Kenneth Paolo Dagdag Lising, MSN, APRN, FNP-C in Fullerton, CA

Kenneth Paolo Dagdag Lising, MSN, APRN, FNP-C is a medicare enrolled "Nurse Practitioner - Family" in Fullerton, California. He graduated from nursing school in 2019 and has 5 years of diverse experience with area of expertise as Nurse Practitioner. He is a member of the group practice Providence Medical Foundation and his current practice location is 2141 N Harbor Blvd Ste 25000, Fullerton, California. You can reach out to his office (for appointments etc.) via phone at (714) 626-8650.

Kenneth Paolo Dagdag Lising is licensed to practice in California (license number 95012739) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1003465105.

Contact Information

	Kenneth Paolo Dagdag Lising, MSN, APRN, FNP-C
	2141 N Harbor Blvd Ste 25000, Fullerton, CA 92835-3830
	(714) 626-8650
	Not Available

Map and Direction

Provider's Profile

Full Name	Kenneth Paolo Dagdag Lising
Gender	Male
Speciality	Nurse Practitioner
Experience	5 Years
Location	2141 N Harbor Blvd Ste 25000, Fullerton, California
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Kenneth Paolo Dagdag Lising graduated from nursing school in 2019

NPI Data:

NPI Number: 1003465105
Provider Enumeration Date: 09/11/2019
Last Update Date: 11/11/2021

Medicare PECOS Information:

PECOS PAC ID: 9931599834
Enrollment ID: I20211208002719

Medical Identifiers

Medical identifiers for Kenneth Paolo Dagdag Lising such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1003465105	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	95012739 (California)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
St Jude Medical Center	Fullerton, CA	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Providence Medical Foundation	8921993205	1312

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kenneth Paolo Dagdag Lising allows following entities to bill medicare on his behalf.

Entity Name	Providence Medical Foundation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1285890624 PECOS PAC ID: 8921993205 Enrollment ID: O20040216001346

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kenneth Paolo Dagdag Lising is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Kenneth Paolo Dagdag Lising, MSN, APRN, FNP-C 10283 Jasmine Ct, Stanton, CA 90680-8505 Ph: (714) 262-1660	Kenneth Paolo Dagdag Lising, MSN, APRN, FNP-C 2141 N Harbor Blvd Ste 25000, Fullerton, CA 92835-3830 Ph: (714) 626-8650

Reviews and Comments

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Kenneth Paolo Dagdag Lising, MSN, APRN, FNP-C - Medicare Nurse Practitioner in Fullerton, CA