| 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 |
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