KELSEY LYNN KOON (NPI# 1669954269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669954269 |
| Entity Type | Individual |
| Full Name | KELSEY LYNN KOON |
| Other Name | KELSEY L KOON |
| Credential | PA |
| Practice Address |
330 W Ramsey St Banning CA 92220-4823 |
| Mailing Address |
7661 Paseo Breve Highland CA 92346-5940 |
| Practice Telephone | 9518491950 |
| Practice Fax Number | 9518490080 |
| Mailing Telephone | 9099658256 |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2019-09-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 56109 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICAL LICENSE | 56109 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10590 Town Center Dr, Rancho Cucamonga, CA 91730 | 9094830000 |
| Street Address |
330 W RAMSEY ST |
| City | BANNING |
| State | CA |
| Zip Code | 92220-4823 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063591915 | Michael Raymund Oliverio Jr. | Family Medicine | 330 W Ramsey St, Banning, CA 92220-4823 | 2006-11-03 |
| 1093228926 | Monemala Philavong-danh | Nurse Practitioner | 330 W Ramsey St, Banning, CA 92220-4823 | 2017-11-14 |
| 1710415492 | Oliverio Medical Corporation | Family Medicine | 330 W Ramsey St, Banning, CA 92220-4823 | 2017-05-25 |
| 1902134539 | Sandra Velazquez Perkins | Physician Assistant | 330 W Ramsey St, Banning, CA 92220-4823 | 2009-11-19 |
| 1144403676 | Long Thanh Tran | Physician Assistant | 330 W Ramsey St, Banning, CA 92220 | 2007-12-06 |
| 1053530295 | New Millenium Medical Associates | Family Medicine | 330 W Ramsey St, Banning, CA 92220-4823 | 2007-04-25 |
| 1215052873 | Michael Tan Oliverio | Internal Medicine | 330 W Ramsey St, Banning, CA 92220-4823 | 2007-03-20 |
| 1578618088 | Oliverio Medical Group | Internal Medicine | 330 W Ramsey St, Banning, CA 92220-4823 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962056523 | Golden View Guest Home, Inc. | Assisted Living Facility | 5466 West Wilson, Banning, CA 92220 | 2019-07-31 |
| 1780246157 | Fjs Hearing Professionals | Hearing Instrument Specialist | 3559 W Ramsey Ave Suit C-2, Banning, CA 92220 | 2019-07-05 |
| 1790237832 | Jennifer De Geus | Counselor | 1627 Hargrave St., Banning, CA 92220 | 2016-10-25 |
| 1427447507 | Dalonna Blackwell | Counselor | 2781 W. Ramsey St., Banning, CA 92220 | 2015-01-13 |
| 1639575962 | Eunjung J. Jung Choi | Dentist | 300 S Highland Springs Ave Ste 2l, Banning, CA 92220 | 2014-11-13 |
| 1861810244 | Genevra Diana Glenn | Counselor | 2781 W Ramsey, Suite 1, Banning, CA 92220 | 2014-04-02 |
| 1841617420 | Kristen Lew | Internal Medicine | 6109 W.ramsey Street, Banning, CA 92220 | 2014-03-21 |
| 1588917884 | Jamison William Murphy | Military Health Care Provider | Uss Howard Ddg 83, Fpo, AP 92220 | 2012-10-24 |
| 1972871390 | John Hong | Pharmacist | 60 N Highlandsprings, Beaumont, CA 92220 | 2011-12-13 |
| 1679855936 | Lydia Session | Marriage & Family Therapist | 1627 S. Hargrave, Banning, CA 92220 | 2011-09-13 |
| Find all providers in zip 92220 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598048407 | Alan A Valenzuela | Physician Assistant | 264 N Highland Springs Ave Ste 4, Banning, CA 92220-3082 | 2011-09-27 |
| 1346550381 | John M D'spain | Physician Assistant | 43395 Dunlap Rd, Banning, CA 92220-1514 | 2010-10-08 |
| 1861432833 | Susan H Doddridge | Physician Assistant | 600 N Higland Springs Avenue, Banning, CA 92220 | 2006-06-07 |
| 1821577222 | Natasha Stephanie Plantak | Physician Assistant | 264 N Highland Springs Ave Ste 4, Banning, CA 92220-3082 | 2018-08-07 |
| 1407371602 | Heather Katherine Rosemary Cabrera | Physician Assistant | 600 N Highland Springs Ave, Banning, CA 92220-3046 | 2017-08-08 |
| 1477093714 | Jennifer Kaori Fukasawa | Physician Assistant | 600 N Highland Springs Ave, Banning, CA 92220-3046 | 2017-03-06 |
| 1659736825 | California Em-i Medical Services A Medical Corporation | Physician Assistant | 600 N Highland Springs Ave, Banning, CA 92220-3046 | 2015-12-15 |
| 1679944565 | Cindy Lerch | Physician Assistant | 5957 W Ramsey St, Banning, CA 92220-3058 | 2015-10-17 |
| 1063897890 | Brianne Walters Nabet | Physician Assistant | 600 N Highland Springs Ave, Banning, CA 92220-3046 | 2015-07-22 |
| 1083954473 | Sarah Chan | Physician Assistant | 600 N Highland Springs Ave, Banning, CA 92220-3046 | 2013-02-21 |
| Find all providers in BANNING | ||||
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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.