| 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 | 
|---|---|
| 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 | 
|---|---|
| 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 | 
|---|---|
| Provider Enumeration Date | 10/09/2018 | 
| Last Update Date | 08/08/2019 | 
| Medicare PECOS PAC ID | 4688904592 | 
|---|---|
| Medicare Enrollment ID | O20190919000593 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1548735202 | NPI | - | NPPES | 
| Provider Name | Brian T Lam | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1194846725 PECOS PAC ID: 0042202913 Enrollment ID: I20040331001233 | 
| Provider Name | Jason P Kellogg | 
|---|---|
| Provider Type | Practitioner - Psychiatry | 
| Provider Identifiers | NPI Number: 1952331530 PECOS PAC ID: 5597789123 Enrollment ID: I20060120000873 | 
| Provider Name | Geoffrey A Dibella | 
|---|---|
| Provider Type | Practitioner - Psychiatry | 
| Provider Identifiers | NPI Number: 1982730230 PECOS PAC ID: 1153416722 Enrollment ID: I20070927000906 | 
| Provider Name | Reginald Casilang | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1780784488 PECOS PAC ID: 6608923156 Enrollment ID: I20090420000659 | 
| Provider Name | Clint H Salo | 
|---|---|
| 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 | Michael Frazier | 
|---|---|
| Provider Type | Practitioner - Psychiatry | 
| Provider Identifiers | NPI Number: 1225396591 PECOS PAC ID: 8224258132 Enrollment ID: I20140926002221 | 
| Provider Name | Shaheen Emmanuel Lakhan | 
|---|---|
| Provider Type | Practitioner - Neurology | 
| Provider Identifiers | NPI Number: 1649585944 PECOS PAC ID: 4082937255 Enrollment ID: I20151105000541 | 
| 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 | 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 | Helen Oh Kim | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1497380356 PECOS PAC ID: 5092136697 Enrollment ID: I20200608001928 | 
| 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 | Kelly Joelle Eguchi | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1013453612 PECOS PAC ID: 5597141747 Enrollment ID: I20220926002785 | 
| 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 | Nathan Thien Phuc Ngo | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1043935380 PECOS PAC ID: 6204280852 Enrollment ID: I20230929003032 | 
| 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 | 
| Provider Name | Nili Askari | 
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist | 
| Provider Identifiers | NPI Number: 1366098279 PECOS PAC ID: 0941748107 Enrollment ID: I20240819003480 | 
| Provider Name | Joan Nicole Green | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1306615836 PECOS PAC ID: 8224562335 Enrollment ID: I20241112003855 | 
| Provider Name | Destinee Torres | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1154142545 PECOS PAC ID: 0648707273 Enrollment ID: I20241220002001 | 
| Provider Name | Tina Huong Ho | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1457136285 PECOS PAC ID: 7012428428 Enrollment ID: I20250613000244 | 
| New Skin And Body Aesthetics Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4980 Barranca Parkway, 201, Irvine, CA 92604 Phone: 949-485-2100 | |
| Simon Ka Chun So, M.d., Professional Medical Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4330 Barranca Pkwy Ste 245, Irvine, CA 92604 Phone: 949-273-2888 Fax: 949-273-2801 | |
| Joseph J Pinzone M D Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16300 Sand Canyon Ave Ste 711, Irvine, CA 92618 Phone: 888-580-5900 Fax: 855-510-0119 | |
| Red Acorn Medical Group Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 71 Purplejasmine, Irvine, CA 92620 Phone: 714-922-0017 | |
| Tekyogi, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 380 Shadow Oaks, Irvine, CA 92618 Phone: 408-828-9909 | |
| Pci Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2151 Michelson Dr, Suite 260, Irvine, CA 92612 Phone: 714-462-8181 Fax: 888-504-6948 | |
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