NDIKA FOMUKONG (NPI# 1497700066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1497700066 |
Entity Type | Individual |
Full Name | NDIKA FOMUKONG |
Credential | P.A.C |
Practice Address |
210 Canal St King City CA 93930-3432 |
Practice Telephone | 8313855471 |
Practice Fax Number | 8313855940 |
Mailing Telephone | 8313855471 |
Mailing Fax Number | 8313855940 |
Enumeration Date | 2006-05-23 |
Last Update Date | 2013-11-20 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363A00000X | Physician Assistant | PA17839 | CA | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
NP 17180 | CA | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
210 CANAL ST |
City | KING CITY |
State | CA |
Zip Code | 93930-3432 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255316931 | Sandra Montijo | Pediatrics | 210 Canal St, King City, CA 93930-3432 | 2005-12-14 |
1164607180 | Southern Monterey County Memorial Hospital | Clinic/Center | 210 Canal St, King City, CA 93930-3432 | 2008-01-09 |
1720279094 | Southern Monterey County Memorial Hospital | Clinic/Center | 210 Canal St, King City, CA 93930-3432 | 2007-08-05 |
1811188188 | Southern Monterey County Memorial Hospital | Clinic/Center | 210 Canal St, King City, CA 93930-3432 | 2007-08-05 |
1518185305 | Dan Q. Tran | Internal Medicine | 210 Canal St, King City, CA 93930-3432 | 2007-04-24 |
1760516314 | Gilbert E. Flores | Surgery | 210 Canal St, King City, CA 93930-3432 | 2007-03-15 |
1467521922 | Barbara Corinne Pekema | Nurse Practitioner | 210 Canal St, King City, CA 93930-3432 | 2006-11-07 |
1285685743 | Southern Monterey County Memorial Hospital | Clinic/Center | 210 Canal St, King City, CA 93930-3432 | 2006-05-12 |
1659344927 | Richard H. Fair | Obstetrics & Gynecology | 210 Canal St, King City, CA 93930-3432 | 2006-02-08 |
1477539831 | Jonathan Pace | Surgery | 210 Canal St, King City, CA 93930-3432 | 2005-12-19 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841841202 | Carl Jorgensen | Pharmacist | Riteaid, 540 Canal Street, King City, CA 93930 | 2019-09-26 |
1750780284 | Kayla Noon | Counselor | 200 Broadway St., Suite 70, King City, CA 93930 | 2014-08-20 |
1831323906 | Tawfiq Imam | Pharmacist | 540 Canal St, Rite Aid Pharmacy #5880, King City, CA 93930 | 2009-05-05 |
1588165351 | Mirella Mendoza | Nurse Practitioner | 122 E San Antonio Dr, King City, CA 93930 | 2018-02-26 |
1437510641 | Christina Sandoval | Counselor | 200 Broadway St, 70, King City, CA 93930 | 2016-03-15 |
1376920850 | Celia Trujillo | Counselor | 200 Broadway St, King City, CA 93930 | 2015-05-04 |
1497152078 | Nguyen Pham | Internal Medicine | 300 Canal St, King City, CA 93930 | 2014-11-26 |
1104171925 | Hassan Jadid | Internal Medicine | 300 Canal St, King City, CA 93930 | 2012-07-18 |
1821227422 | Jovanna M Velazquez | Technician, Other | 200 Broadway, Suite 88, King City, CA 93930 | 2009-07-06 |
1598961161 | Diane Lynn Hardy | Marriage & Family Therapist | 522 Broadway St, Suite D, King City, CA 93930 | 2007-06-21 |
Find all providers in zip 93930 |
Taxonomy Code | 363LP2300X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Primary Care |
Definition to come... |
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1962014381 | Mario Javier Herrera | Nurse Practitioner | 2130 High Pointe Dr, Apt 108, Corona, CA 92879 | 2020-08-18 |
1952912131 | Norman Ivan Kier | Nurse Practitioner | 3834 Edison Ave, Sacramento, CA 95821-2728 | 2020-08-12 |
1942811377 | Thanhan Mathews | Nurse Practitioner | 114 W Cameron St Apt B, Hanford, CA 93230-2965 | 2020-08-10 |
1972113355 | Marine Mary Kademyan | Nurse Practitioner | 6528 Babcock Ave, North Hollywood, CA 91606 | 2020-07-31 |
1245849645 | Shannon Pereira | Nurse Practitioner | 2368 Honeysuckle Way, Hemet, CA 92545-4796 | 2020-07-31 |
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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.