Ji Eun Vongphoe
Nurse Practitioner, Primary Care in Rancho Cucamonga, CA. Individual provider (NPI-1).
NPI number1962034199
StatusActive
Last updated in NPPESFeb 5, 2020
Details
- NPI
- 1962034199
- Entity type
- Individual (NPI-1)
- Name
- Ji Eun Vongphoe
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 5, 2020
- Certification date
- Feb 5, 2020
- Last updated
- Feb 5, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | NP95010302 | CA | Yes |
Practice location
12341 Alamo DrRancho Cucamonga, CA 91739-2290
Phone 323-829-5485
Mailing address
12341 Alamo DrRancho Cucamonga, CA 91739-2290
Phone 323-829-5485
Is something wrong?
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