ave # 1144
Riverside, CA 92505-3528
Phone (951) 840-5836

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
I20200930001513 CA Practitioner - Psychiatry 1355760083 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of California, Davis School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians
Department of State HospitalsGroup PAC ID 9638174238, 275 clinicians

Practice addresses (Care Compare)

1225 W 190TH St
Suite 280
Gardena, CA 90248-4305
Phone (877) 515-8113

3102 E Highland Ave
Patton, CA 92369-7813
Phone (916) 651-8811

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A151492CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals CurrentSince Feb 27, 2023 Accepting new patients
Department of State Hospitals Current Accepting new patients
Cep America - Psychiatry PC Psychiatry CurrentSince Oct 9, 2020 Accepting new patients
Department of State Hospitals CurrentSince Feb 27, 2023 Accepting new patients
Cep America - Psychiatry PC Psychiatry CurrentSince Oct 9, 2020 Accepting new patients
Ehab Yacoub MD Inc. Child & Adolescent Psychiatry CurrentSince Apr 3, 2025 Accepting new patients
Cep America - Psychiatry PC Psychiatry Current Accepting new patients
Riverside County Regional Medical Center PastSince Aug 1, 2021 Accepting new patients
University of California, Health Riverside PastSince Sep 1, 2019 Accepting new patients

Locations

400 N Pepper Ave
Colton, CA 92324
Phone (909) 580-1400

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

17075 Devonshire St
Ste 204
Northridge, CA 91325
Phone (818) 368-8929

3102 E Highland Ave
Patton, CA 92369
Phone (909) 425-7000

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

2033 Gateway Pl
Fl 5
San Jose, CA 95110
Phone (408) 290-9118

Interoperability endpoints

  • Direct secure messaging: knguyen101398@direct.llu.edu

Organizations & group practices 9

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": "1416355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1992102990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3870 LA SIERRA AVE # 1144",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053528",
            "telephone_number": "951-840-5836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 E HIGHLAND AVE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "923697813",
            "telephone_number": "951-840-5836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KHAI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-19",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A151492",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "A151492",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Patton, CA

Sources for this page

Verify at the official NPI Registry.