KELLY J TUCKER (NPI# 1356372643) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356372643 |
| Entity Type | Individual |
| Full Name | KELLY J TUCKER |
| Credential | M.D. |
| Practice Address |
1140 W. La Veta Ave Suite # 640 Orange CA 92868-4228 |
| Practice Telephone | 7145643300 |
| Practice Fax Number | 7145643318 |
| Mailing Telephone | 7145643300 |
| Mailing Fax Number | 7145643318 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-09-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
G64833 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DEA | BT1786954 | 01 |
| CA | GR0064090 | 05 | |
| CA | MEDICAL LICENSE | G64833 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245728237 | Kelly Jean Tucker | Counselor | 9 W Summit Ave # B, Asheville, NC 28803-0047 | 2018-04-25 |
| 1205070976 | Kelly A Tucker | Registered Nurse | 1523 Camp St, Sandusky, OH 44870-3162 | 2009-04-27 |
| 1104962083 | Kelly A Tucker | Speech-Language Pathologist | 909 W. Alabama Ave., Lafayette, AL 36862 | 2007-01-29 |
| 1023543063 | Kelly Tucker | Student in an Organized Health Care Education/Training Program | 410 W 10th Ave, Columbus, OH 43210-1240 | 2017-04-27 |
| 1790156164 | Kelly C Tucker | Nurse Practitioner | 800 N Maitland Ave Ste 101, Maitland, FL 32751-4499 | 2015-10-12 |
| 1164815866 | Kelly Tucker | Registered Nurse | 1600 S Andrews Ave, Third Floor, Fort Lauderdale, FL 33316-2510 | 2015-03-05 |
| 1982092144 | Kelly Ann Tucker | Licensed Practical Nurse | 1100 Warburton Ave, 4p, Yonkers, NY 10701-1009 | 2014-12-22 |
| 1295060499 | Kelly Ann Tucker | Community Health Worker | 4371 E 72nd Ave, Commerce City, CO 80022-1471 | 2009-10-06 |
| 1295754927 | Kelly Tucker | Physical Therapist | 5161 E Arapahoe Rd, 250, Centennial, CO 80122-2387 | 2006-07-19 |
| 1871568782 | Kelly Wade Tucker | Family Medicine | 2520 W 16th St, Greeley, CO 80634-4902 | 2006-02-22 |
| Street Address |
1140 W. LA VETA AVE SUITE # 640 |
| City | ORANGE |
| State | CA |
| Zip Code | 92868-4228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316974686 | Nordy S Spivack | Internal Medicine | 1140 W. La Veta Ave, Suite # 640, Orange, CA 92868-4228 | 2006-06-26 |
| 1992730709 | Maged Azer | Internal Medicine | 1140 W. La Veta Ave, Suite # 640, Orange, CA 92868-4228 | 2006-07-11 |
| 1013942986 | George W. Wesley | Internal Medicine | 1140 W. La Veta Ave, Suite # 640, Orange, CA 92868-4228 | 2006-07-11 |
| 1982635645 | Lawrence Santora | Internal Medicine | 1140 W. La Veta Ave, Suite # 640, Orange, CA 92868-4228 | 2006-07-05 |
| 1467482174 | Jack S Vangrow | Internal Medicine | 1140 W. La Veta Ave, Suite # 640, Orange, CA 92868-4228 | 2006-07-05 |
| 1659308591 | Shalizeh Shokooh | Internal Medicine | 1140 W. La Veta Ave, Suite # 640, Orange, CA 92868-4228 | 2006-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346859386 | Sadaf Abrishami | Pharmacist | 101 The City Dr S., Orange, CA 92868 | 2020-07-27 |
| 1245869825 | Helena Yijia Hong | Student in an Organized Health Care Education/Training Program | Uci Medical Center, 101 The City Drive, Orange, CA 92868 | 2020-04-06 |
| 1932736527 | Joshua Kristopher Livingston | Student in an Organized Health Care Education/Training Program | 101 The City Dr S, Rte. 128-01, Orange, CA 92868 | 2020-03-24 |
| 1831725894 | Michelle Brown | Student in an Organized Health Care Education/Training Program | 101 The City Dr S. Rte 128-01, Orange, CA 92868 | 2020-03-20 |
| 1093363491 | Kristin Lee | Pharmacist | 132 S. Anita Dr., Orange, CA 92868 | 2019-08-28 |
| 1740834217 | Matthew Brian Mecheal | Dentist | 725 W. La Veta Suite 260, Orange, CA 92868 | 2019-08-01 |
| 1245897990 | Brent Tyler Louie | Student in an Organized Health Care Education/Training Program | 101 The City Drive South Building 3, Route 88, Neuropsychiatric Center Uc Irvine Medical Center, Orange, CA 92868 | 2019-05-28 |
| 1093277972 | Danielle Amato | Student in an Organized Health Care Education/Training Program | Uc Irvine Health 101 The City Drive, City Tower, Ste 40, Orange, CA 92868 | 2019-04-01 |
| 1851852206 | Julia Ting Bu | Student in an Organized Health Care Education/Training Program | Uc Irvine Health, 101 The City Drive, City Tower, Ste 400, Orange, CA 92868 | 2019-03-28 |
| 1326507344 | Harrison Beene Lowder | Student in an Organized Health Care Education/Training Program | 505 S. Main St, Suite 525, Orange, CA 92868 | 2019-03-19 |
| Find all providers in zip 92868 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902465792 | Pacific Heart & Vascular | Internal Medicine | 1234 W. Chapman Ave, Ste #101, Orange, CA 92868-2862 | 2019-06-06 |
| 1992206940 | Oc Healthy Heart LLC | Internal Medicine | 438 E Katella Ave Suite B, Orange, CA 92867 | 2018-02-26 |
| 1518200443 | Elizabeth Hill Dineen | Internal Medicine | 101 The City Dr S Bldg 25, Orange, CA 92868-3201 | 2013-03-28 |
| 1881728426 | Andres Deluna | Internal Medicine | 680 South Parker Street, Suite 100, Orange, CA 92868 | 2007-03-15 |
| 1396776746 | Jairo J Marin | Internal Medicine | 1140 W. La Veta Ave., Suite # 640, Orange, CA 92868-4228 | 2006-07-05 |
| 1285664029 | Hossein Alimadadian | Internal Medicine | 1140 W La Veta Ave Ste 640, Orange, CA 92868-4228 | 2006-07-04 |
| 1316974686 | Nordy S Spivack | Internal Medicine | 1140 W. La Veta Ave, Suite # 640, Orange, CA 92868-4228 | 2006-06-26 |
| 1447294178 | Jayant Barai | Internal Medicine | 345 Henry St, Orange, NJ 07050-2577 | 2006-06-15 |
| 1912986944 | Jacqueline A Eubany | Internal Medicine | 438 E Katella Ave Ste B, Orange, CA 92867-4857 | 2006-01-09 |
| 1881689347 | Dicran B Baron | Internal Medicine | 705 W La Veta Ave, #112, Orange, CA 92868-4402 | 2005-09-12 |
| Find all providers in ORANGE | ||||
Please comment or provide details below to improve the information on KELLY J TUCKER.
| 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.