DR. KELSEY CARL PETERSON JR. (NPI# 1033281019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033281019 |
| Entity Type | Individual |
| Full Name | DR. KELSEY CARL PETERSON JR. |
| Credential | M.D. |
| Practice Address |
17742 Beach Blvd 245 Huntington Beach CA 92647-6818 |
| Mailing Address |
20462 Kenworth Cir Huntington Beach CA 92646-5446 |
| Practice Telephone | 7143290179 |
| Practice Fax Number | 7149650311 |
| Mailing Telephone | 7143290179 |
| Mailing Fax Number | 7149650311 |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2016-03-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | G17592 | CA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396069712 | Kelsey Peterson | Dentist | 1312 South Washington Street, Emmett, ID 83617 | 2010-03-15 |
| 1942813126 | Kelsey Lin Peterson | Social Worker | 5698 W Glen Eagle Dr, West Valley City, UT 84128-4013 | 2020-08-26 |
| 1174084008 | Kelsey Rae Peterson | Pharmacist | 800 Rose St Rm H110, Lexington, KY 40536-0293 | 2019-03-25 |
| 1639658479 | Kelsey Peterson | Physician Assistant | 900 W Norfolk Ave, Norfolk, NE 68701-5006 | 2018-08-13 |
| 1003393604 | Kelsey Peterson | Nurse Practitioner | 816 22nd Ave Ste 100, Kearney, NE 68845-2226 | 2018-07-26 |
| 1659894855 | Kelsey Peterson | Occupational Therapist | 118 N 7th Ave, Sheldon, IA 51201-1235 | 2017-07-19 |
| 1932653219 | Kelsey Peterson | Dietitian, Registered | 6046 Cornerstone Ct W, Suite 226, San Diego, CA 92121-4758 | 2016-08-04 |
| 1902144983 | Kelsey Rose Peterson | Physician Assistant | 1245 Nw 4th St Ste 101, Redmond, OR 97756-1680 | 2013-01-25 |
| Street Address |
17742 BEACH BLVD 245 |
| City | HUNTINGTON BEACH |
| State | CA |
| Zip Code | 92647-6818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124015888 | Bassil Aish | Family Medicine | 17742 Beach Blvd, Ste 215, Huntington Beach, CA 92647-6818 | 2005-09-28 |
| 1871910265 | Claudine Yamaoka | Nurse Practitioner | 17742 Beach Blvd, #240, Huntington Beach, CA 92647-6818 | 2014-03-24 |
| 1154745842 | Paul Alan Reggiardo | Dentist | 17742 Beach Blvd, Suite 320, Huntington Beach, CA 92647-6818 | 2014-02-14 |
| 1053680736 | Rozita Pouroushasb | Pediatrics | 17742 Beach Blvd, Suite 360, Huntington Beach, CA 92647-6854 | 2011-12-24 |
| 1164723284 | Surf City Peds | Pediatrics | 17742 Beach Blvd, Suite 240, Huntington Beach, CA 92647-6818 | 2010-11-04 |
| 1962702084 | Katherine L Vo-gonzalez | Physician Assistant | 17742 Beach Blvd, Ste 215, Huntington Beach, CA 92647-6818 | 2010-10-22 |
| 1689983330 | Glenda B Secor, Od, Faao, Inc | Optometrist | 17742 Beach Blvd, 305, Huntington Beach, CA 92647-6818 | 2010-09-29 |
| 1962726331 | Vipal Soni M.d., Inc. | Dermatology | 17742 Beach Blvd, Suite 325, Huntington Beach, CA 92647-6852 | 2010-03-15 |
| 1518289503 | Cao Van Pham M D Inc | Internal Medicine | 17742 Beach Blvd, Suite #230, Huntington Beach, CA 92647-6835 | 2010-02-18 |
| 1831322403 | Hsin Chang, Chao Shuo Huang Medical Group Inc. | Pediatrics | 17742 Beach Blvd, Suite 240, Huntington Beach, CA 92647-6818 | 2009-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417464231 | Patricia Michelle Ramsey | Counselor | 16761 Viewpoint Lane, Apt 386, Huntington Beach, CA 92647 | 2018-01-02 |
| 1780103390 | Luz Flores | Health Educator | 8041 Newman Avenue, Hungtington Beach, CA 92647 | 2017-09-14 |
| 1134649106 | Louise Polzel | Social Worker | 17111 Beach Blvd St 205, Huntington Beach, CA 92647 | 2017-06-21 |
| 1205364015 | Chi Hong Nguyen | Family Medicine | 8201 Newman Ave 101, Huntington, CA 92647 | 2017-05-24 |
| 1396281770 | Sandra Vera | Specialist/Technologist | 7812 Edinger Ave. #400, Huntington Beach, CA 92647 | 2017-01-10 |
| 1245773050 | Sherika Benjamin | Technician, Pathology | 8211 San Angelo Drive Suit #f2, Huntington Beach, CA 92647 | 2016-11-28 |
| 1306389440 | Nhi Pham Nguyen | Behavioral Analyst | 17732 Beach Blvd., Suite G, Huntington Beach, CA 92647 | 2016-11-21 |
| 1710345095 | Pacific Beach Medical Group, Inc. | Internal Medicine | 16111 Beach Blvd., Huntington Beach, CA 92647 | 2016-02-02 |
| 1699148494 | Daniel Bui | Dentist | 16900-a Goldenwest St, Huntington Beach, CA 92647 | 2015-11-03 |
| 1598132359 | Hayley Patricia Buchanan | Specialist/Technologist | 23441 S. Pointe Drive, Suite 245, Laguna Hills, ORANGE COUNTY 92647 | 2015-08-27 |
| Find all providers in zip 92647 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427323831 | Thiet Tan Nguyen | Specialist | 8762 Sailport Dr, Huntington Beach, CA 92646-2640 | 2012-03-19 |
| 1407126238 | Ronald Lee Gilbert | Specialist | 19471 Peninsula Ln, Huntington Beach, CA 92648-6615 | 2012-01-10 |
| 1447557707 | Accetta Institute of Womens Health, Inc. | Specialist | 19671 Beach Blvd Ste 315, Huntington Beach, CA 92648-5904 | 2011-02-23 |
| 1215269634 | Angeline M Dao, M.d., Inc. | Specialist | 7777 Center Ave, Suite 180, Huntington Beach, CA 92647-3063 | 2010-02-10 |
| 1497984991 | Catherine Elizabeth Liebermann | Specialist | 16086 Tortola Cir, Huntington Beach, CA 92649-2042 | 2009-07-07 |
| 1215185640 | Edinger Medical Group, Inc. | Specialist | 18682 Beach Blvd Ste 145-155, Huntington Beach, CA 92648-2048 | 2008-08-27 |
| 1639368368 | Huntington Beach Dermatology Medical Group | Specialist | 8101 Newman Ave Ste C, Huntington Beach, CA 92647-7042 | 2007-10-18 |
| 1689872053 | April Michelle Kurtyka | Specialist | 8101 Indianapolis Ave, Huntington Beach, CA 92646-5006 | 2007-07-06 |
| 1528281607 | Stanton S Kremsky | Specialist | 10102 Beverly Dr, Huntington Beach, CA 92646-5415 | 2007-04-10 |
| 1124140777 | Monarch Diagnostic Services, Inc. | Specialist | 18351 Beach Blvd Ste G, Huntington Beach, CA 92648-1347 | 2007-04-04 |
| Find all providers in HUNTINGTON BEACH | ||||
| City | HUNTINGTON BEACH |
| Zip Code | 92647 |
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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.