KRYSTAL SOOJUNG JIN (NPI# 1821618018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821618018 |
| Entity Type | Individual |
| Full Name | KRYSTAL SOOJUNG JIN |
| Credential | MD |
| Practice Address |
9300 Valley Children's Place Madera CA 93636-8762 |
| Practice Telephone | 5593533000 |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2020-04-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
9300 VALLEY CHILDREN'S PLACE |
| City | MADERA |
| State | CA |
| Zip Code | 93636-8762 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124088000 | Melissa Ann Chase | Pharmacist | 9300 Valley Children's Place, Pharmacy, Madera, CA 93636-8762 | 2006-03-24 |
| 1578087268 | Erica Neuhaus Ortiz | Pediatrics | 9300 Valley Children's Place, Madera, CA 93636 | 2017-08-03 |
| 1184148850 | Juan Acatl Topiltzin Torres | Student in an Organized Health Care Education/Training Program | 9300 Valley Children's Place, Madera, CA 93636-8762 | 2017-08-03 |
| 1174043442 | Christian Gabriel Gentile | Audiologist | 9300 Valley Children's Place, Madera, CA 93636 | 2017-06-27 |
| 1699127803 | Anita Michelle Morris | Social Worker | 9300 Valley Children's Place, Madera, CA 93636 | 2016-07-12 |
| 1972972461 | Pamela D Wing | Speech-Language Pathologist | 9300 Valley Children's Place, Madera, CA 93636-8762 | 2015-09-15 |
| 1144605353 | Sarah Elizabeth Warkentin | Social Worker | 9300 Valley Children's Place, Madera, CA 93636-8762 | 2015-07-29 |
| 1871981662 | Jessica Dillon-stathacopulos | Speech-Language Pathologist | 9300 Valley Children's Place, Madera, CA 93638 | 2014-12-31 |
| 1518380799 | Richard Sakai | Pharmacist | 9300 Valley Children's Place, Madera, CA 93636-8762 | 2014-01-24 |
| 1366793135 | Cynthia Ann Cavazos | Audiologist | 9300 Valley Children's Place, Madera, CA 93636 | 2012-09-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043695257 | Kati Pitts | Social Worker | 9300 Valley Children's Pl., Madera, CA 93636 | 2015-07-29 |
| 1386903177 | Christina Lee-ann Badgett | Registered Nurse | 40617 Rd 406, Madera, CA 93636 | 2012-05-14 |
| 1205134897 | Gina West | Counselor | 10120 Lanes Bridge Dr, Madera, CA 93636 | 2011-03-04 |
| 1326342593 | Re Zaw | Pediatrics | 9300 Valley Children's Place, Residency Dept (ge20), Madera, CA 93636 | 2011-01-03 |
| 1013144179 | Cynthia Romer Fata | Pathology | 9300 Valley Childrens Pl # Sc12, Madera, CA 93636 | 2009-06-16 |
| 1689815888 | Nasser Moiduddin | Pediatrics | 9300 Valley Childrens Pl # PC14, Madera, CA 93636 | 2009-03-18 |
| 1174503338 | James Clifton Horspool | Pediatrics | 9300 Valley Children's Place, Mb01, Madera, CA 93636 | 2006-01-21 |
| 1205818465 | James Weston Hole | Obstetrics & Gynecology | 9300 Valley Children's Pl, Fe16, Madera, CA 93636 | 2005-11-15 |
| 1740838994 | Francisco Alvarez | Nurse Practitioner | 9300 Valley Childrens Pl, Madera, CA 93636 | 2019-08-30 |
| 1679056493 | Catherine K. Beaumier | Surgery | 9300 Valley Children's Pl., Madera, CA 93636 | 2018-09-07 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164748455 | Francisco O Rugama | Student in an Organized Health Care Education/Training Program | 344 E. 6th Street, Madera, CA 93638-3631 | 2010-04-13 |
| 1487979878 | Lily C Wang | Student in an Organized Health Care Education/Training Program | 9300 Valley Children's Place Mb16, Madera, CA 93636-8761 | 2010-03-29 |
| 1447866090 | Mai Yang | Student in an Organized Health Care Education/Training Program | 209 E 7th St, Madera, CA 93638-3780 | 2020-09-18 |
| 1447872288 | Rosalie Anja Perrot | Student in an Organized Health Care Education/Training Program | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-05-14 |
| 1730701541 | Harrold Navea | Student in an Organized Health Care Education/Training Program | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-05-14 |
| 1083236004 | Kelly Kathleen Hady | Student in an Organized Health Care Education/Training Program | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-05-13 |
| 1184246050 | Angela Bizzarri Pflugrath | Student in an Organized Health Care Education/Training Program | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-05-13 |
| 1194347062 | Maryam Hockley | Student in an Organized Health Care Education/Training Program | 9300 Valley Childrens Pl, Madera, CA 93636-8762 | 2020-05-13 |
| 1093337479 | Brandon Ang | Student in an Organized Health Care Education/Training Program | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-05-08 |
| 1750903241 | Youmna Elena Moufarrej | Student in an Organized Health Care Education/Training Program | 9300 Valley Childrens Pl, Madera, CA 93636-8762 | 2020-05-07 |
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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.