Progeny Psychiatric Clinic A Medical Corporation | |
17782 Cowan Ste A Irvine CA 92614-6041 | |
(949) 722-7118 | |
(949) 396-0965 |
Full Name | Progeny Psychiatric Clinic A Medical Corporation |
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Speciality | Psychiatry & Neurology |
Location | 17782 Cowan Ste A, Irvine, California |
Authorized Official Name and Position | Jason P Kellogg (CEO) |
Authorized Official Contact | 9497227118 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Progeny Psychiatric Clinic A Medical Corporation 17782 Cowan Ste A Irvine CA 92614-6041 Ph: (949) 722-7118 | Progeny Psychiatric Clinic A Medical Corporation 17782 Cowan Ste A Irvine CA 92614-6041 Ph: (949) 722-7118 |
NPI Number | 1548735202 |
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Provider Enumeration Date | 10/09/2018 |
Last Update Date | 08/08/2019 |
Medicare PECOS PAC ID | 4688904592 |
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Medicare Enrollment ID | O20190919000593 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548735202 | NPI | - | NPPES |
Provider Name | Brian T Lam |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1194846725 PECOS PAC ID: 0042202913 Enrollment ID: I20040331001233 |
Provider Name | Charles Tuan-tu S Nguyen |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1942380118 PECOS PAC ID: 4688607906 Enrollment ID: I20050915001194 |
Provider Name | Jason P Kellogg |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1952331530 PECOS PAC ID: 5597789123 Enrollment ID: I20060120000873 |
Provider Name | Geoffrey A Dibella |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1982730230 PECOS PAC ID: 1153416722 Enrollment ID: I20070927000906 |
Provider Name | Farhad G Nikoo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740485101 PECOS PAC ID: 9133214083 Enrollment ID: I20090223000335 |
Provider Name | Reginald Casilang |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780784488 PECOS PAC ID: 6608923156 Enrollment ID: I20090420000659 |
Provider Name | Parvin Afshar |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1437247335 PECOS PAC ID: 8729248992 Enrollment ID: I20120326000337 |
Provider Name | Clint H Salo |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1811159221 PECOS PAC ID: 5193988301 Enrollment ID: I20120529000178 |
Provider Name | Linda H Trinh |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124333828 PECOS PAC ID: 0547498834 Enrollment ID: I20140113001084 |
Provider Name | Michelle C Nguyen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740601269 PECOS PAC ID: 1850516568 Enrollment ID: I20140711001821 |
Provider Name | Cindy Capretz |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1134409907 PECOS PAC ID: 0042533986 Enrollment ID: I20141229000312 |
Provider Name | Phuong Tran |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275990111 PECOS PAC ID: 4981900297 Enrollment ID: I20160314000930 |
Provider Name | Jayson C Jun |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760808240 PECOS PAC ID: 1951607688 Enrollment ID: I20160929001727 |
Provider Name | Dylan Thomas Guiney |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295242410 PECOS PAC ID: 2567714983 Enrollment ID: I20181015000173 |
Provider Name | Hong T Tran |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447723879 PECOS PAC ID: 9931447992 Enrollment ID: I20190218000209 |
Provider Name | Melissa Edwards |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598252173 PECOS PAC ID: 5698027936 Enrollment ID: I20191025001426 |
Provider Name | Maria D Acevedo |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992363535 PECOS PAC ID: 2860724770 Enrollment ID: I20191025002338 |
Provider Name | Jada Alston |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427692375 PECOS PAC ID: 4082044532 Enrollment ID: I20200423001885 |
Provider Name | Grace Marasigan Dualan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225682446 PECOS PAC ID: 9931539491 Enrollment ID: I20200423002548 |
Provider Name | Helen Oh Kim |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497380356 PECOS PAC ID: 5092136697 Enrollment ID: I20200608001928 |
Provider Name | Edward Kim |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053088799 PECOS PAC ID: 0941694178 Enrollment ID: I20220303001268 |
Provider Name | Sylvia Cyntia Guthrie |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861146045 PECOS PAC ID: 9537546999 Enrollment ID: I20220524002960 |
Provider Name | Francis Mae Magdadaro |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1376200337 PECOS PAC ID: 3678951472 Enrollment ID: I20220607002704 |
Provider Name | Tuyen Ngoc Ho |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1235612656 PECOS PAC ID: 0244611713 Enrollment ID: I20220714001497 |
Provider Name | Agnes Andal Maramba |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770158172 PECOS PAC ID: 3870979081 Enrollment ID: I20220926001298 |
Provider Name | Kelly Joelle Eguchi |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013453612 PECOS PAC ID: 5597141747 Enrollment ID: I20220926002785 |
Provider Name | Hilary Julianna Breedon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1215602883 PECOS PAC ID: 5698151561 Enrollment ID: I20220929001585 |
Provider Name | Jenna Nhan Vo |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699448969 PECOS PAC ID: 0840676599 Enrollment ID: I20221003002758 |
Provider Name | Salina Vong Lum |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245710391 PECOS PAC ID: 8224414719 Enrollment ID: I20221006002454 |
Provider Name | Kristi Lebesco |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386279172 PECOS PAC ID: 4880060961 Enrollment ID: I20221013003154 |
Provider Name | Vanessa Michelle Yan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790458883 PECOS PAC ID: 9931575958 Enrollment ID: I20221017001687 |
Provider Name | Tiffany Thanh Tran |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922770551 PECOS PAC ID: 4981070927 Enrollment ID: I20221017002868 |
Provider Name | Angelo Jovito Caezar Santos Santiago |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356069900 PECOS PAC ID: 2163890914 Enrollment ID: I20221129000436 |
Provider Name | Jennifer Ann Java |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053046912 PECOS PAC ID: 6901277268 Enrollment ID: I20230124001506 |
Provider Name | Jason Giang |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1104440163 PECOS PAC ID: 4385097294 Enrollment ID: I20240126003127 |
Provider Name | Rafael Speck |
---|---|
Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1154888055 PECOS PAC ID: 8921443771 Enrollment ID: I20240301003629 |
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