KELVIN YOHANES SOEWONO (NPI# 1225667017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225667017 |
| Entity Type | Individual |
| Full Name | KELVIN YOHANES SOEWONO |
| Credential | DO |
| Practice Address |
1441 N Beckley Ave Dallas TX 75203-1201 |
| Practice Telephone | 2149476700 |
| Practice Fax Number | 2149476701 |
| Mailing Telephone | 2149476700 |
| Mailing Fax Number | 2149476701 |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-04-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
1441 N BECKLEY AVE |
| City | DALLAS |
| State | TX |
| Zip Code | 75203-1201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972500395 | Alan Roach | Pharmacist | 1441 N Beckley Ave, Methodist Hospital of Dallas, Dallas, TX 75203-1201 | 2005-06-30 |
| 1740881648 | Joan Kaminar | Nurse Practitioner | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-11-06 |
| 1508473794 | Marlo Jeffrey | Nurse Practitioner | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-09-30 |
| 1457967523 | Misty Whitmire | Nurse Practitioner | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-09-23 |
| 1073127379 | Shurekkia Shantrice Hudgen | Registered Nurse | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-09-03 |
| 1134731193 | Cynthia Nachae Wrenn | Nurse Practitioner | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-08-20 |
| 1609490036 | Emily Nicole Seymour | Nurse Practitioner | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-06-01 |
| 1992328983 | Rachel Mentzel | Physical Therapist | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-05-25 |
| 1891316204 | Pooja Dasari | Student in an Organized Health Care Education/Training Program | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-04-27 |
| 1891315669 | Bobby Palmos | Surgery | 1441 N Beckley Ave, Dallas, TX 75203-1201 | 2020-04-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386264125 | Dylan Lopez | Internal Medicine | Methodist Health System, Methodist Dallas Medical Center 1441 N. Beckley Ave., Dallas, TX 75203 | 2020-04-22 |
| 1902303183 | Sarah Mcferon | Nurse Practitioner | 1411 N. Beckley Ave, Pavilion IIi Suite 268, Dallas, TX 75203 | 2018-04-12 |
| 1659727030 | Kathy Lightsey | Counselor | 1836 Berwick Ave, Dall, TX 75203 | 2016-05-04 |
| 1659712453 | Maura M Mcglynn | Occupational Therapist | 1520 North Beckley Ave 1033, Dallas, TX 75203 | 2013-07-10 |
| 1093153454 | Adrienne Workman | Internal Medicine | 1441 North Beckley Avenue, Dallas, TX 75203 | 2013-06-07 |
| 1851642490 | April Rebecca Meras | Nurse Practitioner | 610 E Jefferson Blvd Ste 110, Dallas, TX 75203 | 2012-09-22 |
| 1699081612 | East Run Management, Ltd. Company | Alzheimer Center (Dementia Center) | 2653 Cedar Crest Blvd, Dallas, TX 75203 | 2010-08-27 |
| 1538471305 | Preetivi Ellis | Internal Medicine | 1441 N Beckley Ave Fl 4, Dallas, TX 75203 | 2010-07-09 |
| 1306085378 | Maggie Fardella | Counselor | 201 E 9th St, Dallas, TX 75203 | 2009-02-13 |
| 1811159122 | Maryam Raza Md Pa | Internal Medicine | 1441 N. Beckley, Dallas, TX 75203 | 2008-06-27 |
| Find all providers in zip 75203 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760098271 | Danielle Mortimer | Student in an Organized Health Care Education/Training Program | 1340 Prudential Dr Ste A, Dallas, TX 75235-4115 | 2020-09-20 |
| 1114536331 | Victor Liaw | Student in an Organized Health Care Education/Training Program | 5233 Harry Hines Blvd, Dallas, TX 75390-9006 | 2020-07-23 |
| 1285243469 | Tommy Tan | Student in an Organized Health Care Education/Training Program | 5226 Fleetwood Oaks Ave Apt 114, Dallas, TX 75235-8105 | 2020-07-23 |
| 1982213138 | Sophia Cosmich | Student in an Organized Health Care Education/Training Program | Ut Southwestern Medical School 5325 Harry Hines Blvd, Dallas, TX 75390-9006 | 2020-07-23 |
| 1093323552 | Joshua D Cox | Student in an Organized Health Care Education/Training Program | 2222 Medical District Dr Apt 4315, Dallas, TX 75235-8054 | 2020-07-21 |
| 1386252997 | Johnston Bartlett Norton | Student in an Organized Health Care Education/Training Program | 4214 Rawlins St Apt 116, Dallas, TX 75219-2738 | 2020-07-20 |
| 1063020014 | Bilaal Hassan | Student in an Organized Health Care Education/Training Program | Ut Southwestern Medical Center 5323 Harry Hines Blvd D, Dallas, TX 75390-0001 | 2020-07-15 |
| 1255959805 | Richard Tanner Hardy | Student in an Organized Health Care Education/Training Program | Ut Southwestern Medical Center 5323 Harr Hines Blvd, Dallas, TX 75390-0001 | 2020-07-09 |
| 1902424534 | Paula Marie Mofor | Student in an Organized Health Care Education/Training Program | Ut Southwestern Medical School 5323 Harry Hines Blvd, Dallas, TX 75390-9006 | 2020-07-09 |
| 1912525015 | Yasmeen Jordan Alayli | Student in an Organized Health Care Education/Training Program | 4606 Cedar Springs Rd Apt 924, Dallas, TX 75219-7205 | 2020-07-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.