INGRID N WAHJUDI (NPI# 1528479342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528479342 |
| Entity Type | Individual |
| Full Name | INGRID N WAHJUDI |
| Credential | MD |
| Practice Address |
632 W Gibson Rd Woodland CA 95695-5169 |
| Mailing Address |
3400 Data Dr Attn: Credentialing/payer Enrollment Rancho Cordova CA 95670-7956 |
| Practice Telephone | 5306682600 |
| Practice Fax Number | 5306693638 |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2020-08-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | A145785 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
632 W GIBSON RD |
| City | WOODLAND |
| State | CA |
| Zip Code | 95695-5169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780665166 | Kathryn A. Glatter | Internal Medicine | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2005-11-10 |
| 1871050542 | Nou Thao | Pharmacy Technician | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2019-02-28 |
| 1154885515 | Laura Mazza | Nurse Practitioner | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2019-01-29 |
| 1114426327 | Uyen Phuong Nguyen-sharma | Nurse Practitioner | 632 W Gibson Rd, Woodland, CA 95695 | 2018-02-03 |
| 1922519222 | Sarah Leslie Thrasher | Physician Assistant | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2017-10-13 |
| 1760916274 | Melody W Steeples | Dietitian, Registered | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2017-04-12 |
| 1184160301 | Aleksandr Palenyy | Physician Assistant | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2017-01-11 |
| 1770039828 | Kristen J Rewick | Registered Nurse | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2016-08-29 |
| 1023480159 | Isaac Dominguez | Physician Assistant | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2015-10-28 |
| 1174928253 | Lonna Marie Hampton | Physician Assistant | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2014-10-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346851144 | Tariro Angela Sawaya | Student in an Organized Health Care Education/Training Program | 445 1st Street, Woodland, CA 95695 | 2020-08-14 |
| 1093277683 | Christie Lynne Vice | Marriage & Family Therapist | 255 W Court St Ste D, Woodland, CA 95695 | 2019-04-02 |
| 1912479437 | Phillips Scoliosis Center | Chiropractor | 375 W Main St., Ste C-1, Woodland, CA 95695 | 2018-12-21 |
| 1568947042 | Nikhil Sibal | Dentist | Woodland Family Dental, 58 W Court Street, Woodland, CA 95695 | 2018-10-01 |
| 1659860849 | Savannah Ellizabeth Lindley | Behavior Technician | 260 West Main St, Woodland, CA 95695 | 2018-05-03 |
| 1982133344 | Brittanie Ann Akey | Behavior Technician | 1102 Gary Way, Woodland, CA 95695 | 2017-06-08 |
| 1083163604 | Arthur Hernandez | Nurse Practitioner | 215 West Beamer Street, Woodland, CA 95695 | 2016-09-23 |
| 1386191856 | Kelly Lee | Registered Nurse | 25 N. Cottonwood St., Adult and Aging Branch, Yolo County Hhsa, Woodland, CA 95695 | 2016-09-01 |
| 1730634486 | Ida Nilanthi Lonnerdal | Marriage & Family Therapist | 455 First Street, Woodland, CA 95695 | 2016-08-23 |
| 1912365974 | Yaretzi Counseling and Consulting LLC | Social Worker | 327 College St Ste 105, Woodland, CA 95695 | 2016-02-05 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366580532 | Christie Lyn Carroll | Dermatology | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2007-02-01 |
| 1861579021 | Paige Radell | Dermatology | 632 W Gibson Rd, Woodland, CA 95695-5169 | 2006-11-01 |
| 1841214244 | Debra A Horney | Dermatology | 2081 Bronze Star Dr, Woodland, CA 95776 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275144024 | Lumins Aesthetic and Wellness, Inc | Dermatology | 20281 Sw Birch St, Suite 201, Newport Beach, CA 92660 | 2020-08-14 |
| 1669081204 | Lucy Boyadzhian | Dermatology | 7472 Melrose Ave, Los Angeles, CA 90046-7524 | 2020-07-29 |
| 1033730981 | Adrianna Janell Browne, Md, Inc. | Dermatology | 8 Camino Encinas Ste 115, Orinda, CA 94563-3350 | 2020-05-01 |
| 1215564877 | Jasmine Khachatrian | Dermatology | 302 Sierra Woods Dr, Sierra Madre, CA 91024-1015 | 2020-03-24 |
| 1386277499 | Jessica Hsu, M.d.,inc | Dermatology | 1506 Chapman Avenue, Address Line 2, Orange, CA 92866 | 2020-02-17 |
| 1245862101 | Yuval Bibi, A Professional Corporation | Dermatology | 7266 Franklin Ave Apt 321, Los Angeles, CA 90046-8324 | 2020-02-09 |
| 1457982001 | Modesty Joy Isaguirre | Dermatology | 140 S Grand Ave, Glendora, CA 91741-4259 | 2020-02-03 |
| 1790322063 | Mfc Dermatology | Dermatology | 3655 Lomita Blvd Ste 221, Torrance, CA 90505-1918 | 2019-12-05 |
| 1336784206 | Barbara Kinkle Pa Inc., A Physician Assistant Corporation | Dermatology | 24575 Hunt Ave, Corning, CA 96021-8607 | 2019-11-14 |
| 1497399141 | Dermatology Specialists Inc | Dermatology | 4765 Carmel Mountain Rd Ste 201, San Diego, CA 92130-6657 | 2019-11-05 |
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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.