Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like K*

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  *

objectid	provider_source	provider_number	npi	owner_number	service_location_number	legal_name	enroll_status_eff_dt	provider_taxonomy	nemt_nmt_provider_type	anc_provider_type	fi_provider_type_cd	fi_provider_type	provider_license	fi_provider_specialty_cd	fi_provider_specialty	out_of_state_indicator	in_out_state	address_attention	address	address2	city	state	zip	zip_4	dhcs_county_cd	fips_county_cd	latitude	longitude	countyname
13	Fee-for-Service	1447218599	1447218599	1	1	KIM, GRACE E MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61861	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
22	Fee-for-Service	1194045161	1194045161	1	1	KANEKO, JENNIFER L MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107814	40	Pediatrics	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
67	Fee-for-Service	1508830944	1508830944	1	1	KIMMEL, BONNIE S MD	1/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98500	41	Internal Medicine	0	In state provider	None	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3086	07	06013	37.91255783	-122.0428047	Contra Costa County
71	Fee-for-Service	1720696438	1720696438	1	1	KONGTIM, PIYANUCH MD	1/1/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
74	Fee-for-Service	1184659609	1184659609	1	1	KHOURY, MARIBEL P MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88689	08	Family Practice	0	In state provider	None	14906 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	3409	19	06037	33.8979564	-118.1600565	Los Angeles County
88	Fee-for-Service	1013010685	1013010685	1	1	KERMANI, MICHAEL MD INC	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75009	18	Ophthalmology	0	In state provider	None	1441 AVOCADO AVE	STE 501	NEWPORT BEACH	CA	92660	7706	30	06059	33.61338536	-117.8693961	Orange County
91	Fee-for-Service	1013095652	1013095652	1	1	KNOX, CATHERINE M MD	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53994	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
105	Fee-for-Service	1366825622	1366825622	1	1	KSERI, RAMIZ Y MD	5/7/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
110	Fee-for-Service	1386783884	1386783884	1	1	KONKIN, TAYLOR A MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97741	20	Orthopedic Surgery	0	In state provider	None	1600 ESPLANADE	STE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
125	Fee-for-Service	1164408993	1164408993	1	1	KAZEMAINI MOFRAD, MOHAMMAD R	2/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92090	30	Radiology	0	In state provider	MD	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
145	Fee-for-Service	1801982343	1801982343	1	1	KIM, MICHELLE A	5/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81149	None	None	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
150	Fee-for-Service	1790099810	1790099810	1	1	KWAN, TINA W MD	2/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2218	00	None	36.135288	-115.1368705	Clark County
188	Fee-for-Service	1053798082	1053798082	1	1	KIMBALL, DAVID T MD	6/3/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172655	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
197	Fee-for-Service	1770612152	1770612152	1	1	KIM, JUN YOUNG	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1020 S BRONSON AVE	None	LOS ANGELES	CA	90019	3214	19	06037	34.05365798	-118.3221666	Los Angeles County
205	Fee-for-Service	1972690790	1972690790	1	1	KOLINS, JERRY MD	8/21/1996	207ZP0102X	NA	Other	026	PHYSICIANS	34975	None	None	0	In state provider	None	2339 VALLECITOS	None	LA JOLLA	CA	92037	3144	37	06073	32.85544007	-117.2515178	San Diego County
227	Fee-for-Service	1033404645	1033404645	1	1	KIM, BRIAN Y MD	5/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123721	01	General Practice	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
285	Fee-for-Service	1770776510	1770776510	1	1	KRISHNAMURTHY, VIDHYA PHD	9/19/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25845 BARTON RD	None	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
292	Fee-for-Service	1376986232	1376986232	1	1	KLEIMEYER, JOHN P MD	9/10/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	132110	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
301	Fee-for-Service	1447218599	1447218599	1	1	KIM, GRACE E MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61861	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
334	Fee-for-Service	1053612341	1053612341	1	1	KUMMAR, SHIVAANI MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133954	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
345	Fee-for-Service	1942264858	1942264858	1	1	KUMAR, ABHA B MD	6/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	53636	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
359	Fee-for-Service	1558642637	1558642637	1	1	KIM, WARREN LCSW	10/7/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
368	Fee-for-Service	1811182454	1811182454	1	1	KIRKEBY, KJERSTI M MD	8/4/2009	207R00000X	NA	Other	026	PHYSICIANS	92167	67	Endocrinology	0	In state provider	None	1375 SUTTER STREET	None	SAN FRANCISCO	CA	94109	5438	38	06075	37.78738239	-122.4229066	San Francisco County
370	Fee-for-Service	1972754497	1972754497	1	1	KIMOTO, MALIN PHD	5/18/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
429	Fee-for-Service	1891761276	1891761276	1	1	KELLY, MICHAEL R MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69217	05	Anesthesiology	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
434	Fee-for-Service	1043376254	1043376254	1	1	KLINE, AMY E PHD	7/1/1998	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	720 MAIN STREET	SUITE B	WOODLAND	CA	95695	3407	57	06113	38.67740253	-121.7709405	Yolo County
445	Fee-for-Service	1720154545	1720154545	1	1	KASSAYE, SEBLE G MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77888	40	Pediatrics	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
521	Fee-for-Service	1588790315	1588790315	1	1	KIM, AMY L MD	9/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102809	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
524	Fee-for-Service	1184285520	1184285520	1	1	KHALILI, SOHILA	8/9/2023	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3300 E SOUTH ST	STE 203	LAKEWOOD	CA	90805	4589	19	06037	33.86018093	-118.1537163	Los Angeles County
531	Fee-for-Service	1518000652	1518000652	1	1	KNEETER, MARCI C PT	10/18/2018	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	01	06001	37.53211262	-121.9981587	Alameda County
537	Fee-for-Service	1770652349	1770652349	1	1	KELLY, STEPHEN M OD	9/15/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	#25 BAYHILL CENTER	851 CHERRY AVE	None	SAN BRUNO	CA	94066	2900	41	06081	37.6267145	-122.4249013	San Mateo County
551	Fee-for-Service	1871707133	1871707133	1	1	KIM, CATHERINE M MD	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125269	66	Emergency Medicine (Urgent Care)	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
593	Fee-for-Service	1649903170	1649903170	1	1	KIM, PAUL PT	8/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
608	Fee-for-Service	1497923866	1497923866	1	1	KIM, SUNHWA J MD	6/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86184	40	Pediatrics	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
610	Fee-for-Service	1649634957	1649634957	1	1	KRISHNAN, SRIKANTH MD	11/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154918	41	Internal Medicine	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
620	Fee-for-Service	1750310496	1750310496	1	1	KELAITA, DEAN M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80069	08	Family Practice	0	In state provider	None	265 W SAINT CHARLES ST	STE 2	SAN ANDREAS	CA	95249	9618	05	06009	38.19773927	-120.6861154	Calaveras County
622	Fee-for-Service	1053612341	1053612341	1	1	KUMMAR, SHIVAANI MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133954	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
626	Fee-for-Service	1386711208	1386711208	1	1	KELLER, BRIAN CRAIG MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75073	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
655	Fee-for-Service	1962765909	1962765909	1	1	KU, NATALIE C MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128071	02	General Surgery	0	In state provider	None	975 MAPLE STREET	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
656	Fee-for-Service	1811182454	1811182454	1	1	KIRKEBY, KJERSTI M MD	8/4/2009	207R00000X	NA	Other	026	PHYSICIANS	92167	41	Internal Medicine	0	In state provider	None	1375 SUTTER STREET	None	SAN FRANCISCO	CA	94109	5438	38	06075	37.78738239	-122.4229066	San Francisco County
672	Fee-for-Service	1811216245	1811216245	1	1	KIM, PETER H MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103698	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
673	Fee-for-Service	1386103406	1386103406	1	1	KANTIPUDI, AMAR MD	11/14/2022	207P00000X	NA	Other	026	PHYSICIANS	178285	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
709	Fee-for-Service	1578534566	1578534566	1	1	KANE, EDWARD J JR MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87558	22	Pathology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
736	Fee-for-Service	1720154545	1720154545	1	1	KASSAYE, SEBLE G MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77888	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
743	Fee-for-Service	1639286495	1639286495	1	1	KORE, ARPUTHARAJA H MD	7/1/1998	2086S0129X	NA	General Surgery	026	PHYSICIANS	51824	02	General Surgery	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
780	Fee-for-Service	1770652422	1770652422	1	1	KAJI, TROY T	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61656	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
795	Fee-for-Service	1093811085	1093811085	1	1	KAIA, JUDY A NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3733 SAN DIMAS ST	STE 104	BAKERSFIELD	CA	93309	7032	15	06029	35.393499	-119.008257	Kern County
836	Fee-for-Service	1063421923	1063421923	1	1	KIM, NEUNG S MD	2/8/2015	2085R0001X	NA	Other	026	PHYSICIANS	40287	30	Radiology	0	In state provider	CORONA-YORBA LINDA R/O	17021 YORBA LINDA BLVD	# E60	YORBA LINDA	CA	92886	3743	30	06059	33.88847378	-117.8372198	Orange County
854	Fee-for-Service	1942311246	1942311246	1	1	KAYALEH, RAOUF MD	7/15/2015	207RP1001X	NA	Pulmonology	026	PHYSICIANS	41449	41	Internal Medicine	0	In state provider	None	1125 E 17TH STREET	SUITE E-109	SANTA ANA	CA	92701	2214	30	06059	33.76004145	-117.854838	Orange County
856	Fee-for-Service	1659867166	1659867166	1	1	KOCHARIAN, HEIDI LCSW	1/13/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
900	Fee-for-Service	1497923866	1497923866	1	1	KIM, SUNHWA J MD	6/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86184	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
901	Fee-for-Service	1649634957	1649634957	1	1	KRISHNAN, SRIKANTH MD	11/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154918	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
944	Fee-for-Service	1457199705	1457199705	1	1	KIM, SHANNON S AU	10/30/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
958	Fee-for-Service	1447419502	1447419502	1	1	KEEFE, PATRICIA M MD	10/10/2008	207K00000X	NA	Other	026	PHYSICIANS	87337	40	Pediatrics	0	In state provider	None	6386 ALVARADO CT	STE 210	SAN DIEGO	CA	92120	4907	37	06073	32.77666838	-117.0614255	San Diego County
1009	Fee-for-Service	1104946300	1104946300	1	1	KIMBLE, SANDRA LMFT	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
1021	Fee-for-Service	1720154545	1720154545	1	1	KASSAYE, SEBLE G MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77888	77	Infectious Disease	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
1047	Fee-for-Service	1144318817	1144318817	1	1	KREISHEIMERL,DIANE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MARICOPA MEDICAL CENTER	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85005	0000	00	None	33.457203	-112.0262625	Maricopa County
1091	Fee-for-Service	1316234941	1316234941	1	1	KANG, YADWINDER S	8/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117812	None	None	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
1110	Fee-for-Service	1548318538	1548318538	1	1	KUNINOBU, ANDREW MD	12/9/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80883	01	General Practice	0	In state provider	None	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0486	31	06061	39.03521526	-120.9755343	Placer County
1138	Fee-for-Service	1699160754	1699160754	1	1	KUNZA, BRITTANY E MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144398	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
1139	Fee-for-Service	1942311246	1942311246	1	1	KAYALEH, RAOUF MD	7/15/2015	207RP1001X	NA	Pulmonology	026	PHYSICIANS	41449	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1125 E 17TH STREET	SUITE E-109	SANTA ANA	CA	92701	2214	30	06059	33.76004145	-117.854838	Orange County
1152	Fee-for-Service	1518649763	1518649763	1	1	KEPLEY, BROOKE NP	9/29/2023	2080P0203X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
1215	Fee-for-Service	1689735953	1689735953	1	1	KIM, JAE MYUNG MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	38835	41	Internal Medicine	0	In state provider	None	1433 W MERCED AVE	STE 217	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
1235	Fee-for-Service	1023192267	1023192267	1	1	KAISER, CHRISTINE C MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113028	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
1245	Fee-for-Service	1447419502	1447419502	1	1	KEEFE, PATRICIA M MD	10/10/2008	207K00000X	NA	Other	026	PHYSICIANS	87337	43	Pediatric Allergy	0	In state provider	None	6386 ALVARADO CT	STE 210	SAN DIEGO	CA	92120	4907	37	06073	32.77666838	-117.0614255	San Diego County
1266	Fee-for-Service	1508095795	1508095795	1	1	KIM, EUNICE Y PHD	3/16/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
1304	Fee-for-Service	1114007093	1114007093	1	1	KILKENNY, THOMAS E MD	11/22/1977	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	33772	20	Orthopedic Surgery	0	In state provider	None	740 S DORA ST	None	UKIAH	CA	95482	5336	23	06045	39.14375265	-123.2111226	Mendocino County
1305	Fee-for-Service	1700380631	1700380631	1	1	KIM, SARASA T MD	6/1/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165915	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
1332	Fee-for-Service	1134122633	1134122633	1	1	KAYSER, DENISE L MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66761	18	Ophthalmology	0	In state provider	None	3536 MENDOCINO AVE	STE 380	SANTA ROSA	CA	95403	3612	49	06097	38.473326	-122.725935	Sonoma County
1406	Fee-for-Service	1326138991	1326138991	1	1	KLEIN,SARAH G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 MARSHALL STREET	STE#653	LITTLE ROCK	AR	72202	0000	00	None	34.74346583	-92.29154425	Pulaski County
1418	Fee-for-Service	1003013442	1003013442	1	1	KAN, JACK M MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105169	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1424	Fee-for-Service	1275076721	1275076721	1	1	KHAN, CEMONE R OD	7/21/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
1431	Fee-for-Service	1225491293	1225491293	1	1	KRAUS, CHRISTINA N MD	2/6/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	150386	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
1463	Fee-for-Service	1982720124	1982720124	1	1	KAPADIA, ROBERT H CRNA	5/25/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
1494	Fee-for-Service	1215565791	1215565791	1	1	KHAN, TOOBA MD	3/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186836	None	None	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
1496	Fee-for-Service	1336210392	1336210392	1	1	KEJRIWAL,KAMAL MD	8/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76033	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
1525	Fee-for-Service	1295837557	1295837557	1	1	KRISHNA, PAD MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30918	08	Family Practice	0	In state provider	None	3650 SOUTH ST	STE 411	LAKEWOOD	CA	90712	1512	19	06037	33.86019847	-118.149255	Los Angeles County
1550	Fee-for-Service	1760633457	1760633457	1	1	KOOTURU, SRI V	9/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112243	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
1554	Fee-for-Service	1073698882	1073698882	1	1	KAYSEN, DEBRA L PHD	11/4/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1576	Fee-for-Service	1558310938	1558310938	1	1	KNIGHT, JOHN M MD	11/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	40293	20	Orthopedic Surgery	0	In state provider	None	3100 SAN PABLO AVE	410	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
1583	Fee-for-Service	1639345929	1639345929	1	1	KO, ERIC C MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124930	30	Radiology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
1597	Fee-for-Service	1013301225	1013301225	1	1	KUFTINEC, GABRIELA N MD	10/19/2021	207R00000X	NA	Other	026	PHYSICIANS	147360	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
1602	Fee-for-Service	1194161091	1194161091	1	1	KIM, ERIC S MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136000	13	Neurology (M.D. only)	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
1616	Fee-for-Service	1962501833	1962501833	1	1	KEYOUNG, JINSOO A MD	10/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84087	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1647	Fee-for-Service	1306203138	1306203138	1	1	KEENE, CORA A LMFT	8/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	830 OLMSTEAD ST	None	SAN FRANCISCO	CA	94134	1839	38	06075	37.72064786	-122.4100413	San Francisco County
1660	Fee-for-Service	1730237538	1730237538	1	1	KAISER HOSP PHARMACY 052	11/9/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9400 E ROSECRANS BLVD #O	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
1667	Fee-for-Service	1750455507	1750455507	1	1	KOWALL, MARK G MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	74354	20	Orthopedic Surgery	0	In state provider	None	8390 MORRO RD	None	ATASCADERO	CA	93422	3927	40	06079	35.47178332	-120.6690573	San Luis Obispo County
1709	Fee-for-Service	1881909760	1881909760	1	1	KARKOS, PETROS MD	8/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
1713	Fee-for-Service	1225022601	1225022601	1	1	KING, ANTHONY H MD	4/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48070	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	980 TRANCAS ST	STE 11	NAPA	CA	94558	2933	28	06055	38.32369771	-122.2951869	Napa County
1715	Fee-for-Service	1104912336	1104912336	1	1	KOROSHEC, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49623	01	General Practice	0	In state provider	None	6411 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	6315	19	06037	34.10163163	-118.3299793	Los Angeles County
1730	Fee-for-Service	1508457912	1508457912	1	1	KHAN, ALEENA CNP	2/28/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
1784	Fee-for-Service	1336210392	1336210392	1	1	KEJRIWAL,KAMAL MD	8/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76033	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
1799	Fee-for-Service	1528163003	1528163003	1	1	KLINEBERG, ERIC O MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100293	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
1843	Fee-for-Service	1437258183	1437258183	1	1	KIM, STEVENS Y MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	76813	None	None	0	In state provider	None	1421 OAKDALE RD	STE 2	MODESTO	CA	95355	3359	50	06099	37.664802	-120.9576055	Stanislaus County
1861	Fee-for-Service	1649376534	1649376534	1	1	KONGCHALALAI, AMARIN MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67705	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9655 MONTE VISTA AVE	STE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
1863	Fee-for-Service	1518004688	1518004688	1	1	KIM, CHARLES D OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FAMILY EYECARE OPTOMETRY	44407 10TH ST W	None	LANCASTER	CA	93534	3345	19	06037	34.68965953	-118.148053	Los Angeles County
1878	Fee-for-Service	1083767024	1083767024	1	1	KHAN, SAAD MUNIB AHMED MD	10/9/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	164010	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1969	Fee-for-Service	1144262593	1144262593	1	1	KHAN, MOHAMED H MD INC	10/17/2005	207R00000X	NA	Other	026	PHYSICIANS	49275	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2425 SONOMA ST	None	REDDING	CA	96001	9798	45	06089	40.5730743	-122.4016681	Shasta County
1973	Fee-for-Service	1326482084	1326482084	1	1	KOLOTINIUK, NIKOLAI V MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135082	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
1974	Fee-for-Service	1598036832	1598036832	1	1	KARAELIAS, LINDSAY M CRNA	2/17/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
2013	Fee-for-Service	1508967548	1508967548	1	1	KUMAR, PRADEEP J MD	4/30/1991	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	73865	20	Orthopedic Surgery	0	In state provider	SOUTHERN CA PERM MED	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
2023	Fee-for-Service	1922111731	1922111731	1	1	KRISHNA, KRISHAN MD	1/1/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25344	41	Internal Medicine	0	In state provider	None	3356 W BALL RD	STE 210	ANAHEIM	CA	92804	3728	30	06059	33.81726453	-118.007451	Orange County
2029	Fee-for-Service	1649619339	1649619339	1	1	KUNG, RAYMOND W MD	8/13/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	158415	04	Otology, Laryngology, Rhinology	0	In state provider	None	1450 SAN PABLO STREET	SUITE 5901	LOS ANGELES	CA	90033	5313	19	06037	34.06189518	-118.203256	Los Angeles County
2033	Fee-for-Service	1871655837	1871655837	1	1	KOSTKA, JANE E LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE AVENUE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
2062	Fee-for-Service	1679861694	1679861694	1	1	KIM, YOUNG M MD	11/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141523	40	Pediatrics	0	In state provider	None	25845 BARTON RD	None	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
2106	Fee-for-Service	1811429418	1811429418	1	1	KELADA, ALEXANDRAMARY Y DO	12/4/2020	207R00000X	NA	Other	026	PHYSICIANS	18267	None	None	0	In state provider	None	680 SUNRISE AVE	None	ROSEVILLE	CA	95661	4110	31	06061	38.7360182	-121.2720418	Placer County
2109	Fee-for-Service	1215460951	1215460951	1	1	KIHIU, RUTH MD	9/20/2020	207P00000X	NA	Other	026	PHYSICIANS	169684	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
2111	Fee-for-Service	1346815990	1346815990	1	1	KOH, AMY OT	10/18/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
2117	Fee-for-Service	1790783256	1790783256	1	1	KAO, DAISY P NP	2/6/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
2148	Fee-for-Service	1649376534	1649376534	1	1	KONGCHALALAI, AMARIN MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67705	41	Internal Medicine	0	In state provider	None	9655 MONTE VISTA AVE	STE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
2163	Fee-for-Service	1114918851	1114918851	1	1	KURTZMAN, STEVEN M MD	7/31/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66136	78	Neoplastic Diseases/Oncology	0	In state provider	None	170 ALAMEDA DE LAS	PUGLAS	REDWOOD CITY	CA	94062	0000	41	06081	37.48095011	-122.2532536	San Mateo County
2167	Fee-for-Service	1346440971	1346440971	1	1	KINCHSULAR, JAMES J DPM	12/3/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2020 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.60234303	-121.3921365	Sacramento County
2181	Fee-for-Service	1255872693	1255872693	1	1	KELLEY, KRISTEN D MD	5/11/2020	390200000X	NA	Other	026	PHYSICIANS	157523	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
2227	Fee-for-Service	1043655301	1043655301	1	1	KAVUSI, SUZAN MD	9/14/2021	207ZD0900X	NA	Other	026	PHYSICIANS	127069	None	None	0	In state provider	None	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
2232	Fee-for-Service	1104912336	1104912336	1	2	KOROSHEC, DAVID MD	11/24/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	49623	-	NOT APPLICABLE	0	In state provider	None	1926 WEST BEVERLY BLVD	None	LOS ANGELES	CA	90057	2402	19	06037	34.06588198	-118.2686209	Los Angeles County
2244	Fee-for-Service	1245355742	1245355742	1	1	KEMP, SUMIRA NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1717 E DATE PLACE	None	SAN BERNARDINO	CA	92404	4428	36	06071	34.14094893	-117.2500411	San Bernardino County
2246	Fee-for-Service	1619023264	1619023264	1	1	KOPP, ANNE PHD	10/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
2256	Fee-for-Service	1144262593	1144262593	1	1	KHAN, MOHAMED H MD INC	10/17/2005	207R00000X	NA	Other	026	PHYSICIANS	49275	41	Internal Medicine	0	In state provider	None	2425 SONOMA ST	None	REDDING	CA	96001	9798	45	06089	40.5730743	-122.4016681	Shasta County
2284	Fee-for-Service	1669250189	1669250189	1	1	KASHKOULI, HELAY N NP	11/13/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
2285	Fee-for-Service	1649238114	1649238114	1	1	KATO, KEVIN K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	53 S PUUNENE AVE	STE 125	KAHULUI	HI	96732	2192	00	None	20.8899246	-156.4667371	Maui County
2292	Fee-for-Service	1184675357	1184675357	1	1	KAN, MICHAEL K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25862	22	Pathology (M.D. only)	0	In state provider	None	7625 MESA COLLEGE DR	None	SAN DIEGO	CA	92111	5343	37	06073	32.80089797	-117.1572727	San Diego County
2301	Fee-for-Service	1477951564	1477951564	1	1	KOMP, AMELIA T NP	12/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2311	Fee-for-Service	1922111731	1922111731	1	1	KRISHNA, KRISHAN MD	1/1/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25344	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3356 W BALL RD	STE 210	ANAHEIM	CA	92804	3728	30	06059	33.81726453	-118.007451	Orange County
2349	Fee-for-Service	1316250525	1316250525	1	1	KOOLAEE, ROODABEH M DO	2/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12722	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	SUITE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
2384	Fee-for-Service	1871532051	1871532051	1	1	KIM, BRIAN K MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88900	78	Neoplastic Diseases/Oncology	0	In state provider	None	2800 L ST	STE 300	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
2391	Fee-for-Service	1215407358	1215407358	1	1	KATTIYAMAN, ROSILYN NP	1/1/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
2405	Fee-for-Service	1801906722	1801906722	1	1	KATSEV, DOUGLAS A MD	10/31/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	65027	18	Ophthalmology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
2451	Fee-for-Service	1114918851	1114918851	1	1	KURTZMAN, STEVEN M MD	7/31/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66136	30	Radiology	0	In state provider	None	170 ALAMEDA DE LAS	PUGLAS	REDWOOD CITY	CA	94062	0000	41	06081	37.48095011	-122.2532536	San Mateo County
2511	Fee-for-Service	1073540340	1073540340	1	1	KAMARZARIAN, ANITA MD	7/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79337	45	Nephrology (Renal-Kidney)	0	In state provider	None	255 E ORANGE GROVE AVE	STE D	BURBANK	CA	91502	1240	19	06037	34.18236815	-118.3089281	Los Angeles County
2527	Fee-for-Service	1285712182	1285712182	1	1	KOSTECKI-CSANYI, LYNN M	8/2/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86598	36	Psychiatry	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
2541	Fee-for-Service	1639616410	1639616410	1	1	KIM, JEANNIE MD A	2/28/2018	207RP1001X	NA	Pulmonology	026	PHYSICIANS	72965	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	7922 PALM STREET	None	LEMON GROVE	CA	91945	2956	37	06073	32.73475153	-117.028116	San Diego County
2547	Fee-for-Service	1720742513	1720742513	1	1	KONG, RAYMOND PT	12/10/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	800 S. RAYMOND AVE	None	PASADENA	CA	91105	3229	19	06037	34.13185488	-118.1487468	Los Angeles County
2552	Fee-for-Service	1477642510	1477642510	1	1	KUO, SU-MUI MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36124	40	Pediatrics	0	In state provider	None	728 PACIFIC AVE	STE 406	SAN FRANCISCO	CA	94133	4449	38	06075	37.79687859	-122.4074282	San Francisco County
2556	Fee-for-Service	1336345750	1336345750	1	1	KAISER FOUNDATION HEALTH	1/23/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER P PHARMACY #253	13652 CANTARA STREET	1ST FLOOR, ROOM 12R01	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
2557	Fee-for-Service	1215962451	1215962451	1	1	KAPLAN, ROY A MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	31859	83	Rheumatology	0	In state provider	None	345 SAXONY RD	STE 105	ENCINITAS	CA	92024	2787	37	06073	33.05403165	-117.285548	San Diego County
2569	Fee-for-Service	1194744631	1194744631	1	1	KIEU, ANH THU NGUYEN MD	12/1/1998	207R00000X	NA	Other	026	PHYSICIANS	54664	41	Internal Medicine	0	In state provider	None	11303 W WASHINGTON BLVD	STE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
2580	Fee-for-Service	1184675357	1184675357	1	1	KAN, MICHAEL K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25862	42	Nuclear Medicine	0	In state provider	None	7625 MESA COLLEGE DR	None	SAN DIEGO	CA	92111	5343	37	06073	32.80089797	-117.1572727	San Diego County
2585	Fee-for-Service	1659097459	1659097459	1	1	KIM, HYUNJIB	5/16/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
2588	Fee-for-Service	1013311448	1013311448	1	6	KOREAN HEALTH EDUCATION	8/23/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3671 WEST 6TH STREET	SUITE A	LOS ANGELES	CA	90020	3894	19	06037	34.06360149	-118.302543	Los Angeles County
2652	Fee-for-Service	1538477906	1538477906	1	1	KOLNICK, DEAN L MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128880	30	Radiology	0	In state provider	None	14651 S BASCOM AVE	STE 120	LOS GATOS	CA	95032	2004	43	06085	37.25556684	-121.9504578	Santa Clara County
2672	Fee-for-Service	1871532051	1871532051	1	1	KIM, BRIAN K MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88900	68	Hematology	0	In state provider	None	2800 L ST	STE 300	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
2682	Fee-for-Service	1063236677	1063236677	1	1	KIM, JENNIFER LMFT	1/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
2703	Fee-for-Service	1952728164	1952728164	1	1	KALINJIAN, SEVAG B DO	1/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14348	01	General Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
2742	Fee-for-Service	1760545503	1760545503	1	1	KATUKOTA, VIJAY C MD INC	9/30/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORPORATION	1177 N PARK AVE	None	POMONA	CA	91768	3028	19	06037	34.06950662	-117.7549507	Los Angeles County
2748	Fee-for-Service	1598813180	1598813180	1	1	KAISER FOUNDATION HEALTH	4/15/2003	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMNTE PHRM 245	3875 AVOCADO BLVD	None	LA MESA	CA	91941	7303	37	06073	32.750325	-116.9607955	San Diego County
2783	Fee-for-Service	1659767606	1659767606	1	1	KIM, JESSICA MD	10/1/2021	207P00000X	NA	Other	026	PHYSICIANS	172283	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
2793	Fee-for-Service	1447612403	1447612403	1	1	KAUR, PALWINDER OD	2/24/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3223 HAMMER LN	None	STOCKTON	CA	95212	2815	39	06077	38.023479	-121.2736095	San Joaquin County
2801	Fee-for-Service	1073540340	1073540340	1	1	KAMARZARIAN, ANITA MD	7/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79337	41	Internal Medicine	0	In state provider	None	255 E ORANGE GROVE AVE	STE D	BURBANK	CA	91502	1240	19	06037	34.18236815	-118.3089281	Los Angeles County
2808	Fee-for-Service	1477009686	1477009686	1	1	KHALID, ZEESHAN MD	9/3/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
2822	Fee-for-Service	1467406850	1467406850	1	1	KATIRAEI, PEJMAN DO	6/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8994	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
2826	Fee-for-Service	1740817659	1740817659	1	1	KHAN, LAUREN MD	12/27/2022	390200000X	NA	Other	026	PHYSICIANS	19552	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
2832	Fee-for-Service	1639616410	1639616410	1	1	KIM, JEANNIE MD A	2/28/2018	207RP1001X	NA	Pulmonology	026	PHYSICIANS	72965	29	Pulmonary Diseases (M.D. only)	0	In state provider	PROFESSIONAL CORPORATION	7922 PALM STREET	None	LEMON GROVE	CA	91945	2956	37	06073	32.73475153	-117.028116	San Diego County
2841	Fee-for-Service	1891060067	1891060067	1	1	KOLAITIS, NICHOLAS A MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129772	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2863	Fee-for-Service	1912319120	1912319120	1	1	KIM, NGOC K MD	9/13/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	145354	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
2869	Fee-for-Service	1316049620	1316049620	1	1	KYNARD, ANDREA A RN	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	ALLIED HEALTH CARE INC	301 N PRAIRIE AVE	STE 400	INGLEWOOD	CA	90301	4511	19	06037	33.965712	-118.3439965	Los Angeles County
2879	Fee-for-Service	1013311448	1013311448	1	6	KOREAN HEALTH EDUCATION	8/23/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3671 WEST 6TH STREET	SUITE A	LOS ANGELES	CA	90020	3894	19	06037	34.06360149	-118.302543	Los Angeles County
2924	Fee-for-Service	1437526738	1437526738	1	1	KURANISHI, MICHELLE R PHD	1/2/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
2932	Fee-for-Service	1205984960	1205984960	1	1	KAUFMAN, AVRUM A DO	1/26/2009	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	7892	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	SOUTH COAST EAR NOSE & T	800 CORPORATE DR	STE 290	LADERA RANCH	CA	92694	1152	30	06059	33.5574	-117.6292535	Orange County
2939	Fee-for-Service	1770661316	1770661316	1	1	KRAFT, ANGELA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56089	18	Ophthalmology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
2974	Fee-for-Service	1487996195	1487996195	1	1	KAISER FOUNDATION HEALTH	3/12/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	9961 SIERRA AVE	HOSPITAL BLDG FLOOR 1	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
2990	Fee-for-Service	1144229329	1144229329	1	1	KAPHAN, MARVIN N LCSW	12/1/2008	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	12520 MAGNOLIA BLVD	STE 210	VALLEY VILLAGE	CA	91607	2349	19	06037	34.16485451	-118.406106	Los Angeles County
3041	Fee-for-Service	1518163013	1518163013	1	1	KOEHLER, TARIN M DO	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10764	01	General Practice	0	In state provider	None	250 N ROBERTSON	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
3076	Fee-for-Service	1902239528	1902239528	1	1	KHINE, KAY T MD	1/25/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	169548	None	None	0	In state provider	None	3733 SAN DIMAS ST	STE 104	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
3082	Fee-for-Service	1063589075	1063589075	1	1	KRISTIANTO, EMANUEL B MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88106	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
3096	Fee-for-Service	1730665795	1730665795	1	1	KING, LAURA M DO	5/20/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18012	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
3120	Fee-for-Service	1053475061	1053475061	1	1	KANNO, IVAN T MD	10/31/1988	207P00000X	NA	Other	026	PHYSICIANS	40555	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
3125	Fee-for-Service	1881639342	1881639342	1	1	KIDNEY CENTER OF	4/27/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	PANORAMA CITY INC	14600 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4105	19	06037	34.22149954	-118.4503725	Los Angeles County
3132	Fee-for-Service	1487751251	1487751251	1	1	KOBAYASHI, WESLEY M DPM	1/1/1994	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	18800 MAIN ST	STE 104	HUNTINGTON BEACH	CA	92648	1717	30	06059	33.68890364	-117.9949974	Orange County
3138	Fee-for-Service	1003056516	1003056516	1	1	KHEMICHIAN, ARBI MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117900	18	Ophthalmology	0	In state provider	None	10 CONGRESS ST	STE 340	PASADENA	CA	91105	3020	19	06037	34.13396893	-118.1528162	Los Angeles County
3151	Fee-for-Service	1770650665	1770650665	1	1	KIM, PAUL B MD	8/23/1995	207R00000X	NA	Other	026	PHYSICIANS	80833	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
3164	Fee-for-Service	1477564938	1477564938	1	1	KAMINKER, SHARON B MD	6/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62098	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	STE 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
3189	Fee-for-Service	1154614097	1154614097	1	1	KAWEAH DELTA HEALTH CARE	3/8/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	180 E ANTELOPE AVE	None	WOODLAKE	CA	93286	1506	54	06107	36.4156335	-119.097918	Tulare County
3227	Fee-for-Service	1528694403	1528694403	1	1	KARIMI, MEHRDAD MD	10/16/2023	208M00000X	NA	Other	026	PHYSICIANS	184810	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
3234	Fee-for-Service	1245693472	1245693472	1	1	KHAN, ABEER A	7/11/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
3240	Fee-for-Service	1750746723	1750746723	1	1	KING, STEPHANIE D	4/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2295 S VINEYARD	BLDG A	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
3251	Fee-for-Service	1184078685	1184078685	1	1	KOZAK, ELIZABETH S CNP	9/22/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
3261	Fee-for-Service	1801885132	1801885132	1	2	KATZ, NEIL OD	7/31/1993	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10630 TOWN CENTER DR	STE 127	RANCHO CUCAMONGA	CA	91730	6889	36	06071	34.11112305	-117.5729644	San Bernardino County
3264	Fee-for-Service	1790795458	1790795458	1	1	KAWEAH DELTA HEALTH CARE	8/10/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1633 S COURT ST	None	VISALIA	CA	93277	4945	54	06107	36.315972	-119.292237	Tulare County
3303	Fee-for-Service	1083494272	1083494272	1	1	KEENAN, PATRICIA LAC	11/8/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY DR	SUITE 180	SCOTTS VALLEY	CA	95066	3452	44	06087	37.06204883	-122.0069319	Santa Cruz County
3349	Fee-for-Service	1588713119	1588713119	1	1	KIM, MICHELLE H OD	1/20/2006	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	833 S WESTERN AVE	STE 2	LOS ANGELES	CA	90005	3376	19	06037	34.057368	-118.309118	Los Angeles County
3361	Fee-for-Service	1477665503	1477665503	1	1	KLOMPUS, JOEL M MD	5/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	23532	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	STE 423	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
3388	Fee-for-Service	1013311448	1013311448	1	5	KOREAN HEALTH EDUCATION	10/29/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3255 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
3395	Fee-for-Service	1366452245	1366452245	1	1	KIM, SUNG K MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86113	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
3404	Fee-for-Service	1255902938	1255902938	1	1	KARUCHI, CHRISTINE WANJIKU	10/24/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13025 GOLDENROD DRIVE	None	EASTVALE	CA	92880	0717	33	06065	33.97599898	-117.5678807	Riverside County
3408	Fee-for-Service	1053475061	1053475061	1	1	KANNO, IVAN T MD	10/31/1988	207P00000X	NA	Other	026	PHYSICIANS	40555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
3423	Fee-for-Service	1528364536	1528364536	1	1	KULWANT SINGH MD INC	3/21/2011	2084P0800X	NA	Psychiatry	026	PHYSICIANS	105095	36	Psychiatry	0	In state provider	None	5000 WINDPLAY DR	SUITE 4	EL DORADO HILLS	CA	49576	2936	09	06017	38.63978974	-121.0710527	El Dorado County
3450	Fee-for-Service	1922002468	1922002468	1	1	KIM, KENNETH MD	11/3/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77876	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
3477	Fee-for-Service	1154614097	1154614097	1	1	KAWEAH DELTA HEALTH CARE	1/12/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	180 E ANTELOPE AVE	None	WOODLAKE	CA	93286	1506	54	06107	36.4156335	-119.097918	Tulare County
3484	Fee-for-Service	1851569552	1851569552	1	1	KHAN, AYESHA S MD	1/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112002	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3497	Fee-for-Service	1073587481	1073587481	1	1	KAYE, JOSHUA M DPM INC	12/19/2008	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 106	LOS ANGELES	CA	90045	3811	19	06037	33.96022076	-118.3961982	Los Angeles County
3506	Fee-for-Service	1851365878	1851365878	1	1	KELLY,KATHLEEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20010 CENTURY BLVD	STE 200	GERMANTOWN	MD	20874	1118	00	None	39.18560725	-77.25950536	Montgomery County
3513	Fee-for-Service	1902022924	1902022924	1	1	KIM, IN-YUL	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	EYE CONNECT	16300 CRENSHAW BLVD	STE 105	TORRANCE	CA	90504	1440	19	06037	33.88242243	-118.3264875	Los Angeles County
3561	Fee-for-Service	1649539263	1649539263	1	1	KHADEM, NASIM R MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129623	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
3592	Fee-for-Service	1730354929	1730354929	1	1	KANG, JOSEPH INSUNG MD	9/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112375	01	General Practice	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
3594	Fee-for-Service	1649242587	1649242587	1	1	KUAN, CALVIN C MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54145	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3659	Fee-for-Service	1447277413	1447277413	1	1	KULSHRESTHA, AARTI MD FAAP	8/31/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71264	40	Pediatrics	0	In state provider	None	1433 W MERCED AVENUE	STE 103	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
3669	Fee-for-Service	1033102736	1033102736	1	1	KARAMITSOS WILTCHIK AMC	2/10/2005	207VG0400X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CNTRL CST WOMNS HLTH,INC	300 S STRATFORD AVE	None	SANTA MARIA	CA	93454	5907	42	06083	34.95093895	-120.4146959	Santa Barbara County
3673	Fee-for-Service	1467473751	1467473751	1	1	KLEINMAN, WAYNE	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	57617	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
3676	Fee-for-Service	1013311448	1013311448	1	5	KOREAN HEALTH EDUCATION	11/3/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3255 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
3692	Fee-for-Service	1255902938	1255902938	1	1	KARUCHI, CHRISTINE WANJIKU	10/24/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13025 GOLDENROD DRIVE	None	EASTVALE	CA	92880	0717	33	06065	33.97599898	-117.5678807	Riverside County
3726	Fee-for-Service	1477869428	1477869428	1	1	KHERA, GURCHARAN S MD	7/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122584	41	Internal Medicine	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
3729	Fee-for-Service	1326015132	1326015132	1	1	KASAVIN, MARINA A MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40671	13	Neurology (M.D. only)	0	In state provider	None	2299 POST ST	STE 102	SAN FRANCISCO	CA	94115	3443	38	06075	37.78434298	-122.4392033	San Francisco County
3751	Fee-for-Service	1962574145	1962574145	1	1	KING, CHRISTOPHER R MD	5/18/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85732	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
3757	Fee-for-Service	1568812675	1568812675	1	1	KHAN, ADAM MD	8/25/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	188047	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
3764	Fee-for-Service	1457463481	1457463481	1	1	KALISH, GRACE M. MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
3768	Fee-for-Service	1154614097	1154614097	1	1	KAWEAH DELTA HEALTH CARE	1/12/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	180 E ANTELOPE AVE	None	WOODLAKE	CA	93286	1506	54	06107	36.4156335	-119.097918	Tulare County
3800	Fee-for-Service	1245264175	1245264175	2	1	KPS CARE INC	6/9/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8851 CENTER DR	STE 110	LA MESA	CA	91942	3017	37	06073	32.78189749	-117.0075062	San Diego County
3832	Fee-for-Service	1770816381	1770816381	1	1	KOSOFF, ANNA R LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	649 EAST ALBERTONI	SUITE 100	CARSON	CA	90746	1538	19	06037	33.87194399	-118.2643054	Los Angeles County
3838	Fee-for-Service	1801885132	1801885132	1	3	KATZ, NEIL OD	10/7/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	471 N CENTRAL AVE	None	UPLAND	CA	91786	4219	36	06071	34.099308	-117.689689	San Bernardino County
3879	Fee-for-Service	1699897470	1699897470	1	1	KING, URSULA M MFT	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	81041	-	NOT APPLICABLE	0	In state provider	None	2218 N 1ST STREET	None	SAN JOSE	CA	95131	2007	43	06085	37.37769052	-121.9213491	Santa Clara County
3881	Fee-for-Service	1730354929	1730354929	1	1	KANG, JOSEPH INSUNG MD	9/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112375	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
3883	Fee-for-Service	1649242587	1649242587	1	1	KUAN, CALVIN C MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54145	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3929	Fee-for-Service	1275050833	1275050833	1	1	KHOSRAVIANI, NEELUFAR PT	2/11/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
3942	Fee-for-Service	1962643379	1962643379	1	1	KIM, JONATHAN K MD	3/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138566	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
3948	Fee-for-Service	1558962100	1558962100	1	1	KEMEN, CHRISTOPHER MD	2/19/2025	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
3954	Fee-for-Service	1467471326	1467471326	1	1	KIM FOOT AND ANKLE MEDICAL C	12/1/1996	213EP0504X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ENTERS OF LONG BEACH	701 E 28TH ST	STE 111	LONG BEACH	CA	90806	2759	19	06037	33.80803441	-118.1847137	Los Angeles County
3967	Fee-for-Service	1013311448	1013311448	1	5	KOREAN HEALTH EDUCATION	10/29/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3255 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
3990	Fee-for-Service	1013076942	1013076942	1	1	KIM, JONG K CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NATURAL HEALING CENTER	9339 FOOTHILL BLVD	STE A	RANCHO CUCAMONGA	CA	91730	3548	36	06071	34.10649454	-117.6003855	San Bernardino County
4014	Fee-for-Service	1093753774	1093753774	1	1	KAPANKA,HEIDI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DRIVE	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
4027	Fee-for-Service	1740577238	1740577238	1	1	KAGAN, LAUREN MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114293	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
4054	Fee-for-Service	1154614097	1154614097	1	1	KAWEAH DELTA HEALTH CARE	1/12/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	180 E ANTELOPE AVE	None	WOODLAKE	CA	93286	1506	54	06107	36.4156335	-119.097918	Tulare County
4102	Fee-for-Service	1558064188	1558064188	1	1	KRUEGER, CHRISTOPHER	12/1/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
4124	Fee-for-Service	1487114799	1487114799	1	1	KIM, JAMES H MD	10/31/2024	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	182189	04	Otology, Laryngology, Rhinology	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
4155	Fee-for-Service	1295826790	1295826790	1	1	KHEMKA, PANKAJ M MD	5/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75135	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 410	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
4180	Fee-for-Service	1528252285	1528252285	1	1	KAO, KENNETH K MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98652	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
4182	Fee-for-Service	1114031721	1114031721	1	1	KANCHANANAKHIN, PHACHARAWUT	3/30/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	91530	None	None	0	In state provider	MD	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
4184	Fee-for-Service	1104861467	1104861467	1	1	KIWI PEDIATRICS MEDICAL	6/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP INC	1744 ALCATRAZ AVE	None	BERKELEY	CA	94703	2713	01	06001	37.84860565	-122.2722184	Alameda County
4195	Fee-for-Service	1730294547	1730294547	1	1	KENCH, SALEENA A PT	10/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12411 POWAY RD	STE 202B	POWAY	CA	92064	4302	37	06073	32.95170468	-117.0621893	San Diego County
4210	Fee-for-Service	1013023365	1013023365	1	1	KIM, HYUN S MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85388	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
4225	Fee-for-Service	1922364900	1922364900	1	1	KO, ELI J LMFT	10/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92563	7906	30	06059	33.62516256	-117.7353393	Orange County
4241	Fee-for-Service	1740279934	1740279934	1	1	KIM PARK, JOY MD	4/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138094	01	General Practice	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
4259	Fee-for-Service	1801183173	1801183173	1	1	KENNEDY, DANA E MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128688	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA BLVD	EMERGENCY DEPARTMENT	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
4268	Fee-for-Service	1023386174	1023386174	1	1	KING, TIFFANY M DO	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11898	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4899	38	06075	37.78956486	-122.417072	San Francisco County
4271	Fee-for-Service	1922057256	1922057256	1	1	KARUNANANTHAN, RUTH MD	10/1/1999	207R00000X	NA	Other	026	PHYSICIANS	64387	41	Internal Medicine	0	In state provider	None	65 N MADISON AVE	STE 200	PASADENA	CA	91101	2051	19	06037	34.14705803	-118.1384317	Los Angeles County
4275	Fee-for-Service	1588712970	1588712970	1	1	KRAUS, CAROLINE A LCSW	6/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
4301	Fee-for-Service	1649248626	1649248626	1	1	KENNESTONE HOSPITAL INC	7/17/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	677 CHURCH ST	None	MARIETTA	GA	30060	1142	00	None	33.96871334	-84.55031278	Cobb County
4331	Fee-for-Service	1184972713	1184972713	1	1	KRBOYAN, SVETLANA	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3180 E SHIELDS AVE	SUITE 105A	FRESNO	CA	93726	6900	10	06019	36.77948975	-119.7708048	Fresno County
4395	Fee-for-Service	1023772837	1023772837	1	1	KAROKI, LUCY W	9/15/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9809 SUMMER GLEN WAY	None	ELK GROVE	CA	95757	8323	34	06067	38.401605	-121.4376435	Sacramento County
4403	Fee-for-Service	1922060565	1922060565	1	1	KING, KERRY J MD	9/30/1993	207P00000X	NA	Other	026	PHYSICIANS	78790	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1688 E MAIN ST	None	EL CAJON	CA	92021	5204	37	06073	32.81173156	-116.9190219	San Diego County
4411	Fee-for-Service	1508904244	1508904244	1	1	KLISHEVICH, CERGEI W DC	4/3/2017	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4560 ADMIRALTY WAY	STE 302	MARINA DEL REY	CA	90292	5426	19	06037	33.98364904	-118.4449069	Los Angeles County
4493	Fee-for-Service	1104861467	1104861467	1	2	KIWI PEDIATRICS MEDICAL	3/4/2010	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1178 SAN PABLO AVE	None	BERKELEY	CA	94706	2245	01	06001	37.88303205	-122.2967317	Alameda County
4500	Fee-for-Service	1013023365	1013023365	1	1	KIM, HYUN S MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85388	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
4511	Fee-for-Service	1184043150	1184043150	1	1	KRISTY SHINE,MD	10/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
4528	Fee-for-Service	1275565707	1275565707	1	1	KUNDU, SUDESHNA MD	2/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105649	None	None	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
4548	Fee-for-Service	1275943946	1275943946	1	1	KULKARNI, ABHAY K MD	7/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
4580	Fee-for-Service	1861916637	1861916637	1	1	KAMOTHO, EDWARD KIRERI	8/22/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11972 GADWALL DR	None	JURUPA VALLEY	CA	91752	2941	33	06065	33.9792245	-117.543096	Riverside County
4591	Fee-for-Service	1649248626	1649248626	1	1	KENNESTONE HOSPITAL INC	7/11/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	677 CHURCH ST	None	MARIETTA	GA	30060	1142	00	None	33.96871334	-84.55031278	Cobb County
4605	Fee-for-Service	1952553380	1952553380	1	1	KIM, ANDREW H MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126764	10	Gastroenterology (M.D. only)	0	In state provider	None	1414 S GRAND AVE	SUITE 303	LOS ANGELES	CA	90015	3071	19	06037	34.03661142	-118.2657227	Los Angeles County
4619	Fee-for-Service	1184972713	1184972713	1	1	KRBOYAN, SVETLANA	5/28/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3180 E SHIELDS AVE	SUITE 105A	FRESNO	CA	93726	6900	10	06019	36.77948975	-119.7708048	Fresno County
4634	Fee-for-Service	1356318901	1356318901	1	1	KACZANOWSKI, TANIA C OD	7/1/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	681 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.6284656	-117.0748498	San Diego County
4667	Fee-for-Service	1053571828	1053571828	1	1	KEPLINGER, LISBETH M DPM	12/4/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2141 N HARBOR BLVD	SUITE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
4680	Fee-for-Service	1023772837	1023772837	1	1	KAROKI, LUCY W	9/15/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9809 SUMMER GLEN WAY	None	ELK GROVE	CA	95757	8323	34	06067	38.401605	-121.4376435	Sacramento County
4681	Fee-for-Service	1811963762	1811963762	1	1	KROE, DONALD MD	4/30/1991	207RP1001X	NA	Pulmonology	026	PHYSICIANS	73486	01	General Practice	0	In state provider	PERMANENTE MEDICAL GROUP	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
4693	Fee-for-Service	1447274220	1447274220	1	1	KAGEYAMA, JENNIE Y OD	7/25/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
4711	Fee-for-Service	1982052924	1982052924	1	1	KURIAN, DIVYA M MD	8/11/2020	207P00000X	NA	Other	026	PHYSICIANS	168541	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
4722	Fee-for-Service	1447308267	1447308267	1	1	KAISER FOUNDATION HEALTH	2/26/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY #2	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
4737	Fee-for-Service	1164687661	1164687661	1	1	KLIMISCH, CHRISTI L MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101881	40	Pediatrics	0	In state provider	None	5725 W LAS POSITAS BLVD	#110	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
4761	Fee-for-Service	1043534928	1043534928	1	1	KAZMIEROWSKI, PATRICIA A LAC	2/5/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
4775	Fee-for-Service	1528095999	1528095999	1	1	KEIFER, TERESA J MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54596	30	Radiology	0	In state provider	None	9515 SOQUEL DR	SUITE 100	APTOS	CA	95003	4135	44	06087	36.9753751	-121.8848219	Santa Cruz County
4783	Fee-for-Service	1003802612	1003802612	1	1	KAMARAJU, MANJULA MD	7/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51292	08	Family Practice	0	In state provider	None	15425 LOS GATOS BLVD	120	LOS GATOS	CA	95032	2553	43	06085	37.24444696	-121.9589876	Santa Clara County
4785	Fee-for-Service	1205041225	1205041225	1	1	KAMNANI,ASHA J MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	49082	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2929 HEALTH CENTER DRIVE	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
4788	Fee-for-Service	1013023365	1013023365	1	1	KIM, HYUN S MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85388	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
4823	Fee-for-Service	1265777684	1265777684	1	1	KUO, JONATHAN W MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	116635	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
4865	Fee-for-Service	1306078118	1306078118	1	1	KANUKUNTLA, TULASI MD	8/13/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154032	None	None	0	In state provider	None	540 W BASELINE RD	SUITE 3	CLAREMONT	CA	91711	1612	19	06037	34.12158153	-117.723276	Los Angeles County
4866	Fee-for-Service	1861916637	1861916637	1	1	KAMOTHO, EDWARD KIRERI	8/22/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11972 GADWALL DR	None	JURUPA VALLEY	CA	91752	2941	33	06065	33.9792245	-117.543096	Riverside County
4880	Fee-for-Service	1922105485	1922105485	1	1	KAREN B LESSER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
4882	Fee-for-Service	1669611729	1669611729	1	1	KWAN, CHUK W MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	929 CLAY ST	STE 600	SAN FRANCISCO	CA	94108	1571	38	06075	37.79398652	-122.4083496	San Francisco County
4900	Fee-for-Service	1528022530	1528022530	1	1	KELSEY, THOMAS G MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	38050	38	Geriatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
4902	Fee-for-Service	1043402332	1043402332	1	1	KUO, CAROLINE Y MD	6/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105714	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	MDCC12/311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
4935	Fee-for-Service	1710246400	1710246400	1	1	KHATIBI, BAHAREH MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111498	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
4964	Fee-for-Service	1427681386	1427681386	1	1	KIM, RACHEL PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1027 N HARBOR BLVD	SUITE B	FULLERTON	CA	92832	1310	30	06059	33.88084265	-117.9245141	Orange County
4986	Fee-for-Service	1225102742	1225102742	2	1	K&S HEALTH GROUP INC	2/19/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12519 ALONDRA BLVD	None	NORWALK	CA	90650	7351	19	06037	33.88784277	-118.0656536	Los Angeles County
4989	Fee-for-Service	1952888687	1952888687	1	1	KYUNG IN ACUPUNCTURE A	9/24/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	3030 BALL RD	STE B	ANAHEIM	CA	92804	3805	30	06059	33.81735848	-117.995031	Orange County
5007	Fee-for-Service	1801455191	1801455191	1	1	KAPLAN, JASON A	4/18/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	724 MEDICAL CENTER DR E	STE 102	CLOVIS	CA	93611	6811	10	06019	36.84107334	-119.6587409	Fresno County
5030	Fee-for-Service	1255674511	1255674511	1	1	KOBSA, SERGE S MD	9/6/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	172343	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
5047	Fee-for-Service	1588765085	1588765085	1	1	KRINSKY, MARY L DO	4/1/1999	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	7425	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
5057	Fee-for-Service	1184772964	1184772964	1	1	KIM, GRACE Y MD	11/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82551	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
5060	Fee-for-Service	1164718524	1164718524	1	1	KARIPINENI, FARAH B MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149093	02	General Surgery	0	In state provider	None	7415 NORTH CEDAR AVENUE	SUITE 102	FRESNO	CA	93720	2124	10	06019	36.8438171	-119.7568857	Fresno County
5153	Fee-for-Service	1801319298	1801319298	1	1	KESSEL, ALEXANDRA LCSW	10/3/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	790 E SANTA CLARA ST	STE 101A	VENTURA	CA	93001	2964	56	06111	34.27950947	-119.2888755	Ventura County
5189	Fee-for-Service	1528022530	1528022530	1	1	KELSEY, THOMAS G MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	38050	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
5221	Fee-for-Service	1962609230	1962609230	1	1	KOLTS, ROBERT H LCSW	1/22/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
5234	Fee-for-Service	1144831900	1144831900	1	1	KAKU, AIRIN NP	2/10/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
5266	Fee-for-Service	1225300106	1225300106	1	1	KHACHEKIAN, ARSINEH DO	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12430	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
5275	Fee-for-Service	1104020296	1104020296	1	1	KEVIN BRADLEY CEDERBERG, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
5284	Fee-for-Service	1356571681	1356571681	1	1	KOTAK, KAMAL M MD	12/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109136	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
5307	Fee-for-Service	1902802358	1902802358	1	1	KHURANA, RENU MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54114	22	Pathology (M.D. only)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
5311	Fee-for-Service	1619048592	1619048592	1	1	KREISMAN, ERNEST	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40545	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
5319	Fee-for-Service	1689176174	1689176174	1	1	KWONG, JOANNE C CCC-SLP	8/23/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
5331	Fee-for-Service	1508823824	1508823824	1	1	KAPLAN, STUART S MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	14	Neurological Surgery	1	Border provider	None	3061 S MARYLAND PKWY	STE 200	LAS VEGAS	NV	89109	6227	00	None	36.134172	-115.1369265	Clark County
5342	Fee-for-Service	1497588362	1497588362	1	1	KIM, JENNY OD	9/17/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1481 E PLAZA BLVD	None	NATIONAL CITY	CA	91950	3613	37	06073	32.6768163	-117.0909096	San Diego County
5349	Fee-for-Service	1265490551	1265490551	1	1	KHURSHID, AMBREEN MD	2/3/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52016	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
5418	Fee-for-Service	1730335845	1730335845	1	1	KAWAMOTO, KRISTAL C MD	12/10/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18525 S WESTERN AVE	None	GARDENA	CA	90248	3830	19	06037	33.86241877	-118.3091794	Los Angeles County
5421	Fee-for-Service	1518998053	1518998053	1	1	KNOX, JAMI A MD	3/8/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3001 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1114	00	None	42.25288307	-121.7896138	Klamath County
5467	Fee-for-Service	1700107265	1700107265	1	1	KIM, STEPHANIE Y DO	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13417	25	Physical Medicine and Rehabilitation	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4533	23	06045	39.15305697	-123.2037774	Mendocino County
5521	Fee-for-Service	1457366916	1457366916	1	1	KERRY DALEN,NP	7/29/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
5535	Fee-for-Service	1831278530	1831278530	1	1	KIM, HONG G MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	34969	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
5622	Fee-for-Service	1427078393	1427078393	1	2	KINGLSEY, MICHAEL C DO	5/16/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7895	08	Family Practice	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
5626	Fee-for-Service	1194167429	1194167429	1	1	KHAMSY SIHARATH, RN	11/1/2013	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	15 SHASTA COURT	None	OCEANSIDE	CA	92057	6024	37	06073	33.24208349	-117.318386	San Diego County
5633	Fee-for-Service	1952834285	1952834285	1	1	KNECHT, CORY S MD	7/1/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	177605	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
5652	Fee-for-Service	1760413710	1760413710	1	1	KINDLE, ELAINE LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2211 S HACIENDA BLVD	STE 103C	HACIENDA HEIGHTS	CA	91745	4642	19	06037	33.99441132	-117.9687562	Los Angeles County
5699	Fee-for-Service	1700821402	1700821402	1	1	KAREN GOODMAN MD	8/18/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
5700	Fee-for-Service	1386808285	1386808285	1	1	KASHMIRI, HIMALA DO	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14189	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
5708	Fee-for-Service	1952480097	1952480097	1	1	KUO, ANGELA H MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87412	08	Family Practice	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
5719	Fee-for-Service	1508038415	1508038415	1	1	KANG, SOO YEON K MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103239	36	Psychiatry	0	In state provider	None	11303 WASHINGTON BLVD	#100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
5756	Fee-for-Service	1639253610	1639253610	1	1	KOBALTER, KEVIN MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60633	67	Endocrinology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
5762	Fee-for-Service	1740212851	1740212851	1	1	KAWAKAMI, SUSAN R MD	2/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	6720	08	Family Practice	0	In state provider	None	8556 FLORENCE AVE	None	DOWNEY	CA	90240	4015	19	06037	33.94902678	-118.1202601	Los Angeles County
5765	Fee-for-Service	1194742825	1194742825	1	1	KRISHNAMOORTHY, DIVYA MD	11/9/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	54901	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
5792	Fee-for-Service	1013356229	1013356229	1	1	KLOSAK, SHANNON L LMFT	3/13/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4193 FLAT ROCK DR	SUITE 200	RIVERSIDE	CA	92505	7113	33	06065	33.90361212	-117.4930456	Riverside County
5794	Fee-for-Service	1851612170	1851612170	1	1	KIM, JIYOON DO	2/24/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18413	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
5843	Fee-for-Service	1306059936	1306059936	1	1	KOTTON, RYAN MD	10/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107539	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
5851	Fee-for-Service	1710086400	1710086400	1	1	KEITH, JENNIFER C MD	8/5/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83301	40	Pediatrics	0	In state provider	None	950 N STATE ST	None	HEMET	CA	92543	1485	33	06065	33.763266	-116.9717935	Riverside County
5862	Fee-for-Service	1528270410	1528270410	2	1	KHURANA, HARGOBIND S MD	11/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89578	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
5891	Fee-for-Service	1932244373	1932244373	1	1	KIM, YOU J LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	153 ACUPUNCTURE & HERBS	2011 LOMITA BLVD	None	LOMITA	CA	90717	1701	19	06037	33.80032943	-118.3150936	Los Angeles County
5901	Fee-for-Service	1861427528	1861427528	1	1	KHAN-VARIBA, JOHN A MD	2/8/2015	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	30544	40	Pediatrics	0	In state provider	None	1551 BISHOP STREET	STE A160	NIPOMO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
5947	Fee-for-Service	1477552727	1477552727	1	1	KIM, THOMAS C MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2650 N TENAYA WAY	STE 301	LAS VEGAS	NV	89128	1112	00	None	36.20804839	-115.2501292	Clark County
5950	Fee-for-Service	1750886982	1750886982	1	1	KURINSKY, CAITLYN P DO	2/16/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19079	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
5952	Fee-for-Service	1902935646	1902935646	1	1	KIM, STANLEY S LMFT	12/6/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
5986	Fee-for-Service	1255490678	1255490678	1	2	K. MITCHELL NAFICY MD INC	7/12/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	27512 CALLE ARROYO	SUITE A	SAN JUAN CAPISTRA	CA	92675	2753	30	06059	33.50269689	-117.6501363	Orange County
5993	Fee-for-Service	1083775787	1083775787	1	1	KOH, KER Y	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140941	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
6006	Fee-for-Service	1467795427	1467795427	1	1	KITTLER, NICOLE W MD	9/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147926	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
6025	Fee-for-Service	1881734655	1881734655	1	1	KENNEDY, WILLIAM A MD	4/30/1995	208800000X	NA	Other	026	PHYSICIANS	83789	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
6039	Fee-for-Service	1639669328	1639669328	1	1	KWONG, TAMMIE DO	10/12/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18965	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
6141	Fee-for-Service	1558415000	1558415000	1	1	KARANJAWALA, ZARIR E MD	1/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109519	22	Pathology (M.D. only)	0	In state provider	None	3301 C STREET	SUITE 200-E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
6189	Fee-for-Service	1992977037	1992977037	1	1	KYLER, THOMAS J MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92763	05	Anesthesiology	0	In state provider	None	616 E CHAPEL STREET	None	SANTA MARIA	CA	93454	4522	42	06083	34.95426953	-120.427596	Santa Barbara County
6261	Fee-for-Service	1528048709	1528048709	1	1	KUMAR, BRIJENDRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4735 OGLETOWN STANTON RD	None	NEWARK	DE	19713	2072	00	None	39.685662	-75.672873	New Castle County
6281	Fee-for-Service	1205983525	1205983525	1	1	KAISER FOUND HLTH PLAN	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #385	22550 SAVI RANCH RD	None	YORBA LINDA	CA	92887	4670	30	06059	33.87448406	-117.7441707	Orange County
6289	Fee-for-Service	1285243360	1285243360	1	1	KAUR, CHARANJIT NP	10/11/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	39	06077	38.02415455	-121.2934722	San Joaquin County
6307	Fee-for-Service	1467489187	1467489187	1	1	KESSLER, KAREN L LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
6329	Fee-for-Service	1235171638	1235171638	1	1	KLEIN, JUDITH R MD	4/1/2000	207P00000X	NA	Other	026	PHYSICIANS	62490	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
6375	Fee-for-Service	1245291558	1245291558	1	1	KAWEAH DELTA HEALTH CARE	12/1/1977	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5040 W TULARE AVE	None	VISALIA	CA	93277	1593	54	06107	36.321111	-119.3469165	Tulare County
6381	Fee-for-Service	1518919729	1518919729	1	1	KOROBKIN, ROWENA K MD	12/10/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	20779	40	Pediatrics	0	In state provider	None	2340 CLAY ST	# 313	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
6419	Fee-for-Service	1922399906	1922399906	1	1	KIM, PETER MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142457	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
6427	Fee-for-Service	1841502176	1841502176	1	1	KEREM, YANIV MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135950	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
6444	Fee-for-Service	1528261021	1528261021	1	1	KAWECKI, KATHRYN L LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
6551	Fee-for-Service	1740443282	1740443282	1	1	KASI, SANKARI E MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115087	08	Family Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
6557	Fee-for-Service	1154943181	1154943181	1	1	KANG, ELLICE DO	6/14/2024	207L00000X	NA	Other	026	PHYSICIANS	20029	05	Anesthesiology	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
6567	Fee-for-Service	1467698720	1467698720	1	1	KAHANA, DORON D MD	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91621	None	None	0	In state provider	None	21840 SOUTH NORMANDIE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
6572	Fee-for-Service	1053555003	1053555003	1	1	KIM, GRACE N MD	4/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115335	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
6575	Fee-for-Service	1184631996	1184631996	1	1	KLITZNER, THOMAS S MD	10/30/1992	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40826	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 22	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
6616	Fee-for-Service	1730566134	1730566134	1	1	KOSKEY, JESSE MD	11/24/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159618	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
6643	Fee-for-Service	1861837346	1861837346	1	1	KAISER FOUNDATION HEALTH	3/10/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	3851 SHAW RIDGE RD	FLOOR 1	SAN DIEGO	CA	92130	2807	37	06073	32.93516088	-117.2297377	San Diego County
6651	Fee-for-Service	1477907293	1477907293	1	1	KHOO, BRYANT MD	8/20/2018	207P00000X	NA	Other	026	PHYSICIANS	151080	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
6665	Fee-for-Service	1144516345	1144516345	1	1	KARNO, CATHERINE K MD	8/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
6694	Fee-for-Service	1578597332	1578597332	1	1	KHANDAKER, NURUN N MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51415	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
6756	Fee-for-Service	1306828033	1306828033	1	1	KONIA, THOMAS H MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69381	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
6766	Fee-for-Service	1467481192	1467481192	1	1	KRISHNAM, MAYIL S MD	11/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	10081	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
6782	Fee-for-Service	1740367093	1740367093	1	1	KURTZ, MICHELLE S	5/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
6795	Fee-for-Service	1104899160	1104899160	1	1	KOZAL, MICHAEL J MD	11/14/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	71875	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
6830	Fee-for-Service	1851308860	1851308860	1	1	KARAM, AMER K MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87777	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90096	6975	19	06037	34.06527974	-118.4462792	Los Angeles County
6843	Fee-for-Service	1801943675	1801943675	1	1	KIMBALL, SARAH E MD	4/29/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	141338	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
6913	Fee-for-Service	1073691564	1073691564	1	1	KHAIRA, HERKANWAL S MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95113	34	Urology and Urological Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
6939	Fee-for-Service	1043374648	1043374648	1	1	KUBAC, GEORGE MD	2/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	2200 BRYANT WILLIAMS DR	FL 3	KLAMATH FALLS	OR	97601	1121	00	None	42.25198664	-121.7841082	Klamath County
6978	Fee-for-Service	1982752721	1982752721	1	1	KAISER FOUNDATION HEALTH PLA	1/27/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMAN PHAR#587	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
6981	Fee-for-Service	1578597332	1578597332	1	1	KHANDAKER, NURUN N MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51415	08	Family Practice	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
6992	Fee-for-Service	1679546808	1679546808	1	1	KIM, MAY PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1643 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
6998	Fee-for-Service	1316430788	1316430788	1	1	KHEPERA HOUSE INC	11/27/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	125 W HARRISON AVE	None	VENTURA	CA	93001	1886	56	06111	34.28646833	-119.301324	Ventura County
7013	Fee-for-Service	1093123986	1093123986	1	1	KAMARZARIAN, EVLINE LMFT	2/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15545 DEVONSHIRE STREET	SUITE 208	MISSION HILLS	CA	91345	2655	19	06037	34.25734153	-118.4710734	Los Angeles County
7020	Fee-for-Service	1093925786	1093925786	1	1	KHOSLA, ROHIT K MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104942	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
7029	Fee-for-Service	1043232291	1043232291	1	1	KRAUS, MARTIN J MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	36512	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
7079	Fee-for-Service	1740354851	1740354851	1	4	KAISER FOUNDATION	2/27/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
7081	Fee-for-Service	1104899160	1104899160	1	1	KOZAL, MICHAEL J MD	11/14/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	71875	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
7089	Fee-for-Service	1033121272	1033121272	1	1	KHARAZMI, MOHAMMAD S	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77981	None	None	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
7129	Fee-for-Service	1235407719	1235407719	1	1	KONG, GARY MD MPH INC	3/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51276	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3808 RIVERSIDE DRIVE	SUITE 406	BURBANK	CA	91505	4325	19	06037	34.15252315	-118.3412174	Los Angeles County
7151	Fee-for-Service	1912044256	1912044256	1	1	KAUR, SHANINDER MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41188	41	Internal Medicine	0	In state provider	None	165 ROWLAND WAY	STE 301	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
7186	Fee-for-Service	1902240203	1902240203	1	1	KOLSTAD, KATHLEEN D MD	8/4/2020	207RR0500X	NA	Other	026	PHYSICIANS	133255	83	Rheumatology	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
7201	Fee-for-Service	1073660395	1073660395	1	1	KAISER FND HLTH PLN INC	3/15/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #513	12815 HEACOCK ST	FL 2	MORENO VALLEY	CA	92553	2836	33	06065	33.934842	-117.2438195	Riverside County
7225	Fee-for-Service	1568472165	1568472165	1	1	KELLY-DANSSAERT, JOANNE PT	3/8/2011	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	530 LOMAS SANTA FE	STE G	SOLANA BEACH	CA	92075	1346	37	06073	32.99511173	-117.2659419	San Diego County
7254	Fee-for-Service	1770557779	1770557779	1	1	KROKHALEVA, YULIYA MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55944	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
7261	Fee-for-Service	1508815242	1508815242	1	1	KWAN, SCOTT W PT	3/6/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1300 E MAIN ST	STE. 210	ALHAMBRA	CA	91801	4150	19	06037	34.10150419	-118.1134548	Los Angeles County
7265	Fee-for-Service	1447204474	1447204474	1	1	KALIMADA, PONNAPPA MD	5/24/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	33463	05	Anesthesiology	0	In state provider	None	23201 LAKE CENTER DR	STE 214	LAKE FOREST	CA	92630	6808	30	06059	33.6255281	-117.7160257	Orange County
7271	Fee-for-Service	1184657637	1184657637	1	1	KIBLER, GEORGE K MD	12/5/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37172	01	General Practice	0	In state provider	None	686 W LINE ST	None	BISHOP	CA	93514	3315	14	06027	37.36133867	-118.4014701	Inyo County
7332	Fee-for-Service	1033504642	1033504642	1	1	KUMAR, NITIN MD	9/10/2021	207L00000X	NA	Other	026	PHYSICIANS	160293	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
7335	Fee-for-Service	1548477631	1548477631	1	1	KWON, MICHAEL S MD	3/1/2025	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
7339	Fee-for-Service	1255577961	1255577961	1	1	KORABATHINA, LAVANYA MD	6/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119290	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
7354	Fee-for-Service	1952515322	1952515322	1	1	KIM, LIZA S MD	5/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116202	24	Plastic Surgery	0	In state provider	None	3000 Q ST	5TH FLR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
7358	Fee-for-Service	1548275324	1548275324	1	2	KOMOTO PHARMACY, INC	6/21/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1017 ELLINGTON ST.	None	DELANO	CA	93215	2621	15	06029	35.76891908	-119.2515219	Kern County
7367	Fee-for-Service	1366787764	1366787764	1	1	KRAETZ, FRANK A PSYD	10/24/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
7368	Fee-for-Service	1124107883	1124107883	1	1	KIM, JOHN Y MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83968	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
7384	Fee-for-Service	1861449373	1861449373	1	1	KONECNY, JIRI A DO	11/29/2005	208G00000X	NA	General Surgery	026	PHYSICIANS	7020	33	Thoracic Surgery	0	In state provider	None	1045 ATLANTIC AVE	STE 511	LONG BEACH	CA	90813	3408	19	06037	33.780267	-118.1850795	Los Angeles County
7409	Fee-for-Service	1962922393	1962922393	1	1	KHALIFE, SHIREEN Z DO	6/12/2020	207R00000X	NA	Other	026	PHYSICIANS	17040	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1901	30	06059	33.77450141	-117.9123364	Orange County
7413	Fee-for-Service	1417111766	1417111766	1	1	KHAN, NAVEED A MD	5/1/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	159086	41	Internal Medicine	0	In state provider	None	1250 S SUNSET AVE	STE 303	WEST COVINA	CA	91790	3912	19	06037	34.0610671	-117.9463685	Los Angeles County
7418	Fee-for-Service	1235407719	1235407719	1	1	KONG, GARY MD MPH INC	3/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51276	41	Internal Medicine	0	In state provider	None	3808 RIVERSIDE DRIVE	SUITE 406	BURBANK	CA	91505	4325	19	06037	34.15252315	-118.3412174	Los Angeles County
7429	Fee-for-Service	1477601425	1477601425	1	1	KAUR, HARWINDER MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34785	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
7433	Fee-for-Service	1437206752	1437206752	1	1	KAISER PERMANENTE	10/15/1997	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #240	1630 E MAIN ST	None	EL CAJON	CA	92021	5204	37	06073	32.80766827	-116.9222044	San Diego County
7441	Fee-for-Service	1154365088	1154365088	1	1	KARLON, WILLIAM J MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87881	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
7466	Fee-for-Service	1487633764	1487633764	1	1	KHAIRA, AJIT S MD	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	46411	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3120 TULARE ST	STE 102	FRESNO	CA	93721	1443	10	06019	36.74193828	-119.7786169	Fresno County
7469	Fee-for-Service	1154143824	1154143824	1	1	KERN BRIDGES YOUTH HOMES, IN	1/27/2025	261QM0801X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	C.	1321 STINE RD	None	BAKERSFIELD	CA	93309	4176	15	06029	35.34206978	-119.049523	Kern County
7474	Fee-for-Service	1871551887	1871551887	1	1	KATYAL, ALOK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MIDWEST CARDIOVASCULAR	12255 DE PAUL DRIVE	SUITE 205	BRIDGETON	MO	63044	0000	00	None	38.7521045	-90.43168907	St. Louis County
7476	Fee-for-Service	1437187994	1437187994	1	1	KARAN, PANKAJ K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54018	41	Internal Medicine	0	In state provider	GREATER VALLEY PHYSICIAN	2219 S HACIENDA BLVD	STE 101	HACIENDA HEIGHTS	CA	91745	4610	19	06037	33.99411596	-117.9688231	Los Angeles County
7495	Fee-for-Service	1659524304	1659524304	1	1	KIM, PAUL MD	10/18/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112241	08	Family Practice	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
7510	Fee-for-Service	1659456515	1659456515	1	1	KING AMERICAN AMB CO	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2570 BUSH ST	None	SAN FRANCISCO	CA	94115	3082	38	06075	37.78628938	-122.4395044	San Francisco County
7533	Fee-for-Service	1245248681	1245248681	1	1	KOKHAB, MORRIS MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75850	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365,420,120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
7539	Fee-for-Service	1770557779	1770557779	1	1	KROKHALEVA, YULIYA MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55944	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
7540	Fee-for-Service	1538605142	1538605142	1	1	KIM, MICHELLE LPCC	12/1/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
7602	Fee-for-Service	1265451777	1265451777	1	1	KLASHMAN, DAVID J MD	11/1/1994	207RR0500X	NA	Other	026	PHYSICIANS	56545	83	Rheumatology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	1300	19	06037	34.06527974	-118.4462792	Los Angeles County
7605	Fee-for-Service	1245760818	1245760818	1	1	KOLKOWITZ, ILAN D MD	6/29/2021	207P00000X	NA	Other	026	PHYSICIANS	172780	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
7618	Fee-for-Service	1851355853	1851355853	1	1	KO, ANDREW H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65880	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
7633	Fee-for-Service	1427017185	1427017185	1	1	KUNG, SHIANGCHENG MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143042	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
7655	Fee-for-Service	1912946674	1912946674	1	1	KNUDSON, MARY M MD	7/31/1983	207LC0200X	NA	Other	026	PHYSICIANS	47446	01	General Practice	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
7664	Fee-for-Service	1992112171	1992112171	1	1	KAGAN, MATTHEW D MD	11/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140695	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
7732	Fee-for-Service	1154365088	1154365088	1	1	KARLON, WILLIAM J MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87881	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
7739	Fee-for-Service	1245734623	1245734623	1	1	KHALIFA, HADY M MD	10/1/2021	207P00000X	NA	Other	026	PHYSICIANS	164566	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
7755	Fee-for-Service	1487633764	1487633764	1	1	KHAIRA, AJIT S MD	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	46411	41	Internal Medicine	0	In state provider	None	3120 TULARE ST	STE 102	FRESNO	CA	93721	1443	10	06019	36.74193828	-119.7786169	Fresno County
7762	Fee-for-Service	1437187994	1437187994	1	1	KARAN, PANKAJ K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54018	08	Family Practice	0	In state provider	GREATER VALLEY PHYSICIAN	2219 S HACIENDA BLVD	STE 101	HACIENDA HEIGHTS	CA	91745	4610	19	06037	33.99411596	-117.9688231	Los Angeles County
7765	Fee-for-Service	1922441443	1922441443	1	1	KOTAS, MAYA N MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135932	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN JOSE	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
7776	Fee-for-Service	1124483193	1124483193	1	1	KINNEY, ELIN Q PT	12/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1045 W REDONDO BEACH BLV	130	GARDENA	CA	90247	4129	19	06037	33.89247044	-118.2931941	Los Angeles County
7777	Fee-for-Service	1457605685	1457605685	1	1	KOUSAGAN, AMY E CNP	9/3/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
7881	Fee-for-Service	1629206552	1629206552	1	1	KARIMOTO, MAXINE A MD	9/24/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	136350	09	Gynecology (D.O. only)	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
7899	Fee-for-Service	1124747522	1124747522	1	1	KARLI OGUZ, HATICE KADER MD	2/15/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
7906	Fee-for-Service	1962441238	1962441238	1	1	KERAMATI, MICHAEL M DO	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8906	01	General Practice	0	In state provider	None	16550 VENTURA BLVD	STE 214	ENCINO	CA	91436	2055	19	06037	34.15778374	-118.4942662	Los Angeles County
7964	Fee-for-Service	1861495475	1861495475	1	1	KASHYAP, ASHWIN MD	10/6/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52406	41	Internal Medicine	0	In state provider	None	1240 S WESTLAKE BLVD	STE 117	WESTLAKE VILLAGE	CA	91361	1978	56	06111	34.14966879	-118.8378084	Ventura County
7965	Fee-for-Service	1578741369	1578741369	1	1	KOSHY, RUBY E MD	7/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105884	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
7972	Fee-for-Service	1427476381	1427476381	1	1	KIM, SUEJUNG G MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137692	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
7977	Fee-for-Service	1023625035	1023625035	1	1	K AND S HOSPICE INC	2/24/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4100 ALAMEDA AVE	3RD FLOOR	BURBANK	CA	91505	4194	19	06037	34.1526111	-118.3447742	Los Angeles County
7979	Fee-for-Service	1730237546	1730237546	1	1	KAISER FDN HEALTH PLAN	12/12/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHAR #613	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
8063	Fee-for-Service	1255353900	1255353900	1	1	KHANNA, MONICA M MD	1/1/1993	2085R0001X	NA	Other	026	PHYSICIANS	70929	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
8110	Fee-for-Service	1083230361	1083230361	1	1	KHAN, RABEEA DPM	6/3/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
8170	Fee-for-Service	1629206552	1629206552	1	1	KARIMOTO, MAXINE A MD	9/24/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	136350	15	Obstetrics (D.O. only)	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
8211	Fee-for-Service	1487825972	1487825972	1	1	KAVOOSSI, BENJAMIN J MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94166	05	Anesthesiology	0	In state provider	None	1798 NORTH GAREY AVENUE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
8212	Fee-for-Service	1659339752	1659339752	1	1	KESWANI, SANJIVINI C MD	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67294	40	Pediatrics	0	In state provider	None	320 DARDANELLI LN	STE 16	LOS GATOS	CA	95032	1419	43	06085	37.262079	-121.9673345	Santa Clara County
8250	Fee-for-Service	1437485513	1437485513	1	1	KELVIN MAI, D.O., INC	1/21/2011	261QP2300X	NA	Other	026	PHYSICIANS	8944	41	Internal Medicine	0	In state provider	None	1002 N FAIRVIEW ST	None	SANTA ANA	CA	92703	1811	30	06059	33.75346151	-117.9023004	Orange County
8257	Fee-for-Service	1154090694	1154090694	1	1	KIM, DEBORA C NP	4/21/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
8266	Fee-for-Service	1023625035	1023625035	1	1	K AND S HOSPICE INC	2/24/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4100 ALAMEDA AVE	3RD FLOOR	BURBANK	CA	91505	4194	19	06037	34.1526111	-118.3447742	Los Angeles County
8269	Fee-for-Service	1194950196	1194950196	1	1	KANNAPPAN, AARTHY MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113855	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
8305	Fee-for-Service	1770889628	1770889628	1	1	KRAUEL, KRISTEN S LCSW	5/22/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23 MASONIC AVE	None	SAN FRANCISCO	CA	94118	3417	38	06075	37.7819416	-122.4478032	San Francisco County
8358	Fee-for-Service	1689644528	1689644528	1	1	KISHAN, SHYAM MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84740	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
8365	Fee-for-Service	1871938191	1871938191	1	1	KHAN, FAHAD MD	6/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141996	None	None	0	In state provider	None	1880 N ORANGE GROVE AVE	None	POMONA	CA	91767	3028	19	06037	34.07803211	-117.74833	Los Angeles County
8368	Fee-for-Service	1154301646	1154301646	1	1	KYLE, MARK C MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71167	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
8411	Fee-for-Service	1619080942	1619080942	2	1	KPAP INC	5/25/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8881 FLETCHER PKWY	103	LA MESA	CA	91942	3134	37	06073	32.78442148	-117.0073814	San Diego County
8415	Fee-for-Service	1184608259	1184608259	1	1	KIM, DAVID S MD	3/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53881	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
8437	Fee-for-Service	1780956136	1780956136	1	1	KING, AMANDA L LMFT	8/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
8442	Fee-for-Service	1972657641	1972657641	1	1	KAUFMAN, SANDRA R LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
8451	Fee-for-Service	1881985794	1881985794	1	1	KANTOR, LISA D LMFT	5/30/2023	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
8497	Fee-for-Service	1710902523	1710902523	1	1	KETABGIAN, ANI A MD	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55268	41	Internal Medicine	0	In state provider	None	301 W HUNTINGTON DR	None	ARCADIA	CA	91007	3462	19	06037	34.13481053	-118.0425638	Los Angeles County
8506	Fee-for-Service	1467426320	1467426320	1	1	KADIYALA, MADHURI MD	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55694	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
8511	Fee-for-Service	1164719506	1164719506	1	1	KEI KIKUHARA M.D.	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
8548	Fee-for-Service	1437481769	1437481769	1	1	KATRINA SCHMELL NP	11/17/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
8585	Fee-for-Service	1780653832	1780653832	1	1	KING, APRIL C CRNA	7/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
8599	Fee-for-Service	1366704660	1366704660	1	1	KING, CAROLINE A MD	3/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125271	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
8631	Fee-for-Service	1356349260	1356349260	1	1	KANG, HO MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46410	25	Physical Medicine and Rehabilitation	0	In state provider	None	816 W YOSEMITE AVE	STE 102	MADERA	CA	93637	4587	20	06039	36.9560274	-120.0681086	Madera County
8636	Fee-for-Service	1730143082	1730143082	1	1	KIPPS, ALAINA K MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88136	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
8649	Fee-for-Service	1265518443	1265518443	1	1	KHAJAVI, KIARASH MD	12/21/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	76316	20	Orthopedic Surgery	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
8675	Fee-for-Service	1508317520	1508317520	1	1	KAISER, MEGAN R	5/23/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
8684	Fee-for-Service	1518038215	1518038215	1	1	KOAM PHARMACY INC	8/1/1998	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18102 PIONEER BLVD	STE 101	ARTESIA	CA	90701	3953	19	06037	33.86654413	-118.0821405	Los Angeles County
8691	Fee-for-Service	1144849407	1144849407	1	1	KOTRAN, SAMUEL N DO	6/22/2023	207P00000X	NA	Other	026	PHYSICIANS	19742	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
8764	Fee-for-Service	1972810547	1972810547	1	1	KOSHIMUNE, DIANE M DPM	4/17/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
8794	Fee-for-Service	1467426320	1467426320	1	1	KADIYALA, MADHURI MD	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55694	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
8827	Fee-for-Service	1932255668	1932255668	1	1	KIMBALL, AMY MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87696	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
8837	Fee-for-Service	1023016110	1023016110	1	1	KLAUDT, MONTE R MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
8869	Fee-for-Service	1477638138	1477638138	1	1	KRUGER, KAREN J MD	10/9/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69978	40	Pediatrics	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
8878	Fee-for-Service	1477180891	1477180891	1	1	KLEPPER, KRISTIN T MA OTR	10/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177393	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
8887	Fee-for-Service	1154685360	1154685360	1	1	KAO, ANDREW A MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137160	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
8892	Fee-for-Service	1467744284	1467744284	1	1	KRAUSHAAR, DIANA Z MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129677	01	General Practice	0	In state provider	None	45 NIELSON STREET	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7925859	Santa Cruz County
8920	Fee-for-Service	1992894034	1992894034	1	1	KAYE, VLADIMIR MD	11/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	64244	25	Physical Medicine and Rehabilitation	0	In state provider	None	941 S ATLANTIC BLVD	SUITE 101	MONTEREY PARK	CA	91754	4722	19	06037	34.04918291	-118.1391218	Los Angeles County
8924	Fee-for-Service	1417554528	1417554528	1	6	KECK MEDICAL CENTER OF USC	8/4/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	5832 BEACH BLVD	SUITE 101	BUENA PARK	CA	90621	2022	30	06059	33.875469	-117.9981525	Orange County
8925	Fee-for-Service	1174087175	1174087175	1	1	KELTY, KATHERINE R RCP	2/5/2019	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
8943	Fee-for-Service	1124133137	1124133137	1	1	KIM, DAVID C MD	4/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81747	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
9018	Fee-for-Service	1912165549	1912165549	1	1	KAYALI, MOHAMMED MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115527	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MISSION BLVD	None	JACKSON	CA	95624	2564	03	06005	38.35007723	-120.7659932	Amador County
9040	Fee-for-Service	1982199162	1982199162	1	1	KHOKHAR, FARHAN Z MD	8/5/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174254	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
9046	Fee-for-Service	1790048734	1790048734	1	1	KAISEY, MARWA MD	8/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130961	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
9086	Fee-for-Service	1598357592	1598357592	1	1	KARTOUNIAN, MEGRI LMFT	7/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
9104	Fee-for-Service	1760530786	1760530786	1	1	KIM, THOMAS D MD	8/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90400	41	Internal Medicine	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
9114	Fee-for-Service	1932255668	1932255668	1	1	KIMBALL, AMY MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87696	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
9119	Fee-for-Service	1528403391	1528403391	1	1	KAUR, GURNEET MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123285	08	Family Practice	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
9124	Fee-for-Service	1235271396	1235271396	1	1	KUMWENDA, ZINDABA L MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72465	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
9137	Fee-for-Service	1356756118	1356756118	1	1	KOHAR SHU YUAN, AUDREY S	8/3/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14779	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
9143	Fee-for-Service	1245318971	1245318971	1	1	KELLY, MICHAEL F MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	54680	41	Internal Medicine	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
9146	Fee-for-Service	1437354263	1437354263	1	1	KIM, TODD S MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75099	20	Orthopedic Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
9147	Fee-for-Service	1073500294	1073500294	1	1	KNOPKE, CARL G MD III	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82718	41	Internal Medicine	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
9171	Fee-for-Service	1700406311	1700406311	1	1	KIM, PAUL M DPM	8/1/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	110 NEW STINE RD	None	BAKERSFIELD	CA	93309	2605	15	06029	35.35333762	-119.0610348	Kern County
9172	Fee-for-Service	1346265881	1346265881	1	1	KATZ, GUY E MD	10/5/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	160110	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
9186	Fee-for-Service	1700066032	1700066032	1	1	KIM, MONICA S MFT	11/4/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	641 HIGUERA ST	SUITE 202	SAN LUIS OBISPO	CA	93401	0508	40	06079	35.27821723	-120.6655382	San Luis Obispo County
9197	Fee-for-Service	1457422289	1457422289	1	1	KAMALNATH, PRAKASH J MD	9/30/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	46409	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
9211	Fee-for-Service	1609368935	1609368935	1	1	KHODAKIVSKYI, SERGII MD	10/15/2021	207R00000X	NA	Other	026	PHYSICIANS	174583	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
9242	Fee-for-Service	1326019043	1326019043	1	1	KHALID, TANIA MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 N DURANGO DR	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
9271	Fee-for-Service	1134457161	1134457161	1	1	KIDANE, TEWODROS A MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110208	08	Family Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
9280	Fee-for-Service	1619004058	1619004058	1	1	KRATZ, JOHANNES U R MD	6/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	104347	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
9290	Fee-for-Service	1134163165	1134163165	1	1	KINCAID, PATRICIA K MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76053	30	Radiology	0	In state provider	None	1100 N TUSTIN AVE	None	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
9317	Fee-for-Service	1265797518	1265797518	1	1	KHAN, RABIA S MD	7/13/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	187485	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
9327	Fee-for-Service	1811170400	1811170400	1	1	KAMAL, MOHAMMAD A MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71874	22	Pathology (M.D. only)	0	In state provider	None	1356 VIA DEL REY	None	SOUTH PASADENA	CA	91030	3631	19	06037	34.10774005	-118.1612776	Los Angeles County
9398	Fee-for-Service	1851732614	1851732614	1	1	KLEKMAN, JACLYN R MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132381	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
9414	Fee-for-Service	1235271396	1235271396	1	1	KUMWENDA, ZINDABA L MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72465	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
9461	Fee-for-Service	1629116058	1629116058	1	1	KASTO, ASHRAF S DO	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8452	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
9475	Fee-for-Service	1356987580	1356987580	1	1	KIM, ALEX OT	3/24/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 SOLAR DR	STE 150	OXNARD	CA	93036	0680	56	06111	34.22025454	-119.1449192	Ventura County
9557	Fee-for-Service	1548695547	1548695547	1	1	KAHLON, RAVINDER S MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	125871	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27830 BRADLEY RD	None	SUN CITY	CA	92586	2201	33	06065	33.71615891	-117.1906431	Riverside County
9558	Fee-for-Service	1861428930	1861428930	1	1	KERBAVAZ, RICHARD J MD	11/30/1985	208600000X	NA	General Surgery	026	PHYSICIANS	43225	04	Otology, Laryngology, Rhinology	0	In state provider	None	2316 DWIGHT WAY	None	BERKELEY	CA	94704	2212	01	06001	37.86460853	-122.2621987	Alameda County
9583	Fee-for-Service	1679805089	1679805089	1	1	KAPATKAR, TRUPTI S MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109815	08	Family Practice	0	In state provider	None	306 SPRUCE AVE	None	S SAN FRANCISCO	CA	94080	2741	41	06081	37.65669155	-122.4159146	San Mateo County
9604	Fee-for-Service	1588735526	1588735526	1	1	KLIGER, DAVID M MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62165	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
9633	Fee-for-Service	1972650208	1972650208	1	1	KAISER FOUNDATION HEALTH	7/3/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENT PHARM	75036 GERALD FORD DR	None	PALM DESERT	CA	92211	2080	33	06065	33.78158473	-116.353994	Riverside County
9679	Fee-for-Service	1477580017	1477580017	1	1	KANG, SANGKU MD	7/1/2001	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61860	30	Radiology	0	In state provider	None	9320 BASELINE RD	STE C	RANCHO CUCAMONGA	CA	91701	5829	36	06071	34.12156453	-117.6018255	San Bernardino County
9714	Fee-for-Service	1831661578	1831661578	1	2	KOELEWYN, KRISTOPHER E DPM	7/20/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
9719	Fee-for-Service	1932218781	1932218781	1	1	KADEMIAN, MAKROUHI A MD	5/9/2023	208600000X	NA	General Surgery	026	PHYSICIANS	70037	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
9732	Fee-for-Service	1831426774	1831426774	1	1	KARIM, SHAHNAWAZ MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151108	13	Neurology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
9734	Fee-for-Service	1295391738	1295391738	1	1	KIMURA, TOMOKI	5/17/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177160	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
9760	Fee-for-Service	1477695393	1477695393	1	1	KIM, YUNG-TAE MD	5/1/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34417	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3010 W ORANGE AVE	STE 108	ANAHEIM	CA	92804	3170	30	06059	33.82472315	-117.994133	Orange County
9779	Fee-for-Service	1386084333	1386084333	1	1	KIM, JIEUN NP	7/25/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
9785	Fee-for-Service	1134121049	1134121049	2	1	KAMRA, DHEERAJ MD	3/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89808	41	Internal Medicine	0	In state provider	None	1600 CREEKSIDE DR	SUITE 1300	FOLSOM	CA	95630	3445	34	06067	38.669994	-121.147488	Sacramento County
9817	Fee-for-Service	1629759857	1629759857	1	1	KHONG, MARIO CRNA	10/5/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
9834	Fee-for-Service	1134117435	1134117435	1	1	KNEPFER, ARNOLD L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	5489	36	Psychiatry	0	In state provider	None	21 TAMAL VISTA BLVD	STE 212	CORTE MADERA	CA	94925	1127	21	06041	37.93173997	-122.5179353	Marin County
9855	Fee-for-Service	1235504572	1235504572	1	1	KELLY, TIMOTHY MD	11/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
9861	Fee-for-Service	1538237433	1538237433	1	1	KREBS BROWN, ALISON H LMFT	10/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
9891	Fee-for-Service	1588735526	1588735526	1	1	KLIGER, DAVID M MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62165	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
9899	Fee-for-Service	1659712420	1659712420	1	1	KUNADHARAJU, RAJESH MD	5/24/2023	207RC0200X	NA	Other	026	PHYSICIANS	176071	None	None	0	In state provider	None	1801 EAST MARCH LN	STE C300	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
9951	Fee-for-Service	1144541624	1144541624	1	1	KILE, JEFFREY A MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126950	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
9969	Fee-for-Service	1912154246	1912154246	1	1	KEARNS, ANTHONY W DC	4/11/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9974	Fee-for-Service	1316067457	1316067457	1	1	KUPFERWASSER, LEON I MD	5/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83900	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90017	3907	19	06037	34.05270508	-118.2641005	Los Angeles County
9986	Fee-for-Service	1275977407	1275977407	1	1	KIM, JAMES H MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134852	05	Anesthesiology	0	In state provider	None	1328 22ND STREET	None	SANTA MONICA	CA	90024	5316	19	06037	34.03122319	-118.4797185	Los Angeles County
10001	Fee-for-Service	1063760858	1063760858	1	1	KOHANOF, SAMAN DO	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14619	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
10004	Fee-for-Service	1609099969	1609099969	1	1	KOIRALA, KANCHAN MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128481	41	Internal Medicine	0	In state provider	None	180 NORTHPOINT DR	None	REDDING	CA	96003	2510	45	06089	40.6130167	-122.377436	Shasta County
10012	Fee-for-Service	1891997631	1891997631	1	1	KARCHES, KELLI CHRISTINE MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80931	41	Internal Medicine	0	In state provider	None	4020 FIFTH AVENUE	MER 14	SAN DIEGO	CA	92103	2106	37	06073	32.75032457	-117.1610686	San Diego County
10042	Fee-for-Service	1871274142	1871274142	1	1	KIM, MICHELLE CRNA	11/17/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
10074	Fee-for-Service	1619397296	1619397296	1	1	KIM, HYUNGJIN B DO	7/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14406	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
10114	Fee-for-Service	1760413710	1760413710	1	2	KINDLE, ELAINE LCSW	10/27/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	9096	-	NOT APPLICABLE	0	In state provider	None	1825 E THELBORN STREET	None	WEST COVINA	CA	91791	1442	19	06037	34.07731718	-117.9071155	Los Angeles County
10120	Fee-for-Service	1043489248	1043489248	1	1	KIM, JUSTIN T MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81099	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
10140	Fee-for-Service	1124078282	1124078282	2	1	KIM, HAN MD	5/5/2024	208600000X	NA	General Surgery	026	PHYSICIANS	92762	02	General Surgery	0	In state provider	None	316 STRATFORD AVE	STE B	SANTA MARIA	CA	93454	5908	42	06083	34.95019447	-120.4147816	Santa Barbara County
10185	Fee-for-Service	1255411518	1255411518	1	1	KALE, ARUNDHATI S MD	5/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148383	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
10250	Fee-for-Service	1275875668	1275875668	1	1	KATAN, OGNJEN MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153761	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
10275	Fee-for-Service	1306949672	1306949672	1	1	KEANEY, ROBERT M DO	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5333	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
10290	Fee-for-Service	1477186583	1477186583	1	1	KIM, NOEMI NP	6/18/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
10301	Fee-for-Service	1891997631	1891997631	1	1	KARCHES, KELLI CHRISTINE MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80931	67	Endocrinology	0	In state provider	None	4020 FIFTH AVENUE	MER 14	SAN DIEGO	CA	92103	2106	37	06073	32.75032457	-117.1610686	San Diego County
10310	Fee-for-Service	1215491857	1215491857	1	1	KE, XUAN NP	10/15/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15610 OUTER BEAR VALLEY	None	VICTORVILLE	CA	92395	8822	36	06071	34.470875	-117.3231568	San Bernardino County
10332	Fee-for-Service	1871571992	1871571992	1	1	KISPERT,DAVID B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 JACKSON STREET	None	ST PAUL	MN	55101	2502	00	None	44.95496967	-93.09587426	Ramsey County
10356	Fee-for-Service	1235163866	1235163866	1	1	KATTA, PRASAD V MD	8/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79208	41	Internal Medicine	0	In state provider	None	2557 MOWRY AVE	STE 12	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
10378	Fee-for-Service	1154785731	1154785731	1	1	KHRLOBYAN, MANYA DO	7/6/2020	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	16437	13	Neurology (M.D. only)	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
10384	Fee-for-Service	1003857020	1003857020	1	1	KWONG, EUGENE L MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65879	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
10389	Fee-for-Service	1538190855	1538190855	1	1	KORN, RONALD D LMFT	7/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15643 SHERMAN WAY	SUITE 430	VAN NUYS	CA	91406	4185	19	06037	34.20128049	-118.474155	Los Angeles County
10408	Fee-for-Service	1568403194	1568403194	1	1	KHAN, ALAM MD	5/31/1995	207L00000X	NA	Other	026	PHYSICIANS	79534	05	Anesthesiology	0	In state provider	None	726 FOURTH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
10409	Fee-for-Service	1164770798	1164770798	1	1	KAO, AMY Y OD	4/22/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
10413	Fee-for-Service	1346363405	1346363405	1	1	KHERADPEZHOUH, MOHSEN MD	4/2/2008	207R00000X	NA	Other	026	PHYSICIANS	99424	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
10471	Fee-for-Service	1255411518	1255411518	1	1	KALE, ARUNDHATI S MD	5/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148383	45	Nephrology (Renal-Kidney)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
10498	Fee-for-Service	1265616684	1265616684	1	1	KIM, JEROME G MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106308	78	Neoplastic Diseases/Oncology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
10520	Fee-for-Service	1063505030	1063505030	1	1	KENNETH WILLIAM GOW, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
10538	Fee-for-Service	1275875668	1275875668	1	1	KATAN, OGNJEN MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153761	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
10550	Fee-for-Service	1992014153	1992014153	1	1	KINNE, ALLISON LMFT	1/7/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	DAVIS HEALING SOLUTIONS	231 W MAIN STREET	SUITE 206	QUINCY	CA	95971	9373	32	06063	39.93669773	-120.9432538	Plumas County
10556	Fee-for-Service	1861569436	1861569436	1	1	KUO, SU YONG MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	32308	08	Family Practice	0	In state provider	None	11100 WARNER AVE	STE 154	FOUNTAIN VALLEY	CA	92708	7510	30	06059	33.716291	-117.9355051	Orange County
10562	Fee-for-Service	1003190133	1003190133	1	1	KARY, KRISHNA G PHD	10/3/2022	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
10569	Fee-for-Service	1831319383	1831319383	1	1	KELLER, RICHARD MD	12/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111086	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK DR	STE 300	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
10572	Fee-for-Service	1700113248	1700113248	1	2	KASTAN, ERIC LMFT	5/28/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47461	-	NOT APPLICABLE	0	In state provider	None	8929 WILSHIRE BLVD STE 2	None	BEVERLY HILLS	CA	90211	1951	19	06037	34.06709669	-118.386182	Los Angeles County
10601	Fee-for-Service	1306235486	1306235486	1	1	KUKESH, JESSICA W	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
10624	Fee-for-Service	1003264011	1003264011	1	1	KHINE, PWINT P DO	6/25/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18632	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
10628	Fee-for-Service	1548453830	1548453830	1	1	KAUSHAL, MANIKA V MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97286	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
10641	Fee-for-Service	1235163866	1235163866	1	1	KATTA, PRASAD V MD	8/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79208	67	Endocrinology	0	In state provider	None	2557 MOWRY AVE	STE 12	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
10667	Fee-for-Service	1427351311	1427351311	1	1	KEFFELER PHARMACEUTICAL INC	5/5/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 HOSPITAL DR	SUITE 111	UKIAH	CA	95482	4533	23	06045	39.15349918	-123.2039443	Mendocino County
10677	Fee-for-Service	1356705230	1356705230	1	1	KIM-ORDEN, NATALIE A MD	8/6/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	141427	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
10682	Fee-for-Service	1609834316	1609834316	1	1	KALAMAS, ALICIA G MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74896	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
10685	Fee-for-Service	1467548073	1467548073	1	1	KOBASHIGAWA, JON A MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45447	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
10689	Fee-for-Service	1972681625	1972681625	1	1	KOCZAT, DIANNE L DO	10/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8456	26	Psychiatry (child)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
10732	Fee-for-Service	1184934051	1184934051	1	1	KIM, MINSOOK	3/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 170-16	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
10766	Fee-for-Service	1801936802	1801936802	1	1	KENNY, KATHLEEN A MD	5/1/1999	207R00000X	NA	Other	026	PHYSICIANS	64545	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
10793	Fee-for-Service	1194319814	1194319814	1	1	KUKREJA, HIMANI OT	12/14/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
10798	Fee-for-Service	1053493759	1053493759	1	1	KAZARIAN, NICK CARL OD	9/1/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5786 S ELM AVE	None	FRESNO	CA	93706	5813	10	06019	36.65125916	-119.7907476	Fresno County
10842	Fee-for-Service	1861569436	1861569436	1	1	KUO, SU YONG MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	32308	41	Internal Medicine	0	In state provider	None	11100 WARNER AVE	STE 154	FOUNTAIN VALLEY	CA	92708	7510	30	06059	33.716291	-117.9355051	Orange County
10861	Fee-for-Service	1629533666	1629533666	1	1	KIM, TAE K DC	10/28/2019	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	11441 HEACOCK ST	E	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
10890	Fee-for-Service	1831134162	1831134162	1	1	KLIJIAN, ARA S MD	9/18/2008	208G00000X	NA	General Surgery	026	PHYSICIANS	54227	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3131 BERGER AVE	STE 250	SAN DIEGO	CA	92123	4233	37	06073	32.8019999	-117.1515447	San Diego County
10927	Fee-for-Service	1669525739	1669525739	1	1	KAEHLER, MARK R MD	1/1/1989	207P00000X	NA	Other	026	PHYSICIANS	56629	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 CHERRY AVE	None	TULARE	CA	93274	0000	54	06107	36.220932	-119.337698	Tulare County
10928	Fee-for-Service	1629717467	1629717467	1	1	KALESKI, ALICIA LMFT	1/14/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	132779	-	NOT APPLICABLE	0	In state provider	None	28632 ROADSIDE DR	210	AGOURA HILLS	CA	91301	6091	19	06037	34.14375168	-118.7497422	Los Angeles County
10943	Fee-for-Service	1174283659	1174283659	1	1	KH HOME HEALTH SERVICES INC	1/2/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7590 N GLENOAKS BLVD	SUITE 106	BURBANK	CA	91504	1011	19	06037	34.20858506	-118.3436243	Los Angeles County
10957	Fee-for-Service	1528364536	1528364536	1	2	KULWANT SINGH MD INC	12/13/2024	2084P0800X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3035 EL CAMINO AVE	None	SACRAMENTO	CA	95821	6014	34	06067	38.610828	-121.3926255	Sacramento County
10960	Fee-for-Service	1174546006	1174546006	1	1	KERN FACULTY MED GROUP	1/31/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2201 MOUNT VERNON AVE	STE 211	BAKERSFIELD	CA	93306	3312	15	06029	35.38781796	-118.9673567	Kern County
10977	Fee-for-Service	1972681625	1972681625	1	1	KOCZAT, DIANNE L DO	10/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8456	36	Psychiatry	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
10991	Fee-for-Service	1225032881	1225032881	1	1	KNOX COUNTY HOSPITAL	8/6/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	520 S 7TH ST	None	VINCENNES	IN	47591	1038	00	None	38.67357264	-87.53284772	Knox County
11068	Fee-for-Service	1053981316	1053981316	1	1	KEAMY, ERICA S CNM	10/21/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
11082	Fee-for-Service	1730503442	1730503442	1	1	KINDCARE HOSPICE INC	2/20/2017	251E00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	226	ENCINO	CA	91436	2976	19	06037	34.15524484	-118.4756687	Los Angeles County
11132	Fee-for-Service	1447437165	1447437165	1	1	KUMAR, ASHA R MD INC	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	29494	40	Pediatrics	0	In state provider	None	820 W SERVICE AVE	None	WEST COVINA	CA	91790	3716	19	06037	34.06348712	-117.9309405	Los Angeles County
11153	Fee-for-Service	1558326975	1558326975	1	1	KASIMIAN, DENNIS MD	4/30/1992	207ZC0500X	NA	Other	026	PHYSICIANS	37511	20	Orthopedic Surgery	0	In state provider	TMI PATHOLOGY ASSOCIATES	15243 VANOWEN ST	STE 101	VAN NUYS	CA	91405	3636	19	06037	34.19394848	-118.4654115	Los Angeles County
11158	Fee-for-Service	1780991497	1780991497	1	1	KIM, PARSI S LMFT	3/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
11166	Fee-for-Service	1538689138	1538689138	1	1	KENNETH G KORVER, MD MEDICAL	2/14/2018	261QP2300X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	CORPORATION	575 HOSPITAL LN	None	SUSANVILLE	CA	96130	4808	18	06035	40.40760229	-120.6662006	Lassen County
11178	Fee-for-Service	1831134162	1831134162	1	1	KLIJIAN, ARA S MD	9/18/2008	208G00000X	NA	General Surgery	026	PHYSICIANS	54227	33	Thoracic Surgery	0	In state provider	None	3131 BERGER AVE	STE 250	SAN DIEGO	CA	92123	4233	37	06073	32.8019999	-117.1515447	San Diego County
11222	Fee-for-Service	1790164226	1790164226	1	1	KIWAN, WISSAM MD	7/1/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	172717	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
11229	Fee-for-Service	1326200478	1326200478	1	1	KOYLE, ROBERT E LMFT	11/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	431 S PALM CANYON DR	214	PALM SPRINGS	CA	92262	7300	33	06065	33.81701886	-116.5468141	Riverside County
11245	Fee-for-Service	1528364536	1528364536	1	2	KULWANT SINGH MD INC	12/13/2024	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3035 EL CAMINO AVE	None	SACRAMENTO	CA	95821	6014	34	06067	38.610828	-121.3926255	Sacramento County
11258	Fee-for-Service	1639148539	1639148539	1	1	KAREN H CHAO OD INC	9/12/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	121 S DEL MAR AVE	STE A	SAN GABRIEL	CA	91776	1345	19	06037	34.102161	-118.0997095	Los Angeles County
11281	Fee-for-Service	1225032881	1225032881	1	1	KNOX COUNTY HOSPITAL	8/6/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	520 S 7TH ST	None	VINCENNES	IN	47591	1038	00	None	38.67357264	-87.53284772	Knox County
11303	Fee-for-Service	1609954171	1609954171	1	1	KAMALI, POURANG MD	10/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90859	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	655 EUCLID AVE	STE 409	NATIONAL CITY	CA	91950	2981	37	06073	32.68353398	-117.082625	San Diego County
11369	Fee-for-Service	1730503442	1730503442	1	1	KINDCARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	226	ENCINO	CA	91436	2976	19	06037	34.15524484	-118.4756687	Los Angeles County
11370	Fee-for-Service	1194977249	1194977249	1	1	KETTERMAN, NICOLE S MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105499	40	Pediatrics	0	In state provider	None	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6285	43	06085	37.36812305	-122.0312314	Santa Clara County
11378	Fee-for-Service	1043279995	1043279995	1	1	KUAN, MING C MD	8/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76127	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
11385	Fee-for-Service	1518999325	1518999325	1	1	KATTAPURAM, AMY S MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84506	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VAN OWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
11453	Fee-for-Service	1972584753	1972584753	1	1	KYSER, JAMES P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEDIATRIC CARDIOLOGY CTR	501 N GRAHAM, #220	None	PORTLAND	OR	97227	0000	00	None	45.54285348	-122.671035	Multnomah County
11467	Fee-for-Service	1831134162	1831134162	1	1	KLIJIAN, ARA S MD	9/18/2008	208G00000X	NA	General Surgery	026	PHYSICIANS	54227	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3131 BERGER AVE	STE 250	SAN DIEGO	CA	92123	4233	37	06073	32.8019999	-117.1515447	San Diego County
11486	Fee-for-Service	1124083316	1124083316	1	1	KEELER,JARED MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	0000	00	None	39.08455286	-94.57578107	Jackson County
11494	Fee-for-Service	1679790034	1679790034	1	1	KNAPIK, THERSIA J MD	5/12/2022	2086S0127X	NA	General Surgery	026	PHYSICIANS	173811	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
11510	Fee-for-Service	1780028183	1780028183	2	1	KHALAFIAN, ANDREY K MD	11/18/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	146799	None	None	0	In state provider	M.D.	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
11520	Fee-for-Service	1750647863	1750647863	1	1	KOBRAEI, EDWARD M MD	3/26/2021	208200000X	NA	General Surgery	026	PHYSICIANS	154927	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
11525	Fee-for-Service	1497784862	1497784862	1	1	KRUEGER, RICHARD C MD	3/1/1999	174400000X	NA	Other	026	PHYSICIANS	85014	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
11542	Fee-for-Service	1598843658	1598843658	1	1	KOSHLAP, ROBERT E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36830	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
11555	Fee-for-Service	1487425807	1487425807	1	1	KABILING, CHESSA NP	9/25/2024	163WP0807X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
11571	Fee-for-Service	1356846109	1356846109	1	1	KNITTEL-HLIDDAL, SONJA MD	9/6/2023	207RC0200X	NA	Other	026	PHYSICIANS	184723	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
11582	Fee-for-Service	1326289463	1326289463	1	1	KERNEY, JENNIFER M NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
11604	Fee-for-Service	1154959583	1154959583	1	1	KHAN, AWAIZ A MD	6/22/2023	207P00000X	NA	Other	026	PHYSICIANS	184988	None	None	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
11621	Fee-for-Service	1871640193	1871640193	1	1	KAISER FOUNDATION HLTH	2/21/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHCY	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
11629	Fee-for-Service	1821281791	1821281791	1	1	KRIEG, SACHA A MD	5/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88748	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11660	Fee-for-Service	1952391112	1952391112	1	1	KREITENBERG, ARTHUR MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	51724	None	None	0	In state provider	None	434 S SAN VICENTE BLVD	None	LOS ANGELES	CA	90048	4108	19	06037	34.07053591	-118.375828	Los Angeles County
11670	Fee-for-Service	1518999325	1518999325	1	1	KATTAPURAM, AMY S MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84506	08	Family Practice	0	In state provider	None	15107 VAN OWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
11690	Fee-for-Service	1639471006	1639471006	1	1	KELIGIAN, BRIAN C LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
11717	Fee-for-Service	1477721355	1477721355	1	1	KATARIA, PURSHOTAM B MD	5/31/1988	261QM0850X	NA	Other	026	PHYSICIANS	43456	36	Psychiatry	0	In state provider	INC	112 WEST GRAND BLVD	None	CORONA	CA	92882	2006	33	06065	33.88122071	-117.5696654	Riverside County
11784	Fee-for-Service	1336588110	1336588110	1	1	KAYA HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	43805 15TH STREET WEST	None	LANCASTER	CA	93534	4756	19	06037	34.67792824	-118.1568032	Los Angeles County
11785	Fee-for-Service	1174673008	1174673008	1	1	KAPOOR, JERINA MD	7/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51788	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
11790	Fee-for-Service	1083903884	1083903884	1	1	KASHFIAN, SHARLINE MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124209	05	Anesthesiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
11804	Fee-for-Service	1265096788	1265096788	1	1	KIM, RICHARD D MD	4/14/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	183313	None	None	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
11879	Fee-for-Service	1033291562	1033291562	1	1	KIM, DANIEL J MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	91209	78	Neoplastic Diseases/Oncology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
11900	Fee-for-Service	1083732648	1083732648	1	1	KHAN, SHEHMA MD	4/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99004	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
11959	Fee-for-Service	1881828341	1881828341	1	1	KU, TSESUN MD	8/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107242	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
11984	Fee-for-Service	1750602884	1750602884	1	1	KIM, JANICE Y MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118067	08	Family Practice	0	In state provider	None	805 VETERANS BLVD	STE 201	REDWOOD CITY	CA	94063	1736	41	06081	37.49076853	-122.2291439	San Mateo County
12004	Fee-for-Service	1013531987	1013531987	1	1	KWAPNOSKI, ZACHARY J MD	6/2/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	181514	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
12028	Fee-for-Service	1144885948	1144885948	1	1	KORDBACHEH, PEJMAN MD	11/8/2022	208M00000X	NA	Other	026	PHYSICIANS	179825	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
12044	Fee-for-Service	1831118942	1831118942	1	1	KANCHANANAHIN, VEERAPARN	7/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93614	40	Pediatrics	0	In state provider	MD	7275 E SOUTHGATE DR	STE 306	SACRAMENTO	CA	95823	2631	34	06067	38.493576	-121.436559	Sacramento County
12072	Fee-for-Service	1336588110	1336588110	1	1	KAYA HOSPICE INC	6/10/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	43805 15TH STREET WEST	None	LANCASTER	CA	93534	4756	19	06037	34.67792824	-118.1568032	Los Angeles County
12075	Fee-for-Service	1417554528	1417554528	1	5	KECK MEDICAL CENTER OF USC	12/7/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	330 OLD NEWPORT BLVD	STE 100	NEWPORT BEACH	CA	92663	4121	30	06059	33.6250427	-117.9274101	Orange County
12077	Fee-for-Service	1154426849	1154426849	2	1	KILLEEN, TIMOTHY J MD	9/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55364	41	Internal Medicine	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
12089	Fee-for-Service	1578751632	1578751632	1	1	KANAPICKI, JENNIFER L MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107239	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
12112	Fee-for-Service	1669895942	1669895942	1	1	KAISER FOUNDATION HEALTH	8/13/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	2500 MERCED ST	FL 1	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
12115	Fee-for-Service	1386736007	1386736007	1	1	KERR, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
12129	Fee-for-Service	1447721972	1447721972	1	1	KARWANDE, SARINA PT	10/22/2019	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 170	POMONA	CA	91767	3030	19	06037	34.07791925	-117.746146	Los Angeles County
12153	Fee-for-Service	1477247435	1477247435	1	1	KDOC INC	8/24/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	None	2727 W OLYMPIC BLVD	SUITE 208	LOS ANGELES	CA	90006	2640	19	06037	34.0527015	-118.2931155	Los Angeles County
12167	Fee-for-Service	1033291562	1033291562	1	1	KIM, DANIEL J MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	91209	68	Hematology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
12178	Fee-for-Service	1174812531	1174812531	1	1	KANTH, POOJA M MD	8/27/2018	207R00000X	NA	Other	026	PHYSICIANS	156987	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
12186	Fee-for-Service	1720050032	1720050032	2	1	KHUDATYAN, HRACH MD	4/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	60871	08	Family Practice	0	In state provider	None	610 N CENTRAL AVENUE	SUITE 209	GLENDALE	CA	91203	1410	19	06037	34.15531106	-118.2579125	Los Angeles County
12264	Fee-for-Service	1740688894	1740688894	1	1	KAWEAH DELTA HEALTH CARE	10/8/2015	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-WILLOW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
12286	Fee-for-Service	1275263584	1275263584	1	1	KHALIL, VADY OD	7/6/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
12334	Fee-for-Service	1639532302	1639532302	1	1	KUTTAMPEROOR, FRANCIS	12/7/2022	207R00000X	NA	Other	026	PHYSICIANS	178103	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
12364	Fee-for-Service	1679612360	1679612360	1	1	KHAJA, ASAD U MD	2/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94996	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
12393	Fee-for-Service	1023309051	1023309051	1	1	KPADUWA, CHINWE S MD	8/4/2020	208200000X	NA	General Surgery	026	PHYSICIANS	143513	02	General Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
12439	Fee-for-Service	1457718520	1457718520	1	1	KHANNA, PRERNA M MD PC	6/6/2017	193400000X	NA	Other	026	PHYSICIANS	75180	41	Internal Medicine	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE 400	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
12464	Fee-for-Service	1932287745	1932287745	1	1	KENYON, ERIK L DPM	5/17/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
12476	Fee-for-Service	1467742700	1467742700	1	1	KONG, ROBERT L MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142100	05	Anesthesiology	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
12490	Fee-for-Service	1720577554	1720577554	1	1	KERN HOSPICE CARE INC	3/19/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2920 F STREET	STE I-10	BAKERSFIELD	CA	93301	1829	15	06029	35.385993	-119.0234435	Kern County
12494	Fee-for-Service	1386837607	1386837607	1	1	KITRAR, ELVIRA LMFT	4/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1801 BUSH ST.	300	SAN FRANCISCO	CA	94109	5239	38	06075	37.78777536	-122.427321	San Francisco County
12513	Fee-for-Service	1336159052	1336159052	1	2	KATZ, TOBY J MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67345	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
12535	Fee-for-Service	1376624148	1376624148	1	1	KAUFMAN, FRANCINE MD	7/1/1996	2080P0205X	NA	Endocrinology	026	PHYSICIANS	36616	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
12541	Fee-for-Service	1295231249	1295231249	1	1	KANG, MANDIP S MD	8/2/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	173539	None	None	0	In state provider	None	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
12546	Fee-for-Service	1134438922	1134438922	1	1	KLEIN, EMILY A MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128323	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
12550	Fee-for-Service	1740688894	1740688894	1	1	KAWEAH DELTA HEALTH CARE	5/26/2021	261QP2300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	-WILLOW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
12573	Fee-for-Service	1528094547	1528094547	1	1	KELL, WILLIAM P MD	6/21/1978	207P00000X	NA	Other	026	PHYSICIANS	24866	01	General Practice	0	In state provider	None	3455 PACIFIC BLVD	None	SAN MATEO	CA	94403	2836	41	06081	37.53612333	-122.2954324	San Mateo County
12592	Fee-for-Service	1053433979	1053433979	1	1	KEENAN, JEREMY D MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99498	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
12643	Fee-for-Service	1194055715	1194055715	1	1	KING, JOHN F	5/5/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12655	Fee-for-Service	1972741965	1972741965	1	1	KESAVAN, KALPASHRI MD	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128788	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	MDCC RM B2-325	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
12674	Fee-for-Service	1285829036	1285829036	1	1	KING, BENJAMIN L MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146703	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
12681	Fee-for-Service	1023309051	1023309051	1	1	KPADUWA, CHINWE S MD	8/4/2020	208200000X	NA	General Surgery	026	PHYSICIANS	143513	24	Plastic Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
12688	Fee-for-Service	1669881397	1669881397	1	1	KELLUM, SANDRA M MD FAAP	11/23/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168793	40	Pediatrics	0	In state provider	None	1401 AVOCADO AVE	STE 802	NEWPORT BEACH	CA	92660	7784	30	06059	33.61235015	-117.8704573	Orange County
12690	Fee-for-Service	1346269990	1346269990	1	1	KALUNIAN, KENNETH C MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43645	83	Rheumatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12703	Fee-for-Service	1063664753	1063664753	1	1	KHAN, SARAH N MD	3/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115893	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
12710	Fee-for-Service	1104910041	1104910041	1	1	KALRA, RUBY P MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	68435	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
12751	Fee-for-Service	1205496197	1205496197	1	1	KHOSHKISH, ALI	8/15/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180503	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
12769	Fee-for-Service	1417014036	1417014036	1	1	KARDASHIAN, JANE F MD	3/7/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	43958	None	None	0	In state provider	None	6769 N FRESNO ST	STE 101	FRESNO	CA	93710	3715	10	06019	36.83686637	-119.7813437	Fresno County
12777	Fee-for-Service	1720577554	1720577554	1	1	KERN HOSPICE CARE INC	3/19/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2920 F STREET	STE I-10	BAKERSFIELD	CA	93301	1829	15	06029	35.385993	-119.0234435	Kern County
12784	Fee-for-Service	1538206321	1538206321	1	1	KAUFMAN, KATE MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87015	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
12804	Fee-for-Service	1336159052	1336159052	1	2	KATZ, TOBY J MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67345	41	Internal Medicine	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
12829	Fee-for-Service	1164534103	1164534103	1	1	KARPANIAN, HAGOP V MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101692	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
12833	Fee-for-Service	1134438922	1134438922	1	1	KLEIN, EMILY A MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128323	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
12837	Fee-for-Service	1609924489	1609924489	1	1	KAY, PHILLIP K MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66682	25	Physical Medicine and Rehabilitation	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
12842	Fee-for-Service	1740688894	1740688894	1	1	KAWEAH DELTA HEALTH CARE	4/20/2017	261QP2300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	-WILLOW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
12861	Fee-for-Service	1528094547	1528094547	1	1	KELL, WILLIAM P MD	6/21/1978	207P00000X	NA	Other	026	PHYSICIANS	24866	41	Internal Medicine	0	In state provider	None	3455 PACIFIC BLVD	None	SAN MATEO	CA	94403	2836	41	06081	37.53612333	-122.2954324	San Mateo County
12918	Fee-for-Service	1063985455	1063985455	1	1	KUBASTA, MATTHEW CNP	12/23/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
12930	Fee-for-Service	1487856431	1487856431	1	1	KENNETH IMMERMAN	9/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
12942	Fee-for-Service	1972741965	1972741965	1	1	KESAVAN, KALPASHRI MD	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128788	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	MDCC RM B2-325	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
12998	Fee-for-Service	1972739944	1972739944	1	1	KEMPF, KATHERINE P MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107282	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
13032	Fee-for-Service	1902945603	1902945603	1	1	KHAW, HUATHIN MD	1/1/1989	208800000X	NA	Other	026	PHYSICIANS	43806	34	Urology and Urological Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
13062	Fee-for-Service	1083001754	1083001754	1	1	KAUFMAN, MILENA DO	11/5/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16214	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
13079	Fee-for-Service	1982166641	1982166641	1	1	KHAN, ABDULLAH S	4/19/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182188	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
13089	Fee-for-Service	1336159052	1336159052	1	2	KATZ, TOBY J MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67345	10	Gastroenterology (M.D. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
13090	Fee-for-Service	1407266984	1407266984	1	1	KAISER FOUNDATION HEALTH	9/1/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	14305 MERIDIAN PKWY	FL 1	RIVERSIDE	CA	92518	3034	33	06065	33.91093033	-117.2887655	Riverside County
13109	Fee-for-Service	1316042542	1316042542	1	1	KWAN, KAREN W MD	8/31/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	88896	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
13125	Fee-for-Service	1609924489	1609924489	1	1	KAY, PHILLIP K MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66682	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
13127	Fee-for-Service	1740688894	1740688894	1	1	KAWEAH DELTA HEALTH CARE	11/25/2024	261QP2300X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	-WILLOW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
13128	Fee-for-Service	1598783177	1598783177	1	1	KARLIN, ANDREW S MD	3/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51072	41	Internal Medicine	0	In state provider	None	27924 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3870	19	06037	34.4588501	-118.5343405	Los Angeles County
13153	Fee-for-Service	1396276895	1396276895	1	1	KONG, JEREMY MD	8/5/2022	207R00000X	NA	Other	026	PHYSICIANS	159270	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
13159	Fee-for-Service	1629069760	1629069760	1	1	KUO, CHRISTINE Y DO	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8458	None	None	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
13170	Fee-for-Service	1285730069	1285730069	1	1	KAPLAN, ROBERT A MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	59526	41	Internal Medicine	0	In state provider	None	3811 VALLEY CENTRE DR	None	SAN DIEGO	CA	92130	3318	37	06073	32.93760492	-117.2320932	San Diego County
13243	Fee-for-Service	1699834309	1699834309	1	1	KONISHI, BARBARA T OD	2/3/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
13264	Fee-for-Service	1336380351	1336380351	1	1	KAPOOR, KARAN MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126446	30	Radiology	0	In state provider	None	7300 N. FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
13304	Fee-for-Service	1811006018	1811006018	1	1	KRAFT, CHARLES G PHD	1/4/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	7492	-	NOT APPLICABLE	0	In state provider	None	890 HAYES STREET	None	SAN FRANCISCO	CA	94117	2615	38	06075	37.77587721	-122.4309963	San Francisco County
13307	Fee-for-Service	1538206750	1538206750	1	1	KEYES, JEFFREY M MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89577	05	Anesthesiology	0	In state provider	None	28062 BAXTER ROAD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
13397	Fee-for-Service	1467807735	1467807735	1	1	KOTTE, ABHILASH MD	12/9/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163508	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
13414	Fee-for-Service	1740688894	1740688894	1	1	KAWEAH DELTA HEALTH CARE	10/8/2015	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	-WILLOW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
13449	Fee-for-Service	1205861614	1205861614	1	1	KANSAGRA, PRAVIN MD	4/7/2011	2084P0800X	NA	Psychiatry	026	PHYSICIANS	44685	36	Psychiatry	0	In state provider	None	1020 S ANAHEIM BLVD	STE 215	ANAHEIM	CA	92805	5808	30	06059	33.82002206	-117.9087091	Orange County
13492	Fee-for-Service	1245590447	1245590447	1	1	KAGIHARA, JAMIE M MD	2/6/2018	208M00000X	NA	Other	026	PHYSICIANS	135922	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
13524	Fee-for-Service	1508250770	1508250770	1	1	KAOKAF, KAZI H MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158697	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
13561	Fee-for-Service	1124002381	1124002381	1	1	KAZLAUSKAS, LINAS J MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	74679	30	Radiology	0	In state provider	None	36450 INLAND VALLEY DR	STE 101	WILDOMAR	CA	92595	7720	33	06065	33.591168	-117.2367715	Riverside County
13576	Fee-for-Service	1043398639	1043398639	1	1	KASS, DEBORAH A MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	40970	30	Radiology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
13616	Fee-for-Service	1780064998	1780064998	1	1	KUEBLER, CHRISTOPHER MD	3/24/2020	207L00000X	NA	Other	026	PHYSICIANS	161794	05	Anesthesiology	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
13629	Fee-for-Service	1891879516	1891879516	1	1	KIM, EUGENE J MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73969	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
13683	Fee-for-Service	1588900229	1588900229	1	1	KAMPP, JACQUELINE A NP	8/20/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
13702	Fee-for-Service	1740688894	1740688894	1	1	KAWEAH DELTA HEALTH CARE	12/24/2018	261QP2300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	-WILLOW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
13721	Fee-for-Service	1073125522	1073125522	1	1	KIM, ERIN LMFT	12/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
13725	Fee-for-Service	1083865836	1083865836	1	1	KANESHIRO, MARC C MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109630	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
13773	Fee-for-Service	1174320733	1174320733	1	1	KUSICKI, ROCHELLE L CD	5/23/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
13774	Fee-for-Service	1235453069	1235453069	1	1	KIANPOUR, DANIEL N MD	12/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143545	05	Anesthesiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
13850	Fee-for-Service	1124002381	1124002381	1	1	KAZLAUSKAS, LINAS J MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	74679	78	Neoplastic Diseases/Oncology	0	In state provider	None	36450 INLAND VALLEY DR	STE 101	WILDOMAR	CA	92595	7720	33	06065	33.591168	-117.2367715	Riverside County
13870	Fee-for-Service	1487816211	1487816211	1	1	KHANDWALLA, RAJ M MD	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121064	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
13880	Fee-for-Service	1689741407	1689741407	1	1	KONG, LAWRENCE B MD	5/31/1992	208G00000X	NA	General Surgery	026	PHYSICIANS	75183	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
13890	Fee-for-Service	1790817088	1790817088	1	1	KAYASTHA, ARCHANA MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	87175	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
13894	Fee-for-Service	1801329792	1801329792	1	1	KERMGARD, ELIZABETH MD	7/24/2023	246ZN0300X	NA	Other	026	PHYSICIANS	160075	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
13902	Fee-for-Service	1407099492	1407099492	1	2	KIM, DAVID S MEDICAL INC	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61312	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 S VIRGIL AVE	SUITE 201	LOS ANGELES	CA	90020	1404	19	06037	34.064964	-118.2870335	Los Angeles County
13915	Fee-for-Service	1912215435	1912215435	1	1	KWUN, SOON YULL MD INC	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33048	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3131 SANTA ANITA AVENUE	#105	SOUTH EL MONTE	CA	91733	0927	19	06037	34.064991	-118.0427595	Los Angeles County
13921	Fee-for-Service	1376691253	1376691253	1	1	KAISER FOUND HLTH PLAN	2/3/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHCY	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4098	07	06013	38.00403417	-121.8422798	Contra Costa County
13924	Fee-for-Service	1922340355	1922340355	1	1	KAPUR, PUNEET MD	1/17/2025	390200000X	NA	Other	026	PHYSICIANS	140315	13	Neurology (M.D. only)	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
13967	Fee-for-Service	1922206135	1922206135	1	1	KIM, JIYEON MD	10/14/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	144212	40	Pediatrics	0	In state provider	None	4968 BOOTH	106	IRVINE	CA	92604	3360	30	06059	33.68590715	-117.7855253	Orange County
13980	Fee-for-Service	1609314525	1609314525	1	1	KAWASHIMA, CRAIG T	10/26/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
13990	Fee-for-Service	1740688894	1740688894	1	1	KAWEAH DELTA HEALTH CARE	10/8/2015	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	-WILLOW	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
14042	Fee-for-Service	1417415910	1417415910	1	1	KRAIMER, KRISTEN L MD	4/22/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
14085	Fee-for-Service	1457569626	1457569626	1	1	KWOK, KARL K MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116170	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
14112	Fee-for-Service	1629423512	1629423512	1	1	KREIDL, RENEE A MD	3/17/2020	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	155739	08	Family Practice	0	In state provider	None	555 WASHINGTON STREET	None	SAN DIEGO	CA	92103	2289	37	06073	32.74986289	-117.1599343	San Diego County
14140	Fee-for-Service	1235217068	1235217068	1	1	KASS, ELIZABETH M MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67871	01	General Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
14174	Fee-for-Service	1518347988	1518347988	1	1	KIM, JENNIE S MD	8/26/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	173096	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
14195	Fee-for-Service	1154476158	1154476158	1	1	KOKAL, PAULA J	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	572 RIO LINDO AVE	STE 101	CHICO	CA	95926	1851	04	06007	39.75508407	-121.8487933	Butte County
14217	Fee-for-Service	1467411819	1467411819	1	1	KIM, JASON YOUNGHOON	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	64108	40	Pediatrics	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
14226	Fee-for-Service	1245787217	1245787217	1	1	KHEIR, RAWAN I PT	9/24/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15095 AMARGOSA RD	SUITE 104	VICTORVILLE	CA	92394	1875	36	06071	34.52479785	-117.3303132	San Bernardino County
14245	Fee-for-Service	1215015029	1215015029	1	1	KIM, EUGENE H DO	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8383	08	Family Practice	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
14289	Fee-for-Service	1861095671	1861095671	1	2	KANITA BOURNE LICENSED CLINI	1/7/2021	1041C0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CAL SOCIAL WORKER INC.	10601 CIVIC CENTER DR	STE 100 A-D	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
14304	Fee-for-Service	1861456246	1861456246	1	1	KENT, GEORGE P.	6/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46421	08	Family Practice	0	In state provider	None	25 N 14TH ST	STE 1020	SAN JOSE	CA	95112	6209	43	06085	37.34293357	-121.8775187	Santa Clara County
14359	Fee-for-Service	1881981082	1881981082	1	1	KAJI, AKIKO PHD	3/12/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1801 BUSH ST	SUITE 131B	SAN FRANCISCO	CA	94109	5273	38	06075	37.78777536	-122.427321	San Francisco County
14381	Fee-for-Service	1912364407	1912364407	1	1	KIBERENGE, JANET J CRNA	11/21/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
14400	Fee-for-Service	1629423512	1629423512	1	1	KREIDL, RENEE A MD	3/17/2020	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	155739	38	Geriatrics	0	In state provider	None	555 WASHINGTON STREET	None	SAN DIEGO	CA	92103	2289	37	06073	32.74986289	-117.1599343	San Diego County
14416	Fee-for-Service	1861811424	1861811424	1	1	KHAN, AAZIB MD	2/8/2021	207R00000X	NA	Other	026	PHYSICIANS	168622	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
14417	Fee-for-Service	1962836098	1962836098	1	1	KIM, SARAH J DO	12/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13998	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	36 W YOKUTS AVE	#1	STOCKTON	CA	95207	5713	39	06077	37.99833959	-121.3074229	San Joaquin County
14418	Fee-for-Service	1770765794	1770765794	1	1	KATHERINE M KILGORE PHD INC	1/9/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13405 FOLSOM BLVD	SUITE 220	FOLSOM	CA	95630	4738	34	06067	38.657493	-121.1840775	Sacramento County
14425	Fee-for-Service	1386172260	1386172260	1	1	KURTH, LISA M MD	7/31/2023	208600000X	NA	General Surgery	026	PHYSICIANS	178218	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
14437	Fee-for-Service	1205414984	1205414984	1	1	KHAN, IBRAHIM MD	9/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
14460	Fee-for-Service	1508299256	1508299256	1	1	KAWASE, SAYAKA LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
14484	Fee-for-Service	1669493110	1669493110	1	1	KRAMER, ERIC L OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1208 FLOYD AVE	STE C9	MODESTO	CA	95350	2454	50	06099	37.67801219	-120.977686	Stanislaus County
14486	Fee-for-Service	1962713636	1962713636	1	1	KLEIN, TERI L DO	11/12/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	10569	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
14512	Fee-for-Service	1972979433	1972979433	1	1	KERR, MATTHEW A	4/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	568 NORTH SUNRISE	STE 100	ROSEVILLE	CA	95661	3035	31	06061	38.7576732	-121.2534645	Placer County
14518	Fee-for-Service	1699105247	1699105247	1	1	KATZ, ARIANE H LCSW	10/8/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1141 PEAR TREE LN	None	NAPA	CA	94558	6485	28	06055	38.32125908	-122.2921523	Napa County
14578	Fee-for-Service	1861095671	1861095671	1	2	KANITA BOURNE LICENSED CLINI	1/7/2021	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER INC.	10601 CIVIC CENTER DR	STE 100 A-D	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
14603	Fee-for-Service	1801815998	1801815998	1	1	KANG, VERONICA NP	12/2/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
14620	Fee-for-Service	1457544660	1457544660	1	1	KIM, HYUNMIE L NP	11/22/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
14621	Fee-for-Service	1275952301	1275952301	1	1	KATZ, JACKLYN I MD	12/16/2021	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	141187	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
14643	Fee-for-Service	1336130145	1336130145	1	1	KAO, ANN K MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65338	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2 BON AIR RD	STE 100	LARKSPUR	CA	94939	1144	21	06041	37.94364568	-122.5396483	Marin County
14650	Fee-for-Service	1518565738	1518565738	1	1	KIL, LENA CNP	3/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
14656	Fee-for-Service	1457335580	1457335580	1	1	KARCHEMSKAYA, YULIYA PT	1/29/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16573 VENTURA BLVD	5	ENCINO	CA	91436	2022	19	06037	34.1578643	-118.4944187	Los Angeles County
14678	Fee-for-Service	1689984668	1689984668	1	1	KND DEVELOPMENT 52 LLC	11/1/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	14148 FRANCISQUITO AVE	None	BALDWIN PARK	CA	91706	6120	19	06037	34.06339562	-117.9671298	Los Angeles County
14707	Fee-for-Service	1821656299	1821656299	1	1	KALEKAS, NICHOLAS C DO	4/20/2023	207L00000X	NA	Other	026	PHYSICIANS	19743	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
14708	Fee-for-Service	1245318815	1245318815	1	1	KLEIN, NICOLA P MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68589	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
14714	Fee-for-Service	1508211889	1508211889	1	1	KNOPPER, RYAN MD	8/20/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
14730	Fee-for-Service	1518137116	1518137116	1	1	KERNS, JENNIFER L MD	9/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104345	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVENUE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
14763	Fee-for-Service	1023459807	1023459807	1	1	KUMAR, ALOK MD	3/24/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	175778	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
14764	Fee-for-Service	1811099633	1811099633	1	1	KOEMPEL, JEFFREY A MD	10/1/1996	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	83920	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
14787	Fee-for-Service	1578798864	1578798864	1	1	KARAYAN, RONNIE MD APC	6/16/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	2701 WEST ALAMEDA AVE	SUITE 202	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
14844	Fee-for-Service	1538222104	1538222104	1	1	KINDELAN, JOSHUA MD	5/2/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	157423	33	Thoracic Surgery	0	In state provider	None	5330 CARROLL CANYON RD	140	SAN DIEGO	CA	92121	3758	37	06073	32.8917216	-117.1927751	San Diego County
14882	Fee-for-Service	1245598200	1245598200	1	1	KHALAF, DAREEN MD	8/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122011	None	None	0	In state provider	None	191 S BUENA VISTA ST	STE 150	BURBANK	CA	91505	4522	19	06037	34.15872557	-118.3283863	Los Angeles County
14963	Fee-for-Service	1487948584	1487948584	1	1	KESANAPALLI, DEEPTHI MD	2/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130264	None	None	0	In state provider	None	7910 FROST ST	STE 335	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
14967	Fee-for-Service	1689984668	1689984668	1	1	KND DEVELOPMENT 52 LLC	11/1/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	14148 FRANCISQUITO AVE	None	BALDWIN PARK	CA	91706	6120	19	06037	34.06339562	-117.9671298	Los Angeles County
14999	Fee-for-Service	1750765392	1750765392	1	1	KHAN, ASFANDYAR MD	12/20/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	280 SIERRA COLLEGE DR	STE 105	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
15007	Fee-for-Service	1104979897	1104979897	1	1	KLOSTERMAN, MICHELLE R NP	4/4/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
15035	Fee-for-Service	1366645491	1366645491	1	1	KLEIN, WALTER F II MD	7/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97881	None	None	0	In state provider	None	26520 CACTUS AVENUE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
15041	Fee-for-Service	1073557203	1073557203	1	1	KAPUR, VINEET MD	11/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68823	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
15067	Fee-for-Service	1831392141	1831392141	1	1	KROH, ESTHER S MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	501 EAST HAMPDEN AVENUE	None	ENGLEWOOD	CO	80113	2702	00	None	39.6531952	-104.9810967	Arapahoe County
15110	Fee-for-Service	1083799753	1083799753	1	1	KWOK, DENNIS MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64274	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
15198	Fee-for-Service	1508155367	1508155367	1	1	KREKLER, LISA M LCSW	6/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
15216	Fee-for-Service	1619906872	1619906872	1	1	KUNDARIA, BHANJI D MD	2/22/2009	174400000X	NA	Other	026	PHYSICIANS	35703	47	Miscellaneous	0	In state provider	CAROL	1505 SHEPARD DR	STE 106	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
15258	Fee-for-Service	1639129034	1639129034	1	1	KRONICK, JOHN L MD	8/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79932	20	Orthopedic Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
15277	Fee-for-Service	1114324662	1114324662	1	1	KAPLAN, KATHERINE A PHD	9/6/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15279	Fee-for-Service	1922162114	1922162114	1	2	KHAN, GAUHAR R MD	1/4/2014	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	102895	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1540 FLORIDA AVE	STE 100	MODESTO	CA	95350	4430	50	06099	37.667115	-120.9962205	Stanislaus County
15290	Fee-for-Service	1578644480	1578644480	1	1	KLEIN, MELANIE L MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60786	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
15296	Fee-for-Service	1508162686	1508162686	1	1	KOLKER, DENISE JOY S PHD	5/3/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 CHERRY ST	None	SANTA ROSA	CA	95404	4207	49	06097	38.444382	-122.712858	Sonoma County
15307	Fee-for-Service	1639226954	1639226954	1	1	KAISER PERMANENTE	6/29/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #216	4650 PALM AVE	None	SAN DIEGO	CA	92154	8404	37	06073	32.5839467	-117.0337851	San Diego County
15327	Fee-for-Service	1326570656	1326570656	1	1	KWON, MATT H MD	11/29/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176251	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
15384	Fee-for-Service	1528044757	1528044757	1	1	KUMAR, SANKAR P MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75852	01	General Practice	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
15385	Fee-for-Service	1710399449	1710399449	1	1	KIM, MYOUNG M NP	12/19/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16323 CLARK AVENUE	None	BELLFLOWER	CA	90706	5209	19	06037	33.885693	-118.1339975	Los Angeles County
15455	Fee-for-Service	1356047153	1356047153	1	1	KNOX, LATANIA	5/24/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
15466	Fee-for-Service	1942716550	1942716550	1	1	KILIMANJARO PHARMACY, INC	5/14/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2435-A HIGHWAY 46	None	WASCO	CA	93280	1167	15	06029	35.60149951	-119.353275	Kern County
15481	Fee-for-Service	1265056311	1265056311	1	1	KIND HEART HOSPICE AND	10/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1442 IRVINE BLVD	SUITE 134	TUSTIN	CA	92780	3801	30	06059	33.74510442	-117.8049024	Orange County
15485	Fee-for-Service	1093061459	1093061459	1	2	KAMRA, PALLAVI MD	3/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	139383	40	Pediatrics	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
15498	Fee-for-Service	1487097846	1487097846	1	1	KWON, EDWIN K MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134063	01	General Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
15503	Fee-for-Service	1689800849	1689800849	1	1	KOLODIN, STEVEN J	2/8/2011	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	19520 NORDHOFF ST	STE 5	NORTHRIDGE	CA	91324	2451	19	06037	34.23392022	-118.557451	Los Angeles County
15511	Fee-for-Service	1598992695	1598992695	1	1	KORI COSSEY DO	2/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18100 NE UNION HILL RD	None	REDMOND	WA	98052	3330	00	None	47.67592663	-122.0989712	King County
15530	Fee-for-Service	1386057354	1386057354	1	1	KAHAL, AMANDEEP K MD	4/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144738	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
15557	Fee-for-Service	1841841129	1841841129	1	1	KLENSHTEYN, KATHRIN B OT	8/17/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
15612	Fee-for-Service	1326518168	1326518168	1	1	KATHERINE CLAIR TRISTAN LCSW	10/28/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PC	255 N D ST STE 220	None	SAN BERNARDINO	CA	92401	1713	36	06071	34.1036709	-117.291874	San Bernardino County
15631	Fee-for-Service	1518917640	1518917640	1	1	KHERADYAR, DAVID MD	9/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74610	13	Neurology (M.D. only)	0	In state provider	None	323 N PRAIRIE AVE	STE 200	INGLEWOOD	CA	90301	4504	19	06037	33.966333	-118.3439975	Los Angeles County
15634	Fee-for-Service	1740918325	1740918325	1	1	KAUR, MANMEET NP	1/17/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4043 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	0000	15	06029	35.35411151	-119.0532915	Kern County
15706	Fee-for-Service	1124165030	1124165030	1	1	KUNKLE, JANEY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	57462	05	Anesthesiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
15709	Fee-for-Service	1093895047	1093895047	1	1	KORMANIK, PATRICIA A NP	2/12/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
15739	Fee-for-Service	1225097694	1225097694	1	1	KOTHARI, ALKA R	9/30/1994	207ZP0102X	NA	Other	026	PHYSICIANS	49012	None	None	0	In state provider	None	13100 STUDEBAKER RD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
15769	Fee-for-Service	1265056311	1265056311	1	1	KIND HEART HOSPICE AND	10/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1442 IRVINE BLVD	SUITE 134	TUSTIN	CA	92780	3801	30	06059	33.74510442	-117.8049024	Orange County
15804	Fee-for-Service	1447347596	1447347596	1	1	KINCHEN, DELANEY DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
15854	Fee-for-Service	1861570673	1861570673	1	1	KASCHAK, THOMAS J DPM	9/18/1986	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
15860	Fee-for-Service	1629011762	1629011762	1	1	KO, WILLIAM M MD	9/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82916	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
15873	Fee-for-Service	1558935908	1558935908	1	1	KAMBALAPALLI, SOUMYA MD	12/14/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
15896	Fee-for-Service	1831447283	1831447283	1	1	KARI, KSHITIJA MD	11/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121118	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
15955	Fee-for-Service	1144412560	1144412560	1	1	KANAAN, ZEYAD MD	9/30/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	157617	41	Internal Medicine	0	In state provider	None	3883 AIRWAY DRIVE	SUITE 220	SANTA ROSA	CA	95403	1670	49	06097	38.483226	-122.739705	Sonoma County
15988	Fee-for-Service	1972098275	1972098275	1	1	KEBEDE, AMANUEL A MD	8/26/2022	207R00000X	NA	Other	026	PHYSICIANS	174760	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
16037	Fee-for-Service	1255612339	1255612339	1	1	KAFI, AARYA	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123008	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
16071	Fee-for-Service	1821269382	1821269382	1	1	KERN COUNTY HISPANIC COMMISS	4/4/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5080 CALIFORNIA AVE	SUITE 100	BAKERSFIELD	CA	93309	1597	15	06029	35.36158575	-119.0598492	Kern County
16105	Fee-for-Service	1053637330	1053637330	1	1	KF CASITAS LLC	7/1/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10626 BALBOA BOULEVARD	None	GRANADA HILLS	CA	91344	6399	19	06037	34.263225	-118.5022435	Los Angeles County
16137	Fee-for-Service	1801807557	1801807557	1	1	KAZATO, ERNEST MD	4/30/1996	207P00000X	NA	Other	026	PHYSICIANS	22977	66	Emergency Medicine (Urgent Care)	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
16141	Fee-for-Service	1073919866	1073919866	1	1	KIM, CLOE T LCSW	3/12/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
16142	Fee-for-Service	1700827870	1700827870	1	1	KIM, PAUL S K MD	9/16/1991	207L00000X	NA	Other	026	PHYSICIANS	72462	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
16164	Fee-for-Service	1801871819	1801871819	1	1	KABBINAVAR, FAIROOZ F MD	2/28/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	45968	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
16195	Fee-for-Service	1497380539	1497380539	1	1	KURIYAMA, TOMOYO CNP	5/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
16202	Fee-for-Service	1821004797	1821004797	1	1	KANEL, GARY C MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	39010	22	Pathology (M.D. only)	0	In state provider	None	7601 E IMPERIAL HWY	None	LOS ANGELES	CA	90033	1029	19	06037	33.9309663	-118.4309476	Los Angeles County
16244	Fee-for-Service	1144412560	1144412560	1	1	KANAAN, ZEYAD MD	9/30/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	157617	68	Hematology	0	In state provider	None	3883 AIRWAY DRIVE	SUITE 220	SANTA ROSA	CA	95403	1670	49	06097	38.483226	-122.739705	Sonoma County
16251	Fee-for-Service	1952832909	1952832909	1	1	KOBASHIGAWA, ERIN MD	5/16/2020	207R00000X	NA	Other	026	PHYSICIANS	158707	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
16271	Fee-for-Service	1487636270	1487636270	1	1	KOIKE, ALAN KENJI MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	72180	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
16315	Fee-for-Service	1295821171	1295821171	1	1	KUKOLECK, KEVIN PSYD	4/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
16341	Fee-for-Service	1467042804	1467042804	1	1	KLOPFENSTEIN, MARIA CRNA	9/22/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
16369	Fee-for-Service	1063599397	1063599397	1	1	KOKORIS, NICHOLAS MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36012	18	Ophthalmology	0	In state provider	None	7749 PAINTER AVE	None	WHITTIER	CA	90602	2411	19	06037	33.9703591	-118.0327069	Los Angeles County
16377	Fee-for-Service	1063464675	1063464675	1	1	KONING, LAWRENCE K MD	11/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	48583	01	General Practice	0	In state provider	INC	900 S MAIN ST	STE 205	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
16394	Fee-for-Service	1811131972	1811131972	1	1	KAHKEDJIAN, ZEPURE LMFT	5/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20300 VENTURA BLVD	STE 330	WOODLAND HILLS	CA	91364	2448	19	06037	34.16931134	-118.5754465	Los Angeles County
16429	Fee-for-Service	1700827870	1700827870	1	1	KIM, PAUL S K MD	9/16/1991	207L00000X	NA	Other	026	PHYSICIANS	72462	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
16434	Fee-for-Service	1053365437	1053365437	1	1	KONCHADA, RAVISHANKAR S MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
16441	Fee-for-Service	1790907962	1790907962	1	1	KARRAS, NICOLE A MD	8/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120423	40	Pediatrics	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
16526	Fee-for-Service	1851528947	1851528947	1	1	KUHN, BROOKS T MD	9/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116207	41	Internal Medicine	0	In state provider	None	2825 J STREET	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
16542	Fee-for-Service	1588864805	1588864805	1	1	KHAN, AMIR S MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126949	14	Neurological Surgery	0	In state provider	None	2335 E KASHIAN LANE	STE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
16555	Fee-for-Service	1386806362	1386806362	1	2	KLYSIK, MICHAL MD	5/18/2023	2085N0700X	NA	MRI Provider	026	PHYSICIANS	186017	None	None	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
16559	Fee-for-Service	1487636270	1487636270	1	1	KOIKE, ALAN KENJI MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	72180	36	Psychiatry	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
16562	Fee-for-Service	1043655525	1043655525	1	1	KOSLOV, DAVID S MD	9/3/2020	208800000X	NA	Other	026	PHYSICIANS	168921	34	Urology and Urological Surgery	0	In state provider	None	489 E 21ST	None	SAN BERNARDINO	CA	92404	4816	36	06071	34.13403455	-117.2756115	San Bernardino County
16574	Fee-for-Service	1346651718	1346651718	1	1	KOY, BUNRITH DO	10/23/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16565	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
16578	Fee-for-Service	1528487204	1528487204	1	1	KAPOOR, LINSEY LMFT	9/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21 N EL CIRCULO AVE	None	PATTERSON	CA	95363	2535	50	06099	37.47121868	-121.1322863	Stanislaus County
16580	Fee-for-Service	1255655072	1255655072	1	1	KABAEI, FARZIN MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112374	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
16610	Fee-for-Service	1114472669	1114472669	2	1	KLISH, JENNIFER CRNA	10/21/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
16617	Fee-for-Service	1275983744	1275983744	1	1	KALRA, SALIL MD	3/30/2023	207RC0200X	NA	Other	026	PHYSICIANS	175835	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
16620	Fee-for-Service	1083721849	1083721849	1	1	KAVIRAJAN, HARISH C MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55485	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
16622	Fee-for-Service	1104974054	1104974054	1	1	KAMATH, H MOHAN MD	2/1/1982	207N00000X	NA	Dermatology	026	PHYSICIANS	25682	07	Dermatology	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
16692	Fee-for-Service	1386711190	1386711190	1	1	KULKARNI, KUMAR N MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	35497	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
16707	Fee-for-Service	1972882876	1972882876	1	1	KAJA MEDICAL EQUIPTMENT &	10/29/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLY INC	1416 E MAIN ST	None	VENTURA	CA	93001	3228	56	06111	34.28016503	-119.278768	Ventura County
16716	Fee-for-Service	1366718884	1366718884	2	1	KING, JENNA A PHD	9/26/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	333 GELLERT BLVD	SUITE 143	DALY CITY	CA	94015	2621	41	06081	37.66672018	-122.4685948	San Mateo County
16725	Fee-for-Service	1457863094	1457863094	1	1	KWOK, ALLAN PT	7/29/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
16729	Fee-for-Service	1093784332	1093784332	1	1	KEVIN A ROSSITER MD	7/27/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1910 SOUTH AVE	None	LA CROSSE	WI	54601	5467	00	None	43.79473653	-91.24623835	La Crosse County
16765	Fee-for-Service	1669457057	1669457057	1	1	KINSER, DONNA MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40096	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
16768	Fee-for-Service	1578980033	1578980033	1	1	KNAPP,KATRINA	6/13/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
16790	Fee-for-Service	1295808632	1295808632	1	1	KARP, MICHAEL W MD	1/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65498	40	Pediatrics	0	In state provider	None	2067 W VISTA WAY	STE 100	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
16794	Fee-for-Service	1790719755	1790719755	1	1	KHAZANOVA, NATALIA S PHD	2/2/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	198 MIRALOMA DR	None	SAN FRANCISCO	CA	94127	1643	38	06075	37.73609409	-122.4610956	San Francisco County
16796	Fee-for-Service	1245414846	1245414846	1	1	KIM, HELLEN J MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98213	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
16816	Fee-for-Service	1851528947	1851528947	1	1	KUHN, BROOKS T MD	9/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116207	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J STREET	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
16831	Fee-for-Service	1457384075	1457384075	1	1	KOMAS, NICHOLAS M MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86463	20	Orthopedic Surgery	0	In state provider	None	111 RALEY BLVD	STE 160	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
16865	Fee-for-Service	1346298924	1346298924	1	1	KALKAT, GURJEET S	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46604	41	Internal Medicine	0	In state provider	None	412 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4711	19	06037	34.13415622	-117.8702547	Los Angeles County
16876	Fee-for-Service	1588610786	1588610786	1	1	KIM, S.DON DPM	10/16/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E 28TH ST	STE 111	LONG BEACH	CA	90806	2759	19	06037	33.80803441	-118.1847137	Los Angeles County
16891	Fee-for-Service	1316970742	1316970742	1	1	KJELLIN, INGRID B MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50153	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
16920	Fee-for-Service	1316198500	1316198500	1	1	KIANG, CHARLENE MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109170	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
16940	Fee-for-Service	1659647873	1659647873	1	1	KABBA, CHIDINMA D MD	10/26/2023	207P00000X	NA	Other	026	PHYSICIANS	173281	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
16978	Fee-for-Service	1386711190	1386711190	1	1	KULKARNI, KUMAR N MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	35497	03	Allergy	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
17009	Fee-for-Service	1760562755	1760562755	1	1	KIM, FRANCIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
17011	Fee-for-Service	1306869573	1306869573	1	1	KORETZ, ALEXANDER MD	12/1/1998	207L00000X	NA	Other	026	PHYSICIANS	55014	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
17068	Fee-for-Service	1124062351	1124062351	1	1	KRIEG, RICHARD M MD	12/1/1997	2085R0203X	NA	Other	026	PHYSICIANS	38686	30	Radiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
17097	Fee-for-Service	1467413708	1467413708	1	1	KAWEAH DELTA DIST HOSP	3/15/2001	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	CYPRESS MENTAL HEALTH CT	1100 S AKERS ST	None	VISALIA	CA	93277	8311	54	06107	36.320823	-119.3480235	Tulare County
17115	Fee-for-Service	1831933290	1831933290	1	1	KOCH, ROCHELLE M LCSW	7/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 WHITTIER BLVD	None	LA HABRA	CA	90631	3610	30	06059	33.9391647	-117.9595151	Orange County
17129	Fee-for-Service	1598051328	1598051328	1	1	KENNEDY, ROBERT MD	8/12/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
17154	Fee-for-Service	1346298924	1346298924	1	1	KALKAT, GURJEET S	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46604	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	412 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4711	19	06037	34.13415622	-117.8702547	Los Angeles County
17198	Fee-for-Service	1891322780	1891322780	1	1	KAN, CAROLYN K MD	5/16/2023	208M00000X	NA	Other	026	PHYSICIANS	184566	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
17206	Fee-for-Service	1598108383	1598108383	1	1	KUNIGELIS, KATHERINE MD	1/18/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	192114	None	None	0	In state provider	None	251 COHASSET RD	SUITE 370	CHICO	CA	95926	2241	04	06007	39.75090044	-121.8522609	Butte County
17226	Fee-for-Service	1841466638	1841466638	1	1	KHALIL, AMER K A MD	12/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	139554	14	Neurological Surgery	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
17230	Fee-for-Service	1578796397	1578796397	1	1	KRISTIN LIANG A PHD	10/6/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	500 W BADILLO ST	None	COVINA	CA	91722	3762	19	06037	34.0862325	-117.899253	Los Angeles County
17299	Fee-for-Service	1487698114	1487698114	1	1	KOSTICH, ZELJA H MD	5/4/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71520	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
17300	Fee-for-Service	1366785651	1366785651	1	1	KRYZHANOVSKAYA, IRINA V MD	6/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134909	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
17355	Fee-for-Service	1245288240	1245288240	1	1	KORNBLUTH, RICHARD MD	7/1/1986	207RP1001X	NA	Pulmonology	026	PHYSICIANS	51776	77	Infectious Disease	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
17360	Fee-for-Service	1124062351	1124062351	1	1	KRIEG, RICHARD M MD	12/1/1997	2085R0203X	NA	Other	026	PHYSICIANS	38686	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
17390	Fee-for-Service	1730368721	1730368721	1	1	KRAKOWSKI, DAVID MD	7/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183714	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
17425	Fee-for-Service	1174188254	1174188254	1	1	KNIGHT, CAROL MD	2/10/2023	207P00000X	NA	Other	026	PHYSICIANS	181074	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
17465	Fee-for-Service	1851316228	1851316228	1	1	KENT, RONALD N MD	9/30/1982	2084N0400X	NA	Neurology	026	PHYSICIANS	45058	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
17504	Fee-for-Service	1649038118	1649038118	1	1	KUNGU, STEPHEN K	5/1/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	547 HILLSWICK CIRCLE	None	FOLSOM	CA	95630	8470	34	06067	38.658006	-121.119723	Sacramento County
17505	Fee-for-Service	1619048295	1619048295	1	1	KHAN, SHAHBAZ R	3/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53269	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
17513	Fee-for-Service	1659516094	1659516094	1	1	KIM, ILKYOON MD APC	10/7/2008	302F00000X	NA	Other	026	PHYSICIANS	34081	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15666 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93616777	-122.619287	Lake County
17577	Fee-for-Service	1225350804	1225350804	1	1	KERN RURAL WELLNESS CENTERS	10/12/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	146 N HILL ST	None	ARVIN	CA	93203	1014	15	06029	35.210097	-118.8309345	Kern County
17621	Fee-for-Service	1114095627	1114095627	1	1	KHANNA, ANUBHA MD	11/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98055	40	Pediatrics	0	In state provider	None	9281 OFFICE PARK CIRCLE	#120	ELK GROVE	CA	95758	8069	34	06067	38.418264	-121.39641	Sacramento County
17660	Fee-for-Service	1417554528	1417554528	1	4	KECK MEDICAL CENTER OF USC	12/7/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	330 OLD NEWPORT BLVD	STE 200	NEWPORT BEACH	CA	92663	4121	30	06059	33.6250427	-117.9274101	Orange County
17709	Fee-for-Service	1336248616	1336248616	1	1	KARL, KERN B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
17728	Fee-for-Service	1053471433	1053471433	1	1	KAHN, MARGIE A MD	12/13/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	53013	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
17733	Fee-for-Service	1720092679	1720092679	1	1	KAISER, ANDREAS M MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81359	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	STE 7418	LOS ANGELES	CA	90089	0178	19	06037	34.06169385	-118.2044698	Los Angeles County
17737	Fee-for-Service	1841378684	1841378684	1	1	KAER, SEAN R MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75766	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
17751	Fee-for-Service	1881741114	1881741114	1	1	KAISER FOUNDATION HEALTH	3/7/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMNTE PHRM #261	1900 DRESDEN DR	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
17777	Fee-for-Service	1619151990	1619151990	1	1	KIMMEL, PAMELA J LMFT	3/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 CIVIC CENTER DRIVE	STE 100	SAN RAFAEL	CA	94903	4173	21	06041	38.0041783	-122.538861	Marin County
17794	Fee-for-Service	1649038118	1649038118	1	1	KUNGU, STEPHEN K	5/1/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	547 HILLSWICK CIRCLE	None	FOLSOM	CA	95630	8470	34	06067	38.658006	-121.119723	Sacramento County
17797	Fee-for-Service	1265705974	1265705974	1	1	KUCH, SALLY B LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
17819	Fee-for-Service	1134445166	1134445166	1	1	KIM, NANCY H	3/28/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
17829	Fee-for-Service	1528488723	1528488723	1	1	KHALILI, ARASH MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144021	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
17852	Fee-for-Service	1821148628	1821148628	1	1	KHAING, MAUNG C MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93202	41	Internal Medicine	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
17865	Fee-for-Service	1386834091	1386834091	1	1	KHALAFBEIGI, HELEN MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103696	08	Family Practice	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
17900	Fee-for-Service	1073665618	1073665618	1	1	KUROHARA, WILLIAM S MD	3/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	12393 WASHINGTON BLVD	None	WHITTIER	CA	90606	2502	19	06037	33.96719187	-118.0496563	Los Angeles County
17953	Fee-for-Service	1003057316	1003057316	1	1	KOH, STEPHEN S MD	9/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98501	22	Pathology (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
17959	Fee-for-Service	1306292867	1306292867	1	1	KIM, RICHARD K MD	6/16/2020	207L00000X	NA	Other	026	PHYSICIANS	150385	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
17962	Fee-for-Service	1144426909	1144426909	1	1	KRYSTIE FUJIMOTO	10/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	98-1079 MOANALUA RD	None	AIEA	HI	96701	4713	00	None	21.38373524	-157.937629	Honolulu County
17971	Fee-for-Service	1700213832	1700213832	1	1	KABACKA, JULIA A MD	9/26/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148065	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
17974	Fee-for-Service	1578689691	1578689691	1	1	KANT, SHRUTI MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108928	40	Pediatrics	0	In state provider	None	400 PARANASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
17985	Fee-for-Service	1366863565	1366863565	1	2	KAYE, STEVEN M MD INC	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	29768	None	None	0	In state provider	None	710 S BROOKHURST STREET	SUITE E	ANAHEIM	CA	92804	4321	30	06059	33.822027	-117.958914	Orange County
18022	Fee-for-Service	1720092679	1720092679	1	1	KAISER, ANDREAS M MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81359	28	Proctology (colon and rectal)	0	In state provider	None	1441 EASTLAKE AVE	STE 7418	LOS ANGELES	CA	90089	0178	19	06037	34.06169385	-118.2044698	Los Angeles County
18043	Fee-for-Service	1508102690	1508102690	1	1	KWONG, WAIYEE NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18055	Fee-for-Service	1336506104	1336506104	1	1	KIM, JIN K LAC	3/21/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4940 VAN NUYS BLVD	STE 304	SHERMAN OAKS	CA	91403	1700	19	06037	34.160589	-118.4486715	Los Angeles County
18079	Fee-for-Service	1093973026	1093973026	1	1	KAMAL, SALLY M MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109965	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
18082	Fee-for-Service	1851690465	1851690465	1	1	KALUDI, IRENE LCSW	11/4/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	828 SAN PABLO AVE	109	ALBANY	CA	94706	1678	01	06001	37.89159884	-122.2994097	Alameda County
18099	Fee-for-Service	1285653980	1285653980	1	1	KWONG, BERTRAM OD	12/6/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9959 WALKER ST	None	CYPRESS	CA	90630	3827	30	06059	33.81768404	-118.0369005	Orange County
18139	Fee-for-Service	1235193319	1235193319	1	1	KATZENBERG, DANIEL R MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71675	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
18153	Fee-for-Service	1386834091	1386834091	1	1	KHALAFBEIGI, HELEN MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103696	01	General Practice	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
18155	Fee-for-Service	1437237161	1437237161	1	1	KISSINGER, DAVID P MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50136	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
18166	Fee-for-Service	1326045196	1326045196	1	1	KHAKOO, FATMA S MD	4/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106306	41	Internal Medicine	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
18187	Fee-for-Service	1073665618	1073665618	1	1	KUROHARA, WILLIAM S MD	3/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	78	Neoplastic Diseases/Oncology	0	In state provider	None	12393 WASHINGTON BLVD	None	WHITTIER	CA	90606	2502	19	06037	33.96719187	-118.0496563	Los Angeles County
18188	Fee-for-Service	1629657531	1629657531	1	1	KWON, YONG-JEI MD	5/2/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
18221	Fee-for-Service	1861095671	1861095671	1	1	KANITA BOURNE LICENSED CLINI	1/7/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER INC.	10601 CIVIC CENTER DR	#100 A-D	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
18231	Fee-for-Service	1710054697	1710054697	1	1	KOYLE, BRUCE R DO	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7775	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
18242	Fee-for-Service	1629587068	1629587068	1	1	KING, RACHEL E OT	7/1/2020	225XP0019X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
18249	Fee-for-Service	1437137551	1437137551	1	1	KETCHAM,BRUCE DOUGLAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	ST PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
18302	Fee-for-Service	1396897880	1396897880	1	1	KHALIGHI, PAYMAN OD	1/23/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
18327	Fee-for-Service	1154555340	1154555340	1	1	KASTURI, SESHADRI MD	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121695	34	Urology and Urological Surgery	0	In state provider	None	87 SCRIPPS DRIVE	SUITE 310	SACRAMENTO	CA	95825	6318	34	06067	38.572092	-121.410261	Sacramento County
18329	Fee-for-Service	1841679008	1841679008	1	1	KNIGHT, ARIEL W MD	6/4/2021	208600000X	NA	General Surgery	026	PHYSICIANS	169411	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
18343	Fee-for-Service	1750304408	1750304408	1	1	KHERADPOUR, ALBERT MD	1/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51384	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
18399	Fee-for-Service	1043462146	1043462146	1	1	KIM, JUYONG B MD	10/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102168	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18450	Fee-for-Service	1487649711	1487649711	1	1	KULAWIAK, PATRICIA W MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66816	08	Family Practice	0	In state provider	None	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	49	06097	38.62729851	-122.8637785	Sonoma County
18470	Fee-for-Service	1831139252	1831139252	1	1	KEPNER, KATIE	6/20/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4650 PALM AVE	None	SAN DIEGO	CA	92154	9404	37	06073	32.5839467	-117.0337851	San Diego County
18491	Fee-for-Service	1841482981	1841482981	1	1	KWON, MURRAY H MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63040	89	Surgery-Traumatic	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
18505	Fee-for-Service	1295026862	1295026862	1	1	KAMERMAN-KRETZMER, RORY J MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123581	40	Pediatrics	0	In state provider	None	2828 FRESNO STREET	SUITE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
18538	Fee-for-Service	1750469581	1750469581	1	1	KIM, CHRISTOPHER J MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75957	04	Otology, Laryngology, Rhinology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
18561	Fee-for-Service	1679736672	1679736672	1	1	KHAN, SAMIRA A MD	9/3/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172118	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
18571	Fee-for-Service	1164058798	1164058798	1	1	KENNETH BOYER OD, INC	1/15/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1637 N. MOUNTAIN AVENUE	None	UPLAND	CA	91784	1732	36	06071	34.12292187	-117.6704005	San Bernardino County
18596	Fee-for-Service	1275616468	1275616468	1	1	KLEIN, ROBERT S MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	24035	None	None	0	In state provider	None	897 MACARTHUR BLVD	None	SAN LEANDRO	CA	94577	3002	01	06001	37.7370484	-122.1413528	Alameda County
18601	Fee-for-Service	1124357207	1124357207	1	1	KWON, MAC PT	10/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
18658	Fee-for-Service	1861426470	1861426470	1	1	KHANGURA, SUKHDER A MD	5/1/1996	207R00000X	NA	Other	026	PHYSICIANS	50172	41	Internal Medicine	0	In state provider	None	3609 MISSION AVE	STE H	CARMICHAEL	CA	95608	2955	34	06067	38.63052	-121.3559145	Sacramento County
18688	Fee-for-Service	1043462146	1043462146	1	1	KIM, JUYONG B MD	10/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102168	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18724	Fee-for-Service	1417573031	1417573031	1	1	KIM, CAROLYN MD	7/18/2023	207R00000X	NA	Other	026	PHYSICIANS	184661	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
18734	Fee-for-Service	1861050494	1861050494	1	1	KAPADIA, NAHEL N MD	7/22/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	177966	77	Infectious Disease	0	In state provider	None	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	34	06067	38.567007	-121.468068	Sacramento County
18742	Fee-for-Service	1487649711	1487649711	1	1	KULAWIAK, PATRICIA W MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66816	02	General Surgery	0	In state provider	None	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	49	06097	38.62729851	-122.8637785	Sonoma County
18803	Fee-for-Service	1760493506	1760493506	1	1	KEVIN THOMAS BROWN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5325 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.81283161	-96.83881481	Dallas County
18824	Fee-for-Service	1104115450	1104115450	1	1	KANG, HUN MD INC	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61497	08	Family Practice	0	In state provider	None	2900 W 8TH STREET	None	LOS ANGELES	CA	90005	1524	19	06037	34.05771353	-118.2892832	Los Angeles County
18826	Fee-for-Service	1417554528	1417554528	1	2	KECK MEDICAL CENTER OF USC	8/4/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	5832 BEACH BLVD	SUITE 201	BUENA PARK	CA	90621	5501	30	06059	33.875469	-117.9981525	Orange County
18858	Fee-for-Service	1548310105	1548310105	1	1	KHORRAM, KAMBIZ OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1191 GALLERIA BLVD	None	ROSEVILLE	CA	95678	1935	31	06061	38.77545636	-121.2706043	Placer County
18871	Fee-for-Service	1225052590	1225052590	1	1	KAYZAK H MELKONIAN	2/15/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	GLORY MEDICAL SUPPLY	1727 W BURBANK BLVD	None	BURBANK	CA	91506	1312	19	06037	34.18135984	-118.330363	Los Angeles County
18948	Fee-for-Service	1083694319	1083694319	1	1	KINGS EYE CENTER MEDICAL	4/16/1997	261Q00000X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1395 W LACEY BLVD	None	HANFORD	CA	93230	5904	16	06031	36.32798439	-119.6660001	Kings County
18956	Fee-for-Service	1417554528	1417554528	1	3	KECK MEDICAL CENTER OF USC	9/2/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	625 S FAIR OAKS BLVD	STE 365	PASADENA	CA	91105	2682	19	06037	34.134894	-118.1504155	Los Angeles County
18958	Fee-for-Service	1992062186	1992062186	1	1	KARIMI, FEROZAN MD	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121179	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18965	Fee-for-Service	1669853768	1669853768	1	1	KOROT, EDWARD MD	6/30/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168016	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18975	Fee-for-Service	1841291549	1841291549	1	1	KELLY,JULIE L	11/4/2010	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2818 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047846	-124.1361634	Humboldt County
19002	Fee-for-Service	1265938054	1265938054	1	1	KHOSHABIAN, COLIN NP	3/8/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19021	Fee-for-Service	1861050494	1861050494	1	1	KAPADIA, NAHEL N MD	7/22/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	177966	41	Internal Medicine	0	In state provider	None	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	34	06067	38.567007	-121.468068	Sacramento County
19026	Fee-for-Service	1033554381	1033554381	1	1	KONG, CALVIN MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140444	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19051	Fee-for-Service	1598330763	1598330763	1	1	KROPP, ROBERT G MD	5/2/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
19056	Fee-for-Service	1396740841	1396740841	1	1	KRATKA, REED F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KRATKA, REED F. MD	1200 HILYARD STREET	SUITE 470	EUGENE	OR	97401	8110	00	None	44.04616862	-123.082151	Lane County
19057	Fee-for-Service	1114269685	1114269685	1	1	KUNAM, NEELIMA MD	9/24/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159299	36	Psychiatry	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
19060	Fee-for-Service	1699065029	1699065029	1	1	KAMERMAN, TIFFANY L DO	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12462	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
19062	Fee-for-Service	1770518771	1770518771	1	1	KHAN, SHAHID M MD	9/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	49009	41	Internal Medicine	0	In state provider	VALLEY HEALTHCARE INC	17075 DEVONSHIRE ST	STE 104	NORTHRIDGE	CA	91325	5406	19	06037	34.25755945	-118.50471	Los Angeles County
19109	Fee-for-Service	1851319503	1851319503	1	1	KWON, KENNETH MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80161	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
19112	Fee-for-Service	1104115450	1104115450	1	1	KANG, HUN MD INC	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61497	40	Pediatrics	0	In state provider	None	2900 W 8TH STREET	None	LOS ANGELES	CA	90005	1524	19	06037	34.05771353	-118.2892832	Los Angeles County
19124	Fee-for-Service	1063575678	1063575678	1	1	KOVAR, CARYN G PHD	8/2/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19161	Fee-for-Service	1477015089	1477015089	1	1	KHONG, ASIANNA	8/19/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2716 S VERMONT AVE	UNIT 9	LOS ANGELES	CA	90007	2671	19	06037	34.029891	-118.2915225	Los Angeles County
19182	Fee-for-Service	1689677866	1689677866	1	1	KROEGER,MICHAEL R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 SO 90TH STREET	None	OMAHA	NE	68114	3907	00	None	41.25896385	-96.05251169	Douglas County
19186	Fee-for-Service	1053439992	1053439992	1	1	KIM, ANDREA H MD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141592	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
19223	Fee-for-Service	1285253468	1285253468	1	1	KERRIGAN, DANIELLE MD	7/29/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
19236	Fee-for-Service	1881762870	1881762870	1	1	KROMBACH, JENS MD	6/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92984	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
19249	Fee-for-Service	1437221611	1437221611	1	1	KAPOOR, NIMMI S MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116258	02	General Surgery	0	In state provider	None	230 SOUTH MAIN ST	STE 100	ORANGE	CA	92868	3851	30	06059	33.785154	-117.867318	Orange County
19268	Fee-for-Service	1780404236	1780404236	1	1	KINDER, SHELLY LCSW	10/31/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
19277	Fee-for-Service	1992201677	1992201677	1	1	KAGANJO, PETER MD	9/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165977	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
19285	Fee-for-Service	1932434628	1932434628	1	1	KAUFMAN, JENYA A MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109755	36	Psychiatry	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
19329	Fee-for-Service	1003647918	1003647918	1	1	KLEFFEL, MARLENE DOULA	8/6/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
19348	Fee-for-Service	1629180179	1629180179	1	1	KIMBERLY L GORDON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
19351	Fee-for-Service	1700272309	1700272309	1	1	KIM, ROY B MD	3/23/2020	207L00000X	NA	Other	026	PHYSICIANS	160872	05	Anesthesiology	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
19373	Fee-for-Service	1366176943	1366176943	1	1	KADENCE HEALTHCARE, INC	2/17/2023	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2370 WESTWOOD BLVD	STE D	LOS ANGELES	CA	90064	2120	19	06037	34.0408993	-118.4291065	Los Angeles County
19384	Fee-for-Service	1770661522	1770661522	1	1	KATZ, SIMONE L MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70483	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
19396	Fee-for-Service	1033375605	1033375605	1	1	KIMBERLY N MEREDITH, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ONE CHILDREN'S PLACE	1 CHILDRENS PL	# 5	SAINT LOUIS	MO	63110	1002	00	None	38.63728519	-90.26492064	St. Louis city
19423	Fee-for-Service	1922364900	1922364900	1	2	KO, ELI J LMFT	1/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3001 RED HILL AVE.	BUILDING 1 SUITE 221	COSTA MESA	CA	92626	4529	30	06059	33.67355743	-117.8787954	Orange County
19458	Fee-for-Service	1154429389	1154429389	1	1	KENT, DIANA M MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149482	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 SOUTH OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
19499	Fee-for-Service	1326726118	1326726118	1	1	KELLY KAO ACUPUNCTURE & WELL	8/23/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NESS CENTER PROFESSIONAL	920 SARATOGA AVE	105A	SAN JOSE	CA	95129	3403	43	06085	37.30971921	-121.9773167	Santa Clara County
19502	Fee-for-Service	1699013441	1699013441	1	1	KIM, HANSOL MD	9/20/2018	2085R0204X	NA	Other	026	PHYSICIANS	147348	30	Radiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
19517	Fee-for-Service	1578742888	1578742888	1	1	KAO, LILY MD	8/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100943	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95150	5280	43	06085	37.313433	-121.9318385	Santa Clara County
19529	Fee-for-Service	1780025338	1780025338	1	1	KAE, MELISSA B PSYD	2/7/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
19547	Fee-for-Service	1477500775	1477500775	1	1	KESSLER, HOWARD B MD	5/23/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171860	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
19615	Fee-for-Service	1114242047	1114242047	1	1	KURANI, MOHAMAD MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127540	41	Internal Medicine	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
19629	Fee-for-Service	1013965359	1013965359	1	1	KAMATH, SACHIN S MD	5/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53361	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 TAYLOR BLVD	# 202	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
19636	Fee-for-Service	1316290521	1316290521	1	1	KARA, ARMEN G MD	5/17/2016	207L00000X	NA	Other	026	PHYSICIANS	119214	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
19676	Fee-for-Service	1932428513	1932428513	1	1	KEILANI, LOUAY MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112071	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
19681	Fee-for-Service	1750439535	1750439535	1	1	KAISER FOUND HLTH PLAN	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #336	2238 GEARY BLVD	FL 6	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
19691	Fee-for-Service	1477895803	1477895803	1	1	KOTHARI, RISHI P MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147914	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
19699	Fee-for-Service	1720041379	1720041379	1	1	KINORI, ILAN MD	3/24/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87458	30	Radiology	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
19723	Fee-for-Service	1457641433	1457641433	1	1	KELLER, KAREN M MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122375	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
19753	Fee-for-Service	1043993926	1043993926	1	1	KATE PHARMACEUTICAL CORP	11/15/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13394 LIMONITE AVE	STE. B120	EASTVALE	CA	92880	7272	33	06065	33.97535937	-117.5754567	Riverside County
19771	Fee-for-Service	1881157972	1881157972	1	1	KIM, JENNIFER J DO	8/21/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	19464	None	None	0	In state provider	None	7695 CARDINAL CT	STE 240	SAN DIEGO	CA	92123	3357	37	06073	32.79146985	-117.1578472	San Diego County
19812	Fee-for-Service	1578742888	1578742888	1	1	KAO, LILY MD	8/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100943	83	Rheumatology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95150	5280	43	06085	37.313433	-121.9318385	Santa Clara County
19825	Fee-for-Service	1427462795	1427462795	1	1	KRASS, LAURIE M MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
19907	Fee-for-Service	1831695667	1831695667	1	1	KIM, DO YOUNG MD	7/17/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	186070	None	None	0	In state provider	None	8135 S PAINTER AVENUE	SUITE 103	WHITTIER	CA	90602	3171	19	06037	33.965829	-118.032738	Los Angeles County
19918	Fee-for-Service	1013965359	1013965359	1	1	KAMATH, SACHIN S MD	5/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53361	30	Radiology	0	In state provider	None	400 TAYLOR BLVD	# 202	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
20043	Fee-for-Service	1972790178	1972790178	1	1	KIN, CINDY MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102131	02	General Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20048	Fee-for-Service	1740376656	1740376656	1	1	KELL, KELLIE T NP	3/5/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
20077	Fee-for-Service	1164794673	1164794673	1	1	KADRY-HASSANEIN, MOHAMED M	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135448	41	Internal Medicine	0	In state provider	None	1020 29TH ST	SUITE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
20079	Fee-for-Service	1184091985	1184091985	1	1	KANG, SOPHIA LMFT	6/23/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
20083	Fee-for-Service	1841283009	1841283009	1	1	KOH, JOHN J MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	31915	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2876 SYCAMORE DR	STE 200	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
20109	Fee-for-Service	1396708772	1396708772	1	1	KALHOR, NASIM DPM	5/8/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	230 W PUEBLO ST	STE 1	SANTA BARBARA	CA	93105	6818	42	06083	34.43081942	-119.7216759	Santa Barbara County
20146	Fee-for-Service	1881115632	1881115632	1	1	KOHN, LISA A MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	147349	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
20147	Fee-for-Service	1972571263	1972571263	1	1	KOGLER, JURGEN W MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	30978	68	Hematology	0	In state provider	None	8008 FROST ST	STE 300	SAN DIEGO	CA	92123	4230	37	06073	32.80027859	-117.1524832	San Diego County
20150	Fee-for-Service	1215971148	1215971148	1	1	KERLAN, ROBERT K JR MD	10/31/1984	2085R0204X	NA	Other	026	PHYSICIANS	38916	30	Radiology	0	In state provider	None	505 PARNASSUS AVE	STE 628	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
20159	Fee-for-Service	1295048551	1295048551	1	1	KAO, RICHARD MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117556	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
20168	Fee-for-Service	1700010311	1700010311	1	1	KARIA, PRATIMA MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115252	30	Radiology	0	In state provider	None	8750 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	2713	19	06037	34.06685846	-118.3829408	Los Angeles County
20200	Fee-for-Service	1770868069	1770868069	1	1	KEHOEJERGENS, SUSAN LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 EAST FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
20233	Fee-for-Service	1750955704	1750955704	1	1	KIM, DEBORAH	11/11/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
20300	Fee-for-Service	1124467519	1124467519	2	1	KAVIAN, RONAK MD	6/9/2023	207R00000X	NA	Other	026	PHYSICIANS	141394	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
20303	Fee-for-Service	1326687120	1326687120	1	1	KELLY, KYLE J NP	3/26/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	360 S LOLA LN	None	PAHRUMP	NV	89048	0884	00	None	36.214524	-116.025615	Nye County
20314	Fee-for-Service	1487765863	1487765863	1	1	KRISDAKUMTORN, THANA DPM	4/17/2003	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
20330	Fee-for-Service	1043579113	1043579113	1	1	KALTMAN, JESSICA M MD	8/25/2015	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	128448	41	Internal Medicine	0	In state provider	None	200 ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.06481928	-118.3836235	Los Angeles County
20337	Fee-for-Service	1790883080	1790883080	1	1	KEFALIDES, PAUL T MD	1/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75614	41	Internal Medicine	0	In state provider	None	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
20341	Fee-for-Service	1477694214	1477694214	1	1	KELLER OPTOMETRIC, INC.	2/26/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36891 COOK ST	STE 7	PALM DESERT	CA	92211	6063	33	06065	33.77991452	-116.3558533	Riverside County
20342	Fee-for-Service	1982917225	1982917225	1	1	KIRINGODA, RUWAN MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120942	04	Otology, Laryngology, Rhinology	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
20423	Fee-for-Service	1801844881	1801844881	1	1	KASSUBA, SONJA MD	3/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51995	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
20451	Fee-for-Service	1982768396	1982768396	1	1	KRISHNANKUTTY, REKHA MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73226	40	Pediatrics	0	In state provider	None	2240 E GONZALES ROAD	SUITE 260	OXNARD	CA	93036	8220	56	06111	34.21873112	-119.1469396	Ventura County
20460	Fee-for-Service	1548454341	1548454341	1	1	KIM, JUDONG MD	12/7/2007	207R00000X	NA	Other	026	PHYSICIANS	94669	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
20528	Fee-for-Service	1811068455	1811068455	1	1	KAYE, DAVID B MD INC	10/23/2013	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	NATURAL VISION MED GRP	6767 N FRESNO ST	None	FRESNO	CA	93710	3709	10	06019	36.83686637	-119.7813437	Fresno County
20564	Fee-for-Service	1629410022	1629410022	1	1	KAIROS PSYCHOLOGY PC	7/25/2024	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	790 MASON ST	STE 102	VACAVILLE	CA	95688	4661	48	06095	38.3550515	-121.9832505	Solano County
20603	Fee-for-Service	1376784678	1376784678	1	1	KHANLOU, NEGAR MD	9/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91536	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
20614	Fee-for-Service	1992890297	1992890297	1	1	KROETTINGER, BIANCA	6/23/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	STE 100	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
20620	Fee-for-Service	1457905093	1457905093	1	1	KELLY, LEONA LMFT	12/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
20630	Fee-for-Service	1366530107	1366530107	1	1	KATZ, MITCHELL H MD	1/18/1982	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	46842	40	Pediatrics	0	In state provider	None	1580 VALENCIA ST	RM 200	SAN FRANCISCO	CA	94110	4423	38	06075	37.74746923	-122.4202583	San Francisco County
20633	Fee-for-Service	1831175421	1831175421	1	1	KOK, MITCHELL P MD	12/16/2022	2085N0700X	NA	MRI Provider	026	PHYSICIANS	178082	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
20691	Fee-for-Service	1467531822	1467531822	1	1	KHAN, AUSIM MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95234	41	Internal Medicine	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
20703	Fee-for-Service	1558555870	1558555870	1	1	KHU, JAMES M MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108989	18	Ophthalmology	0	In state provider	None	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
20706	Fee-for-Service	1205924784	1205924784	1	1	KEEM, SEAN K MD	6/4/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	168800	20	Orthopedic Surgery	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
20719	Fee-for-Service	1316389265	1316389265	1	1	KHAN, YASIR A MD	8/28/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	138396	68	Hematology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20730	Fee-for-Service	1750946729	1750946729	2	1	KATHRYN MADUFORO	2/14/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11223 LOCKWOOD DR	None	SILVER SPRING	MD	20901	4554	00	None	39.03916986	-76.99148192	Montgomery County
20735	Fee-for-Service	1013397058	1013397058	1	1	KELLOGG, KORNELIA R DO	4/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17509	15	Obstetrics (D.O. only)	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
20737	Fee-for-Service	1982768396	1982768396	1	1	KRISHNANKUTTY, REKHA MD	4/1/2010	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 E GONZALES ROAD	SUITE 260	OXNARD	CA	93036	8220	56	06111	34.21873112	-119.1469396	Ventura County
20742	Fee-for-Service	1750310496	1750310496	1	2	KELAITA, DEAN M MD	4/6/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	80069	-	NOT APPLICABLE	0	In state provider	None	7260 O'BRYNES FERRY RD	None	COPPEROPOLIS	CA	95228	9245	05	06009	37.89619081	-120.5739836	Calaveras County
20770	Fee-for-Service	1659727915	1659727915	1	1	KIM, JOSEPH H MD	4/10/2020	208M00000X	NA	Other	026	PHYSICIANS	150477	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
20788	Fee-for-Service	1477578193	1477578193	1	1	KATZ, JAMES R MD INC	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45640	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	201 S ALVARADO ST	STE 415	LOS ANGELES	CA	90057	2353	19	06037	34.06417777	-118.2719543	Los Angeles County
20805	Fee-for-Service	1548404262	1548404262	1	1	KELLY, DON R LCSW	12/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18245 HWY 18	STE 6	APPLE VALLEY	CA	92307	2217	36	06071	34.54026632	-117.2656302	San Bernardino County
20813	Fee-for-Service	1811068455	1811068455	1	1	KAYE, DAVID B MD INC	9/30/1990	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	NATURAL VISION MED GRP	6767 N FRESNO ST	None	FRESNO	CA	93710	3709	10	06019	36.83686637	-119.7813437	Fresno County
20818	Fee-for-Service	1699816850	1699816850	1	1	KO, JIM S CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	18750 COLIMA RD	STE D	ROWLAND HEIGHTS	CA	91748	2962	19	06037	33.98769568	-117.8941434	Los Angeles County
20829	Fee-for-Service	1568623635	1568623635	1	1	KABBANY, VICTOR J MD	6/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103370	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
20846	Fee-for-Service	1508896440	1508896440	1	1	KINSLEYDAME, GAIL J LMFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2702 CLAYTON ROAD	None	CONCORD	CA	94519	2789	07	06013	37.97495822	-122.0271497	Contra Costa County
20851	Fee-for-Service	1629410022	1629410022	1	1	KAIROS PSYCHOLOGY PC	7/25/2024	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	790 MASON ST	STE 102	VACAVILLE	CA	95688	4661	48	06095	38.3550515	-121.9832505	Solano County
20859	Fee-for-Service	1265580138	1265580138	1	1	KAISER PERMANENTE PHCY	7/26/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#552	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
20883	Fee-for-Service	1689917171	1689917171	1	1	KALAM, SHARMIN MD	7/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148310	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
20975	Fee-for-Service	1508831678	1508831678	1	1	KELEDJIAN, VARUJAN A MD	11/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46647	10	Gastroenterology (M.D. only)	0	In state provider	None	3903 LONE TREE WAY	STE 205	ANTIOCH	CA	94509	9329	07	06013	37.98216807	-121.8054744	Contra Costa County
20986	Fee-for-Service	1467522086	1467522086	1	1	KERR, MELISSA A CRNA	6/5/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
20989	Fee-for-Service	1063433068	1063433068	1	1	KONTAXIS, EUTHYM MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53131	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
21020	Fee-for-Service	1467795203	1467795203	1	1	KUVHENGUHWA, MAITA S MD	5/5/2018	207R00000X	NA	Other	026	PHYSICIANS	132619	77	Infectious Disease	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
21025	Fee-for-Service	1013397058	1013397058	1	1	KELLOGG, KORNELIA R DO	4/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17509	08	Family Practice	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
21034	Fee-for-Service	1841584349	1841584349	1	1	KO, JUNE J MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132731	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
21045	Fee-for-Service	1922044239	1922044239	1	1	KIMMEL, DOUGLAS J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	24 2ND AVE SW	None	ABERDEEN	SD	57401	4115	00	None	45.46312848	-98.4890295	Brown County
21069	Fee-for-Service	1942714233	1942714233	1	1	KEITZ, BRITNI PT	11/11/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1500 16TH ST FL 2	None	SAN FRANCISCO	CA	94103	5112	38	06075	37.76615387	-122.4020523	San Francisco County
21077	Fee-for-Service	1477578193	1477578193	1	1	KATZ, JAMES R MD INC	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45640	41	Internal Medicine	0	In state provider	None	201 S ALVARADO ST	STE 415	LOS ANGELES	CA	90057	2353	19	06037	34.06417777	-118.2719543	Los Angeles County
21094	Fee-for-Service	1750725511	1750725511	1	1	KINTALA, SREELATA MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144573	01	General Practice	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
21108	Fee-for-Service	1043263353	1043263353	1	1	KOSS, WEGA MD	7/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	72727	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
21111	Fee-for-Service	1699845982	1699845982	1	1	KAGAN, BEVERLY L LCSW	10/5/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7828 HAVEN AVE	105	RANCHO CUCAMONGA	CA	91730	3049	36	06071	34.111854	-117.5759995	San Bernardino County
21143	Fee-for-Service	1609079425	1609079425	1	1	KARUNANAYAKE, MALA R MD	6/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101184	22	Pathology (M.D. only)	0	In state provider	None	2615 EYE STREET	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
21156	Fee-for-Service	1336777143	1336777143	1	1	KULATTI, ART MD	10/28/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	186391	40	Pediatrics	0	In state provider	None	8701 CUYAMACA ST	None	SANTEE	CA	92071	4253	37	06073	32.83439779	-116.98366	San Diego County
21206	Fee-for-Service	1669487112	1669487112	1	1	KRISHNAPRIYAN, GEETA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50043	41	Internal Medicine	0	In state provider	None	665 S KNICKERBOCKER DR	STE 5	SUNNYVALE	CA	94087	1059	43	06085	37.37243191	-122.0590527	Santa Clara County
21225	Fee-for-Service	1952460248	1952460248	1	1	KHANAL, SANJAYA MD	1/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	54074	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	43807 N 10TH ST W	STE D	LANCASTER	CA	93534	4805	19	06037	34.6788	-118.1479295	Los Angeles County
21226	Fee-for-Service	1518053982	1518053982	1	1	KRISTIN STUKUS	2/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
21232	Fee-for-Service	1801857099	1801857099	1	1	KOSTY, MICHAEL MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43511	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
21245	Fee-for-Service	1588078141	1588078141	1	1	KIM, SOOMIE LCSW	3/14/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
21280	Fee-for-Service	1003234717	1003234717	1	1	KUSONRUKSA, MELANIE R MD	9/1/2021	207L00000X	NA	Other	026	PHYSICIANS	139310	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
21303	Fee-for-Service	1336997808	1336997808	1	1	KILGORE, BRADLEY	8/23/2024	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
21304	Fee-for-Service	1629003652	1629003652	1	1	KRAJISNIK, SANJA MD	6/17/2008	207ZP0102X	NA	Other	026	PHYSICIANS	76485	22	Pathology (M.D. only)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
21308	Fee-for-Service	1467795203	1467795203	1	1	KUVHENGUHWA, MAITA S MD	5/5/2018	207R00000X	NA	Other	026	PHYSICIANS	132619	41	Internal Medicine	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
21320	Fee-for-Service	1740354851	1740354851	1	5	KAISER FOUNDATION	5/4/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
21353	Fee-for-Service	1366855355	1366855355	1	1	KVIATKOVSKY, MILLA J DO	8/9/2017	207R00000X	NA	Other	026	PHYSICIANS	15453	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
21356	Fee-for-Service	1417045238	1417045238	1	1	KHANANASHVILI, NANI MD	5/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77565	41	Internal Medicine	0	In state provider	LEMI MEDICAL CTR INC	1838 EL CAMINO REAL	STE 100	BURLINGAME	CA	94010	3105	41	06081	37.59576691	-122.3841581	San Mateo County
21415	Fee-for-Service	1629652565	1629652565	1	1	KATZMAN, KAYLA L	11/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21416	Fee-for-Service	1003067331	1003067331	1	1	KANANI, MEERA D MD	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10244	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
21444	Fee-for-Service	1558667915	1558667915	1	1	KAUR, SAVNEET MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114757	08	Family Practice	0	In state provider	None	2151 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75424753	-121.455621	San Joaquin County
21454	Fee-for-Service	1245410588	1245410588	1	1	KOONTZ, MICHAEL Z MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105130	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	GRANT 5101	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
21485	Fee-for-Service	1982621736	1982621736	1	1	KULKARNI, MANOJ A MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77751	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
21494	Fee-for-Service	1871959312	1871959312	1	1	KARNNET, TISAYA NP	12/28/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	100 W. CALIFORNIA BLVD.	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
21497	Fee-for-Service	1114558350	1114558350	1	1	KIDSTRONG MEDICAL GROUP INC.	5/21/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	220 LAGUNA RD	SUITE 5	FULLERTON	CA	92835	2523	30	06059	33.89562646	-117.9305833	Orange County
21531	Fee-for-Service	1134508773	1134508773	1	1	KIRSTEN, DANIEL A MD	5/23/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	147256	36	Psychiatry	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 401	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
21533	Fee-for-Service	1770938201	1770938201	1	1	KHARADJIAN, TALAR MD	4/8/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	161276	None	None	0	In state provider	None	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	37	06073	33.18081595	-117.3156434	San Diego County
21562	Fee-for-Service	1740296268	1740296268	1	1	KEARNEY, LAUREN K MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83666	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
21590	Fee-for-Service	1083673644	1083673644	1	1	KAZEM, FATIMA MD	7/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84658	30	Radiology	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
21626	Fee-for-Service	1659661692	1659661692	1	1	KOSACK, AMANDA S MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	95139	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	MDCC 12311	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
21646	Fee-for-Service	1437359015	1437359015	1	1	KIMBLE, JENNIFER S MD	12/13/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	96018	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
21690	Fee-for-Service	1003120718	1003120718	1	1	KANOTRA, SOHIT P MD	8/18/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	188790	None	None	0	In state provider	None	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
21704	Fee-for-Service	1891742847	1891742847	1	1	KOSMO, MICHAEL A MD	8/4/1999	207RH0003X	NA	Oncology	026	PHYSICIANS	54074	41	Internal Medicine	0	In state provider	None	701 E GRAND AVE	None	ESCONDIDO	CA	92025	4466	37	06073	33.1249585	-117.0726834	San Diego County
21713	Fee-for-Service	1477620318	1477620318	1	1	KRAMSCH, CHRIS D MD	10/29/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55626	01	General Practice	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
21735	Fee-for-Service	1477595346	1477595346	1	1	KHAN, FARAAZ O MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80088	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
21758	Fee-for-Service	1396939724	1396939724	1	1	KHAING, THINN T MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113104	41	Internal Medicine	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
21804	Fee-for-Service	1275519670	1275519670	1	1	KRELL,JULIE MD	3/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 SOUTH PARKER RD	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
21815	Fee-for-Service	1053547778	1053547778	1	1	KHAN, FAKHAR J MD	6/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127207	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
21818	Fee-for-Service	1689618217	1689618217	1	1	KRAMER, JONAH L MD	1/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69746	40	Pediatrics	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
21838	Fee-for-Service	1932260429	1932260429	1	1	KIM, BONNIE J MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	37244	25	Physical Medicine and Rehabilitation	0	In state provider	None	27800 MEDICAL CENTER RD	STE 116	MISSION VIEJO	CA	92693	6407	30	06059	33.55952733	-117.6645199	Orange County
21863	Fee-for-Service	1386149110	1386149110	1	1	KHAMO, LARA F MD	11/9/2021	207R00000X	NA	Other	026	PHYSICIANS	174394	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
21877	Fee-for-Service	1053466961	1053466961	1	2	KAISER FOUNDATION HOSPITALS	2/7/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17284 SLOVER AVE	SUITE 105	FONTANA	CA	92337	7584	36	06071	34.065396	-117.4277475	San Bernardino County
21909	Fee-for-Service	1033394424	1033394424	1	1	KASSIS, JESSICA A MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105126	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
21975	Fee-for-Service	1235303355	1235303355	1	1	KARALIC, ANA LMFT	5/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
21981	Fee-for-Service	1306855739	1306855739	1	1	KIVNICK, SETH MD	8/5/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55614	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
22008	Fee-for-Service	1790859395	1790859395	1	1	KAVANAGH, MAIHGAN A MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86552	02	General Surgery	0	In state provider	None	1328 22ND ST	FL 3	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
22013	Fee-for-Service	1992949333	1992949333	1	1	KING, CAROL S NP	8/7/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
22037	Fee-for-Service	1730345760	1730345760	1	1	KATSUR, STEPHANY L LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
22057	Fee-for-Service	1700814043	1700814043	1	1	KNOWLES, AMY K LCSW	6/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
22080	Fee-for-Service	1215194733	1215194733	1	1	KATANA, JOHN M MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133356	01	General Practice	0	In state provider	None	408 PINE ST	None	MOUNT SHASTA	CA	96067	2126	47	06093	41.31312726	-122.3154792	Siskiyou County
22119	Fee-for-Service	1982774337	1982774337	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
22129	Fee-for-Service	1275611071	1275611071	1	1	KWONG, PANSY MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	36032	41	Internal Medicine	0	In state provider	None	11222 INGLEWOOD AVE	None	INGLEWOOD	CA	90304	0000	19	06037	33.9309843	-118.3612799	Los Angeles County
22165	Fee-for-Service	1053466961	1053466961	1	2	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17284 SLOVER AVE	SUITE 105	FONTANA	CA	92337	7584	36	06071	34.065396	-117.4277475	San Bernardino County
22168	Fee-for-Service	1518290600	1518290600	1	1	KOH, STANLEY G MD	12/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98602	05	Anesthesiology	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
22172	Fee-for-Service	1972713691	1972713691	1	1	KARROWNI, WASSEF MD	7/22/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	184400	None	None	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
22195	Fee-for-Service	1932147626	1932147626	1	1	KESAVALU, RAMESH C MD	11/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83127	83	Rheumatology	0	In state provider	None	222 W EULALIA ST	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
22198	Fee-for-Service	1558441311	1558441311	1	1	KAU HOSPITAL	4/1/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 KAMANI ST	None	PAHLA	HI	96770	0000	00	None	19.20200793	-155.474099	Hawaii County
22227	Fee-for-Service	1164445417	1164445417	1	1	KHAN, JEHANZEB MD	10/20/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175443	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
22241	Fee-for-Service	1356601520	1356601520	1	1	KIM, KYUNG H LAC	3/16/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3460 WILSHIRE BLVD	STE 500	LOS ANGELES	CA	90010	2223	19	06037	34.06172649	-118.299546	Los Angeles County
22269	Fee-for-Service	1194046821	1194046821	1	1	KATHPALIA, PRIYA MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130316	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
22272	Fee-for-Service	1881881787	1881881787	1	1	KIM, BRIAN S MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92254	30	Radiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
22332	Fee-for-Service	1275600249	1275600249	1	1	KARAMEDIN, FRANGIS MD	5/1/1996	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	50034	40	Pediatrics	0	In state provider	None	3680 E IMPERIAL HWY	STE 306	LYNWOOD	CA	90262	2662	19	06037	33.93211641	-118.2011728	Los Angeles County
22338	Fee-for-Service	1346336070	1346336070	1	1	KIM, MICHEAL P MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70418	08	Family Practice	0	In state provider	None	7919 FOLSOM BLVD	None	SACRAMENTO	CA	95826	2616	34	06067	38.551185	-121.4117505	Sacramento County
22365	Fee-for-Service	1538186507	1538186507	1	1	KERCSMAR,CAROLYN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	0000	00	None	39.14105892	-84.50040782	Hamilton County
22392	Fee-for-Service	1205271517	1205271517	1	1	KIM, WILLIAM G MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135937	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
22421	Fee-for-Service	1457892374	1457892374	1	1	KASHI, MAYUR DO	10/28/2019	207P00000X	NA	Other	026	PHYSICIANS	16696	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
22439	Fee-for-Service	1992026496	1992026496	1	1	KHRAISHA, NESREEN MD	9/24/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	167650	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
22450	Fee-for-Service	1528140639	1528140639	1	2	KHATORE, MANOJ M	1/3/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	65348	None	None	0	In state provider	None	1901 OUTLET CENTER DR	260	OXNARD	CA	93036	0667	56	06111	34.21965581	-119.1491337	Ventura County
22457	Fee-for-Service	1376201947	1376201947	1	1	KSGS RX INC	11/2/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21910 VENTURA BLVD	None	WOODLAND HILLS	CA	91364	1724	19	06037	34.16843148	-118.6042545	Los Angeles County
22493	Fee-for-Service	1508444076	1508444076	1	1	KORNFELD, JACK E MD	5/24/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
22519	Fee-for-Service	1598860637	1598860637	1	1	KING, KIP L MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64157	None	None	0	In state provider	None	105 CATHERINE LN	None	GRASS VALLEY	CA	95945	5705	29	06057	39.23007785	-121.047319	Nevada County
22528	Fee-for-Service	1588732911	1588732911	1	1	KWAAN, MARY R MD	3/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154058	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
22540	Fee-for-Service	1215247978	1215247978	1	1	KND DEVELOPMENT 53 LLC	11/1/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1246 W 155TH STREET	None	GARDENA	CA	90247	4011	19	06037	33.89050425	-118.297444	Los Angeles County
22559	Fee-for-Service	1346558392	1346558392	1	1	KLUFAS, MICHAEL A MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130267	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
22623	Fee-for-Service	1093711384	1093711384	1	1	KRAKORA, GEORGE A MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
22673	Fee-for-Service	1417452715	1417452715	1	1	KIM, CHONG MD	7/27/2020	390200000X	NA	Other	026	PHYSICIANS	166583	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
22679	Fee-for-Service	1053466953	1053466953	1	3	KAISER FOUNDATION HOSPITALS	2/9/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12254 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2804	19	06037	33.921405	-118.125323	Los Angeles County
22692	Fee-for-Service	1093133175	1093133175	1	1	KO, HUAISING C MD	10/14/2019	2085R0203X	NA	Other	026	PHYSICIANS	160134	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
22696	Fee-for-Service	1265746994	1265746994	1	1	KANDUKURI, SHIVANI R MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127205	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
22710	Fee-for-Service	1841450103	1841450103	1	1	KYUREGHIAN, ROBERT R MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123012	05	Anesthesiology	0	In state provider	None	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4618	19	06037	34.22145548	-118.4566005	Los Angeles County
22732	Fee-for-Service	1811214216	1811214216	2	3	KABAFUSION, LLC	12/6/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17777 CENTER COURT DR N	SUITE 175	CERRITOS	CA	90703	9337	19	06037	33.8693357	-118.0609689	Los Angeles County
22754	Fee-for-Service	1255089165	1255089165	1	1	KIMBURI, DOROTHY M	3/24/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12402 FEATHER DRIVE	None	EASTVALE	CA	91752	1483	33	06065	33.96039928	-117.5541147	Riverside County
22767	Fee-for-Service	1730654195	1730654195	1	1	KELEJIAN, SUSAN LCSW	3/12/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E DAILY DR	210	CAMARILLO	CA	93010	5806	56	06111	34.21906637	-119.0621709	Ventura County
22794	Fee-for-Service	1265510028	1265510028	1	1	KWATRA, MEENU MD	8/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85450	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
22798	Fee-for-Service	1578016283	1578016283	1	1	KIRSCH, HANNAH LCSW	2/21/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
22811	Fee-for-Service	1609196302	1609196302	1	1	KUPERMAN, JULIE M K MD	10/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130086	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BLDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
22830	Fee-for-Service	1215247978	1215247978	1	1	KND DEVELOPMENT 53 LLC	11/1/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1246 W 155TH STREET	None	GARDENA	CA	90247	4011	19	06037	33.89050425	-118.297444	Los Angeles County
22835	Fee-for-Service	1821482753	1821482753	1	1	KIRONDE, TENDO S MD	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155875	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
22922	Fee-for-Service	1225321292	1225321292	1	1	KUJOK, HUSSAM MD INC	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92291	41	Internal Medicine	0	In state provider	None	3609 MISSION AVE	SUITE A	CARMICHAEL	CA	95608	2955	34	06067	38.63052	-121.3559145	Sacramento County
22927	Fee-for-Service	1548792344	1548792344	1	1	KIZOR, RUSSELL MD	9/9/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	5333 HOLLISTER AVE	STE 130	SANTA BARBARA	CA	93111	3317	42	06083	34.43491982	-119.8105484	Santa Barbara County
22969	Fee-for-Service	1053466953	1053466953	1	3	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12254 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2804	19	06037	33.921405	-118.125323	Los Angeles County
22983	Fee-for-Service	1265746994	1265746994	1	1	KANDUKURI, SHIVANI R MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127205	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
23013	Fee-for-Service	1750353496	1750353496	1	1	KOBAYASHI, MICHAEL K OD	9/7/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27830 BRADLEY RD	None	SUN CITY	CA	92586	2201	33	06065	33.71615891	-117.1906431	Riverside County
23042	Fee-for-Service	1255089165	1255089165	1	1	KIMBURI, DOROTHY M	3/24/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12402 FEATHER DRIVE	None	EASTVALE	CA	91752	1483	33	06065	33.96039928	-117.5541147	Riverside County
23056	Fee-for-Service	1770550345	1770550345	1	1	KELLER, STEPHEN R OD	2/26/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36891 COOK ST	STE 7	PALM DESERT	CA	92211	6063	33	06065	33.77991452	-116.3558533	Riverside County
23169	Fee-for-Service	1285915488	1285915488	1	1	KOLLER, SARAH E MD	11/13/2019	208C00000X	NA	General Surgery	026	PHYSICIANS	154534	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
23188	Fee-for-Service	1891996773	1891996773	1	1	KIM, JENNIFER K MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77203	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
23219	Fee-for-Service	1891099024	1891099024	1	1	KOOYMAN, DOUGLAS CRNA	2/22/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
23235	Fee-for-Service	1790705150	1790705150	1	1	KLESSIG, JILL M MD	1/1/1995	207R00000X	NA	Other	026	PHYSICIANS	52264	None	None	0	In state provider	DEPT OF MEDICINE PROF	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
23245	Fee-for-Service	1265870729	1265870729	1	1	KELLEY, BRIDGET D MD	10/7/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164072	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
23339	Fee-for-Service	1730232786	1730232786	1	1	KIRKPATRICK, IAIN D C MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84018	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23340	Fee-for-Service	1346821345	1346821345	1	1	KAUR, RAMANDEEP MD	9/27/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
23344	Fee-for-Service	1518645993	1518645993	1	1	KAMAU, ERIC MACHARIA	8/2/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	16945 RAIL WAY	None	LATHROP	CA	95330	8641	39	06077	37.80727503	-121.3098149	San Joaquin County
23346	Fee-for-Service	1205099504	1205099504	1	1	KLINE, MICHELLE D MFT	4/27/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52573	-	NOT APPLICABLE	0	In state provider	None	1341 N ESCONDIDO BLVD	None	ESCONDIDO	CA	92026	2507	37	06073	33.14046993	-117.0924096	San Diego County
23384	Fee-for-Service	1760553515	1760553515	1	1	KLEIN, KAREN O MD	12/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76034	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	# 210	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
23424	Fee-for-Service	1750600458	1750600458	1	1	KESSLER, MOIRA K MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125267	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23456	Fee-for-Service	1215236997	1215236997	1	1	KOVSHILOVSKY, MIKHAIL MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125512	05	Anesthesiology	0	In state provider	None	3330 W LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
23476	Fee-for-Service	1346504206	1346504206	1	1	KUPSKY, DANIEL MD	10/1/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	155145	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
23515	Fee-for-Service	1164996203	1164996203	1	1	KWON, SANGHYEUK	4/10/2025	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10933 MAIN ST.,	UNIT D7	EL MONTE	CA	90630	3510	19	06037	34.07451696	-118.0366845	Los Angeles County
23521	Fee-for-Service	1417973777	1417973777	1	1	KIRK, GERALD A MD	11/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	15364	01	General Practice	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
23523	Fee-for-Service	1487282638	1487282638	1	1	KISER, JEFFREY MD	6/8/2023	207P00000X	NA	Other	026	PHYSICIANS	21177	None	None	0	In state provider	None	1800 SPRING RIDGE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
23547	Fee-for-Service	1407099492	1407099492	1	1	KIM, DAVID S MEDICAL INC	2/16/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61312	None	None	0	In state provider	None	2010 WILSHIRE BLVD	STE 707	LOS ANGELES	CA	90057	3595	19	06037	34.05748989	-118.2750432	Los Angeles County
23569	Fee-for-Service	1639755598	1639755598	1	1	KOEWLER, RYAN R DO	8/22/2024	207P00000X	NA	Other	026	PHYSICIANS	22782	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
23578	Fee-for-Service	1790015311	1790015311	1	1	KANN, DYLAN C MD	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110039	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
23631	Fee-for-Service	1518645993	1518645993	1	1	KAMAU, ERIC MACHARIA	8/2/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	16945 RAIL WAY	None	LATHROP	CA	95330	8641	39	06077	37.80727503	-121.3098149	San Joaquin County
23657	Fee-for-Service	1588712392	1588712392	1	1	KAISER PERM PHCY #155	7/1/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17197 MARYGOLD AVE	None	FONTANA	CA	92335	1705	36	06071	34.0739247	-117.4291588	San Bernardino County
23703	Fee-for-Service	1750586459	1750586459	1	1	KAPILA, KIRAN MD	2/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54217	41	Internal Medicine	0	In state provider	None	3755 BEACON AVE	None	FREMONT	CA	94538	1411	01	06001	37.54813209	-121.9825183	Alameda County
23730	Fee-for-Service	1114998606	1114998606	1	1	KING, KELLY E MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83650	41	Internal Medicine	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
23737	Fee-for-Service	1760019285	1760019285	1	1	KADDEN, DANIEL MD	7/5/2024	2080H0002X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
23745	Fee-for-Service	1740508209	1740508209	1	1	KIM, THERESA H J MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126951	40	Pediatrics	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
23747	Fee-for-Service	1306197520	1306197520	1	1	KIM, EUNICE MD	5/1/2020	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	13325	38	Geriatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
23758	Fee-for-Service	1497026439	1497026439	1	1	KAPOOR, VISHWA MD INC	2/6/2012	193400000X	NA	Other	026	PHYSICIANS	41870	40	Pediatrics	0	In state provider	None	1550 PEPPER DR	STE B-C	EL CENTRO	CA	92243	4165	13	06025	32.77910638	-115.5707385	Imperial County
23772	Fee-for-Service	1083679377	1083679377	1	1	KANOFSKY, MYRON R MD	9/30/1987	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40010	None	None	0	In state provider	None	1010 W LA VETA AVE	STE 775	ORANGE	CA	92868	4306	30	06059	33.78028244	-117.8635552	Orange County
23775	Fee-for-Service	1285054940	1285054940	1	1	KAMBHAMPATI, SWETHA MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148053	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
23781	Fee-for-Service	1982730396	1982730396	1	1	KOMAIKO, MITCHELL S MD	7/31/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	16842	30	Radiology	0	In state provider	None	444 S SAN VICENTE BLVD	FL 1	LOS ANGELES	CA	90048	4165	19	06037	34.06999878	-118.3755119	Los Angeles County
23809	Fee-for-Service	1720698582	1720698582	1	1	KAKOLU, ANUSHA M PHD	10/26/2024	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
23811	Fee-for-Service	1417973777	1417973777	1	1	KIRK, GERALD A MD	11/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	15364	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
23848	Fee-for-Service	1144278938	1144278938	1	1	KROCHMAL, ROBERT P MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73623	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
23855	Fee-for-Service	1407897549	1407897549	1	1	KIM SCHOCK	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
23859	Fee-for-Service	1346393378	1346393378	1	1	KING, ROSA L MD	10/30/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155981	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
23862	Fee-for-Service	1639195837	1639195837	1	1	KINGSLEY, JOLENE A DO	7/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7894	08	Family Practice	0	In state provider	None	2480 SONOMA STREET	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
23911	Fee-for-Service	1558998880	1558998880	1	1	KING, MATTHEW R MD	7/3/2023	207R00000X	NA	Other	026	PHYSICIANS	187299	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
23954	Fee-for-Service	1194835058	1194835058	1	1	KATZMAN, LOUIS J MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	27392	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
23982	Fee-for-Service	1285953364	1285953364	1	1	KELLER, BENJAMIN A MD	9/1/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	118158	85	Surgery-Pediatric	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
24007	Fee-for-Service	1710986740	1710986740	2	1	KHAN, HAMEED A MD	9/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	31453	08	Family Practice	0	In state provider	None	21350 HAWTHORNE BLVD	SUITE 259	TORRANCE	CA	90503	5653	19	06037	33.8344453	-118.3529294	Los Angeles County
24016	Fee-for-Service	1962821629	1962821629	1	1	KOHANCHI, DAVID MD	7/19/2019	207L00000X	NA	Other	026	PHYSICIANS	159433	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
24051	Fee-for-Service	1659436426	1659436426	1	1	KATHRYN FALLON AND	8/11/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES OPTOMETRISTS	6700 FALLBROOK AVE	STE 190	WEST HILLS	CA	91307	3941	19	06037	34.192332	-118.623381	Los Angeles County
24059	Fee-for-Service	1871535633	1871535633	1	1	KOLLA, SRINIVAS R MD	6/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93364	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
24079	Fee-for-Service	1962616656	1962616656	1	1	KAY, JAMES L DO	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9075	40	Pediatrics	0	In state provider	None	32221 CAMINO CAPISTRANO	STE B103	SAN JUAN CAPISTRA	CA	92675	3713	30	06059	33.49460586	-117.6626476	Orange County
24135	Fee-for-Service	1144278938	1144278938	1	1	KROCHMAL, ROBERT P MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73623	08	Family Practice	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
24143	Fee-for-Service	1114039153	1114039153	1	2	KATICS, MATTHEW J DO	1/22/2018	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	9228	01	General Practice	0	In state provider	None	1304 ELLA ST	SUITE A	SAN LUIS OBISPO	CA	93401	4100	40	06079	35.27704692	-120.6496857	San Luis Obispo County
24158	Fee-for-Service	1568546398	1568546398	1	1	KLEIN, SCOTT MD	12/31/1992	207R00000X	NA	Other	026	PHYSICIANS	71558	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
24224	Fee-for-Service	1053817353	1053817353	1	1	KAMBLE, SEEMA DO	1/5/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19151	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1601 N MONTE VISTA AVE	STE 190	CLAREMONT	CA	91711	6601	19	06037	34.112259	-117.698539	Los Angeles County
24244	Fee-for-Service	1194835058	1194835058	1	1	KATZMAN, LOUIS J MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	27392	02	General Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
24264	Fee-for-Service	1295294049	1295294049	1	1	KONYN, PETER G MD	6/22/2022	207R00000X	NA	Other	026	PHYSICIANS	178123	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
24265	Fee-for-Service	1801215793	1801215793	1	1	KINNEBREW, MELISSA A MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139953	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
24268	Fee-for-Service	1285953364	1285953364	1	1	KELLER, BENJAMIN A MD	9/1/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	118158	02	General Surgery	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
24274	Fee-for-Service	1467984260	1467984260	1	1	KANIN, MARALEE R MD	6/1/2020	208M00000X	NA	Other	026	PHYSICIANS	160394	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
24291	Fee-for-Service	1932539699	1932539699	1	1	KHORRAMI, KATAYOUN S MD	12/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127528	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST FOURTH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
24343	Fee-for-Service	1942074638	1942074638	1	1	KOEHLER, LEONOR	5/8/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5113 WHITMAN WAY	APT 314	CARLSBAD	CA	92008	9214	37	06073	33.13999749	-117.3036461	San Diego County
24373	Fee-for-Service	1104339761	1104339761	1	1	KERN COMMUNITY COLLEGE	7/1/2017	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1801 PANORAMA DRIVE	None	BAKERSFIELD	CA	93305	1219	15	06029	35.407539	-118.972026	Kern County
24375	Fee-for-Service	1881621621	1881621621	1	1	KRAEMER, ERIC J MD	10/16/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	113036	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
24392	Fee-for-Service	1225209810	1225209810	1	1	KHAI QUAN TRAN MD INC	7/22/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	100786	08	Family Practice	0	In state provider	None	15068 MORAN ST	None	WESTMINSTER	CA	92683	6505	30	06059	33.7434963	-117.9672691	Orange County
24451	Fee-for-Service	1811946072	1811946072	1	1	KOVACS, ILDIKO K MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72403	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
24457	Fee-for-Service	1760422323	1760422323	1	1	KHAN, RAFAT MD	11/1/1998	207L00000X	NA	Other	026	PHYSICIANS	56136	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
24465	Fee-for-Service	1396893111	1396893111	1	1	KAISER FOUNDATION HOSP	11/17/1975	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #202	4647 ZION AVE	RM A	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
24467	Fee-for-Service	1710118849	1710118849	1	1	KAPLAN, JILL F MD	10/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110974	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
24471	Fee-for-Service	1548740426	1548740426	1	1	KOMAR, KRISTINA M NP	8/31/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	840 S AKERS ST	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
24482	Fee-for-Service	1689787582	1689787582	1	1	KUERSTEN, MARTIN MD	12/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	49298	01	General Practice	0	In state provider	None	658 WASHINGTON ST	None	RED BLUFF	CA	96080	3321	52	06103	40.17665125	-122.2355737	Tehama County
24564	Fee-for-Service	1609137397	1609137397	1	1	KIMURA, YOSHIKO LCSW	8/20/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	76815	-	NOT APPLICABLE	0	In state provider	None	3837,3839,3841,3843,3845	3847 TELEGRAPH AVE	OAKLAND	CA	94609	2419	01	06001	0	0	None
24601	Fee-for-Service	1093002792	1093002792	1	1	KOTHARI, MANSI M MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130825	41	Internal Medicine	0	In state provider	None	11333 N SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
24631	Fee-for-Service	1942074638	1942074638	1	1	KOEHLER, LEONOR	5/8/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5113 WHITMAN WAY	APT 314	CARLSBAD	CA	92008	9214	37	06073	33.13999749	-117.3036461	San Diego County
24638	Fee-for-Service	1699279372	1699279372	1	1	KARALIUS, VYTAS P MD	7/6/2022	207P00000X	NA	Other	026	PHYSICIANS	179470	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
24660	Fee-for-Service	1053466953	1053466953	1	5	KAISER FOUNDATION HOSPITALS	2/9/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1502 W COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06975232	-117.9394512	Los Angeles County
24661	Fee-for-Service	1104339761	1104339761	1	1	KERN COMMUNITY COLLEGE	7/2/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1801 PANORAMA DRIVE	None	BAKERSFIELD	CA	93305	1219	15	06029	35.407539	-118.972026	Kern County
24666	Fee-for-Service	1104951227	1104951227	1	1	KHAN, RAHEEL A DO	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10420	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
24680	Fee-for-Service	1043433535	1043433535	1	1	KIM, JI-EON MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99557	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
24684	Fee-for-Service	1386629970	1386629970	1	1	KASIM, SIDIKA E MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	33466	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
24688	Fee-for-Service	1972522860	1972522860	1	1	KENDRICK, ELIZABETH A MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	58777	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
24712	Fee-for-Service	1689744328	1689744328	1	1	KO, ANDREW P MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76901	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
24735	Fee-for-Service	1336463363	1336463363	1	1	KOPELOW, STANLEY MD INC	4/23/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	14728	18	Ophthalmology	0	In state provider	None	16311 VENTURA BLVD	SUITE 750	ENCINO	CA	91436	4325	19	06037	34.15706864	-118.4885978	Los Angeles County
24740	Fee-for-Service	1023167541	1023167541	1	1	KERN COUNTY DEPARTMENT	6/20/1993	251K00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PUBLIC HEALTH	1800 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	3302	15	06029	35.383626	-118.967417	Kern County
24741	Fee-for-Service	1912926502	1912926502	1	1	KHAN, UZMA MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92001	36	Psychiatry	0	In state provider	None	2101 7TH ST	None	WASCO	CA	93280	1502	15	06029	35.59426049	-119.3498955	Kern County
24744	Fee-for-Service	1033267992	1033267992	1	1	KAISER PERMANENTE PHAR	8/13/1987	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#502	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
24754	Fee-for-Service	1730492992	1730492992	1	1	KLEIN, CORINNE N MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127008	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
24807	Fee-for-Service	1841382330	1841382330	1	1	KOLPE, MANASI V MD	10/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102950	36	Psychiatry	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
24834	Fee-for-Service	1881761708	1881761708	1	1	KO, JACQUELINE Y MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75370	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
24887	Fee-for-Service	1316993884	1316993884	1	1	KERN EMERGENCY PHYSICIAN	3/27/1989	207PE0004X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
24901	Fee-for-Service	1700113248	1700113248	1	1	KASTAN, ERIC LMFT	11/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7672 S. AVALON BLVD.	None	LOS ANGELES	CA	90003	2346	19	06037	33.969483	-118.265141	Los Angeles County
24930	Fee-for-Service	1043487663	1043487663	1	1	KANDASWAMY, SHUNMUGA P MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105400	08	Family Practice	0	In state provider	None	830 SOUTH HAM LANE	SUITE 28	LODI	CA	95242	7510	39	06077	38.123568	-121.2882225	San Joaquin County
24944	Fee-for-Service	1710074133	1710074133	1	1	KOGAN, MILTON L MD	4/30/1992	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	28785	01	General Practice	0	In state provider	None	5901 W OLYMPIC BLVD	STE 300	LOS ANGELES	CA	90036	4675	19	06037	34.05764121	-118.3603115	Los Angeles County
24948	Fee-for-Service	1104339761	1104339761	1	1	KERN COMMUNITY COLLEGE	6/22/2018	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1801 PANORAMA DRIVE	None	BAKERSFIELD	CA	93305	1219	15	06029	35.407539	-118.972026	Kern County
24949	Fee-for-Service	1053466953	1053466953	1	5	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1502 W COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06975232	-117.9394512	Los Angeles County
24959	Fee-for-Service	1790730398	1790730398	1	1	KHAN, MUHAMMAD Q MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
24967	Fee-for-Service	1043433535	1043433535	1	1	KIM, JI-EON MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99557	24	Plastic Surgery	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
24978	Fee-for-Service	1972522860	1972522860	1	1	KENDRICK, ELIZABETH A MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	58777	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
24984	Fee-for-Service	1457416265	1457416265	1	1	KEVORKIAN, SIRANDOSH MD	11/3/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	35663	08	Family Practice	0	In state provider	None	1437 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	5015	19	06037	34.01175497	-118.159261	Los Angeles County
25022	Fee-for-Service	1568955680	1568955680	1	1	KAUR, AVNEET MD	8/19/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173528	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
25025	Fee-for-Service	1689616278	1689616278	1	1	KINNAN, KENNETH W MD	1/1/1979	207L00000X	NA	Other	026	PHYSICIANS	22729	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
25044	Fee-for-Service	1730492992	1730492992	1	1	KLEIN, CORINNE N MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127008	77	Infectious Disease	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
25068	Fee-for-Service	1346482569	1346482569	1	1	KJIRSTEN ANNE SWENSON	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
25074	Fee-for-Service	1477829448	1477829448	1	1	KIM, JOANNE H MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129382	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
25086	Fee-for-Service	1922020783	1922020783	1	1	KIRK, JOHN H MD	11/22/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54807	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 TRANCAS ST	STE 209	NAPA	CA	94558	2908	28	06055	38.32316569	-122.2981938	Napa County
25091	Fee-for-Service	1598720427	1598720427	1	1	KIM, JULIAN MD	8/9/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60721	None	None	0	In state provider	None	1310 HANNA AVE	None	CORCORAN	CA	93212	2314	16	06031	36.09975818	-119.5641426	Kings County
25102	Fee-for-Service	1982720975	1982720975	1	1	KALANTARI, BABAK N MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90858	30	Radiology	0	In state provider	None	24401 CALLE DE LA LOUISA	STE 200	LAGUNA HILLS	CA	92653	0000	30	06059	33.60941999	-117.7083212	Orange County
25103	Fee-for-Service	1083676761	1083676761	1	1	KLINE, STEVEN L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	1	Border provider	A PROFESSIONAL CORP	276 KINGSBURY GRADE	STE 103	STATELINE	NV	89449	9800	00	None	38.96840207	-119.9291194	Douglas County
25124	Fee-for-Service	1801059555	1801059555	1	1	KHAN, TIPU V MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110206	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3009	56	06111	34.27623479	-119.2520218	Ventura County
25152	Fee-for-Service	1962537613	1962537613	1	1	KNIPE, KARL B PSYD	9/19/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
25170	Fee-for-Service	1578982427	1578982427	1	1	KLOOSTERBOER, AMY L MD	9/16/2020	207L00000X	NA	Other	026	PHYSICIANS	138117	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
25176	Fee-for-Service	1801814850	1801814850	1	1	KOLLY, CHRISTOPHER M DO	11/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10246	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
25201	Fee-for-Service	1518926252	1518926252	1	1	KARAOGLAN, DEHA K DPM	1/16/2008	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1041 4TH STREET	SUITE B	SANTA ROSA	CA	95404	4329	49	06097	38.444229	-122.7061935	Sonoma County
25223	Fee-for-Service	1689638587	1689638587	1	1	KUMAR, VIJAY MD	7/31/1993	174400000X	NA	Other	026	PHYSICIANS	46673	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2925 SYCAMORE DR	STE 310	SIMI VALLEY	CA	93065	1209	56	06111	34.288398	-118.7439175	Ventura County
25248	Fee-for-Service	1891728226	1891728226	1	2	KOMOTO PHARMACY INC	7/6/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2110 TRUXTUN	STE. 100	BAKERSFIELD	CA	93301	3703	15	06029	35.37344851	-119.0261655	Kern County
25349	Fee-for-Service	1881631406	1881631406	1	1	KENYON, JONATHAN MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87338	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
25360	Fee-for-Service	1831831486	1831831486	1	1	KINTSUGI FAMILY COUNSELING G	6/21/2022	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ROUP INC	14201 KENTWOOD BLVD	SUITE 2	VICTORVILLE	CA	92392	2472	36	06071	34.508862	-117.327461	San Bernardino County
25389	Fee-for-Service	1316100837	1316100837	1	1	KENNEDY, JEFFREY D MD	6/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117447	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
25422	Fee-for-Service	1336251115	1336251115	1	1	KASS, MICHAEL A MD	4/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37218	40	Pediatrics	0	In state provider	None	3831 HUGHES AVE	STE 607	CULVER CITY	CA	90232	6850	19	06037	34.02243278	-118.3981492	Los Angeles County
25425	Fee-for-Service	1063499937	1063499937	1	1	KOUTNOUYAN, HRAIR A MD	2/12/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79321	04	Otology, Laryngology, Rhinology	0	In state provider	None	1505 WILSON TER	STE 270	GLENDALE	CA	91206	4078	19	06037	34.14960934	-118.2313491	Los Angeles County
25444	Fee-for-Service	1033362348	1033362348	1	1	KYAING, MI MI MD	1/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96940	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
25455	Fee-for-Service	1083479984	1083479984	1	1	KIM, SUJIN	3/7/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4200 CHINO HILLS PKWY	STE 800	CHINO HILLS	CA	91709	3785	36	06071	33.98274451	-117.7129305	San Bernardino County
25486	Fee-for-Service	1104997956	1104997956	1	1	KADOTA, RICHARD P MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54677	40	Pediatrics	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
25511	Fee-for-Service	1689638587	1689638587	1	1	KUMAR, VIJAY MD	7/31/1993	174400000X	NA	Other	026	PHYSICIANS	46673	41	Internal Medicine	0	In state provider	None	2925 SYCAMORE DR	STE 310	SIMI VALLEY	CA	93065	1209	56	06111	34.288398	-118.7439175	Ventura County
25536	Fee-for-Service	1114248390	1114248390	1	1	KELLY, MARY K MD	11/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132897	05	Anesthesiology	0	In state provider	None	351 S PATTERSON AVENUE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
25582	Fee-for-Service	1972773604	1972773604	1	1	KIM, MOSES M MD	8/30/2022	208800000X	NA	Other	026	PHYSICIANS	107538	None	None	0	In state provider	None	23961 CALLE DE LA MAGDAL	500	LAGUNA HILLS	CA	92653	7622	30	06059	33.60999658	-117.7126577	Orange County
25585	Fee-for-Service	1407039571	1407039571	1	1	KATZ, MAOR MD	5/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105648	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
25607	Fee-for-Service	1598774184	1598774184	1	1	KARZ, ALLEN E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	10039	41	Internal Medicine	0	In state provider	None	23861 MCBEAN PKWY	STE C14	VALENCIA	CA	91355	2003	19	06037	34.39567343	-118.5542698	Los Angeles County
25637	Fee-for-Service	1467549642	1467549642	1	1	KIM, YEUEN MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63650	41	Internal Medicine	0	In state provider	None	795 WILLOW RD	BLDG 324	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
25641	Fee-for-Service	1184735235	1184735235	1	1	KIDNEY SPECIALISTS MEDIC	8/8/1996	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SO CAL NEPH MED ASSOC	101 E BEVERLY BLVD	STE 304	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
25659	Fee-for-Service	1992733729	1992733729	1	1	KITTAMS, DAVID W MD	10/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	23042	40	Pediatrics	0	In state provider	None	1744 ALCATRAZ AVE	None	BERKELEY	CA	94703	2713	01	06001	37.84860565	-122.2722184	Alameda County
25673	Fee-for-Service	1568968584	1568968584	1	1	KOMURE, AMY K MD	9/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165128	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
25693	Fee-for-Service	1598232407	1598232407	1	1	KENWARD, MOLLY F NP	12/18/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
25705	Fee-for-Service	1467866459	1467866459	1	1	KAUFMAN, SALLY A MD	1/8/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140759	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
25734	Fee-for-Service	1780866285	1780866285	2	1	KLEPPE, KRISTIN PHD	8/10/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7700 IRVINE CENTER DR	STE 800	IRVINE	CA	92618	3047	30	06059	33.65876225	-117.7500004	Orange County
25752	Fee-for-Service	1568449965	1568449965	1	1	KHEMKA, MAHAVEER P MD	8/8/1995	193400000X	NA	Other	026	PHYSICIANS	25263	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1211 W LA PALMA AVE	STE 410	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
25755	Fee-for-Service	1629485842	1629485842	1	1	KYUNG, DANIEL G MD	7/8/2020	207R00000X	NA	Other	026	PHYSICIANS	164213	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
25772	Fee-for-Service	1104997956	1104997956	1	1	KADOTA, RICHARD P MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54677	68	Hematology	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
25798	Fee-for-Service	1750745394	1750745394	1	1	KUMAR, AVNEE MD	9/12/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	179043	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25813	Fee-for-Service	1376835389	1376835389	1	1	KUIZON, KATRINA CRNA	2/8/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONTE AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
25865	Fee-for-Service	1457325631	1457325631	1	1	KREIT,JOHN W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3601 FIFTH AVE 4TH	FLOOR	PITTSBURGH	PA	15213	0000	00	None	40.44135069	-79.95912416	Allegheny County
25868	Fee-for-Service	1003013277	1003013277	1	1	KALKIN, BENJAMIN M	3/9/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
25894	Fee-for-Service	1467745851	1467745851	1	1	KOHAN, NICOLE K MD	2/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118414	18	Ophthalmology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
25896	Fee-for-Service	1598774184	1598774184	1	1	KARZ, ALLEN E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	10039	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	23861 MCBEAN PKWY	STE C14	VALENCIA	CA	91355	2003	19	06037	34.39567343	-118.5542698	Los Angeles County
25898	Fee-for-Service	1942377841	1942377841	1	1	KALANJIAN, SHANT MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
25919	Fee-for-Service	1053474981	1053474981	1	1	KAMTHAN-SANJAY VINITA	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76838	40	Pediatrics	0	In state provider	MD	795 WILLOW RD	BLDG 334	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
25921	Fee-for-Service	1114529377	1114529377	1	1	KELLY, KARI C CNP	1/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	137 S ASPEN COURT	SUITE B	VISALIA	CA	93291	5381	54	06107	36.32885419	-119.3529996	Tulare County
26028	Fee-for-Service	1376591339	1376591339	1	1	KNOWLTON, KIRK MD	8/1/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60895	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
26057	Fee-for-Service	1164570776	1164570776	1	1	KAISER FOUNDATION HLTH	4/11/1995	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHY 502	350 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92742846	-122.0296765	Contra Costa County
26098	Fee-for-Service	1245271683	1245271683	1	1	KIM, SUNG T MD	12/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52842	05	Anesthesiology	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
26129	Fee-for-Service	1912054248	1912054248	1	1	KAISER FOUNDATION HEALTH	12/17/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL PKWY	LOBBY FL, RM 2015	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
26159	Fee-for-Service	1326119173	1326119173	1	1	KAHN, JEFFREY J PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
26189	Fee-for-Service	1164565727	1164565727	1	1	KRISHNAMOORTHY, SARAVANAN MD	3/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133879	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
26227	Fee-for-Service	1306221262	1306221262	1	1	KAZEM, HARON H DC	7/13/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
26261	Fee-for-Service	1215078399	1215078399	1	1	KRYSTAL, ALAN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74558	08	Family Practice	0	In state provider	None	1582 W SAN MARCOS BLVD	STE 100	SAN MARCOS	CA	92078	4081	37	06073	33.13145446	-117.202167	San Diego County
26272	Fee-for-Service	1447855101	1447855101	1	1	KATHY T'S TRANSPORTATION LLC	1/12/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	9648 9TH AVE	STE 5	HESPERIA	CA	92345	3471	36	06071	34.42572072	-117.3201159	San Bernardino County
26327	Fee-for-Service	1235187634	1235187634	1	1	KAKAR, SANJAY MD	6/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80937	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
26328	Fee-for-Service	1427225630	1427225630	1	1	KANDEEL, AHMED F MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116332	02	General Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
26330	Fee-for-Service	1861649931	1861649931	1	1	KLEIN, KEITH L MD FACP FASN	1/12/2016	207RN0300X	NA	Nephrology	026	PHYSICIANS	22950	None	None	0	In state provider	INC	99 NORTH LA CIENEGA	STE 302	BEVERLY HILLS	CA	90211	2283	19	06037	34.06736471	-118.3763201	Los Angeles County
26339	Fee-for-Service	1457456519	1457456519	1	1	KAHN, ROBERT I MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33338	34	Urology and Urological Surgery	0	In state provider	None	2100 WEBSTER STREET	#222	SAN FRANCISCO	CA	94115	2376	38	06075	37.7904826	-122.4324477	San Francisco County
26354	Fee-for-Service	1013361427	1013361427	1	1	KHAN, IMRAN S MD	6/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156254	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
26369	Fee-for-Service	1346459831	1346459831	1	1	KANG, WOOK S MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103373	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
26385	Fee-for-Service	1851928907	1851928907	1	1	KLAPMAN, SETH MD	4/27/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
26402	Fee-for-Service	1245385244	1245385244	1	1	KAISER FOUNDATION HOSPITALS	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8010 PARKWAY DR	SUITE 6, ROOM 235	LA MESA	CA	91942	2104	37	06073	32.7749024	-117.0246371	San Diego County
26442	Fee-for-Service	1992067508	1992067508	1	1	KIM, JENNIFER A MD	9/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127415	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
26450	Fee-for-Service	1295849602	1295849602	1	1	KEITH A MILLER M.D.	5/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2300 S 16TH	STE 600	LINCOLN	NE	68506	0000	00	None	40.78813482	-96.69915653	Lancaster County
26457	Fee-for-Service	1427084987	1427084987	1	1	KAMALI MEDICAL CORPORATION	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43041	10	Gastroenterology (M.D. only)	0	In state provider	None	5750 DOWNEY AVE	STE 202	LAKEWOOD	CA	90712	1470	19	06037	33.859611	-118.1511435	Los Angeles County
26499	Fee-for-Service	1609020312	1609020312	1	1	KARAM, SANA D MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
26505	Fee-for-Service	1013047596	1013047596	1	1	KARBASSIOUN, MONICA S PSYD	9/29/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ES	73 W SIERRA MADRE BLVD	100	SIERRA MADRE	CA	91024	2462	19	06037	34.16192088	-118.0543747	Los Angeles County
26519	Fee-for-Service	1598261943	1598261943	1	1	KUKURUZA, KELSEY R DO	8/4/2022	207L00000X	NA	Other	026	PHYSICIANS	17817	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
26538	Fee-for-Service	1407987498	1407987498	1	1	KOSSUTH, SARA R DO PC	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8025	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
26569	Fee-for-Service	1215076252	1215076252	1	1	KANDRA, BEA MD	7/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	68491	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
26585	Fee-for-Service	1316996002	1316996002	2	1	KAMATH, SADHANA P MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53268	41	Internal Medicine	0	In state provider	None	43112 N 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
26588	Fee-for-Service	1528351459	1528351459	1	1	KATSMAN, ALINA MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124126	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
26590	Fee-for-Service	1902805914	1902805914	1	1	KANEGAE, THOMAS H MD INC	8/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	25710	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1245 WILSHIRE BVLD	STE 217	LOS ANGELES	CA	90017	0000	19	06037	34.05362775	-118.2661889	Los Angeles County
26616	Fee-for-Service	1235187634	1235187634	1	1	KAKAR, SANJAY MD	6/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80937	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
26619	Fee-for-Service	1336600261	1336600261	1	1	KLEIN, KATELYN H MD	9/8/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178490	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
26647	Fee-for-Service	1881804664	1881804664	1	1	KELLY C GORDON DUBS MD	11/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 PETTIT AVE	None	BELLMORE	NY	11710	3657	00	None	40.669137	-73.530135	Nassau County
26651	Fee-for-Service	1912448564	1912448564	1	1	KISSEN, MICHAEL S MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135031	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	W HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
26676	Fee-for-Service	1144228396	1144228396	1	1	KURERA, HEATHER M DO	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12214	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
26690	Fee-for-Service	1619035870	1619035870	1	1	KOH, HEEJUNG OD	9/20/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18337 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2762	19	06037	33.9885213	-117.9051368	Los Angeles County
26694	Fee-for-Service	1144674128	1144674128	1	1	KALANTARYAN, SHUSHAN	2/1/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
26736	Fee-for-Service	1174907927	1174907927	1	1	KIM, ADELINE J MD	9/4/2020	207L00000X	NA	Other	026	PHYSICIANS	168156	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
26739	Fee-for-Service	1427084987	1427084987	1	1	KAMALI MEDICAL CORPORATION	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43041	01	General Practice	0	In state provider	None	5750 DOWNEY AVE	STE 202	LAKEWOOD	CA	90712	1470	19	06037	33.859611	-118.1511435	Los Angeles County
26740	Fee-for-Service	1528201233	1528201233	1	1	KOTISO, FLORENCE F MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121770	41	Internal Medicine	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
26750	Fee-for-Service	1427157718	1427157718	1	1	KNOPER, STEVEN R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N. CAMPBELL AVENUE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
26752	Fee-for-Service	1417954447	1417954447	2	1	KRUGER, FREDERICK J DPM	6/8/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	530 E HERNDON AVE	STE 104	FRESNO	CA	93720	2990	10	06019	36.83764651	-119.7792307	Fresno County
26764	Fee-for-Service	1548773880	1548773880	1	1	KEIFER, LAUREN	11/27/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	350 BON AIR RD	STE 100	GREENBRAE	CA	94904	1753	21	06041	37.94974377	-122.5342016	Marin County
26768	Fee-for-Service	1831244243	1831244243	1	1	KWOK, JOYCE LAC	3/1/2024	225100000X	NA	Physical Therapist	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
26774	Fee-for-Service	1083711014	1083711014	1	1	KADIFA, FADY G MD	6/9/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50822	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
26831	Fee-for-Service	1871648907	1871648907	1	1	KINGSBURG AMBULANCE SVC	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1460 MARION ST	None	KINGSBURG	CA	93631	1927	10	06019	36.51438495	-119.5523563	Fresno County
26839	Fee-for-Service	1154558062	1154558062	1	1	KHAN, NAZMEEN K MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119475	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
26849	Fee-for-Service	1235221813	1235221813	1	1	KIRKWOOD, KENNETH J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4545 POINT FOSDICK DR NW	None	GIG HARBOR	WA	98335	1700	00	None	47.299275	-122.5792645	Pierce County
26882	Fee-for-Service	1396808622	1396808622	1	1	KOCH, MARK G LMFT	4/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
26941	Fee-for-Service	1427063981	1427063981	1	1	KETAI, LOREN H. MD	1/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
26984	Fee-for-Service	1811289911	1811289911	1	1	KAWAR, YASER F MD	2/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149135	41	Internal Medicine	0	In state provider	None	1680 EAST 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
26997	Fee-for-Service	1376165910	1376165910	1	1	KANG, JI YUN Y PSYD	6/11/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
27009	Fee-for-Service	1639219520	1639219520	2	1	KAMALA BOAST	4/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
27012	Fee-for-Service	1093863888	1093863888	1	1	KENYON, JOSEFINA J MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25309	41	Internal Medicine	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
27060	Fee-for-Service	1083711014	1083711014	1	1	KADIFA, FADY G MD	6/9/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50822	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
27071	Fee-for-Service	1174991640	1174991640	1	1	KOBOLD, DEBRA LMFT	12/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	191 SAND CREEK RD	215	BRENTWOOD	CA	94513	2215	07	06013	37.94665949	-121.7001303	Contra Costa County
27081	Fee-for-Service	1952501470	1952501470	1	1	KEENE, JOSEPH W MD	4/14/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	84228	-	NOT APPLICABLE	0	In state provider	None	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	19	06037	34.05373818	-118.3839685	Los Angeles County
27120	Fee-for-Service	1699766915	1699766915	1	1	KOHAL, SURINDER S MD	4/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50698	08	Family Practice	0	In state provider	None	1240 CENTRAL BLVD	STE A3	BRENTWOOD	CA	94513	2228	07	06013	37.93884851	-121.6980845	Contra Costa County
27186	Fee-for-Service	1780065045	1780065045	1	1	KUSHNIR, SANDRA LMFT	4/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 W OLYMPIC BLVD	STE 815E	LOS ANGELES	CA	90404	3650	19	06037	34.03273663	-118.4516927	Los Angeles County
27199	Fee-for-Service	1568040053	1568040053	1	1	KIM, RACHEL Y DO	7/11/2024	207R00000X	NA	Other	026	PHYSICIANS	22783	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
27201	Fee-for-Service	1437291499	1437291499	1	1	KAMAT, KIRAN J MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	32250	05	Anesthesiology	0	In state provider	None	18531 ROSCOE BLVD	STE 211	NORTHRIDGE	CA	91324	5970	19	06037	34.22075552	-118.5373395	Los Angeles County
27263	Fee-for-Service	1417901877	1417901877	1	1	KIM, SHWAN MD	1/25/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77747	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
27264	Fee-for-Service	1225212855	1225212855	1	1	KERR, KAIVALYA LMFT	9/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ERAPY SERVICES	8300 UTICA AVE	155	RANCHO CUCAMONGA	CA	91730	3879	36	06071	34.10227306	-117.5715643	San Bernardino County
27274	Fee-for-Service	1821146457	1821146457	1	1	KAISER FOUNDATION HEALTH	3/3/1994	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #197	9985 SIERRA AVE	FL 2	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
27304	Fee-for-Service	1548811714	1548811714	1	1	KIMANI, JOYCE W	5/7/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8415 BIANCHI RD	None	ROSEVILLE	CA	95747	9252	31	06061	38.74506298	-121.3438945	Placer County
27335	Fee-for-Service	1639241482	1639241482	1	1	KOBILKA, TONG MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61629	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
27365	Fee-for-Service	1225422744	1225422744	1	1	KIRSCHMAN, KEVIN D MD	5/25/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164746	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
27378	Fee-for-Service	1477004323	1477004323	1	1	KIM, EUN YOUNG LAC	9/18/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	801 N TUSTIN AVE	SUITE 302	SANTA ANA	CA	92705	3612	30	06059	33.752286	-117.8341735	Orange County
27400	Fee-for-Service	1639855810	1639855810	1	1	KIPP SOCAL PUBLIC SCHOOLS	7/1/2023	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1933 S BROADWAY	STE 1144	LOS ANGELES	CA	90007	4527	19	06037	34.03102377	-118.2660738	Los Angeles County
27443	Fee-for-Service	1346252129	1346252129	1	1	KENNETH P DIZON	1/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
27460	Fee-for-Service	1700168382	1700168382	1	1	KHAMLY, JASON Y MD INC	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43000	40	Pediatrics	0	In state provider	None	1314 S EUCLID ST	STE 103	ANAHEIM	CA	92802	2000	30	06059	33.815502	-117.9413935	Orange County
27488	Fee-for-Service	1609897479	1609897479	1	1	KHAN, MUNAZZA MD	9/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52926	41	Internal Medicine	0	In state provider	None	275 VICTORIA ST	STE 1E	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
27525	Fee-for-Service	1639246465	1639246465	1	1	KARPENKO, ALMIRA T MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90568	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
27550	Fee-for-Service	1811937436	1811937436	1	1	KRAM, HARRY BERNARD MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52608	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	3445 PACIFIC COAST HWY	STE 230	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
27559	Fee-for-Service	1194364356	1194364356	1	1	KEMP, MELISSA E DO	7/5/2023	207P00000X	NA	Other	026	PHYSICIANS	20908	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
27575	Fee-for-Service	1558752683	1558752683	1	1	KAWEAH DELTA HEALTH CARE DIS	9/20/2017	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	840 S AKERS ST	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
27591	Fee-for-Service	1548811714	1548811714	1	1	KIMANI, JOYCE W	5/7/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8415 BIANCHI RD	None	ROSEVILLE	CA	95747	9252	31	06061	38.74506298	-121.3438945	Placer County
27597	Fee-for-Service	1942258520	1942258520	1	1	KAO, JERRY K	3/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
27603	Fee-for-Service	1922461946	1922461946	1	1	KHONG, HOAI TRINH MD	4/6/2020	208M00000X	NA	Other	026	PHYSICIANS	166451	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
27604	Fee-for-Service	1710114616	1710114616	1	1	KEHRER, JASON D DO MD	3/5/2018	2085R0001X	NA	Other	026	PHYSICIANS	11414	32	Radiation Therapy (D.O. only)	0	In state provider	None	902 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31781109	-122.3215161	Siskiyou County
27612	Fee-for-Service	1760725709	1760725709	1	1	KRUTZSCH, NANCY J	8/12/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
27630	Fee-for-Service	1063484392	1063484392	1	1	KIM, JOHN J MD	2/28/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74910	40	Pediatrics	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
27641	Fee-for-Service	1619137148	1619137148	1	1	KIM, CHRISTOPHER J MD	9/16/2021	208600000X	NA	General Surgery	026	PHYSICIANS	117177	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
27646	Fee-for-Service	1306017017	1306017017	1	1	KITCHENS-SCHOCK, PAMELA	4/11/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
27647	Fee-for-Service	1497382220	1497382220	1	1	KONG, BUMIN MD	6/6/2023	207P00000X	NA	Other	026	PHYSICIANS	178290	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
27662	Fee-for-Service	1871754887	1871754887	1	1	KLINE, KRISTIN A AU	3/13/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 4TH ST	STE 120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
27713	Fee-for-Service	1205254265	1205254265	1	1	KING, CODY A MD	6/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171420	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
27737	Fee-for-Service	1427191055	1427191055	1	1	KHALATIAN, MARIA E MD	7/21/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	33207	40	Pediatrics	0	In state provider	None	3342 SANTA ANITA AVE	None	EL MONTE	CA	91731	2423	19	06037	34.06966178	-118.042148	Los Angeles County
27747	Fee-for-Service	1700168382	1700168382	1	1	KHAMLY, JASON Y MD INC	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43000	01	General Practice	0	In state provider	None	1314 S EUCLID ST	STE 103	ANAHEIM	CA	92802	2000	30	06059	33.815502	-117.9413935	Orange County
27750	Fee-for-Service	1730265059	1730265059	1	1	KOERNER, INES P MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
27759	Fee-for-Service	1952755225	1952755225	1	1	KAUR, NAVDEEP MD	10/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160601	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
27800	Fee-for-Service	1962794198	1962794198	1	1	KENT, WILLIAM T MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122546	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
27810	Fee-for-Service	1033668330	1033668330	1	1	KIM, JOSEPH B CRNA	10/19/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
27840	Fee-for-Service	1811937436	1811937436	1	1	KRAM, HARRY BERNARD MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52608	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3445 PACIFIC COAST HWY	STE 230	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
27855	Fee-for-Service	1609885581	1609885581	1	1	KIM, HYUNG S MD	7/15/2019	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	81497	25	Physical Medicine and Rehabilitation	0	In state provider	None	69780 STELLAR DR	SUITE A	RANCHO MIRAGE	CA	92270	2954	33	06065	33.76299197	-116.444597	Riverside County
27864	Fee-for-Service	1558752683	1558752683	1	1	KAWEAH DELTA HEALTH CARE DIS	9/20/2017	261Q00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	840 S AKERS ST	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
27877	Fee-for-Service	1013024959	1013024959	1	1	KALSI, ANUPAMA S MD	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	63937	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
27891	Fee-for-Service	1922461946	1922461946	1	1	KHONG, HOAI TRINH MD	4/6/2020	208M00000X	NA	Other	026	PHYSICIANS	166451	40	Pediatrics	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
27917	Fee-for-Service	1467613588	1467613588	1	1	KUMAR, TARUN M MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146911	01	General Practice	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
27919	Fee-for-Service	1972797926	1972797926	1	1	KOTIAN, ZARINE M MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140633	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
27942	Fee-for-Service	1164927745	1164927745	1	1	KOVACS, NICHOLAS MD	12/9/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
27948	Fee-for-Service	1730266677	1730266677	1	1	KASTLEMAN, JAMES S MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	54963	01	General Practice	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
27996	Fee-for-Service	1952895237	1952895237	1	1	KHODABAKHSHIAN, AREEN MD	9/7/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173792	None	None	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
28003	Fee-for-Service	1174701668	1174701668	1	1	KHANDHAR, SUMIT M DO	11/23/2010	390200000X	NA	Other	026	PHYSICIANS	10557	41	Internal Medicine	0	In state provider	None	3770 ELIZABETH ST	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
28069	Fee-for-Service	1225191125	1225191125	1	1	KHODADAD, SHERLY LMFT	7/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10436 SANTA MONICA BLVD	STE 3030	LOS ANGELES	CA	90025	5079	19	06037	34.05657141	-118.4249266	Los Angeles County
28126	Fee-for-Service	1811937436	1811937436	1	1	KRAM, HARRY BERNARD MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52608	02	General Surgery	0	In state provider	None	3445 PACIFIC COAST HWY	STE 230	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
28206	Fee-for-Service	1568434694	1568434694	1	1	KULKARNI, MRINALINI N MD	2/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81966	67	Endocrinology	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
28292	Fee-for-Service	1174701668	1174701668	1	1	KHANDHAR, SUMIT M DO	11/23/2010	390200000X	NA	Other	026	PHYSICIANS	10557	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3770 ELIZABETH ST	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
28318	Fee-for-Service	1093161887	1093161887	1	1	KIMBALL, PAGE O CRNA	6/2/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
28353	Fee-for-Service	1548720378	1548720378	1	1	KONG, JOANNE P MD	11/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20018	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
28366	Fee-for-Service	1659788792	1659788792	1	1	KUYORO, TOYIN NP	10/6/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
28412	Fee-for-Service	1497248231	1497248231	1	1	KORTENHOEVEN, CHRISSY J LMFT	1/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41911 5TH ST	STE 103	TEMECULA	CA	92590	2730	33	06065	33.49563559	-117.1495713	Riverside County
28481	Fee-for-Service	1124142872	1124142872	1	1	KWAN, LESLEY M OD	3/19/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
28493	Fee-for-Service	1780751248	1780751248	1	1	KANEMARU-KLEIN, NIKKI PHD	7/30/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
28495	Fee-for-Service	1043691066	1043691066	1	1	KRUMLAND, STEPHEN MD	9/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162137	08	Family Practice	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
28496	Fee-for-Service	1568434694	1568434694	1	1	KULKARNI, MRINALINI N MD	2/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81966	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
28511	Fee-for-Service	1144425935	1144425935	1	1	KRUEGER, BONNIE S PHD	9/19/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
28601	Fee-for-Service	1902122575	1902122575	1	1	KAMZAN, AUDREY D MD	8/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120135	None	None	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
28617	Fee-for-Service	1548656721	1548656721	1	1	KILLINGSWORTH, QUINN LCSW	5/2/2022	101YA0400X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
28670	Fee-for-Service	1447349006	1447349006	1	1	KHAN, ASMA MASOOD MD	3/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48900	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
28686	Fee-for-Service	1568117174	1568117174	1	1	KHANG PHARMACY LLC	11/24/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2451 S KING RD	A1	SAN JOSE	CA	95122	2540	43	06085	37.32094889	-121.8245857	Santa Clara County
28696	Fee-for-Service	1811470636	1811470636	1	1	KIROFF, KRISTEN L MD	9/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
28702	Fee-for-Service	1588721559	1588721559	1	1	KIM, DAVID C CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	BETHESDA ACUPUNCTURE	2010 WILSHIRE BLVD	STE 704	LOS ANGELES	CA	90057	3595	19	06037	34.05748989	-118.2750432	Los Angeles County
28703	Fee-for-Service	1598990475	1598990475	1	1	KAMEL, LUKE E MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125578	None	None	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
28717	Fee-for-Service	1780285262	1780285262	1	1	KAU, CELESTE Y PT	1/27/2025	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
28745	Fee-for-Service	1154318830	1154318830	1	1	KEAN, LARRY A MD	4/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88498	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
28767	Fee-for-Service	1396048351	1396048351	1	1	KO, PING-RU T MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114331	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
28779	Fee-for-Service	1760074124	1760074124	1	1	KISHOR VACHHANI MD INC	2/3/2022	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	81833 DR CARREON BLVD	SUITE 7	INDIO	CA	92201	5590	33	06065	33.70737252	-116.2365255	Riverside County
28800	Fee-for-Service	1407939465	1407939465	1	1	KUNG, MEI P INC MD	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74051	41	Internal Medicine	0	In state provider	None	325 S MAPLE AVE	STE 20	S SAN FRANCISCO	CA	94080	6315	41	06081	37.64211506	-122.4177061	San Mateo County
28808	Fee-for-Service	1013064336	1013064336	1	1	KAISER FOUNDATION HEALTH	9/18/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY 067	7825 ATLANTIC AVE	None	CUDAHY	CA	90201	5022	19	06037	33.96396181	-118.1866866	Los Angeles County
28825	Fee-for-Service	1164017257	1164017257	1	2	KOLIBA, LYNDA LMFT	8/20/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	601 S HARBOR BLVD	None	ANAHEIM	CA	92805	4527	30	06059	33.82736368	-117.9174159	Orange County
28841	Fee-for-Service	1033266390	1033266390	1	1	KHAWAM, MARJORIE J DPM	7/17/2000	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3816 WOODRUFF AVE	STE 302	LONG BEACH	CA	90808	2146	19	06037	33.828102	-118.1165525	Los Angeles County
28853	Fee-for-Service	1922007152	1922007152	1	1	KOURA, AARYAN N MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	82248	02	General Surgery	0	In state provider	None	7501 HOSPITAL DR	STE 305	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
28930	Fee-for-Service	1134197585	1134197585	1	1	KHAMNEHEI, NILOUFAR MD	12/2/2010	207R00000X	NA	Other	026	PHYSICIANS	88746	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
28934	Fee-for-Service	1437532827	1437532827	1	1	KUNIGONIS, NERINGA DPM	3/12/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	300 N EUCLID ST	STE A	FULLERTON	CA	92832	1623	30	06059	33.87250373	-117.9419615	Orange County
28947	Fee-for-Service	1750871182	1750871182	1	1	KURIA, JUDITH MUTHONI	2/16/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33098 CANOPY LN	None	LAKE ELSINORE	CA	92532	2540	33	06065	33.65746924	-117.2454503	Riverside County
28964	Fee-for-Service	1639370596	1639370596	1	1	KWOK, SOPHIE MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117636	41	Internal Medicine	0	In state provider	None	147 N BRENT	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
28981	Fee-for-Service	1801393871	1801393871	1	1	KUANG, BRANDON MD	9/20/2022	207P00000X	NA	Other	026	PHYSICIANS	164964	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
28987	Fee-for-Service	1124462932	1124462932	1	1	KRATLIAN, RAZMIG G MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
28993	Fee-for-Service	1639835721	1639835721	1	1	KOBAYASHI, MASATO PT	4/11/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
29004	Fee-for-Service	1215767983	1215767983	1	1	KATIE HUANG MD - PROFESSIONA	12/5/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	L CORPORATION	303 SANTA FE DR	None	ENCINITAS	CA	92024	5132	37	06073	33.03619553	-117.2851965	San Diego County
29008	Fee-for-Service	1912723073	1912723073	1	1	KENDALL, ERICA PT	3/24/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
29049	Fee-for-Service	1578640405	1578640405	1	1	KUO, ALBERT M MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66700	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
29052	Fee-for-Service	1003278227	1003278227	1	1	KNEEN, LINDSAY H MD	9/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	188898	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
29055	Fee-for-Service	1396048351	1396048351	1	1	KO, PING-RU T MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114331	79	Neurology-Child	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
29068	Fee-for-Service	1477767648	1477767648	1	1	KESLER-DIAZ, ANNA MD	7/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91622	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
29074	Fee-for-Service	1720514284	1720514284	1	1	KRAUSE, CASSANDRA C MD	10/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	158394	89	Surgery-Traumatic	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
29078	Fee-for-Service	1306869342	1306869342	1	1	KILIAN, BARBARA J MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104691	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
29089	Fee-for-Service	1588671242	1588671242	1	1	KOSINSKI, ANN L LCSW	4/10/2007	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	500 ESPLANADE DR	STE 1140	OXNARD	CA	93036	0558	56	06111	34.22877446	-119.1713365	Ventura County
29096	Fee-for-Service	1558568634	1558568634	1	1	KIM, DAVID S MD	5/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105173	18	Ophthalmology	0	In state provider	None	895 TRANCAS ST	None	NAPA	CA	94558	3040	28	06055	38.32406807	-122.2928218	Napa County
29140	Fee-for-Service	1922007152	1922007152	1	1	KOURA, AARYAN N MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	82248	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7501 HOSPITAL DR	STE 305	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
29144	Fee-for-Service	1366527038	1366527038	1	1	KUO, HELEN C MD	6/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74052	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
29148	Fee-for-Service	1477506236	1477506236	1	1	KRAKKER, KATE NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
29150	Fee-for-Service	1528060308	1528060308	1	1	KOO, JACQUELINE MD	12/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87738	18	Ophthalmology	0	In state provider	None	2250 HAYES ST	None	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
29173	Fee-for-Service	1487761714	1487761714	1	1	KAREN BAKER MD	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	3742	00	None	33.480864	-112.0795155	Maricopa County
29220	Fee-for-Service	1194977413	1194977413	1	1	KIM, SOYUN MD	4/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111810	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
29235	Fee-for-Service	1750871182	1750871182	1	1	KURIA, JUDITH MUTHONI	2/16/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33098 CANOPY LN	None	LAKE ELSINORE	CA	92532	2540	33	06065	33.65746924	-117.2454503	Riverside County
29237	Fee-for-Service	1154620722	1154620722	1	1	KHEMTHONG, APINUNT A DO	12/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12675	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
29247	Fee-for-Service	1285643767	1285643767	1	1	KUERSTEN, MARTIN C MD	9/30/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49298	01	General Practice	0	In state provider	None	658 WASHINGTON ST	None	RED BLUFF	CA	96080	3321	52	06103	40.17665125	-122.2355737	Tehama County
29256	Fee-for-Service	1154433258	1154433258	1	1	KIM, YEUN H NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13821 SAN ANTONIO DRIVE	None	NORWALK	CA	90650	4034	19	06037	33.90548766	-118.0792784	Los Angeles County
29279	Fee-for-Service	1326596404	1326596404	1	1	KILLAM, ELISSA CCC-SLP	6/16/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
29280	Fee-for-Service	1801271549	1801271549	1	1	KING, CHRISTOPHER M NP	9/29/2021	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
29310	Fee-for-Service	1609332501	1609332501	1	1	KIDANE, SELAM LCSW	10/22/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
29314	Fee-for-Service	1659455822	1659455822	1	1	KUNDELL, STEHPEN MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 LOS FELIZ DRIVE	None	THOUSAND OAKS	CA	91362	3153	56	06111	34.1769145	-118.8425289	Ventura County
29361	Fee-for-Service	1720514284	1720514284	1	1	KRAUSE, CASSANDRA C MD	10/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	158394	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
29364	Fee-for-Service	1700012770	1700012770	1	1	KATZEL, JED A MD	1/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109319	78	Neoplastic Diseases/Oncology	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
29377	Fee-for-Service	1861456634	1861456634	1	2	KAMATH, RAM K MD INC	2/23/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	19015 TOWN CENTER DR	STE 101	APPLE VALLEY	CA	92308	8995	36	06071	34.46573792	-117.2485123	San Bernardino County
29406	Fee-for-Service	1942280722	1942280722	1	1	KOOPMAN, JANE K MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63253	08	Family Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
29407	Fee-for-Service	1518026186	1518026186	1	1	KALT, MICHELE S MD	12/31/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51509	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
29434	Fee-for-Service	1447202254	1447202254	1	1	KIM, YOUNG H MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77832	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
29450	Fee-for-Service	1629241054	1629241054	1	1	KERSTETTER, JUSTIN C MD FACP	7/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109169	22	Pathology (M.D. only)	0	In state provider	None	11234 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
29462	Fee-for-Service	1053710228	1053710228	1	1	KADHIM, MUAYAD MD	7/5/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	184435	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
29470	Fee-for-Service	1427112366	1427112366	1	1	KRIS, MADHU K MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41735	41	Internal Medicine	0	In state provider	None	750 W OLIVE AVE	STE 107	MERCED	CA	95348	2436	24	06047	37.31917248	-120.480657	Merced County
29473	Fee-for-Service	1508807652	1508807652	1	1	KLEMENT, IVAN A MD	2/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78548	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
29475	Fee-for-Service	1790172179	1790172179	1	1	KHAZANEHDARI, SHAHAB MD	12/19/2022	2084A2900X	NA	Neurology	026	PHYSICIANS	170719	None	None	0	In state provider	None	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
29483	Fee-for-Service	1902875172	1902875172	1	1	KWASNICA,CHRISTINA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 W THOMAS RD	STE 212	PHOENIX	AZ	85013	4421	00	None	33.480558	-112.077027	Maricopa County
29506	Fee-for-Service	1417388166	1417388166	1	1	KAMIMURA, TAKAHITO DPM	10/25/2017	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1755 WEST HAMMER LANE	SUITE 7B	STOCKTON	CA	95209	2900	39	06077	38.02145403	-121.3355659	San Joaquin County
29537	Fee-for-Service	1285643767	1285643767	1	1	KUERSTEN, MARTIN C MD	9/30/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49298	08	Family Practice	0	In state provider	None	658 WASHINGTON ST	None	RED BLUFF	CA	96080	3321	52	06103	40.17665125	-122.2355737	Tehama County
29545	Fee-for-Service	1023252574	1023252574	1	1	KUZNETSOV, ANDRIY A	7/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
29557	Fee-for-Service	1457643298	1457643298	1	1	KHATRI, BHAVIK DO	5/30/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	12505	41	Internal Medicine	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
29587	Fee-for-Service	1568641207	1568641207	1	1	KARIM, SANDY LCSW	7/14/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
29595	Fee-for-Service	1073785960	1073785960	1	1	KY, NGUYEN DPM INC	9/22/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	660 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1931	43	06085	37.34260528	-121.8769383	Santa Clara County
29654	Fee-for-Service	1306883350	1306883350	1	1	KIM, JENNY J MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	76728	None	None	0	In state provider	None	200 MED PLAZA STE 450	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
29679	Fee-for-Service	1407968670	1407968670	1	1	KADEG, LARRY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
29696	Fee-for-Service	1518026186	1518026186	1	1	KALT, MICHELE S MD	12/31/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51509	41	Internal Medicine	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
29740	Fee-for-Service	1710472907	1710472907	1	1	KOFAHI, AHMAD MD	2/15/2022	207R00000X	NA	Other	026	PHYSICIANS	174234	None	None	0	In state provider	None	7060 RECREATION AVE	None	FRESNO	CA	93720	8022	10	06019	36.8388	-119.7404335	Fresno County
29760	Fee-for-Service	1427112366	1427112366	1	1	KRIS, MADHU K MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41735	10	Gastroenterology (M.D. only)	0	In state provider	None	750 W OLIVE AVE	STE 107	MERCED	CA	95348	2436	24	06047	37.31917248	-120.480657	Merced County
29778	Fee-for-Service	1427061993	1427061993	1	1	KONKIN, LESLIE A MD INC	11/23/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	24534	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1501 OAKDALE RD	STE 301	MODESTO	CA	95355	3382	50	06099	37.665279	-120.957607	Stanislaus County
29785	Fee-for-Service	1104065259	1104065259	1	1	KWAK, SHERYL J MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139253	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
29796	Fee-for-Service	1720061823	1720061823	1	1	KARIMI, KAMBIZ T MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50412	41	Internal Medicine	0	In state provider	None	30131 TOWN CENTER DR	SUITE 215	LAGUNA NIGUEL	CA	92677	2033	30	06059	33.52530096	-117.7148334	Orange County
29810	Fee-for-Service	1457454688	1457454688	1	1	KERRINS, RONNI L CRNA	11/5/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
29846	Fee-for-Service	1457643298	1457643298	1	1	KHATRI, BHAVIK DO	5/30/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	12505	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
29897	Fee-for-Service	1710968292	1710968292	1	1	KNIGHT, CURTIS	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8475 S VAN NESS AVE	STE 103	INGLEWOOD	CA	90305	1561	19	06037	33.960645	-118.317798	Los Angeles County
29902	Fee-for-Service	1326223306	1326223306	1	1	KAWALEK, ADAM Z MD	5/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98208	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
29953	Fee-for-Service	1689783839	1689783839	1	1	KUSHLAN, PAULA D MD	1/1/1982	207RX0202X	NA	Oncology	026	PHYSICIANS	31863	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
29955	Fee-for-Service	1275018681	1275018681	1	1	KAUR, RAJWINDER NP	1/1/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2559 W ROSAMOND BLVD	STE D	ROSAMOND	CA	93560	6267	15	06029	34.86420508	-118.1771868	Kern County
30006	Fee-for-Service	1841712817	1841712817	1	1	KOPILOVA, TATYANA MD	10/4/2022	208600000X	NA	General Surgery	026	PHYSICIANS	159268	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
30034	Fee-for-Service	1427240928	1427240928	1	1	KABSOUN, SARA H MD	12/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
30067	Fee-for-Service	1427061993	1427061993	1	1	KONKIN, LESLIE A MD INC	11/23/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	24534	89	Surgery-Traumatic	0	In state provider	None	1501 OAKDALE RD	STE 301	MODESTO	CA	95355	3382	50	06099	37.665279	-120.957607	Stanislaus County
30122	Fee-for-Service	1396322236	1396322236	1	1	KAHN, ELISE DO	6/12/2024	207P00000X	NA	Other	026	PHYSICIANS	20708	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
30129	Fee-for-Service	1801454400	1801454400	1	1	KEMPTON, ELIZABETH E NP	5/3/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
30135	Fee-for-Service	1790960011	1790960011	1	1	KWAN, STEPHEN K MD INC	6/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35371	41	Internal Medicine	0	In state provider	None	711 W COLLEGE STREET	SUITE 200	LOS ANGELES	CA	90012	1093	19	06037	34.06541412	-118.2414102	Los Angeles County
30138	Fee-for-Service	1316097181	1316097181	1	1	KWONG, HELEN OD	4/2/1984	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1023 9TH ST	None	SACRAMENTO	CA	95814	3507	34	06067	38.579814	-121.494897	Sacramento County
30177	Fee-for-Service	1891734265	1891734265	1	1	KOENKER, RALPLH M MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	60981	30	Radiology	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
30215	Fee-for-Service	1912073339	1912073339	1	1	KARA, SAWSAN S MD	9/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107404	40	Pediatrics	0	In state provider	None	57 EL CAMINO REAL	None	SAN CARLOS	CA	94070	2401	41	06081	37.51218912	-122.2665313	San Mateo County
30301	Fee-for-Service	1447645932	1447645932	1	1	KARP WIEFEL, HANNAH M MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146320	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
30327	Fee-for-Service	1497795140	1497795140	1	1	KARIMI, SOUSAN MD	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68107	45	Nephrology (Renal-Kidney)	0	In state provider	None	8635 W 3RD ST	STE 485	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
30368	Fee-for-Service	1427287382	1427287382	1	1	KARIM, SHAHEEN P MD	8/12/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	101536	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
30369	Fee-for-Service	1417145673	1417145673	2	1	KASHYAP, ASHWIN MD INC	12/27/2007	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	555 MARIN STREET	SUITE 200	THOUSAND OAKS	CA	91360	4105	56	06111	34.18377743	-118.8801886	Ventura County
30372	Fee-for-Service	1215383088	1215383088	1	1	KAUR, AMRITA	1/4/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2299 POST ST	STE 205	SAN FRANCISCO	CA	94115	0000	38	06075	37.78434298	-122.4392033	San Francisco County
30386	Fee-for-Service	1164780284	1164780284	1	1	KHAN, MUHAMMAD O MD	4/27/2020	207P00000X	NA	Other	026	PHYSICIANS	154588	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
30394	Fee-for-Service	1861717613	1861717613	1	1	KRIGBAUM, HENRY MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119945	20	Orthopedic Surgery	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
30424	Fee-for-Service	1790960011	1790960011	1	1	KWAN, STEPHEN K MD INC	6/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35371	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	711 W COLLEGE STREET	SUITE 200	LOS ANGELES	CA	90012	1093	19	06037	34.06541412	-118.2414102	Los Angeles County
30425	Fee-for-Service	1467639880	1467639880	1	1	KANDKHOROVA, NELLYA MD	2/6/2012	207R00000X	NA	Other	026	PHYSICIANS	107129	41	Internal Medicine	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
30438	Fee-for-Service	1730419318	1730419318	1	1	KENNEY, MELISSA L LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
30482	Fee-for-Service	1740978030	1740978030	1	1	KASEBWA, JANE COSTA	7/26/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	700 S MANHATTAN PL	APT 425	LOS ANGELES	CA	90005	4134	19	06037	34.05949133	-118.3101505	Los Angeles County
30504	Fee-for-Service	1063604676	1063604676	1	1	KAISER FND HLTH PLAN	8/27/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #885	2200 E GONZALES RD	1ST FLR	OXNARD	CA	93036	0619	56	06111	34.21872951	-119.148768	Ventura County
30539	Fee-for-Service	1073664231	1073664231	1	2	KASTNER, MARY CNP	1/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
30540	Fee-for-Service	1851349500	1851349500	1	1	KLEIN, JEROME B MD	7/23/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	154106	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
30564	Fee-for-Service	1891818332	1891818332	1	1	KHOSRAVI, AZARMINDOKHT MD	6/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116506	67	Endocrinology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
30605	Fee-for-Service	1427143973	1427143973	1	1	KEMP, NANCY L	12/1/2005	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
30609	Fee-for-Service	1497795140	1497795140	1	1	KARIMI, SOUSAN MD	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68107	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 485	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
30613	Fee-for-Service	1831299254	1831299254	1	1	KIAFAR, CAMRON DO	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	7773	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
30632	Fee-for-Service	1639181134	1639181134	1	1	KOSTRINSKY, JENNIFER DO	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8255	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
30634	Fee-for-Service	1407269673	1407269673	1	1	KARNS, JEFFREY M MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139590	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
30657	Fee-for-Service	1417145673	1417145673	2	1	KASHYAP, ASHWIN MD INC	12/27/2007	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	555 MARIN STREET	SUITE 200	THOUSAND OAKS	CA	91360	4105	56	06111	34.18377743	-118.8801886	Ventura County
30659	Fee-for-Service	1427560549	1427560549	1	1	KODAMA, KENT E LMFT	6/14/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	510 S SECOND AVE	SUITE 6 & 7	COVINA	CA	91723	3017	19	06037	34.0805013	-117.8878213	Los Angeles County
30673	Fee-for-Service	1164780284	1164780284	1	1	KHAN, MUHAMMAD O MD	4/27/2020	207P00000X	NA	Other	026	PHYSICIANS	154588	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
30678	Fee-for-Service	1336231729	1336231729	1	1	KAHANE, SHELLIE M MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73717	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
30686	Fee-for-Service	1861278053	1861278053	1	1	KUK, EFRAIN LMFT	12/9/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25050 AVENUE KEARNY	SUITE 203	VALENCIA	CA	91355	1255	19	06037	34.43517857	-118.5722781	Los Angeles County
30702	Fee-for-Service	1871912790	1871912790	1	1	KNEIB, JONATHAN MD	2/4/2020	207P00000X	NA	Other	026	PHYSICIANS	159374	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
30757	Fee-for-Service	1962522540	1962522540	1	1	KUNIHIRA, DALE V MD	5/31/2006	208800000X	NA	Other	026	PHYSICIANS	59137	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
30769	Fee-for-Service	1740978030	1740978030	1	1	KASEBWA, JANE COSTA	7/26/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	700 S MANHATTAN PL	APT 425	LOS ANGELES	CA	90005	4134	19	06037	34.05949133	-118.3101505	Los Angeles County
30783	Fee-for-Service	1982284600	1982284600	1	1	KULP, DENNIS V DO	7/22/2024	208M00000X	NA	Other	026	PHYSICIANS	22395	41	Internal Medicine	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
30787	Fee-for-Service	1922586643	1922586643	1	1	KIKER, DEVON L NP	8/13/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1187 E HERNDON AVE	SUITE 101	FRESNO	CA	93720	3166	10	06019	36.83640179	-119.7674647	Fresno County
30789	Fee-for-Service	1841827961	1841827961	1	1	KIM, JANICE MD	6/27/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30794	Fee-for-Service	1144582966	1144582966	1	1	KURIAKOSE, MIMI M MD	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
30798	Fee-for-Service	1699923698	1699923698	1	1	KIM, HELEN J MD	10/9/2008	207LP2900X	NA	Other	026	PHYSICIANS	91920	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
30813	Fee-for-Service	1952320301	1952320301	1	1	KESWANI, ANIL MD	6/1/2021	207R00000X	NA	Other	026	PHYSICIANS	55916	None	None	0	In state provider	None	9888 GENESEE AVE.	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
30831	Fee-for-Service	1336389139	1336389139	1	1	KHAN, SHAZIA S MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106856	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
30838	Fee-for-Service	1427078393	1427078393	1	1	KINGLSEY, MICHAEL C DO	12/7/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7895	08	Family Practice	0	In state provider	None	1950 ROSALINE AVENUE	STE A	REDDING	CA	96001	2543	45	06089	40.57330004	-122.3943613	Shasta County
30899	Fee-for-Service	1831299254	1831299254	1	1	KIAFAR, CAMRON DO	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	7773	10	Gastroenterology (M.D. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
30941	Fee-for-Service	1457536427	1457536427	1	1	KHVATSKY, DIMITRY M MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97563	41	Internal Medicine	0	In state provider	None	3010 COLBY STREET	#221	BERKELEY	CA	94705	2056	01	06001	37.85492078	-122.2576101	Alameda County
30942	Fee-for-Service	1972866937	1972866937	1	1	KEARNS, DEVIN T DO	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
30963	Fee-for-Service	1659716884	1659716884	1	1	KOLLI MEDICAL CORPORATION	8/17/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1600 E FLORIDA AVE	103	HEMET	CA	92544	8643	33	06065	33.74768747	-116.9557425	Riverside County
30982	Fee-for-Service	1386807386	1386807386	1	1	KHATIBI, AZADEH MD	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106465	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
31005	Fee-for-Service	1811303035	1811303035	1	1	KRISHNAMURTHY, KRUTHIKA MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149182	41	Internal Medicine	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
31035	Fee-for-Service	1326428657	1326428657	1	1	KIAN, ARY MD	3/2/2018	390200000X	NA	Other	026	PHYSICIANS	151189	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
31037	Fee-for-Service	1962597161	1962597161	1	1	KESAVARAJU, KRISHNAVENI	11/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85021	40	Pediatrics	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
31072	Fee-for-Service	1124173059	1124173059	1	1	KAISER FOUNDATION HOSPITALS	6/17/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3100 THORNTON AVE	STE 105	BURBANK	CA	91504	3183	19	06037	34.19559231	-118.3450477	Los Angeles County
31077	Fee-for-Service	1881717197	1881717197	1	1	KWOK, MICHAEL L MD	2/13/2020	207R00000X	NA	Other	026	PHYSICIANS	54075	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
31100	Fee-for-Service	1386960466	1386960466	1	1	KAREN ANN JOHNSON M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
31104	Fee-for-Service	1588898431	1588898431	1	1	KANDASWAMY, AMSAVANI MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107128	01	General Practice	0	In state provider	None	9661 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07842215	-117.4356173	San Bernardino County
31121	Fee-for-Service	1578926572	1578926572	1	1	KIM, JANE S MD	1/31/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180788	None	None	0	In state provider	None	266 S HARVARD BLVD	SUITE 500	LOS ANGELES	CA	90004	4372	19	06037	34.069221	-118.3041245	Los Angeles County
31123	Fee-for-Service	1497765028	1497765028	1	1	KAPLAN, LAWRENCE E OD	4/9/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1225 N MCDOWELL BLVD	None	SAN DIEGO	CA	94954	1112	49	06097	38.2702492	-122.6613983	Sonoma County
31148	Fee-for-Service	1811068455	1811068455	1	3	KAYE, DAVID B MD INC	10/23/2013	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 W YOSEMITE AVE	None	MADERA	CA	93637	4556	20	06039	36.95468531	-120.0704745	Madera County
31159	Fee-for-Service	1487050282	1487050282	1	1	KIM, DAVID H MD	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133023	01	General Practice	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
31187	Fee-for-Service	1821199001	1821199001	1	1	KRISHNAMOORTHY, MOHAN MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	53075	02	General Surgery	0	In state provider	None	7930 FROST ST	STE 101	SAN DIEGO	CA	92123	2756	37	06073	32.80027001	-117.1532893	San Diego County
31188	Fee-for-Service	1093895674	1093895674	1	1	KIEU, QUYNH D MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31746	40	Pediatrics	0	In state provider	None	11100 WARNER AVE	STE 116	FOUNTAIN VALLEY	CA	92708	4080	30	06059	33.716291	-117.9355051	Orange County
31205	Fee-for-Service	1609316942	1609316942	1	1	KAISER FOUNDATION HEALTH PLA	3/28/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	9455 CLAIREMONT MESA BLV	HSB 1ST FLOOR	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
31244	Fee-for-Service	1093978785	1093978785	1	1	KAPPEL, STEFANI T MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105498	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	6957	19	06037	34.06527974	-118.4462792	Los Angeles County
31248	Fee-for-Service	1669499406	1669499406	1	1	KAELIN, LORRAINE A MD	1/30/1997	207L00000X	NA	Other	026	PHYSICIANS	45728	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
31264	Fee-for-Service	1538592522	1538592522	1	1	KURIHARA, CHIE MD FAAP	8/30/2021	390200000X	NA	Other	026	PHYSICIANS	131951	None	None	0	In state provider	None	1000 WEST CARSON ST	DEPARTMENT OF PEDIATRICS	TORRANCE	CA	90509	0000	19	06037	33.83155851	-118.2920625	Los Angeles County
31267	Fee-for-Service	1841348752	1841348752	1	1	KODEL, GARY S MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58708	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
31294	Fee-for-Service	1447383401	1447383401	1	1	KIM, JEONG UN CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	504 S ALVARADO ST	STE 207	LOS ANGELES	CA	90057	2914	19	06037	34.06017399	-118.274432	Los Angeles County
31313	Fee-for-Service	1003837840	1003837840	1	1	KIM, STANLEY S MD	2/28/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	54395	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	3663 W 6TH ST	STE 200	LOS ANGELES	CA	90020	3048	19	06037	34.06360557	-118.30199	Los Angeles County
31339	Fee-for-Service	1790206407	1790206407	1	1	KAUR, SIMRANJEET MD	2/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169547	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
31342	Fee-for-Service	1316117583	1316117583	1	1	KOHLI, SATJIV S MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114547	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
31380	Fee-for-Service	1598872319	1598872319	1	1	KALIANGARA, OMANA T NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3033 BUNKER HILL ST	None	SAN DIEGO	CA	92109	5705	37	06073	32.80361012	-117.2146946	San Diego County
31390	Fee-for-Service	1679531974	1679531974	1	1	KRIVOY, DANIEL MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84941	18	Ophthalmology	0	In state provider	None	9808 VENICE BLVD	STE 400	CULVER CITY	CA	90232	6800	19	06037	34.0236396	-118.3980847	Los Angeles County
31430	Fee-for-Service	1003840174	1003840174	1	1	KLOCKMANN, MARY C NP	2/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1503 N IMPERIAL AVE	STE 105	EL CENTRO	CA	92243	6302	13	06025	32.806881	-115.5697535	Imperial County
31435	Fee-for-Service	1811068455	1811068455	1	3	KAYE, DAVID B MD INC	10/23/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1011 W YOSEMITE AVE	None	MADERA	CA	93637	4556	20	06039	36.95468531	-120.0704745	Madera County
31441	Fee-for-Service	1699771634	1699771634	1	1	KELLEDY, PATRICK MD	10/3/2018	207L00000X	NA	Other	026	PHYSICIANS	158086	05	Anesthesiology	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
31448	Fee-for-Service	1285263905	1285263905	1	1	KIM, HAI SONG DO	8/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20909	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
31464	Fee-for-Service	1760569610	1760569610	1	1	KAPADIA, CHANDRIKA MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	35992	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
31465	Fee-for-Service	1891254611	1891254611	1	1	KIM, DANIEL S MD	10/25/2023	208M00000X	NA	Other	026	PHYSICIANS	177669	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
31475	Fee-for-Service	1821199001	1821199001	1	1	KRISHNAMOORTHY, MOHAN MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	53075	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7930 FROST ST	STE 101	SAN DIEGO	CA	92123	2756	37	06073	32.80027001	-117.1532893	San Diego County
31479	Fee-for-Service	1740643493	1740643493	1	1	KRAFT, CARY A MD	8/1/2019	208M00000X	NA	Other	026	PHYSICIANS	155763	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
31493	Fee-for-Service	1184099475	1184099475	1	1	KRAUS, ADRIANNE S PT	2/29/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
31522	Fee-for-Service	1790139285	1790139285	1	1	KUWADEKAR, ADITYA MD	1/1/2024	207ZP0102X	NA	Other	026	PHYSICIANS	162870	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
31534	Fee-for-Service	1003889270	1003889270	2	1	KADENCE HEALTHCARE INC	7/29/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	KADENCE HEALTHCARE INC	10840 WALKER ST	None	CYPRESS	CA	90630	5011	30	06059	33.80639098	-118.0369399	Orange County
31615	Fee-for-Service	1033681416	1033681416	1	1	KIM, SEOKMIN LAC	12/3/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	527 PALM	104	ONTARIO	CA	91762	3215	36	06071	34.069059	-117.6538455	San Bernardino County
31631	Fee-for-Service	1568610830	1568610830	1	1	KAR, SHEILA MD AMC	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52841	41	Internal Medicine	0	In state provider	None	150 N ROBERTSON BLVD	SUITE 115	BEVERLY HILLS	CA	90211	2121	19	06037	34.06812722	-118.3837146	Los Angeles County
31646	Fee-for-Service	1588858294	1588858294	1	1	KIM, FABIANA S MD	9/5/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	101294	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
31711	Fee-for-Service	1801240965	1801240965	1	1	KOENIG, KEVIN M MD	12/17/2018	207P00000X	NA	Other	026	PHYSICIANS	150025	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
31736	Fee-for-Service	1073870242	1073870242	1	1	KWAN, MEI W MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143716	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
31772	Fee-for-Service	1558307728	1558307728	1	1	KAPLAN, ROY A MD	5/27/1998	207R00000X	NA	Other	026	PHYSICIANS	30491	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
31782	Fee-for-Service	1275928764	1275928764	1	1	KEARNS, MALCOLM D MD	7/19/2019	208M00000X	NA	Other	026	PHYSICIANS	162706	41	Internal Medicine	0	In state provider	None	1661 SOQUEL DR	STE D	SANTA CRUZ	CA	95065	1816	44	06087	36.98895429	-121.9821088	Santa Cruz County
31785	Fee-for-Service	1518184530	1518184530	1	1	KLAMATH-TRINITY JOINT	1/26/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	UNIFIED SCHOOL DISTRICT	5 LOOP RD	None	HOOPA	CA	95546	0000	12	06023	41.04938203	-123.6773104	Humboldt County
31788	Fee-for-Service	1730237702	1730237702	1	1	KAWATA, CURTIS R MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80880	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
31803	Fee-for-Service	1013367242	1013367242	1	1	KING, ANDREANNA	6/4/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
31838	Fee-for-Service	1093730814	1093730814	1	1	KOTHA, PURUSHOTHAM MD	7/11/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	41538	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2644 M ST	STE D	MERCED	CA	95340	2826	24	06047	37.31137227	-120.4794155	Merced County
31856	Fee-for-Service	1407911951	1407911951	1	1	KRAUSE, RYAN D DO	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9518	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
31857	Fee-for-Service	1609815224	1609815224	1	1	KIM, PETER L MD	3/21/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77031	08	Family Practice	0	In state provider	None	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	30	06059	33.67620851	-117.7948348	Orange County
31912	Fee-for-Service	1871852368	1871852368	1	1	KLEIN, KERRIE M CRNA	12/24/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3460 E LA PALMA AVENUE	None	ANAHEIM	CA	92806	9999	30	06059	33.85429451	-117.8446551	Orange County
31918	Fee-for-Service	1023092178	1023092178	1	1	KURT BRICKNER	1/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 NW STEWART PKWY	None	ROSEBURG	OR	97471	1281	00	None	43.2399838	-123.3665048	Douglas County
31947	Fee-for-Service	1922414101	1922414101	1	1	KAMALPOUR, FARI G DO INC	7/24/2014	207R00000X	NA	Other	026	PHYSICIANS	11842	41	Internal Medicine	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
31949	Fee-for-Service	1225203557	1225203557	1	1	KRUSICH, LINDSAY R PT	7/31/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
31993	Fee-for-Service	1972614493	1972614493	2	1	KAYICHIAN, DESPINA G MD	4/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52950	41	Internal Medicine	0	In state provider	None	1560 E CHEVY CHASE DR	STE 220	GLENDALE	CA	91206	1560	19	06037	34.15290734	-118.2302295	Los Angeles County
32000	Fee-for-Service	1891122651	1891122651	1	1	KRAMER, STEPHEN MD A MEDICAL	4/28/2014	2084P0800X	NA	Psychiatry	026	PHYSICIANS	73420	36	Psychiatry	0	In state provider	PROFESSIONAL CORPORATION	811 W 7TH ST	STE 206	LOS ANGELES	CA	90017	3413	19	06037	34.0489635	-118.2591312	Los Angeles County
32061	Fee-for-Service	1558307728	1558307728	1	1	KAPLAN, ROY A MD	5/27/1998	207R00000X	NA	Other	026	PHYSICIANS	30491	67	Endocrinology	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
32065	Fee-for-Service	1144317629	1144317629	1	1	KUHN, GILBERT J JR MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	29783	03	Allergy	0	In state provider	None	2001 SANTA MONICA BLVD	STE 865W	SANTA MONICA	CA	90404	2128	19	06037	34.02891163	-118.4797466	Los Angeles County
32104	Fee-for-Service	1003886698	1003886698	1	1	KIM, STEVEN W MD	1/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52751	68	Hematology	0	In state provider	None	8283 GROVE AVE	STE 207	RANCHO CUCAMONGA	CA	92879	1770	36	06071	34.10380433	-117.6285116	San Bernardino County
32131	Fee-for-Service	1093730814	1093730814	1	1	KOTHA, PURUSHOTHAM MD	7/11/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	41538	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2644 M ST	STE D	MERCED	CA	95340	2826	24	06047	37.31137227	-120.4794155	Merced County
32171	Fee-for-Service	1952481038	1952481038	1	1	KAO, BERNARD K MD	10/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84175	40	Pediatrics	0	In state provider	None	6501 COYLE AVE	None	SACRAMENTO	CA	95608	0000	34	06067	38.669562	-121.31379	Sacramento
32172	Fee-for-Service	1528168374	1528168374	1	1	KIM, ANJE MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79626	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94302	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32189	Fee-for-Service	1629019781	1629019781	1	1	KAHLER, DANIEL E DO	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	7235	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
32208	Fee-for-Service	1457767741	1457767741	1	1	KULLAR, RUMNEET DO	7/28/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	19004	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET ROAD	STE 165	CHICO	CA	95926	2460	04	06007	39.7519137	-121.8477606	Butte County
32232	Fee-for-Service	1497822696	1497822696	1	1	KIM, ANDREW S	12/4/1995	207R00000X	NA	Other	026	PHYSICIANS	54805	41	Internal Medicine	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
32233	Fee-for-Service	1568949782	1568949782	1	1	KHADJEVAND, FATEMEH MD	5/2/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	177896	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32256	Fee-for-Service	1366098725	1366098725	1	1	KELLER, JULIE A	10/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	214 ESTATES DRIVE,	STE. E	ROSEVILLE	CA	95682	7652	31	06061	38.74766054	-121.273092	Placer County
32280	Fee-for-Service	1972614493	1972614493	2	1	KAYICHIAN, DESPINA G MD	4/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52950	45	Nephrology (Renal-Kidney)	0	In state provider	None	1560 E CHEVY CHASE DR	STE 220	GLENDALE	CA	91206	1560	19	06037	34.15290734	-118.2302295	Los Angeles County
32326	Fee-for-Service	1982759361	1982759361	1	1	KURIAKOSE, JACOBS E MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117179	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
32355	Fee-for-Service	1144317629	1144317629	1	1	KUHN, GILBERT J JR MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	29783	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 865W	SANTA MONICA	CA	90404	2128	19	06037	34.02891163	-118.4797466	Los Angeles County
32370	Fee-for-Service	1174601819	1174601819	1	1	KUMATA, DENNIS S MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	58709	05	Anesthesiology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
32385	Fee-for-Service	1003886698	1003886698	1	1	KIM, STEVEN W MD	1/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52751	78	Neoplastic Diseases/Oncology	0	In state provider	None	8283 GROVE AVE	STE 207	RANCHO CUCAMONGA	CA	92879	1770	36	06071	34.10380433	-117.6285116	San Bernardino County
32410	Fee-for-Service	1770760043	1770760043	1	1	KHURANA, GURVIR S MD INC	11/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93172	40	Pediatrics	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
32411	Fee-for-Service	1437359650	1437359650	1	1	KIM NAYOUNG MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104761	03	Allergy	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
32449	Fee-for-Service	1447551098	1447551098	1	1	KING, ALINA T LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
32452	Fee-for-Service	1992231112	1992231112	1	1	KANAAN, SAMER MD APC	11/6/2017	208G00000X	NA	General Surgery	026	PHYSICIANS	87174	02	General Surgery	0	In state provider	None	27451 LOS ALTOS	STE 290	MISSION VIEJO	CA	92691	6394	30	06059	33.56418857	-117.6648307	Orange County
32459	Fee-for-Service	1952481038	1952481038	1	1	KAO, BERNARD K MD	10/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84175	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6501 COYLE AVE	None	SACRAMENTO	CA	95608	0000	34	06067	38.669562	-121.31379	Sacramento
32473	Fee-for-Service	1609813476	1609813476	1	1	KIM, RICHARD S MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96721	25	Physical Medicine and Rehabilitation	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
32476	Fee-for-Service	1629019781	1629019781	1	1	KAHLER, DANIEL E DO	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	7235	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
32523	Fee-for-Service	1366863565	1366863565	1	1	KAYE, STEVEN M MD INC	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	29768	None	None	0	In state provider	None	6850 VAN NUYS BLVD	SUITE 120	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
32567	Fee-for-Service	1699888917	1699888917	1	1	KURESHI, SOHAIB A MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63235	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
32573	Fee-for-Service	1306991211	1306991211	1	1	KAISER FOUNDATION HOSP	9/28/1989	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	RIVERSIDE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3000	33	06065	33.904782	-117.469323	Riverside County
32641	Fee-for-Service	1114212743	1114212743	1	2	KIM, ANGELO MD	12/12/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	8280 WARM SPRINGS RD	None	LAS VEGAS	NV	89113	3612	00	None	36.057384	-115.2721395	Clark County
32643	Fee-for-Service	1790993160	1790993160	1	1	KARAM, MATTHEW D MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
32667	Fee-for-Service	1871546333	1871546333	1	1	KALINDJIAN, KRIKOR I MD	1/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80255	41	Internal Medicine	0	In state provider	INC	1300 N VERMONT AVE	STE 807	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
32686	Fee-for-Service	1417621327	1417621327	1	1	KAISER FOUNDATION HEALTH PLA	10/20/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	923	2500 MERCED ST	BLDG H, FL 1, RM 1436	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
32688	Fee-for-Service	1245429430	1245429430	1	1	KNAUER, YURI MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95365	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
32704	Fee-for-Service	1982783023	1982783023	1	1	KATZ, PAUL H MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71022	40	Pediatrics	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
32735	Fee-for-Service	1497840888	1497840888	1	1	KUDLU, PURNIMA MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78232	40	Pediatrics	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
32741	Fee-for-Service	1992231112	1992231112	1	1	KANAAN, SAMER MD APC	11/6/2017	208G00000X	NA	General Surgery	026	PHYSICIANS	87174	33	Thoracic Surgery	0	In state provider	None	27451 LOS ALTOS	STE 290	MISSION VIEJO	CA	92691	6394	30	06059	33.56418857	-117.6648307	Orange County
32771	Fee-for-Service	1477707750	1477707750	1	1	KALIMUTHU, RAJALAKSHMI MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111649	08	Family Practice	0	In state provider	None	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	41	06081	37.47644946	-122.2110919	San Mateo County
32796	Fee-for-Service	1972633311	1972633311	1	1	KONICK, GREGORY LMFT	1/21/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2821 CROW CANYON RD	STE 202	SAN RAMON	CA	94583	1659	07	06013	37.77494135	-121.9805388	Contra Costa County
32824	Fee-for-Service	1144288242	1144288242	1	1	KAWANISHI, STANLEY MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	47724	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
32828	Fee-for-Service	1326426842	1326426842	1	1	KENNEDY, GREGORY R MD	5/8/2018	390200000X	NA	Other	026	PHYSICIANS	146207	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
32858	Fee-for-Service	1851562318	1851562318	1	1	KAGAN, LAWRENCE I MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102946	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
32859	Fee-for-Service	1699888917	1699888917	1	1	KURESHI, SOHAIB A MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63235	14	Neurological Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
32874	Fee-for-Service	1932278710	1932278710	1	1	KRIJGER, LISA C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67762	41	Internal Medicine	0	In state provider	None	165 ROWLAND WAY	STE 201	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
32899	Fee-for-Service	1679651327	1679651327	1	2	KAISER FOUNDATION HOSPITAL	9/10/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3240 ARDEN WAY	None	SACRAMENTO	CA	95864	2015	34	06067	38.594898	-121.3884765	Sacramento County
32921	Fee-for-Service	1942654538	1942654538	1	1	KIM, JOHN MD	1/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187777	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
32943	Fee-for-Service	1215998919	1215998919	1	1	KNOX, DALE G MD	11/30/1983	207P00000X	NA	Other	026	PHYSICIANS	25182	66	Emergency Medicine (Urgent Care)	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
32946	Fee-for-Service	1063973543	1063973543	1	1	KNEIBER, DIANA B MD	5/26/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	182437	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
32967	Fee-for-Service	1770514465	1770514465	1	1	KIM, MATTHEW H MD	10/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94998	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
32975	Fee-for-Service	1245429430	1245429430	1	1	KNAUER, YURI MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95365	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
32987	Fee-for-Service	1902032659	1902032659	1	1	KIDNEY CARE INSTITUTE INC	11/9/2009	193200000X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	1711 W TEMPLE STREET	STE 7200	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
32989	Fee-for-Service	1023323813	1023323813	1	1	KANANI, BABAK MD	5/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114238	41	Internal Medicine	0	In state provider	None	200 MISSION BLVD	None	JACKSON	CA	95642	2536	03	06005	38.35007723	-120.7659932	Amador County
32992	Fee-for-Service	1699279679	1699279679	1	1	KARYADI, KENNY A PHD	6/19/2020	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
32997	Fee-for-Service	1104206903	1104206903	1	1	KRBOYAN, MYDA LCSW	3/30/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2600 OLIVE	5TH FLOOR	BURBANK	CA	91505	4549	19	06037	34.15993924	-118.3307814	Los Angeles County
33017	Fee-for-Service	1942542923	1942542923	1	1	KWON, ALBERT H MD	6/15/2021	207L00000X	NA	Other	026	PHYSICIANS	159861	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
33051	Fee-for-Service	1851784763	1851784763	1	1	KHA, CHRISTINE DO	6/29/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	17535	None	None	0	In state provider	None	16055 BROOKHURST ST	SUITE C	FOUNTAIN VALLEY	CA	92708	1544	30	06059	33.72960657	-117.9548029	Orange County
33053	Fee-for-Service	1861502049	1861502049	1	1	KOHLMEIER,PAMELA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 WEST 8TH AVE	None	SPOKANE	WA	99205	0000	00	None	47.647989	-117.4112415	Spokane County
33070	Fee-for-Service	1912382433	1912382433	1	1	KIRAGU, CHRISTOPHER MAINA	4/20/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	45483 PEACOCK PLACE	None	TEMECULA	CA	92592	4829	33	06065	33.46736396	-117.1062253	Riverside County
33085	Fee-for-Service	1598846537	1598846537	1	1	KIM, JOHN YH MD	2/11/2008	2080P0207X	NA	Hematology	026	PHYSICIANS	88089	68	Hematology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
33142	Fee-for-Service	1821143264	1821143264	1	1	KHEHRA, BALRAJ S	8/29/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2390 EAST FLORIDA AVE	STE 201	HEMET	CA	92544	4754	33	06065	33.7477405	-116.94681	Riverside County
33159	Fee-for-Service	1043666795	1043666795	1	1	KIM, YAEHEE CNP	4/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
33167	Fee-for-Service	1184892606	1184892606	1	1	KARANDIKAR, NINAD S MD	7/15/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	117244	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
33168	Fee-for-Service	1407416480	1407416480	1	1	KHARA, GAGANDEEP K NP	8/23/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
33182	Fee-for-Service	1619517562	1619517562	1	1	KOLSIN, SARA L MSW LCSW	12/22/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
33186	Fee-for-Service	1679651327	1679651327	1	2	KAISER FOUNDATION HOSPITAL	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3240 ARDEN WAY	None	SACRAMENTO	CA	95864	2015	34	06067	38.594898	-121.3884765	Sacramento County
33227	Fee-for-Service	1609194125	1609194125	1	1	KARNIK, KUSHAL A MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143229	41	Internal Medicine	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
33231	Fee-for-Service	1831652627	1831652627	1	1	KRISHNAMURTHY, KAMESH MD	7/19/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	179760	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33253	Fee-for-Service	1205833001	1205833001	1	1	KANDES, GEOFFREY M	9/20/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
33277	Fee-for-Service	1699017327	1699017327	1	1	KHULLAR, AASHISH MD	3/25/2019	207R00000X	NA	Other	026	PHYSICIANS	145528	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
33288	Fee-for-Service	1144588385	1144588385	1	1	KOLINSKY, MICHELLE PSYD	6/11/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
33350	Fee-for-Service	1275876054	1275876054	1	1	KANTH, KIRAN MD	9/1/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	162712	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
33359	Fee-for-Service	1912382433	1912382433	1	1	KIRAGU, CHRISTOPHER MAINA	4/20/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	45483 PEACOCK PLACE	None	TEMECULA	CA	92592	4829	33	06065	33.46736396	-117.1062253	Riverside County
33362	Fee-for-Service	1043799158	1043799158	1	1	KHAN, MOHAMMAD MUHIB PT	8/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4004 PANAMA LN	100	BAKERSFIELD	CA	93313	3769	15	06029	35.29595752	-119.0472075	Kern County
33374	Fee-for-Service	1598846537	1598846537	1	1	KIM, JOHN YH MD	2/11/2008	2080P0207X	NA	Hematology	026	PHYSICIANS	88089	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
33393	Fee-for-Service	1861607418	1861607418	1	1	KATERELOS, ARISTIDIS MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99003	78	Neoplastic Diseases/Oncology	0	In state provider	None	6939 PALM COURT	None	RIVERSIDE	CA	92506	0000	33	06065	33.947325	-117.4011395	Riverside County
33409	Fee-for-Service	1932467065	1932467065	1	1	KOLLI, KANTI P MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104291	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33430	Fee-for-Service	1508853771	1508853771	1	1	KAPLAN, ROBERT I MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	36484	04	Otology, Laryngology, Rhinology	0	In state provider	None	4646 BROCKTON AVE	STE 302	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
33467	Fee-for-Service	1679689061	1679689061	1	1	KAYE, BRIAN R	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53046	83	Rheumatology	0	In state provider	None	13851 E 14TH ST	STE 301	SAN LEANDRO	CA	94578	2630	01	06001	37.71458918	-122.1418781	Alameda County
33475	Fee-for-Service	1952315202	1952315202	1	1	KADADA, SAMIR S MD	12/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94909	41	Internal Medicine	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
33514	Fee-for-Service	1265849160	1265849160	1	1	KHAN, IRUM N MD	5/29/2023	207L00000X	NA	Other	026	PHYSICIANS	181312	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
33519	Fee-for-Service	1003105032	1003105032	1	1	KIM, THOMAS J MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149934	20	Orthopedic Surgery	0	In state provider	None	18 BON AIR ROAD	None	LARKSPUR	CA	94939	1123	21	06041	37.94413684	-122.5391261	Marin County
33528	Fee-for-Service	1942824503	1942824503	1	1	KROCHMAL, JOHN J OD	10/8/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 E VENTURA BLVD.	None	OXNARD	CA	93036	1813	56	06111	34.22378048	-119.1501106	Ventura County
33545	Fee-for-Service	1265463731	1265463731	1	1	KWON, ELISE J MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83539	None	None	0	In state provider	None	11177 TAMPA AVE	None	NORTHRIDGE	CA	91326	2254	19	06037	34.27373836	-118.5564202	Los Angeles County
33577	Fee-for-Service	1932558459	1932558459	1	1	KANAGUI-MUNOZ, MARLEN PHD	8/17/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
33625	Fee-for-Service	1598812810	1598812810	1	1	KAISER FOUNDATION HELTH	10/27/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY FABIOLA #1	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
33661	Fee-for-Service	1598846537	1598846537	1	1	KIM, JOHN YH MD	2/11/2008	2080P0207X	NA	Hematology	026	PHYSICIANS	88089	78	Neoplastic Diseases/Oncology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
33663	Fee-for-Service	1689710220	1689710220	1	1	KANG, TARINA L MD	8/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55606	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
33670	Fee-for-Service	1831221126	1831221126	1	1	KLEIN, DOROTHY C MD	8/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93473	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
33693	Fee-for-Service	1629784087	1629784087	1	1	KERN COUNTY HOSPITAL AUTHORI	4/9/2024	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1900 BRUNDAGE LN	None	BAKERSFIELD	CA	93307	2732	15	06029	35.35399417	-118.9813034	Kern County
33707	Fee-for-Service	1114417854	1114417854	1	1	KUKU, OLUKEMI A CNP	11/3/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2740 GRANT ST	None	CONCORD	CA	94520	2265	07	06013	37.98580944	-122.0385574	Contra Costa County
33723	Fee-for-Service	1538488960	1538488960	1	1	KHAN, FAUZIA MD INC	8/23/2010	174400000X	NA	Other	026	PHYSICIANS	50190	41	Internal Medicine	0	In state provider	None	135 LAS TUNAS DR	None	ARCADIA	CA	91007	8513	19	06037	34.10777602	-118.0358402	Los Angeles County
33750	Fee-for-Service	1013960681	1013960681	1	1	K & T DIAGNOSTIC INC	10/12/2010	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	7120 HAYVENHURST AVE	STE 407	VAN NUYS	CA	91406	3813	19	06037	34.200018	-118.492384	Los Angeles County
33756	Fee-for-Service	1679689061	1679689061	1	1	KAYE, BRIAN R	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53046	41	Internal Medicine	0	In state provider	None	13851 E 14TH ST	STE 301	SAN LEANDRO	CA	94578	2630	01	06001	37.71458918	-122.1418781	Alameda County
33768	Fee-for-Service	1831196708	1831196708	1	1	KEVIN J SANDBERG M.D.	5/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1395 GEORGE DIETER DR	None	EL PASO	TX	79936	7499	00	None	31.73238192	-106.3017411	El Paso County
33786	Fee-for-Service	1013311448	1013311448	1	4	KOREAN HEALTH EDUCATION	8/3/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3727 W 6TH ST	SUITE 200	LOS ANGELES	CA	90020	5108	19	06037	34.06358655	-118.3037656	Los Angeles County
33825	Fee-for-Service	1124278320	1124278320	1	1	KAPAMAJIAN, MICHAEL A MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108349	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	200 STEIN PLAZA	RN #1-340	LOS ANGELES	CA	90024	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
33835	Fee-for-Service	1679764179	1679764179	1	1	KAGNOFF, MELISSA N MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121332	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
33845	Fee-for-Service	1932408572	1932408572	1	1	KIM, GRACE S MD	1/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115054	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
33850	Fee-for-Service	1376263319	1376263319	1	1	KELLI CLARK LICENSED CLINICA	7/6/2023	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	L SOCIAL WORKER PROFESSI	3150 18TH ST	STE 350 #202	SAN FRANCISCO	CA	94110	2074	38	06075	37.76218347	-122.4141845	San Francisco County
33874	Fee-for-Service	1679640486	1679640486	1	1	KIRSCHNER, EVE MD	4/1/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52212	10	Gastroenterology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
33897	Fee-for-Service	1407982770	1407982770	1	1	KERNES, CHRISTIANNE B MFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47041	-	NOT APPLICABLE	0	In state provider	None	2015 PIONEER COURT	SUITE B	SAN MATEO	CA	94403	1736	41	06081	37.54712403	-122.3120681	San Mateo County
33957	Fee-for-Service	1578560884	1578560884	1	1	KOMANAPALLI, LALITA M MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64243	41	Internal Medicine	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
33969	Fee-for-Service	1942242912	1942242912	1	1	KEMMERER, LWEIS E OD	1/31/1986	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
33974	Fee-for-Service	1457791378	1457791378	1	1	KIRK, BENJAMIN A DO	8/1/2017	207P00000X	NA	Other	026	PHYSICIANS	15608	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
33987	Fee-for-Service	1629784087	1629784087	1	1	KERN COUNTY HOSPITAL AUTHORI	4/9/2024	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1900 BRUNDAGE LN	None	BAKERSFIELD	CA	93307	2732	15	06029	35.35399417	-118.9813034	Kern County
34049	Fee-for-Service	1205279791	1205279791	1	1	KAISER, IAN D MD	12/1/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	191771	None	None	0	In state provider	None	36955 COOK ST	STE 102	PALM DESERT	CA	92211	6084	33	06065	33.77893112	-116.355881	Riverside County
34070	Fee-for-Service	1013311448	1013311448	1	4	KOREAN HEALTH EDUCATION	8/3/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3727 W 6TH ST	SUITE 200	LOS ANGELES	CA	90020	5108	19	06037	34.06358655	-118.3037656	Los Angeles County
34072	Fee-for-Service	1457374076	1457374076	1	1	KINDALL, DOUGLAS W MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60717	25	Physical Medicine and Rehabilitation	0	In state provider	None	3939 J ST	SUITE 200	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
34094	Fee-for-Service	1528550928	1528550928	1	1	KHANAL, RUBY NP	8/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
34100	Fee-for-Service	1013055011	1013055011	1	1	KNIGHT, RICHARD J MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86627	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
34111	Fee-for-Service	1487816260	1487816260	1	1	KARIA, KUNAL R MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148804	10	Gastroenterology (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
34115	Fee-for-Service	1982680716	1982680716	1	1	KUO, MICHAEL C MD	6/11/2008	2471C3402X	NA	Other	026	PHYSICIANS	88690	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95814	2201	34	06067	38.555181	-121.4566785	Sacramento County
34126	Fee-for-Service	1033142658	1033142658	1	1	KNIGHT, OREL H MD	10/31/1985	174400000X	NA	Other	026	PHYSICIANS	32526	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5301 F ST	STE 318	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
34140	Fee-for-Service	1073664231	1073664231	1	1	KASTNER, MARY CNP	11/20/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17412	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
34161	Fee-for-Service	1679640486	1679640486	1	1	KIRSCHNER, EVE MD	4/1/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52212	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
34163	Fee-for-Service	1427286004	1427286004	1	1	KUZMICH, MEGAN L NP	7/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
34210	Fee-for-Service	1588636203	1588636203	1	1	KIM, KYONG-MEE S MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77494	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	1688 WILLOW ST	STE C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
34278	Fee-for-Service	1629784087	1629784087	1	1	KERN COUNTY HOSPITAL AUTHORI	4/9/2024	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1900 BRUNDAGE LN	None	BAKERSFIELD	CA	93307	2732	15	06029	35.35399417	-118.9813034	Kern County
34323	Fee-for-Service	1992052658	1992052658	1	1	KHURANA, SWAPNIL MD	1/30/2025	2084P0015X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
34343	Fee-for-Service	1437108024	1437108024	1	1	KARE, JOHN A MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55620	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
34367	Fee-for-Service	1932363215	1932363215	1	1	KARAELIAS, LUCAS D MD	8/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97105	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
34399	Fee-for-Service	1487816260	1487816260	1	1	KARIA, KUNAL R MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148804	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
34404	Fee-for-Service	1043247547	1043247547	1	1	KENNEY, PHILIP MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
34461	Fee-for-Service	1215025044	1215025044	1	1	KIROV, IVAN I MD	5/29/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56138	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
34464	Fee-for-Service	1982999116	1982999116	1	1	KHETARPAL, NYRA MD	10/14/2019	207R00000X	NA	Other	026	PHYSICIANS	163181	41	Internal Medicine	0	In state provider	None	18522 US HIGHWAY 18 STE	None	APPLE VALLEY	CA	92307	2321	36	06071	34.53944358	-117.2599885	San Bernardino County
34599	Fee-for-Service	1467734442	1467734442	1	1	KURIAKOSE, EMY M MD	10/1/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
34611	Fee-for-Service	1215060439	1215060439	1	1	KIRKPATRICK, KARLEE DO	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	21730	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
34642	Fee-for-Service	1053469031	1053469031	1	1	KASHINSKY, DANIEL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23627	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
34664	Fee-for-Service	1578210225	1578210225	1	1	KIAN MENTAL HEALTH	9/15/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	350 10TH AVE	SUITE 1000	SAN DIEGO	CA	92101	7496	37	06073	32.708898	-117.1555415	San Diego County
34667	Fee-for-Service	1255795076	1255795076	1	1	KABBACH, GISELE MD	9/12/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	160737	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
34670	Fee-for-Service	1871660639	1871660639	1	1	KNIGHT, LINDA S CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
34683	Fee-for-Service	1952312712	1952312712	1	1	KOCKINIS, THOMAS C MD	2/28/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40769	08	Family Practice	0	In state provider	CALIFORNIA COAST MED CTR	18811 HUNTINGTON ST	STE 130	HUNTINGTON BEACH	CA	92648	6003	30	06059	33.68962104	-117.9954102	Orange County
34689	Fee-for-Service	1649010901	1649010901	1	1	KIHAHU-WAMBUGU, MARY W	6/17/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4090 ELDERBERRY RIDGE	None	LAKE ELSINORE	CA	92530	2043	33	06065	33.70253837	-117.3851972	Riverside County
34761	Fee-for-Service	1174208227	1174208227	1	1	KOROYAN, ERIKNAZ NP	12/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	10	06019	36.80840238	-119.8594473	Fresno County
34812	Fee-for-Service	1194818914	1194818914	1	2	KIM, DAVID S MD	2/17/2013	174400000X	NA	Other	026	PHYSICIANS	61312	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2010 WILSHIRE BLVD	STE 707	LOS ANGELES	CA	90057	3550	19	06037	34.05748989	-118.2750432	Los Angeles County
34823	Fee-for-Service	1699872796	1699872796	1	1	KILBORN, DEBORA C NP	11/10/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7999 GATEWAY BLVD	SUITE 200	NEWARK	CA	94560	1188	01	06001	37.53814232	-122.0629661	Alameda County
34865	Fee-for-Service	1538153549	1538153549	1	1	KOKA, ANURADHA MD	1/1/1997	261QX0203X	NA	Other	026	PHYSICIANS	53741	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
34892	Fee-for-Service	1689945230	1689945230	1	1	KLINGER, KERRY A MD	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120090	05	Anesthesiology	0	In state provider	None	500 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76351054	-122.4579681	San Francisco County
34909	Fee-for-Service	1417995887	1417995887	1	1	KUROWSKI, KURT MD	8/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160562	08	Family Practice	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
34922	Fee-for-Service	1194847475	1194847475	1	1	KENLEY, ERIC S MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100640	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
34957	Fee-for-Service	1609925684	1609925684	1	1	KRIEGER-LOWITZ, FRAN PHD	1/26/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5845 COLLEGE AVE	SUITE 7	OAKLAND	CA	94618	1635	01	06001	37.84677691	-122.2520438	Alameda County
34975	Fee-for-Service	1386113025	1386113025	1	1	KERNEY, CARRIE A NP	1/31/2023	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
34976	Fee-for-Service	1649010901	1649010901	1	1	KIHAHU-WAMBUGU, MARY W	6/17/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4090 ELDERBERRY RIDGE	None	LAKE ELSINORE	CA	92530	2043	33	06065	33.70253837	-117.3851972	Riverside County
35008	Fee-for-Service	1326123134	1326123134	1	1	KRAUS, ERIC E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC STREET	None	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
35015	Fee-for-Service	1093863821	1093863821	1	1	KAISER FNDATION HLTH PLN	12/24/2002	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #217	4405 VANDEVER AVE	FL 1	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
35053	Fee-for-Service	1558418350	1558418350	1	1	KHORSANDI, PARISA A MD	2/4/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71317	40	Pediatrics	0	In state provider	None	2222 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90049	1307	19	06037	34.03052319	-118.4776873	Los Angeles County
35056	Fee-for-Service	1396704078	1396704078	1	1	KAHN, BRUCE S MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75922	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
35061	Fee-for-Service	1790302644	1790302644	1	1	KAO, IRENE LP	1/28/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
35074	Fee-for-Service	1144669177	1144669177	1	1	KHAIRA, UPINDER S MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142239	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
35129	Fee-for-Service	1710425871	1710425871	1	1	KAST, ALISON M NP	9/13/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35150	Fee-for-Service	1821668047	1821668047	1	1	KIM, SO Y LMFT	6/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	548 FILLMORE ST	None	SAN FRANCISCO	CA	94117	2620	38	06075	37.77452171	-122.4308965	San Francisco County
35155	Fee-for-Service	1538153549	1538153549	1	1	KOKA, ANURADHA MD	1/1/1997	261QX0203X	NA	Other	026	PHYSICIANS	53741	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
35209	Fee-for-Service	1710658992	1710658992	1	1	KAZEMI, SALOUMEH LMFT	2/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
35232	Fee-for-Service	1013397546	1013397546	1	1	KIM, JOOYEON MD	2/6/2020	208M00000X	NA	Other	026	PHYSICIANS	144655	41	Internal Medicine	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
35262	Fee-for-Service	1104021963	1104021963	1	2	KAYMAN, JOSHUA E MD	1/30/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	108111	-	NOT APPLICABLE	0	In state provider	None	1816 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87558576	-122.2622904	Alameda County
35285	Fee-for-Service	1710586920	1710586920	1	1	KAPLAN, DANIEL A CRNA	8/3/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
35296	Fee-for-Service	1609079722	1609079722	1	1	KHOSLA, DHIRA DO	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9450	13	Neurology (M.D. only)	0	In state provider	None	1301 SHOREWAY ROAD	SUITE 100	BELMONT	CA	94002	4151	41	06081	37.5239043	-122.2667778	San Mateo County
35330	Fee-for-Service	1740237528	1740237528	1	1	KINGO, ABBAS R MD	4/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
35331	Fee-for-Service	1811254253	1811254253	1	1	KYLE DAVID CLARKE	7/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
35336	Fee-for-Service	1104350917	1104350917	1	1	KASPARIAN, SARO S MD	7/25/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	166690	None	None	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
35393	Fee-for-Service	1164581807	1164581807	1	1	KIM, AUDREY Y MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88597	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
35398	Fee-for-Service	1639174378	1639174378	1	1	KLINK, JEFFREY W	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2860 OLIVE HWY	STE A	OROVILLE	CA	95966	6122	04	06007	39.50347297	-121.5404768	Butte County
35400	Fee-for-Service	1447202551	1447202551	1	1	KAMACHI, KAREN L MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55141	40	Pediatrics	0	In state provider	None	260 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
35419	Fee-for-Service	1972849404	1972849404	1	1	KOENIG, DAVID CRNA	1/29/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
35439	Fee-for-Service	1538211909	1538211909	1	1	KWAN, JUDY SEMON	4/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79486	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
35444	Fee-for-Service	1538153549	1538153549	1	1	KOKA, ANURADHA MD	1/1/1997	261QX0203X	NA	Other	026	PHYSICIANS	53741	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
35450	Fee-for-Service	1053340687	1053340687	1	1	KIM, PETER C DPM	3/14/2016	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9896 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92844	1643	30	06059	33.77397653	-117.959571	Orange County
35466	Fee-for-Service	1235485343	1235485343	1	1	KOHLI, KANCHAN MD	4/24/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183282	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
35474	Fee-for-Service	1124262282	1124262282	1	1	KARAALP, ILYAS S MD INC	10/15/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75786	08	Family Practice	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
35484	Fee-for-Service	1174793459	1174793459	1	2	KAISER FOUNDATION HOSPITAL	9/6/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	27220 IRIS AVENUE	IRIS MOB 2	MORENO VALLEY	CA	92555	4802	33	06065	33.8955513	-117.189448	Riverside County
35509	Fee-for-Service	1437543733	1437543733	1	1	KAGAN, CALVIN MD	8/1/2023	207R00000X	NA	Other	026	PHYSICIANS	185507	None	None	0	In state provider	None	501 WASHINGTON ST	STE 512	SAN DIEGO	CA	92103	2238	37	06073	32.74986289	-117.1599343	San Diego County
35522	Fee-for-Service	1912171000	1912171000	1	1	KALAPATAPU, RAJKUMAR K MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121239	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35528	Fee-for-Service	1457574972	1457574972	1	1	KUPFER, KIMBERLY R LMFT	10/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29099 HOSPITAL RD	STE 107	LAKE ARROWHEAD	CA	92352	0000	36	06071	34.26652661	-117.1690546	San Bernardino County
35562	Fee-for-Service	1578820395	1578820395	1	1	KAMRA, SHEENA L MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131204	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90045	5631	19	06037	34.06527974	-118.4462792	Los Angeles County
35564	Fee-for-Service	1902869662	1902869662	1	1	KLEIN, STANLEY R	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	34332	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
35591	Fee-for-Service	1053336339	1053336339	1	1	KAZANCHI, JOSEPH S MD	7/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90062	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
35592	Fee-for-Service	1114066156	1114066156	1	1	KING, RICHARD D MD	7/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112925	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1645 PINE STREET	None	REDDING	CA	96001	1018	45	06089	40.58295477	-122.3888377	Shasta County
35613	Fee-for-Service	1528684818	1528684818	1	1	K C, DILIP	7/24/2023	207R00000X	NA	Other	026	PHYSICIANS	184939	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
35634	Fee-for-Service	1043420029	1043420029	1	1	KAJITANI, KARI M MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53571	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
35680	Fee-for-Service	1275987828	1275987828	1	1	KO, MICHELE S DO	4/9/2019	208M00000X	NA	Other	026	PHYSICIANS	16228	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
35683	Fee-for-Service	1578740775	1578740775	1	2	KEVIN PHAM, M.D., INC	9/2/2022	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	500 S MAIN ST	STE 101	ORANGE	CA	92868	4535	30	06059	33.77991974	-117.8674745	Orange County
35717	Fee-for-Service	1417128125	1417128125	1	1	KAMINSKY, ILYA D C A	4/13/2010	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PROFESSIONAL	6333 WILSHIRE BLVD	STE 101	LOS ANGELES	CA	90048	5720	19	06037	34.06355697	-118.366413	Los Angeles County
35719	Fee-for-Service	1033278775	1033278775	1	1	KONDO, TRACY M OD	4/4/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
35730	Fee-for-Service	1306991211	1306991211	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	RIVERSIDE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3000	33	06065	33.904782	-117.469323	Riverside County
35731	Fee-for-Service	1689649444	1689649444	1	1	KAVANAUGH, CAROL C DO	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	71520	41	Internal Medicine	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
35753	Fee-for-Service	1013103431	1013103431	1	1	KOTHENBEUTEL, MARCELO T	12/16/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
35770	Fee-for-Service	1447605084	1447605084	1	1	KIM, MONICA E MD	7/28/2022	207L00000X	NA	Other	026	PHYSICIANS	146781	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
35785	Fee-for-Service	1134333511	1134333511	1	1	KNEZEVICH, STEVAN R	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108355	07	Dermatology	0	In state provider	None	305 PARK CREEK DRIVE	None	CLOVIS	CA	93611	4426	10	06019	36.84077548	-119.7076545	Fresno County
35788	Fee-for-Service	1750857751	1750857751	1	1	KIM, SUSAN	7/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	75036 GERALD FORD DRIVE	None	PALM DESERT	CA	92211	2080	33	06065	33.78158473	-116.353994	Riverside County
35837	Fee-for-Service	1245469246	1245469246	1	1	KHAN, ADEENA MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126106	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35853	Fee-for-Service	1902869662	1902869662	1	1	KLEIN, STANLEY R	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	34332	02	General Surgery	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
35862	Fee-for-Service	1881388650	1881388650	1	1	KATIE Y JANG OPTOMETRY PROFE	7/14/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	35 LINDEN AVE	STE 102	LONG BEACH	CA	90802	5033	19	06037	33.76742702	-118.1863903	Los Angeles County
35879	Fee-for-Service	1053336339	1053336339	1	1	KAZANCHI, JOSEPH S MD	7/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90062	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
35902	Fee-for-Service	1336729912	1336729912	1	1	KIM, DAEWOONG MD	9/17/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
35923	Fee-for-Service	1043420029	1043420029	1	1	KAJITANI, KARI M MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53571	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
35970	Fee-for-Service	1821146572	1821146572	1	1	KAISER FOUNDATION HEALTH	7/12/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMNTE PHRM #985	9521 DALEN ST	RM R	DOWNEY	CA	90242	4847	19	06037	33.91499804	-118.1290266	Los Angeles County
35973	Fee-for-Service	1578740775	1578740775	1	2	KEVIN PHAM, M.D., INC	9/2/2022	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	500 S MAIN ST	STE 101	ORANGE	CA	92868	4535	30	06059	33.77991974	-117.8674745	Orange County
35985	Fee-for-Service	1558715110	1558715110	1	1	KIM, KI-YOON MD	2/5/2025	163WG0100X	NA	Other	026	PHYSICIANS	151164	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
35995	Fee-for-Service	1841958931	1841958931	1	1	KRAMARZ, ANNA B LCSW	3/3/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5453 KALES AVE	None	OAKLAND	CA	94618	1504	01	06001	37.84098375	-122.2512009	Alameda County
36006	Fee-for-Service	1417100207	1417100207	1	1	KIM, YOUNGHO MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136132	41	Internal Medicine	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
36015	Fee-for-Service	1922388248	1922388248	1	1	KAMANGAR, ELHAM MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143605	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2200	34	06067	38.555181	-121.4566785	Sacramento County
36026	Fee-for-Service	1962745414	1962745414	1	1	KLAMATH OPHTHALMOLOGY PC	2/5/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	2615 ALMOND ST	None	KLAMATH FALLS	OR	97601	1176	00	None	42.25205113	-121.7885136	Klamath County
36028	Fee-for-Service	1972810448	1972810448	1	1	KIMBALL, KILIANNE R PHD	9/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
36066	Fee-for-Service	1316321920	1316321920	1	1	KAHLON, SUKHRAJ MD	6/12/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145973	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
36067	Fee-for-Service	1982607453	1982607453	1	1	KAMINSKI, ANDREW MD	3/7/2008	174400000X	NA	Other	026	PHYSICIANS	64871	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
36071	Fee-for-Service	1013943588	1013943588	1	1	KOETTERS, PETER J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86407	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
36082	Fee-for-Service	1548212921	1548212921	1	1	KIM, JOHN C MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85023	None	None	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
36093	Fee-for-Service	1558854737	1558854737	1	1	KALANTARY, ATEFEH MD	8/1/2021	207R00000X	NA	Other	026	PHYSICIANS	173921	None	None	0	In state provider	None	2975 NORTH SYCAMORE DR.	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
36148	Fee-for-Service	1346204104	1346204104	1	1	KAMATH, UDAYA R MD	11/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50460	40	Pediatrics	0	In state provider	None	18564 HWY 18	#103-104	APPLE VALLEY	CA	92307	0000	36	06071	34.53926652	-117.2592564	San Bernardino County
36152	Fee-for-Service	1700076551	1700076551	1	1	KIM, DANNY MD	9/15/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	109240	18	Ophthalmology	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
36159	Fee-for-Service	1942682471	1942682471	1	1	KHAN, AFSHAN F DO	10/15/2021	207R00000X	NA	Other	026	PHYSICIANS	18653	None	None	0	In state provider	None	2250 HAYES ST	STE 302	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
36173	Fee-for-Service	1578705000	1578705000	1	1	KROSIN, MICHAEL T MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	96292	20	Orthopedic Surgery	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
36192	Fee-for-Service	1538188990	1538188990	1	1	KURTZ, IRA MD	1/1/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	43682	45	Nephrology (Renal-Kidney)	0	In state provider	DEPT OF MEDICINE	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
36212	Fee-for-Service	1043420029	1043420029	1	1	KAJITANI, KARI M MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53571	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
36216	Fee-for-Service	1376674069	1376674069	1	1	KAZARIAN, SCOTT E LMFT	10/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1173 N DIXIE DR	101	SAN DIMAS	CA	91773	1200	19	06037	34.123185	-117.800536	Los Angeles County
36234	Fee-for-Service	1487742946	1487742946	1	1	KIM, JOSEPH J MD	7/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78547	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
36274	Fee-for-Service	1558715110	1558715110	1	1	KIM, KI-YOON MD	2/5/2025	163WG0100X	NA	Other	026	PHYSICIANS	151164	10	Gastroenterology (M.D. only)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
36301	Fee-for-Service	1316077001	1316077001	1	1	KUSSMAUL, SUSANNAH C MD	5/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98826	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
36315	Fee-for-Service	1962745414	1962745414	1	1	KLAMATH OPHTHALMOLOGY PC	2/5/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	1	Border provider	None	2615 ALMOND ST	None	KLAMATH FALLS	OR	97601	1176	00	None	42.25205113	-121.7885136	Klamath County
36354	Fee-for-Service	1982607453	1982607453	1	1	KAMINSKI, ANDREW MD	3/7/2008	174400000X	NA	Other	026	PHYSICIANS	64871	01	General Practice	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
36359	Fee-for-Service	1295081180	1295081180	1	1	KASOZILUBEGA, SAMALI MD	4/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129262	01	General Practice	0	In state provider	None	1001 POTRERO AVE	ROOM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
36360	Fee-for-Service	1174793459	1174793459	1	1	KAISER FOUNDATION HOSPITAL	12/18/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MORENO VALLEY	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
36363	Fee-for-Service	1790501989	1790501989	1	1	KIM, ERICA CCC-SLP	1/21/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	423 IMPERIAL HWY	None	FULLERTON	CA	92835	1146	30	06059	33.91749052	-117.925452	Orange County
36403	Fee-for-Service	1932427895	1932427895	1	1	KOPECKY, ABIGAIL M MD	2/1/2021	207R00000X	NA	Other	026	PHYSICIANS	119221	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
36422	Fee-for-Service	1124463989	1124463989	1	1	KANJI, REHAN A MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137961	01	General Practice	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
36429	Fee-for-Service	1679917678	1679917678	1	1	KALINOWSKI, AGNIESZKA MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134805	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
36451	Fee-for-Service	1609227156	1609227156	1	1	KING, VIRGINIA LMFT	10/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 E AIRPORT DR	120	SAN BERNARDINO	CA	92408	3444	36	06071	34.06737938	-117.2834702	San Bernardino County
36485	Fee-for-Service	1710547534	1710547534	1	1	KIMURA, BRYAN OD	4/21/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	23861 MCBEAN PKWY	E12	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
36488	Fee-for-Service	1023383007	1023383007	1	1	KAPLAN, HANNAH J PT	7/17/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39930 SIERRA WAY	SUITE A	OAKHURST	CA	93644	8304	20	06039	37.32917044	-119.6483127	Madera County
36539	Fee-for-Service	1124123757	1124123757	1	1	KUNESH, JOHN P MD	4/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	55394	22	Pathology (M.D. only)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
36549	Fee-for-Service	1306950571	1306950571	1	1	KAFILMOUT, IMAD T MD	5/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52768	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
36568	Fee-for-Service	1407924335	1407924335	1	1	KALEEM, GHIZALA R MD	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50692	40	Pediatrics	0	In state provider	None	3850 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1502	38	06075	37.78587201	-122.4578677	San Francisco County
36586	Fee-for-Service	1770595456	1770595456	1	1	KAFKA, JOHN MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38253	40	Pediatrics	0	In state provider	None	9400 ACTIVITY RD	None	SAN DIEGO	CA	92126	4414	37	06073	32.8970675	-117.1250415	San Diego County
36604	Fee-for-Service	1487794434	1487794434	1	1	KHOURY, LIYONA PHD	7/25/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	164 W HOSPITALITY LN	None	SAN BERNARDINO	CA	92408	3316	36	06071	34.06586648	-117.2866005	San Bernardino County
36635	Fee-for-Service	1649386210	1649386210	1	1	KADAKIA, AMAR A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94266	41	Internal Medicine	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
36647	Fee-for-Service	1174793459	1174793459	1	1	KAISER FOUNDATION HOSPITAL	12/18/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MORENO VALLEY	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
36658	Fee-for-Service	1437488160	1437488160	1	1	KONYN, CATHERINE L CNP	6/29/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	3084	37	06073	33.12542915	-117.0764725	San Diego County
36731	Fee-for-Service	1992912935	1992912935	1	1	KAYEKJIAN, AMY L DC	4/4/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1102 IRVINE BLVD	None	TUSTIN	CA	92780	3529	30	06059	33.74822099	-117.8105618	Orange County
36736	Fee-for-Service	1366959686	1366959686	1	1	KORI, ESTHER MUMBI	5/5/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1027 LA MARILLO CIR	None	CORONA	CA	92879	8234	33	06065	33.89993547	-117.5332321	Riverside County
36750	Fee-for-Service	1073691663	1073691663	1	1	KOROL, HAROLD W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	17963	04	Otology, Laryngology, Rhinology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
36761	Fee-for-Service	1144483215	1144483215	1	1	KADIRVELU, SUDARSHAN MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137794	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
36771	Fee-for-Service	1700072550	1700072550	1	1	KIM, BANG SUN J MD INC	5/16/2008	207R00000X	NA	Other	026	PHYSICIANS	72755	None	None	0	In state provider	None	2500 ALTON PKWY	STE 108	IRVINE	CA	92606	5032	30	06059	33.69094915	-117.8356522	Orange County
36774	Fee-for-Service	1093926016	1093926016	1	1	KAUR, MANPREET	10/17/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	34	06067	38.594898	-121.3884765	Sacramento County
36791	Fee-for-Service	1295977312	1295977312	1	1	KUO, KATHERINE T MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113480	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
36851	Fee-for-Service	1770527293	1770527293	1	1	KIM, PEARL S MD	5/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109522	25	Physical Medicine and Rehabilitation	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
36857	Fee-for-Service	1184919003	1184919003	1	1	KANEGAI, CINDY M MD	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111881	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
36903	Fee-for-Service	1700987971	1700987971	1	1	KINDNESS CARE HOME HEALTH	11/27/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1220 HEMLOCK WAY	SUITE 202	SANTA ANA	CA	92707	3650	30	06059	33.70975375	-117.8842792	Orange County
36907	Fee-for-Service	1578731261	1578731261	1	1	KAY, SOPHIE DO	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10226	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
36958	Fee-for-Service	1952530826	1952530826	1	1	KISHORENATH, SNEHA MD	11/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112073	41	Internal Medicine	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
36982	Fee-for-Service	1902522337	1902522337	1	1	KNEALE, MEGHAN E NP	4/14/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
36995	Fee-for-Service	1255530366	1255530366	1	1	KAO, EDWARD Y MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89636	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37000	Fee-for-Service	1972946747	1972946747	1	1	KELLEHER, NICOLE C	2/8/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	165046	None	None	0	In state provider	None	10251 SORRENTO VISTA PAR	SUITE 280	SAN DIEGO	CA	92121	3776	37	06073	32.89524013	-117.2142063	San Diego County
37001	Fee-for-Service	1295496453	1295496453	1	1	KANYI, JUSTINE	11/17/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	37784 VERANDA WAY	None	MURRIETA	CA	92563	4774	33	06065	33.57187966	-117.1404026	Riverside County
37026	Fee-for-Service	1366959686	1366959686	1	1	KORI, ESTHER MUMBI	5/5/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1027 LA MARILLO CIR	None	CORONA	CA	92879	8234	33	06065	33.89993547	-117.5332321	Riverside County
37032	Fee-for-Service	1972149771	1972149771	1	1	KAHURA, LILIAN W	1/17/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	39122 RIMROCK RANCH RD	None	TEMECULA	CA	92591	7428	33	06065	33.55229278	-117.107409	Riverside County
37038	Fee-for-Service	1013311448	1013311448	1	2	KOREAN HEALTH EDUCATION	6/6/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3750 WEST SIXTH ST	None	LOS ANGELES	CA	90020	5100	19	06037	34.06352351	-118.3044105	Los Angeles County
37109	Fee-for-Service	1639264534	1639264534	1	1	KIYABU, MILTON T MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57202	None	None	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
37144	Fee-for-Service	1184919003	1184919003	1	1	KANEGAI, CINDY M MD	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111881	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
37190	Fee-for-Service	1386748325	1386748325	1	1	KIM, MYEONG C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50796	25	Physical Medicine and Rehabilitation	0	In state provider	None	2140 W OLYMPIC BLVD	STE 210	LOS ANGELES	CA	90006	2277	19	06037	34.05206987	-118.2806804	Los Angeles County
37207	Fee-for-Service	1316059348	1316059348	1	1	KANG, ROBERT S MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117521	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
37208	Fee-for-Service	1780073635	1780073635	1	1	KLEIN, DAVID MD	7/24/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155090	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
37223	Fee-for-Service	1598727414	1598727414	1	1	KURKJIAN, ELIZABETH V MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80516	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
37225	Fee-for-Service	1457447955	1457447955	1	1	KOENIG III, PAUL T MD	10/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69821	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
37231	Fee-for-Service	1811495914	1811495914	1	1	KINNE, NOLAN J MD	9/1/2023	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152567	None	None	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
37234	Fee-for-Service	1144433541	1144433541	1	1	KOPPEL, AHRIN B MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96722	68	Hematology	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
37238	Fee-for-Service	1881466613	1881466613	1	1	KAUR, MANDEEP NP	3/14/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
37248	Fee-for-Service	1609241314	1609241314	1	1	KUO, SHYH-SHIAW LMFT	7/15/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16275 MONTEREY RD	STE C	MORGAN HILL	CA	95037	5466	43	06085	37.11612997	-121.6448825	Santa Clara County
37267	Fee-for-Service	1013082643	1013082643	1	1	KATZNELSON, LAURENCE MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87279	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37286	Fee-for-Service	1295496453	1295496453	1	1	KANYI, JUSTINE	11/17/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	37784 VERANDA WAY	None	MURRIETA	CA	92563	4774	33	06065	33.57187966	-117.1404026	Riverside County
37321	Fee-for-Service	1972149771	1972149771	1	1	KAHURA, LILIAN W	1/17/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	39122 RIMROCK RANCH RD	None	TEMECULA	CA	92591	7428	33	06065	33.55229278	-117.107409	Riverside County
37328	Fee-for-Service	1013311448	1013311448	1	2	KOREAN HEALTH EDUCATION	6/6/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3750 WEST SIXTH ST	None	LOS ANGELES	CA	90020	5100	19	06037	34.06352351	-118.3044105	Los Angeles County
37348	Fee-for-Service	1144348848	1144348848	1	1	KREMEN, SARAH A MD	6/2/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	89326	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	6975	19	06037	34.06473399	-118.445865	Los Angeles County
37376	Fee-for-Service	1104993096	1104993096	1	1	KIM, PYONG S MD	12/31/1995	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	80688	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
37474	Fee-for-Service	1174673016	1174673016	1	1	KARDELL-TRUMAN ALISA	2/8/2015	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	11216 TRINITY RIVER DR	None	RANCHO CORDOVA	CA	95670	2961	34	06067	38.622906	-121.2684705	Sacramento County
37482	Fee-for-Service	1538468152	1538468152	1	1	KUO, JANE OD	12/31/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37504	Fee-for-Service	1558976142	1558976142	1	1	KIMANI, MARTIN K	10/9/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2877 S BUENA VISTA AVE	None	CORONA	CA	92882	7541	33	06065	33.84794632	-117.582007	Riverside County
37524	Fee-for-Service	1144433541	1144433541	1	1	KOPPEL, AHRIN B MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96722	78	Neoplastic Diseases/Oncology	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
37533	Fee-for-Service	1164672697	1164672697	1	1	KHATIBI, DAVID MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109033	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
37537	Fee-for-Service	1396878435	1396878435	1	1	KLEINER, BETH C MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	46504	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
37561	Fee-for-Service	1669052957	1669052957	1	1	KAZEMI, MEHDI M MD	3/20/2024	390200000X	NA	Other	026	PHYSICIANS	188977	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
37578	Fee-for-Service	1518182591	1518182591	1	1	KABUNDI, EVELYNE AJEAKWA	1/2/2007	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1629 N CAJUN RD	None	UPLAND	CA	91784	2514	36	06071	34.12239621	-117.6851059	San Bernardino County
37616	Fee-for-Service	1326367848	1326367848	1	1	KIRKPATRICK, VINCENT E MD	8/24/2018	208600000X	NA	General Surgery	026	PHYSICIANS	121737	02	General Surgery	0	In state provider	None	202 W WILLIOW AVE	SUITE 402	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
37634	Fee-for-Service	1730919598	1730919598	1	1	KIEFFER, GARRETT T PT	9/30/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	210 W PINE ST	None	LODI	CA	95240	2020	39	06077	38.13427214	-121.2755342	San Joaquin County
37639	Fee-for-Service	1346538683	1346538683	1	1	KHAMAG, HANEEN A MD	5/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127351	41	Internal Medicine	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
37650	Fee-for-Service	1962617134	1962617134	1	1	KIM, RICHARD W MD	10/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113858	None	None	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06287152	-118.2029433	Los Angeles County
37689	Fee-for-Service	1215975750	1215975750	1	1	KOTTAPALLI, ANU MD	7/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48073	08	Family Practice	0	In state provider	None	105 N BASCOM AVE	STE 102	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
37692	Fee-for-Service	1881698702	1881698702	1	1	KAPLAN, KARL J MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	46045	01	General Practice	0	In state provider	ATTN MGA OFFICE	15211 VANOWEN ST	STE 206	VAN NUYS	CA	91405	3620	19	06037	34.19395411	-118.4642527	Los Angeles County
37700	Fee-for-Service	1164605762	1164605762	1	1	KORSUNSKY, JULIA CNP	8/5/2021	101YA0400X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
37721	Fee-for-Service	1699437756	1699437756	1	1	KIM, LISA A CCC-SP	6/22/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
37740	Fee-for-Service	1003987058	1003987058	1	1	KYI, HLA HLA MD	6/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51825	40	Pediatrics	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
37744	Fee-for-Service	1265638795	1265638795	1	1	KUHN, MAGGIE A MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118415	02	General Surgery	0	In state provider	None	2521 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
37790	Fee-for-Service	1255834008	1255834008	1	1	KAMATH, RAHUL MD	8/2/2021	207R00000X	NA	Other	026	PHYSICIANS	173503	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
37791	Fee-for-Service	1558976142	1558976142	1	1	KIMANI, MARTIN K	10/9/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2877 S BUENA VISTA AVE	None	CORONA	CA	92882	7541	33	06065	33.84794632	-117.582007	Riverside County
37801	Fee-for-Service	1700981966	1700981966	1	1	KULLNAT, JONATHAN MD	5/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	175165	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
37836	Fee-for-Service	1730443839	1730443839	1	1	KHM PHARMACEUTICAL INC	11/20/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	232 CAJON ST	STE A	REDLANDS	CA	92373	5216	36	06071	34.0526025	-117.1806742	San Bernardino County
37841	Fee-for-Service	1265847800	1265847800	1	1	KAUR, JASLEEN MD	11/19/2020	207R00000X	NA	Other	026	PHYSICIANS	153777	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
37861	Fee-for-Service	1003120429	1003120429	1	1	KERSHBERG, BENJAMIN M MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111594	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
37866	Fee-for-Service	1457787566	1457787566	1	1	KASANZA, COSETTE C NP	12/14/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
37892	Fee-for-Service	1659363562	1659363562	1	1	KHAIRULLAH, NAZIFAH MD	9/26/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	142450	40	Pediatrics	0	In state provider	None	800 FAIRMOUNT AVE	110	PASADENA	CA	91105	3151	19	06037	34.13193177	-118.1517805	Los Angeles County
37893	Fee-for-Service	1699925784	1699925784	1	1	KALRA, NEIL MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110203	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	SAN DIEGO	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
37911	Fee-for-Service	1356539423	1356539423	1	1	KIDNEY SPECIALIST INC	3/29/2011	207RN0300X	NA	Nephrology	026	PHYSICIANS	52769	45	Nephrology (Renal-Kidney)	0	In state provider	None	451 E ALMOND AVE	SUITE 101	MADERA	CA	93637	5562	20	06039	36.94554615	-120.0523936	Madera County
37937	Fee-for-Service	1013101633	1013101633	1	1	KOH, WEI LOONG GLENN S MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118722	02	General Surgery	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
37966	Fee-for-Service	1245348655	1245348655	1	1	KASSELS, MICHAEL D DO	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	5953	41	Internal Medicine	0	In state provider	None	2339 ALMOND AVE	None	CONCORD	CA	94520	2027	07	06013	37.98130916	-122.0340489	Contra Costa County
37968	Fee-for-Service	1619024932	1619024932	1	1	KAISER FOUNDATION HEALTH	6/27/1990	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#605	3700 MALL VIEW RD	None	BAKERSFIELD	CA	93306	3050	15	06029	35.39462173	-118.9518506	Kern County
37979	Fee-for-Service	1922412840	1922412840	1	1	KAZEE, MARY E NP	3/30/2025	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
37981	Fee-for-Service	1881698702	1881698702	1	1	KAPLAN, KARL J MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	46045	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	15211 VANOWEN ST	STE 206	VAN NUYS	CA	91405	3620	19	06037	34.19395411	-118.4642527	Los Angeles County
38028	Fee-for-Service	1972666824	1972666824	1	1	KOHMETSCHER, MARK A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	747 BROADWAY	None	SEATTLE	WA	98122	4379	00	None	47.608326	-122.3207985	King County
38045	Fee-for-Service	1972661973	1972661973	1	1	KAMMERER, MARIA E CNM	5/18/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
38068	Fee-for-Service	1982764106	1982764106	1	1	KINDELL-VANDERMOLEN, CLAUDIA	12/15/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MSW LCSW	1125 E CLARK AVE	A2 5	SANTA MARIA	CA	93455	5124	42	06083	34.8650853	-120.4175195	Santa Barbara County
38076	Fee-for-Service	1023268547	1023268547	1	1	KONG, BRIAN N MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110981	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
38114	Fee-for-Service	1851405278	1851405278	1	1	KIM, SARA H MD	6/1/2003	2085R0001X	NA	Other	026	PHYSICIANS	71344	None	None	0	In state provider	None	381 MERRILL AVE	# A	GLENDALE	CA	91206	4119	19	06037	34.15223097	-118.2284757	Los Angeles County
38131	Fee-for-Service	1154313633	1154313633	1	1	KENNEDY, RICHARD J OD	1/1/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	921 ARMORY RD	None	BARSTOW	CA	92311	5460	36	06071	34.88413321	-117.0149963	San Bernardino County
38157	Fee-for-Service	1619523552	1619523552	1	1	KIMBALL, JOSHUA J LMFT	2/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11145 TAMPA AVE	STE. 23A	NORTHRIDGE	CA	91326	2271	19	06037	34.27373836	-118.5564202	Los Angeles County
38177	Fee-for-Service	1356633572	1356633572	1	1	KO, KEVIN MD	10/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133254	08	Family Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
38183	Fee-for-Service	1427285766	1427285766	1	1	KROENER, LINDSAY L MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114707	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
38196	Fee-for-Service	1487725370	1487725370	1	1	KATZ, MARK H MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	46046	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
38199	Fee-for-Service	1356539423	1356539423	1	1	KIDNEY SPECIALIST INC	3/29/2011	207RN0300X	NA	Nephrology	026	PHYSICIANS	52769	41	Internal Medicine	0	In state provider	None	451 E ALMOND AVE	SUITE 101	MADERA	CA	93637	5562	20	06039	36.94554615	-120.0523936	Madera County
38252	Fee-for-Service	1104280056	1104280056	1	1	KIM, SONG J MD	10/18/2021	2084V0102X	NA	Neurology	026	PHYSICIANS	168131	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
38253	Fee-for-Service	1073735700	1073735700	1	1	KOESNODIHARDJO, HADI	4/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1161 CHERRY ST	SUITE K	SAN CARLOS	CA	94070	3135	41	06081	37.50546695	-122.2592986	San Mateo County
38256	Fee-for-Service	1891377115	1891377115	1	1	KIM, JULIE Y DO	3/25/2025	207ZP0101X	NA	Other	026	PHYSICIANS	20338	22	Pathology (M.D. only)	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
38263	Fee-for-Service	1730236050	1730236050	1	1	KAISER FOUNDATION HEALTH PLA	2/1/1997	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	54	43112 15TH ST W	None	LANCASTER	CA	93534	6269	19	06037	34.66467	-118.1567445	Los Angeles County
38267	Fee-for-Service	1083241905	1083241905	1	1	KRAFT, KERRI MD	7/6/2023	207P00000X	NA	Other	026	PHYSICIANS	184163	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
38291	Fee-for-Service	1457617896	1457617896	1	2	KUMAR, JENNIFER MD	1/22/2025	207RN0300X	NA	Nephrology	026	PHYSICIANS	129176	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
38292	Fee-for-Service	1578568614	1578568614	1	1	KIFUNE, MIKE MD	10/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	39833	08	Family Practice	0	In state provider	None	2740 HWY 4	None	ARNOLD	CA	95223	0000	05	06009	38.23252766	-120.3681151	Calaveras County
38294	Fee-for-Service	1568586923	1568586923	1	1	KAYE, JILL L LMFT	12/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
38350	Fee-for-Service	1427218304	1427218304	1	1	KATZ, MAYA MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115851	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
38406	Fee-for-Service	1982108049	1982108049	1	1	KAPYUR, SHEILA N MD	4/29/2021	208M00000X	NA	Other	026	PHYSICIANS	165822	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
38407	Fee-for-Service	1881629368	1881629368	1	1	KOZLOV, IGOR V MD	6/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86248	22	Pathology (M.D. only)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
38422	Fee-for-Service	1851488779	1851488779	1	1	KADRY, BASSAM MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110898	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38445	Fee-for-Service	1154306892	1154306892	1	1	KOTAL, JEAN K OT	2/9/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
38483	Fee-for-Service	1124047600	1124047600	1	1	KEANE,MICHAEL P MD	5/4/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71513	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
38485	Fee-for-Service	1831394790	1831394790	1	1	KATHRYN GETZEWICH	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
38524	Fee-for-Service	1043386170	1043386170	1	1	KARLSSON, PATRIK J LCSW	3/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
38532	Fee-for-Service	1164879656	1164879656	1	1	KUMAR, ANUPAMA D MD	8/22/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	168917	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
38535	Fee-for-Service	1083786818	1083786818	1	1	KEELING, CHRISTINE A MD	1/1/1989	207U00000X	NA	Other	026	PHYSICIANS	44856	42	Nuclear Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
38536	Fee-for-Service	1326146630	1326146630	1	1	KHONG, DOROTHY MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85323	18	Ophthalmology	0	In state provider	None	2844 SUMMIT ST	STE 208	OAKLAND	CA	94609	3642	01	06001	37.81754276	-122.2646445	Alameda County
38579	Fee-for-Service	1396940342	1396940342	1	1	KARIDAS, STEVEN J MD	3/5/2018	2085B0100X	NA	MRI Provider	026	PHYSICIANS	149678	30	Radiology	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
38613	Fee-for-Service	1255568168	1255568168	1	1	KROLL, KATHERINE E MD	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144082	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST STREET	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
38618	Fee-for-Service	1790130441	1790130441	1	1	KHAN, ASLAM DO	7/1/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	15423	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
38622	Fee-for-Service	1528118320	1528118320	1	1	KAJIWARA, GRACE MD	7/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81416	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
38678	Fee-for-Service	1124118005	1124118005	1	1	KATHLEEN,SANDNESS M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MT CARMEL WAY	None	PITTSBURG	KS	66762	0000	00	None	37.38064104	-94.68386502	Crawford County
38701	Fee-for-Service	1639585870	1639585870	1	1	KUNTE, SIDDHARTH MD	11/6/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
38704	Fee-for-Service	1922104835	1922104835	1	1	KENNETH IYAMU M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 SW 1ST AVE	None	OCALA	FL	34471	6504	00	None	29.174976	-82.138905	Marion County
38742	Fee-for-Service	1659576742	1659576742	1	1	KOPELEVICH, PETER D MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100392	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
38752	Fee-for-Service	1841906120	1841906120	1	2	KRISTA RIDE LLC	6/27/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	630 W DUARTE RD	STE 206	ARCADIA	CA	91007	7604	19	06037	34.12627293	-118.0533506	Los Angeles County
38822	Fee-for-Service	1083786818	1083786818	1	1	KEELING, CHRISTINE A MD	1/1/1989	207U00000X	NA	Other	026	PHYSICIANS	44856	30	Radiology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
38911	Fee-for-Service	1922425297	1922425297	1	1	KWON, DAVID H MD	1/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	235 W 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
38924	Fee-for-Service	1407958390	1407958390	1	1	KRISHNAN, MIGUEL DO	1/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8996	04	Otology, Laryngology, Rhinology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	90027	6062	33	06065	33.904782	-117.469323	Riverside County
38934	Fee-for-Service	1437584661	1437584661	1	1	KURLAND, TALIA PSYD	6/28/2024	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
38948	Fee-for-Service	1477882215	1477882215	1	1	KIM, KYOUNG A MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110263	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2815	30	06059	33.84718298	-117.933758	Orange County
38992	Fee-for-Service	1982669701	1982669701	1	1	KEZIRIAN, ERIC J MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83825	04	Otology, Laryngology, Rhinology	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
39013	Fee-for-Service	1811191836	1811191836	1	1	KIM, HYUNMI MD	5/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154141	79	Neurology-Child	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39026	Fee-for-Service	1114505542	1114505542	1	1	KING, EDWARD MD	3/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183242	None	None	0	In state provider	None	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
39076	Fee-for-Service	1710569694	1710569694	1	1	KELLEY, EVELYN G CNP	1/23/2023	390200000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
39079	Fee-for-Service	1619350527	1619350527	1	1	KIANI, VIVIAN LCSW	12/1/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27001 LA PAZ ROAD	STE 448B	MISSION VIEJO	CA	92691	5526	30	06059	33.59720291	-117.6586999	Orange County
39080	Fee-for-Service	1932513116	1932513116	1	1	KARANJIA, RUSTUM MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130726	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
39183	Fee-for-Service	1063919561	1063919561	1	1	KAUR, KAMALPREET NP	11/21/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
39208	Fee-for-Service	1972890564	1972890564	1	1	KHOSHBIN, SINA MD	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152792	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
39214	Fee-for-Service	1316244841	1316244841	1	1	KAZANCHI, HALA Z MD	11/1/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	126947	None	None	0	In state provider	None	4077 FIFTH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
39233	Fee-for-Service	1073574349	1073574349	1	1	KLOPFENSTEIN, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	949 HARMON ST	None	STURGIS	SD	57785	2452	00	None	44.40196678	-103.5084023	Meade County
39256	Fee-for-Service	1326363300	1326363300	1	1	KHATIBI, NIKAN H DO	5/26/2019	207LP2900X	NA	Other	026	PHYSICIANS	11914	05	Anesthesiology	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
39300	Fee-for-Service	1811191836	1811191836	1	1	KIM, HYUNMI MD	5/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154141	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39322	Fee-for-Service	1083781843	1083781843	1	1	KHODADADI, NAVID MD	11/13/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	79476	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
39371	Fee-for-Service	1437440427	1437440427	1	1	KING, KEVIN R MD	11/22/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	151729	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
39401	Fee-for-Service	1477019529	1477019529	1	1	KHALIL, ZAINEH CNP	3/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39439	Fee-for-Service	1578514949	1578514949	1	1	KUHN, JEFFREY P MD	9/30/1992	207L00000X	NA	Other	026	PHYSICIANS	59338	01	General Practice	0	In state provider	SO CA PERMANENTE MED GRP	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
39440	Fee-for-Service	1114323029	1114323029	1	1	KRYLOV, PAVEL NP	8/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
39477	Fee-for-Service	1184796930	1184796930	1	1	KUMAR, NEERU MD	9/4/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62159	36	Psychiatry	0	In state provider	None	18811 HUNTINGTON ST	STE 200	HUNTINGTON BEACH	CA	92648	6003	30	06059	33.68962104	-117.9954102	Orange County
39489	Fee-for-Service	1508001603	1508001603	1	1	KUMAR, MANOJ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM S	SLOT 783	LITTLE ROCK	AR	72225	1420	00	None	34.749009	-92.320101	Pulaski County
39504	Fee-for-Service	1154330298	1154330298	1	1	KIM, TAEWOONG MD	5/22/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	39455	01	General Practice	0	In state provider	None	20249 MODOC RD	None	APPLE VALLEY	CA	92308	6232	36	06071	34.48722079	-117.2226435	San Bernardino County
39524	Fee-for-Service	1609869205	1609869205	1	1	KELCHLIN, THOMAS CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 MASTHEAD ST NE	STE 120	ALBUQUERQUE	NM	87109	4497	00	None	35.16611204	-106.5950398	Bernalillo County
39526	Fee-for-Service	1720111784	1720111784	1	1	KHATIBI, PARISA MD	4/27/2020	207R00000X	NA	Other	026	PHYSICIANS	95851	38	Geriatrics	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
39546	Fee-for-Service	1548445307	1548445307	1	1	KENLY, MICHAEL S MD	12/13/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	113590	25	Physical Medicine and Rehabilitation	0	In state provider	None	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
39612	Fee-for-Service	1104871938	1104871938	1	1	KHAVARIAN, CAMERON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79842	41	Internal Medicine	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
39626	Fee-for-Service	1811954829	1811954829	1	1	KRANZPILLER, SUSAN E MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54129	08	Family Practice	0	In state provider	None	19950 RINALDI ST	None	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
39629	Fee-for-Service	1588193759	1588193759	1	1	KIM, ELAINE J CCC-SLP	10/10/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 S ANAHEIM BLVD	150	ANAHEIM	CA	92805	6205	30	06059	33.8143261	-117.9066647	Orange County
39668	Fee-for-Service	1922302983	1922302983	1	1	KELLEHER, LISA J LMFT	4/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
39685	Fee-for-Service	1013062769	1013062769	1	3	KAISER FOUNDATION HOSPITALS	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
39692	Fee-for-Service	1497821060	1497821060	1	1	KATAHARA, MELINDA LCSW	5/28/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 EL CAMINO REAL	C	CARLSBAD	CA	92008	2110	37	06073	33.17209501	-117.3227345	San Diego County
39695	Fee-for-Service	1558755405	1558755405	1	1	KENNEDY, WILLIAM J MD	5/19/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	None	None	1	Border provider	None	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
39747	Fee-for-Service	1568676252	1568676252	1	1	KIM, JOHNNY MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115126	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
39757	Fee-for-Service	1366455362	1366455362	1	1	KILPATRICK, SARAH J MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43280	01	General Practice	0	In state provider	None	1001 POTRERO AVE	# 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
39758	Fee-for-Service	1982689725	1982689725	1	1	KRYCHMAN, MICHAEL L MD	11/28/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54134	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 HOAG DRIVE EAST TOWER	ROOM 6-160	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
39789	Fee-for-Service	1497368336	1497368336	1	1	KONDROT, EDWARD MD	2/23/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	89041	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
39814	Fee-for-Service	1720111784	1720111784	1	1	KHATIBI, PARISA MD	4/27/2020	207R00000X	NA	Other	026	PHYSICIANS	95851	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
39820	Fee-for-Service	1285637702	1285637702	2	1	KARTSONIS, LOUIS MD	4/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	37754	18	Ophthalmology	0	In state provider	None	4747 MISSION BLVD	SUITE 5	SAN DIEGO	CA	92109	2541	37	06073	32.80002925	-117.2565267	San Diego County
39857	Fee-for-Service	1760017438	1760017438	1	1	KAREN ROMINES PODIATRY INCOR	10/26/2023	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	PORATED	11925 RUBILITE WAY	None	RANCHO CORDOVA	CA	95742	8071	34	06067	38.546658	-121.2327135	Sacramento County
39877	Fee-for-Service	1558591933	1558591933	1	1	KASHEFI, AMIR MD	5/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	116889	30	Radiology	0	In state provider	None	16311 VENTURA BLVD	STE 120	ENCINO	CA	91436	2124	19	06037	34.15706864	-118.4885978	Los Angeles County
39901	Fee-for-Service	1821292863	1821292863	1	1	KOLB, JULIE B	3/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
39905	Fee-for-Service	1043414139	1043414139	1	1	KAURA, CLAIRE MD	8/20/2017	207L00000X	NA	Other	026	PHYSICIANS	112659	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
39909	Fee-for-Service	1740363878	1740363878	1	1	KANKAR, ANITHA R MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56356	01	General Practice	0	In state provider	None	8040 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6010	19	06037	34.21736595	-118.4487378	Los Angeles County
39964	Fee-for-Service	1417488446	1417488446	1	1	KUMAR, SHWETA S MD	8/3/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	188268	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39970	Fee-for-Service	1376598151	1376598151	1	1	KRISHNASWAMI VIJAYARAGHAVAN,	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3099 N CIVIC CTR PLAZA	None	SCOTTSDALE	AZ	85251	0000	00	None	33.483456	-111.921516	Maricopa County
39984	Fee-for-Service	1376742767	1376742767	1	1	KRIEGER, DANIELLE M NP	4/7/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
39986	Fee-for-Service	1730290966	1730290966	1	1	KISHINEFF, SHELDON MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	32522	40	Pediatrics	0	In state provider	None	191 S BUENA VISTA STREET	STE 300	BURBANK	CA	91501	4554	19	06037	34.15872557	-118.3283863	Los Angeles County
40013	Fee-for-Service	1376709733	1376709733	1	1	KARR, JAMES R PT	3/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2001 SOLAR DR	STE 150	OXNARD	CA	93036	0680	56	06111	34.22025454	-119.1449192	Ventura County
40036	Fee-for-Service	1568676252	1568676252	1	1	KIM, JOHNNY MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115126	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
40164	Fee-for-Service	1497280507	1497280507	1	1	KUKLINSKI, LAWRENCE F MD	4/25/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	159152	None	None	0	In state provider	None	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
40188	Fee-for-Service	1942068481	1942068481	1	1	KIMUHU, MERCY	4/24/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	547 HILLSWICK CIR	None	FOLSOM	CA	95630	8470	34	06067	38.658006	-121.119723	Sacramento County
40253	Fee-for-Service	1457519803	1457519803	1	1	KHODAI, NAGHMEH MD	3/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114103	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
40259	Fee-for-Service	1598183444	1598183444	1	1	KENNEL, PATRICIA L MD	9/4/2018	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156269	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 130	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
40269	Fee-for-Service	1144305566	1144305566	1	1	KUMAR, PIYUSH MD	3/21/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44592	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
40334	Fee-for-Service	1023319704	1023319704	1	1	KUZMINSKI, CHRISTOPHER D MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101540	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
40370	Fee-for-Service	1538100508	1538100508	1	1	KATHLEEN SUE WITTICH M.D.	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
40400	Fee-for-Service	1962591990	1962591990	1	1	KUO, JOHN MD	4/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79484	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
40424	Fee-for-Service	1457533044	1457533044	1	1	KELLY, NATALIE C PHD	11/15/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3102	19	06037	34.129683	-117.970857	Los Angeles County
40427	Fee-for-Service	1851356109	1851356109	1	1	KNUDSON, JAMES L	3/1/2001	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9640 VENICE BLVD	None	CULVER CITY	CA	90232	2626	19	06037	34.02441972	-118.3967126	Los Angeles County
40470	Fee-for-Service	1750437000	1750437000	1	1	KOTHARY, NISHITA N MD	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93652	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
40476	Fee-for-Service	1942068481	1942068481	1	1	KIMUHU, MERCY	4/24/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	547 HILLSWICK CIR	None	FOLSOM	CA	95630	8470	34	06067	38.658006	-121.119723	Sacramento County
40491	Fee-for-Service	1164955639	1164955639	1	1	KELLER, ELIZABETH K NP	4/2/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
40527	Fee-for-Service	1699785006	1699785006	1	1	KWOK, PHILLIP OD	8/15/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 N ROXBURY DR	3RD FLR	BEVERLY HILLS	CA	90210	4321	19	06037	34.06820793	-118.4070317	Los Angeles County
40530	Fee-for-Service	1639101793	1639101793	1	1	KOSARI, BABAK DPM	1/29/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	17075 DEVONSHIRE ST	304	NORTHRIDGE	CA	91325	1600	19	06037	34.25755945	-118.50471	Los Angeles County
40535	Fee-for-Service	1376745497	1376745497	1	1	KIKER, DALE G MD	3/9/2009	174400000X	NA	Other	026	PHYSICIANS	43889	05	Anesthesiology	0	In state provider	None	360 MOBIL AVE	STE 200	CAMARILLO	CA	93010	6356	56	06111	34.220151	-119.0429435	Ventura County
40545	Fee-for-Service	1649704610	1649704610	1	1	KILDAY, DANA T NP	11/5/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
40555	Fee-for-Service	1144305566	1144305566	1	1	KUMAR, PIYUSH MD	3/21/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44592	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
40557	Fee-for-Service	1720195894	1720195894	1	1	KENNETH KIST,MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
40568	Fee-for-Service	1841503018	1841503018	1	1	KUNG, ELEANOR W OD	10/25/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	340 W PORTAL AVE	None	SAN FRANCISCO	CA	94127	1412	38	06075	37.73744363	-122.4697471	San Francisco County
40577	Fee-for-Service	1346611225	1346611225	1	1	KL PHARMACY CORPORATION	9/16/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4718 W FIRST ST	SUITE 101	SANTA ANA	CA	92703	3106	30	06059	33.74505053	-117.932085	Orange County
40590	Fee-for-Service	1326468620	1326468620	1	1	KAVAFYAN, LORIE DO	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14532	41	Internal Medicine	0	In state provider	None	15211 VANOWEN ST	STE 315	LOS ANGELES	CA	91405	3616	19	06037	34.19395411	-118.4642527	Los Angeles County
40603	Fee-for-Service	1811068083	1811068083	1	1	KATZ, NEIL T MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87870	20	Orthopedic Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
40606	Fee-for-Service	1568483691	1568483691	1	1	KOURY, THEOPHILE G MD	11/30/1996	207P00000X	NA	Other	026	PHYSICIANS	83451	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1601 CUMMINS DR	STE D	MODESTO	CA	95358	6411	50	06099	37.65889574	-121.0363556	Stanislaus County
40607	Fee-for-Service	1104850536	1104850536	1	1	KERBS, JAMES B DPM INC	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3800 J ST	None	SACRAMENTO	CA	95816	5551	34	06067	38.569869	-121.455729	Sacramento County
40641	Fee-for-Service	1184251225	1184251225	1	1	KOSER, SARAH	12/11/2023	390200000X	NA	Other	026	PHYSICIANS	191127	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
40660	Fee-for-Service	1801885132	1801885132	1	1	KATZ, NEIL OD	1/31/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9190 SIERRA AVE	STE 105	FONTANA	CA	92335	8613	36	06071	34.086879	-117.4357395	San Bernardino County
40673	Fee-for-Service	1588738678	1588738678	1	1	KOBAYASHI, STEPHEN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	22209	02	General Surgery	0	In state provider	None	152 PIONEER LN	STE F	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
40676	Fee-for-Service	1174679849	1174679849	1	1	KELNER, MICHAEL MD	3/31/1988	207ZP0104X	NA	Other	026	PHYSICIANS	48254	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
40694	Fee-for-Service	1336208065	1336208065	1	1	KNIGHT, WENDY J NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1200 DISCOVERY PLAZA	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
40716	Fee-for-Service	1881689321	1881689321	1	1	KLOPE, WILLIAM T MD	4/30/1995	208800000X	NA	Other	026	PHYSICIANS	70045	34	Urology and Urological Surgery	0	In state provider	None	145 N BRENT ST	STE 202	VENTURA	CA	93003	2852	56	06111	34.27394582	-119.2571887	Ventura County
40718	Fee-for-Service	1710116116	1710116116	1	1	KAISER FOUNDATION HOSPITALS	3/1/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
40776	Fee-for-Service	1194979278	1194979278	1	1	KORVES, ASHLEIGH E DPM	6/25/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1701 4TH ST	STE 100	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
40810	Fee-for-Service	1275769622	1275769622	1	1	KRONISH, KATE M MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129490	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
40822	Fee-for-Service	1033581913	1033581913	1	1	KENNEDY, SEAN A LCSW	2/8/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
40838	Fee-for-Service	1124060496	1124060496	1	1	KUPPINGER, JORDAN G MD	1/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
40882	Fee-for-Service	1255660825	1255660825	1	1	KIM, MICHELLE OD	4/20/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3407	33	06065	33.904782	-117.469323	Riverside County
40933	Fee-for-Service	1720212772	1720212772	1	1	KWAN, MONICA MD	7/13/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	106858	40	Pediatrics	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
40960	Fee-for-Service	1356786115	1356786115	1	1	KIM, KYEONG S MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134046	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
40963	Fee-for-Service	1821315243	1821315243	1	1	KATRAK, SHEREEN S MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124954	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	BLDG 80, RM WD84	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
40974	Fee-for-Service	1376690685	1376690685	1	1	KAISER PERM PHCY #223	1/23/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6860 AVENIDA ENCINAS	None	CARLSBAD	CA	92011	3201	37	06073	33.10754269	-117.3146974	San Diego County
40993	Fee-for-Service	1982687539	1982687539	1	1	KAO, PATRICIA MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86535	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
41006	Fee-for-Service	1710116116	1710116116	1	1	KAISER FOUNDATION HOSPITALS	3/1/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
41032	Fee-for-Service	1871937227	1871937227	1	1	KUMAR LIFECARE HOSPICE INC	3/16/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19350 BUSINESS CENTER DR	STE 112	NORTHRIDGE	CA	91324	3500	19	06037	34.23126006	-118.5551178	Los Angeles County
41037	Fee-for-Service	1124434071	1124434071	1	1	KINZINGER, MICHAEL R MD	1/15/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	139760	04	Otology, Laryngology, Rhinology	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
41095	Fee-for-Service	1558793760	1558793760	1	1	KAUR, TARANDEEP MD	8/15/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	152416	67	Endocrinology	0	In state provider	None	782 EAST HARDING WAY	None	STOCKTON	CA	95204	6101	39	06077	37.96910043	-121.284224	San Joaquin County
41096	Fee-for-Service	1548713696	1548713696	1	1	KHAN, BRIAN MD	6/28/2019	207R00000X	NA	Other	026	PHYSICIANS	151096	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
41109	Fee-for-Service	1487665410	1487665410	1	1	KIRKMAN, JASON H MD	7/21/1994	207R00000X	NA	Other	026	PHYSICIANS	47142	41	Internal Medicine	0	In state provider	None	895 SEQUOIA CIR	None	FORT BRAGG	CA	95437	5422	23	06045	39.4300159	-123.8024883	Mendocino County
41114	Fee-for-Service	1881125771	1881125771	1	1	KOBNER, SCOTT A MD	7/7/2021	207P00000X	NA	Other	026	PHYSICIANS	161222	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
41115	Fee-for-Service	1134223134	1134223134	1	1	KIM, ISAAC K	9/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87972	08	Family Practice	0	In state provider	None	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
41127	Fee-for-Service	1902385644	1902385644	1	1	KUMRA, AJAY NP	1/23/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3930 4TH AVE	STE 300	SAN DIEGO	CA	92103	3119	37	06073	32.74892723	-117.1616459	San Diego County
41165	Fee-for-Service	1225422678	1225422678	1	1	KLUCK, SARAH L MD	7/23/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146292	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
41199	Fee-for-Service	1992754121	1992754121	1	1	KHANNA, AJAI MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71256	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
41220	Fee-for-Service	1164613378	1164613378	1	1	KISHORE, ANITA R MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130450	26	Psychiatry (child)	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
41222	Fee-for-Service	1063590875	1063590875	1	1	KUMAR, PARSHOTAM MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71879	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
41224	Fee-for-Service	1891322004	1891322004	1	1	KLAPTHOR, BRENT G MD	12/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178645	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
41252	Fee-for-Service	1821315243	1821315243	1	1	KATRAK, SHEREEN S MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124954	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	BLDG 80, RM WD84	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
41301	Fee-for-Service	1043267321	1043267321	1	1	KIM, SENDIA MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99966	24	Plastic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
41320	Fee-for-Service	1871937227	1871937227	1	1	KUMAR LIFECARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19350 BUSINESS CENTER DR	STE 112	NORTHRIDGE	CA	91324	3500	19	06037	34.23126006	-118.5551178	Los Angeles County
41327	Fee-for-Service	1124434071	1124434071	1	1	KINZINGER, MICHAEL R MD	1/15/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	139760	70	Clinic (mixed specialty)	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
41328	Fee-for-Service	1184770653	1184770653	1	1	KRAUSE, PAUL K MD	5/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66523	08	Family Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 101	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
41336	Fee-for-Service	1326468166	1326468166	1	1	KAZBOUR, HANA MD	8/8/2017	207R00000X	NA	Other	026	PHYSICIANS	138162	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
41351	Fee-for-Service	1467154153	1467154153	1	1	KHALID, SAHAR	1/24/2025	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
41409	Fee-for-Service	1194037960	1194037960	1	1	KESTLER, ARIEH Z MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124128	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1691	43	06085	37.36217918	-121.8472051	Santa Clara County
41420	Fee-for-Service	1326458043	1326458043	1	1	KABIRIAN, NIMA MD	3/6/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	137959	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
41440	Fee-for-Service	1720305584	1720305584	1	1	KIM, JIEUN A MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115677	18	Ophthalmology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
41477	Fee-for-Service	1992739254	1992739254	1	1	KING, BRYAN S MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77678	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
41480	Fee-for-Service	1497802714	1497802714	1	1	KAISER FND HLTH PLN,INC	3/15/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARMACY 409	365 E HILLCREST DR	None	THOUSAND OAKS	CA	91360	5820	56	06111	34.18122452	-118.8704974	Ventura County
41486	Fee-for-Service	1417488123	1417488123	1	1	KELADA, ANDREW MD	10/8/2021	207RC0200X	NA	Other	026	PHYSICIANS	156915	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
41490	Fee-for-Service	1790869196	1790869196	1	1	KOCHENBURGER, RICHARD MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69254	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2111 WHITEHALL PL	STE A	ALAMEDA	CA	94501	6160	01	06001	37.75931545	-122.2543394	Alameda County
41505	Fee-for-Service	1235251661	1235251661	1	2	KAMALAKAR RAMBHATLA, MD, INC	5/9/2022	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A PROFESSIONAL CORPORAT	611 S. FIRST AVE	SUITE A	ARCADIA	CA	91006	6152	19	06037	34.133058	-118.0282375	Los Angeles County
41508	Fee-for-Service	1164613378	1164613378	1	1	KISHORE, ANITA R MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130450	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
41516	Fee-for-Service	1477766426	1477766426	1	1	KAKIMOTO, WILLIAM M MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90810	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
41562	Fee-for-Service	1740701291	1740701291	1	1	KHIDIR, HAZAR MD	2/10/2025	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
41589	Fee-for-Service	1639564537	1639564537	1	1	KNIGHT, ZENA L MD	8/8/2021	207L00000X	NA	Other	026	PHYSICIANS	144587	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
41595	Fee-for-Service	1114234440	1114234440	1	1	KRAUCHUK, DANIEL R DO	9/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11543	02	General Surgery	0	In state provider	None	2323 16TH STREET	SUITE 504	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
41613	Fee-for-Service	1124434071	1124434071	1	1	KINZINGER, MICHAEL R MD	1/15/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	139760	84	Surgery-Head and Neck	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
41629	Fee-for-Service	1528144763	1528144763	1	1	KIDS-CARE MED GROUP INC	2/18/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2115 W CRESCENT AVE	STE 248	ANAHEIM	CA	92801	3836	30	06059	33.83979449	-117.9554355	Orange County
41676	Fee-for-Service	1902201072	1902201072	1	1	KIENTZEL, BETHANY LMFT	11/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	340 SOQUEL AVE	STE 101	SANTA CRUZ	CA	95062	2328	44	06087	36.97429269	-122.0196933	Santa Cruz County
41697	Fee-for-Service	1497803365	1497803365	1	1	KAISER FDN HLTH PLAN INC	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KFHP HSP I/P PHMY #12A	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
41739	Fee-for-Service	1265412969	1265412969	1	1	KROSS, JOE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	VALLEY ANES CONSULTANTS	2901 N CENTRAL AVE,	SUITE 500	PHOENIX	AZ	85012	0000	00	None	33.480666	-112.0729905	Maricopa County
41776	Fee-for-Service	1427167535	1427167535	1	1	KILLEEN, THOMAS E MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59336	04	Otology, Laryngology, Rhinology	0	In state provider	None	3000 L ST	None	SACRAMENTO	CA	95816	5248	34	06067	38.570517	-121.4672175	Sacramento County
41786	Fee-for-Service	1831361542	1831361542	1	1	KRISTIN GRANT	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	125 N 18TH ST	None	MOUNT VERNON	WA	98273	3902	00	None	48.422061	-122.318878	Skagit County
41823	Fee-for-Service	1922183672	1922183672	1	1	KALEUGHER, ELIZABETH NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13611 E COLFAX AVE	None	AURORA	CO	80045	5701	00	None	39.74039327	-104.8302052	Adams County
41834	Fee-for-Service	1740354851	1740354851	1	1	KAISER FOUNDATION	11/1/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL MANTECA	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5187	39	06077	37.79735946	-121.2461325	San Joaquin County
41851	Fee-for-Service	1962684423	1962684423	1	1	KAFAJA, SUZANNE MD	12/29/2010	207RR0500X	NA	Other	026	PHYSICIANS	97104	None	None	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
41885	Fee-for-Service	1114234440	1114234440	1	1	KRAUCHUK, DANIEL R DO	9/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11543	01	General Practice	0	In state provider	None	2323 16TH STREET	SUITE 504	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
41902	Fee-for-Service	1639487150	1639487150	1	1	KLEIN, AJ MD A PROFESSIONAL	11/17/1999	207R00000X	NA	Other	026	PHYSICIANS	4721	41	Internal Medicine	0	In state provider	CORPORATION	6367 ALVARADO COURT	SUITE 200	SAN DIEGO	CA	92120	4915	37	06073	32.77665968	-117.0614306	San Diego County
41919	Fee-for-Service	1225118599	1225118599	1	1	KIM, LUCIA C MD	6/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88101	41	Internal Medicine	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
41926	Fee-for-Service	1730251216	1730251216	1	1	KIM, EDWARD H MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86511	02	General Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
41957	Fee-for-Service	1114069069	1114069069	1	1	KAPPHAHN, CYNTHIA J MD	1/1/1992	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	71797	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
41967	Fee-for-Service	1245408848	1245408848	1	1	KIM, JOHN P MD	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126867	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
41973	Fee-for-Service	1598799330	1598799330	1	1	KEANY, JAMES E JR MD	4/30/1992	207P00000X	NA	Other	026	PHYSICIANS	77535	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
41975	Fee-for-Service	1558999219	1558999219	1	1	KATZ, JARED M MD	3/12/2024	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
41983	Fee-for-Service	1689782120	1689782120	1	1	KULAR, SARINA H MD INC	1/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61563	41	Internal Medicine	0	In state provider	None	7974 HAVEN AVE	STE 210	RANCHO CUCAMONGA	CA	91730	3052	36	06071	34.10875445	-117.5759905	San Bernardino County
42023	Fee-for-Service	1962897439	1962897439	1	1	KELLMAN, BERNIE J LMFT	12/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
42028	Fee-for-Service	1376816330	1376816330	1	1	KOOMSON, GLORIA MD	9/18/2023	207R00000X	NA	Other	026	PHYSICIANS	175239	None	None	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
42050	Fee-for-Service	1396278479	1396278479	1	1	KOTTAPALLI, SAI M DO	10/21/2022	2086S0129X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	None	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
42062	Fee-for-Service	1427167535	1427167535	1	1	KILLEEN, THOMAS E MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59336	84	Surgery-Head and Neck	0	In state provider	None	3000 L ST	None	SACRAMENTO	CA	95816	5248	34	06067	38.570517	-121.4672175	Sacramento County
42107	Fee-for-Service	1356754105	1356754105	1	1	KLUG, MICHAEL MD	4/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144741	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2021 HERNDON AVE	SUITE 101	CLOVIS	CA	93611	6101	10	06019	36.83757551	-119.6792955	Fresno County
42161	Fee-for-Service	1831109982	1831109982	1	1	KETTLEHAKE, PATRICIA M MD	5/7/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68312	41	Internal Medicine	0	In state provider	None	1050 B AVE	STE C	CORONADO	CA	92118	3430	37	06073	32.68408301	-117.1780847	San Diego County
42166	Fee-for-Service	1750474185	1750474185	1	1	KO, ALBERT S MD	10/11/2007	208600000X	NA	General Surgery	026	PHYSICIANS	66865	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
42168	Fee-for-Service	1619175718	1619175718	1	1	KENNEDY, HUMA H MD	1/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113102	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
42209	Fee-for-Service	1225199201	1225199201	1	1	KIM, JONG G MD A MEDICAL	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	32816	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CORPORATION	414 S PROSPECTORS RD	SUITE B	DIAMOND BAR	CA	91765	1615	19	06037	34.0175153	-117.8122207	Los Angeles County
42266	Fee-for-Service	1962714634	1962714634	1	1	KHAN, SALMAN A MEDICAL	2/2/2011	207R00000X	NA	Other	026	PHYSICIANS	108834	02	General Surgery	0	In state provider	CORPORATION	1701 E CESAR CHAVEZ AVE	STE 300	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
42268	Fee-for-Service	1326571969	1326571969	1	1	KATSMA, MARK S DO	8/1/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	19988	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
42304	Fee-for-Service	1043524077	1043524077	1	1	KALMYKOW, BRIANNA C NP	8/4/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
42309	Fee-for-Service	1457438103	1457438103	1	1	KORDANA, KRISTOPHER E MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63588	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
42331	Fee-for-Service	1487620357	1487620357	1	1	KOERNER, ANTHONY G MD	2/10/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	24734	41	Internal Medicine	0	In state provider	None	444 N ALTADENA DR	STE 100	PASADENA	CA	91107	2541	19	06037	34.1539266	-118.0984391	Los Angeles County
42382	Fee-for-Service	1912118894	1912118894	1	1	KANKANAM GAMAGE,THORANAGE H	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107281	41	Internal Medicine	0	In state provider	MD	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
42402	Fee-for-Service	1184068470	1184068470	1	1	KOZMAN, DANIEL M MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133024	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
42449	Fee-for-Service	1831109982	1831109982	1	1	KETTLEHAKE, PATRICIA M MD	5/7/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68312	40	Pediatrics	0	In state provider	None	1050 B AVE	STE C	CORONADO	CA	92118	3430	37	06073	32.68408301	-117.1780847	San Diego County
42494	Fee-for-Service	1467420232	1467420232	1	1	KALRA, PRAVEEN MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55583	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
42495	Fee-for-Service	1356728463	1356728463	1	1	KARRA, ANNAPURNA MD	9/19/2018	390200000X	NA	Other	026	PHYSICIANS	148068	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
42496	Fee-for-Service	1386933885	1386933885	1	1	KAISER FOUNDATION HEALTH	8/1/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2295 S VINEYARD AVE	BLDG D FL1	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
42518	Fee-for-Service	1982697009	1982697009	1	1	KAWASAKI, HIROTO MD	1/23/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
42523	Fee-for-Service	1225302789	1225302789	1	2	KHAMIS, SHERIF MD INC	4/10/2014	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43374	40	Pediatrics	0	In state provider	None	2271 E PALMDALE BLVD	SUITE E	PALMDALE	CA	93550	1340	19	06037	34.58021047	-118.087218	Los Angeles County
42530	Fee-for-Service	1386738839	1386738839	1	1	KATHERINE A LEE M.D.	12/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 2ND ST	None	BOISE	ID	83702	6109	00	None	43.61324894	-116.1951369	Ada County
42548	Fee-for-Service	1912962556	1912962556	1	1	KANEL, JEFFREY S MD	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	57900	40	Pediatrics	0	In state provider	None	2512 SAMARITAN CT	STE K	SAN JOSE	CA	95124	4002	43	06085	37.25087737	-121.9503926	Santa Clara County
42558	Fee-for-Service	1962714634	1962714634	1	1	KHAN, SALMAN A MEDICAL	2/2/2011	207R00000X	NA	Other	026	PHYSICIANS	108834	41	Internal Medicine	0	In state provider	CORPORATION	1701 E CESAR CHAVEZ AVE	STE 300	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
42593	Fee-for-Service	1407970874	1407970874	1	1	KALFUS, FRANCES CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1911 VINE ST	None	BERKELEY	CA	94709	2013	01	06001	37.87974483	-122.273226	Alameda County
42595	Fee-for-Service	1730204231	1730204231	1	1	KLEINBRODT, DAVID G	8/16/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
42604	Fee-for-Service	1073502696	1073502696	1	1	KUNZEL, KURT H MD	7/1/1983	207P00000X	NA	Other	026	PHYSICIANS	34671	None	None	0	In state provider	None	1625 HILL RD	None	NOVATO	CA	94947	4316	21	06041	38.09815363	-122.5798889	Marin County
42610	Fee-for-Service	1851349112	1851349112	1	1	KOPP, ALAN J MD	3/24/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162014	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
42619	Fee-for-Service	1487620357	1487620357	1	1	KOERNER, ANTHONY G MD	2/10/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	24734	66	Emergency Medicine (Urgent Care)	0	In state provider	None	444 N ALTADENA DR	STE 100	PASADENA	CA	91107	2541	19	06037	34.1539266	-118.0984391	Los Angeles County
42640	Fee-for-Service	1376894725	1376894725	2	1	KUM CORPORATION	7/1/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19409 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91351	2632	19	06037	34.41580034	-118.4750661	Los Angeles County
42650	Fee-for-Service	1508284019	1508284019	1	1	KAISER FOUNDATION HEALTH	8/13/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	10820 183RD ST	FL 1	CERRITOS	CA	90703	8013	19	06037	33.86553349	-118.1027115	Los Angeles County
42670	Fee-for-Service	1073557526	1073557526	1	1	KATZ, MICHAEL D MD	12/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	58407	None	None	0	In state provider	None	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
42678	Fee-for-Service	1659096360	1659096360	1	1	KOZLOFF, VIOLET CCC-SLP	12/1/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
42688	Fee-for-Service	1184068470	1184068470	1	1	KOZMAN, DANIEL M MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133024	40	Pediatrics	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
42762	Fee-for-Service	1740867407	1740867407	1	1	KOSARAJU, PRIYANKA S MD	5/20/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
42779	Fee-for-Service	1184746380	1184746380	1	1	KAYPEKIAN, CHRISTOPHER K	7/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86477	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
42789	Fee-for-Service	1316135759	1316135759	1	1	KEH, HAN J OD	4/17/2008	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2690 EAST BIDWELL ST	STE 500	FOLSOM	CA	95630	6432	34	06067	38.657646	-121.1251905	Sacramento County
42795	Fee-for-Service	1043346786	1043346786	1	1	KUNITAKE, HIROKO MD	1/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104901	02	General Surgery	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
42839	Fee-for-Service	1912962556	1912962556	1	1	KANEL, JEFFREY S MD	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	57900	20	Orthopedic Surgery	0	In state provider	None	2512 SAMARITAN CT	STE K	SAN JOSE	CA	95124	4002	43	06085	37.25087737	-121.9503926	Santa Clara County
42890	Fee-for-Service	1194869388	1194869388	1	1	KNIGHT, CHARLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3600 NW SAMARITAN DR	None	CORVALLIS	OR	97330	3737	00	None	44.60340934	-123.2532543	Benton County
42898	Fee-for-Service	1467607648	1467607648	1	1	KRISEMAN, YANA L MD	6/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107026	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
42922	Fee-for-Service	1235442112	1235442112	1	1	KAMDAR, NIRAV V MD	10/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131694	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
42923	Fee-for-Service	1225302789	1225302789	1	1	KHAMIS, SHERIF MD INC	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	43374	None	None	0	In state provider	None	7257 OWENSMOUTH AVE	STE A	CANOGA PARK	CA	91303	1321	19	06037	34.20270201	-118.6015969	Los Angeles County
42949	Fee-for-Service	1205089752	1205089752	1	1	KUMAR, SARITA NP	5/10/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
42964	Fee-for-Service	1316347537	1316347537	1	1	KIM, ANDREW NP	1/12/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
43007	Fee-for-Service	1700988433	1700988433	1	1	KRAEMER, MATTHEW D PT	10/20/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1385 TAVERN RD	None	ALPINE	CA	91901	3833	37	06073	32.83576956	-116.7758893	San Diego County
43011	Fee-for-Service	1093202103	1093202103	1	1	KIM, JUNG W MD	4/16/2024	207R00000X	NA	Other	026	PHYSICIANS	166333	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
43025	Fee-for-Service	1568604965	1568604965	1	1	KENNETHEHOLLIMANINC	11/4/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39719	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	23600 TELO AVE	STE 250	TORRANCE -	CA	90505	4037	19	06037	33.81215054	-118.3384029	Los Angeles County
43027	Fee-for-Service	1972149904	1972149904	1	1	KIM, STEPHANIE Y CNP	4/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2505 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2011	19	06037	34.03287856	-118.4748782	Los Angeles County
43035	Fee-for-Service	1144385758	1144385758	1	1	KURIAN, ALLISON W MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79485	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
43069	Fee-for-Service	1679653869	1679653869	1	1	KIRSCH, HENRY L MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	36527	10	Gastroenterology (M.D. only)	0	In state provider	None	3831 HUGHES AVE	STE 602	CULVER CITY	CA	90232	6845	19	06037	34.02243278	-118.3981492	Los Angeles County
43076	Fee-for-Service	1801343421	1801343421	1	1	KAUL, ANAND MD	7/16/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
43108	Fee-for-Service	1013093327	1013093327	1	1	KENNEDY, ABBEY L MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111548	20	Orthopedic Surgery	0	In state provider	None	18 BON AIR ROAD	None	LARKSPUR	CA	94939	1123	21	06041	37.94413684	-122.5391261	Marin County
43172	Fee-for-Service	1003865197	1003865197	1	1	KRANE, JEFFREY F MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	160031	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
43184	Fee-for-Service	1467734830	1467734830	1	1	KNA HOME HEALTH INC	1/10/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7100 HAYVENHURST AVE	P-D	VAN NUYS	CA	91406	3832	19	06037	34.199064	-118.4923845	Los Angeles County
43191	Fee-for-Service	1447577523	1447577523	1	1	KAUR, NAVNEET MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129174	41	Internal Medicine	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINTAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
43192	Fee-for-Service	1942387808	1942387808	1	1	KHAPCHIK, VLADMIR MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55706	20	Orthopedic Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
43204	Fee-for-Service	1275221327	1275221327	1	1	KING, CHRISTOPHER DO	11/30/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23187	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
43235	Fee-for-Service	1336787910	1336787910	1	1	KARANJA, DORCAS N	9/4/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	24216 GAZANIA WAY	None	LAKE ELSINORE	CA	92532	2735	33	06065	33.66616206	-117.2683924	Riverside County
43243	Fee-for-Service	1053738385	1053738385	1	1	KROIN, ELLEN V MD	8/1/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	161234	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
43244	Fee-for-Service	1306250212	1306250212	1	1	KHAIRA, JAGMOHAN S MD INC	5/24/2016	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	81083	None	None	0	In state provider	None	1050 MARINA VILLAGE PKWY	STE 101	ALAMEDA	CA	94501	1033	01	06001	37.78557847	-122.270065	Alameda County
43250	Fee-for-Service	1376705111	1376705111	1	1	KINDER, KIMBERLY J MD	6/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142311	04	Otology, Laryngology, Rhinology	0	In state provider	None	2350 BUHNE STREET	SUITE B & C	EUREKA	CA	95501	3205	12	06023	40.78592523	-124.1422103	Humboldt County
43256	Fee-for-Service	1790749398	1790749398	1	1	KONA, LAKSHMI C MD	12/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132142	41	Internal Medicine	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
43273	Fee-for-Service	1457336661	1457336661	1	1	KRAVITZ, RICHARD L MD	1/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52777	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
43293	Fee-for-Service	1619922499	1619922499	1	1	KANZARIA, PAULOMI K MD	10/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	42848	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
43301	Fee-for-Service	1114509718	1114509718	1	1	KWONG, ANDREW M OD	1/7/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 BROADWAY	None	SAN FRANCISCO	CA	94133	4405	38	06075	37.79779175	-122.4073064	San Francisco County
43331	Fee-for-Service	1104475201	1104475201	1	1	KAUFMAN, RACHEL PT	6/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
43347	Fee-for-Service	1114988441	1114988441	1	1	KADAMBI, PRAMOD V MD	1/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84174	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	41210 11TH ST W	STE G	PALMDALE	CA	93551	1447	19	06037	34.631649	-118.150154	Los Angeles County
43356	Fee-for-Service	1679653869	1679653869	1	1	KIRSCH, HENRY L MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	36527	41	Internal Medicine	0	In state provider	None	3831 HUGHES AVE	STE 602	CULVER CITY	CA	90232	6845	19	06037	34.02243278	-118.3981492	Los Angeles County
43357	Fee-for-Service	1285306498	1285306498	1	1	KASTEN, ALYSSA H LCSW	12/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	50 S SAN MATEO DR	SUITE 120	SAN MATEO	CA	94401	3857	41	06081	37.56634141	-122.3261145	San Mateo County
43398	Fee-for-Service	1093073231	1093073231	1	1	KARIMI, HOMA MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120770	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
43416	Fee-for-Service	1497933691	1497933691	1	1	KORYO HEALTH FOUNDATION	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1058 S VERMONT AVE	None	LOS ANGELES	CA	90006	2721	19	06037	34.050987	-118.2915745	Los Angeles County
43417	Fee-for-Service	1669552485	1669552485	1	1	KOLLI, HEMCHAND MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	56066	41	Internal Medicine	0	In state provider	None	1275 E LATHAM AVE	None	HEMET	CA	92543	4424	33	06065	33.74938248	-116.9589555	Riverside County
43442	Fee-for-Service	1902195811	1902195811	1	1	KIM, JESSICA J H MD	12/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129230	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
43450	Fee-for-Service	1962722660	1962722660	1	1	KU-BORDEN, TERESA T MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118543	01	General Practice	0	In state provider	None	1701 CESAR CHAVEZ AVENUE	STE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
43467	Fee-for-Service	1336748763	1336748763	1	1	KRAUSE PAMBAKIAN, IVONNE D	11/30/2020	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	275 E HILLCREST DR	STE 160 -121	THOUSAND OAKS	CA	91360	5827	56	06111	34.1812975	-118.8718187	Ventura County
43480	Fee-for-Service	1447577523	1447577523	1	1	KAUR, NAVNEET MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129174	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINTAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
43522	Fee-for-Service	1336787910	1336787910	1	1	KARANJA, DORCAS N	9/4/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	24216 GAZANIA WAY	None	LAKE ELSINORE	CA	92532	2735	33	06065	33.66616206	-117.2683924	Riverside County
43524	Fee-for-Service	1619994175	1619994175	1	1	KATZ, ERIC D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
43549	Fee-for-Service	1376936856	1376936856	1	1	KHAN, SHAMROZE MD	9/6/2024	208M00000X	NA	Other	026	PHYSICIANS	22478	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
43573	Fee-for-Service	1508929290	1508929290	1	1	KAUR, KALWINDER MD	10/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96936	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
43586	Fee-for-Service	1225226228	1225226228	1	1	KRPAN, CHRISTOPHER J DO APC	8/13/2004	193400000X	NA	Other	026	PHYSICIANS	7650	20	Orthopedic Surgery	0	In state provider	None	1300 KURT DR	STE 105	ANGELS CAMP	CA	95222	9324	05	06009	38.07476917	-120.5364629	Calaveras County
43592	Fee-for-Service	1518165539	1518165539	1	1	KORABATHINA, KALYANI MD	4/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98947	13	Neurology (M.D. only)	0	In state provider	None	3907 WARING RD	STE 2	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
43610	Fee-for-Service	1740293299	1740293299	1	1	KAMAL, MAFA R MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42112	36	Psychiatry	0	In state provider	None	1127 WILSHIRE BLVD	STE 500	LOS ANGELES	CA	90017	3906	19	06037	34.05270508	-118.2641005	Los Angeles County
43633	Fee-for-Service	1346515426	1346515426	1	1	KWONG, ALLISON J MD	9/9/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	126767	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
43640	Fee-for-Service	1043234065	1043234065	1	1	KLOTH, THEODORE I MD	12/4/1986	207P00000X	NA	Other	026	PHYSICIANS	25151	08	Family Practice	0	In state provider	None	1715 PLACER ST	None	REDDING	CA	96001	1715	45	06089	40.58138319	-122.3938411	Shasta County
43665	Fee-for-Service	1386072346	1386072346	1	1	KAPLUN, YEKATERINA LMFT	1/3/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
43672	Fee-for-Service	1285209569	1285209569	1	1	KELLY, MADELEINE C LMFT	10/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
43704	Fee-for-Service	1366002347	1366002347	1	1	KOW, SEAN Y MD	7/11/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178615	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
43717	Fee-for-Service	1700125168	1700125168	1	1	KAHEN, TANAZ MD INC	8/9/2016	193400000X	NA	Other	026	PHYSICIANS	79336	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5525 ETIWANDA AVE	STE 209	TARZANA	CA	91356	6117	19	06037	34.17046451	-118.5308463	Los Angeles County
43719	Fee-for-Service	1376670273	1376670273	1	1	KOHN, ROGER MD	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	31087	18	Ophthalmology	0	In state provider	None	2920 F ST	STE C	BAKERSFIELD	CA	93301	1845	15	06029	35.385993	-119.0234435	Kern County
43737	Fee-for-Service	1629572904	1629572904	1	1	KUMAR, MONICA P MD	1/26/2022	390200000X	NA	Other	026	PHYSICIANS	173428	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
43747	Fee-for-Service	1245466929	1245466929	1	1	KOPER, CATHERINE M MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131999	77	Infectious Disease	0	In state provider	None	2752 HARRISON AVE	SUITE A	EUREKA	CA	95501	4738	12	06023	40.7831071	-124.139684	Humboldt County
43766	Fee-for-Service	1447577523	1447577523	1	1	KAUR, NAVNEET MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129174	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINTAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
43796	Fee-for-Service	1952340937	1952340937	1	1	KASZA, ATTILA MD	9/20/2007	208M00000X	NA	Other	026	PHYSICIANS	75512	41	Internal Medicine	0	In state provider	None	251 COHASSET RD	STE 130	CHICO	CA	95926	2235	04	06007	39.75090044	-121.8522609	Butte County
43839	Fee-for-Service	1972919355	1972919355	1	1	KAMIL FAIZ, FATHIMA ZAHRA MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146302	41	Internal Medicine	0	In state provider	None	3610 ATLANTIC AVE	None	LONG BEACH	CA	90807	3418	19	06037	33.822621	-118.185002	Los Angeles County
43860	Fee-for-Service	1023269461	1023269461	1	1	KIM, PHILIP H MD	9/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	100044	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
43863	Fee-for-Service	1902062516	1902062516	1	1	KENDRA L HALL, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 S MILWAUKEE AVE	None	LIBERTYVILLE	IL	60048	3204	00	None	42.274494	-87.957666	Lake County
43872	Fee-for-Service	1275793929	1275793929	1	1	KIDDER, BRENDAN J MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112379	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
43888	Fee-for-Service	1659617124	1659617124	1	1	KAISER FOUNDATION HEALTH	3/10/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	27200 IRIS AVE	MOB 2, FLOOR 1	MORENO VALLEY	CA	92555	4803	33	06065	33.8955513	-117.189743	Riverside County
43900	Fee-for-Service	1710243936	1710243936	1	1	KHODABAKHSH, HADIE MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126763	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
43914	Fee-for-Service	1992893408	1992893408	1	1	KRUEGER, JAMES J MD INC	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	45160	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	701 E 28TH ST	STE 400	LONG BEACH	CA	90806	2778	19	06037	33.80803441	-118.1847137	Los Angeles County
43922	Fee-for-Service	1538746151	1538746151	1	1	KAUR, MANKIRAN MD	11/20/2024	207R00000X	NA	Other	026	PHYSICIANS	192288	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
43925	Fee-for-Service	1104900380	1104900380	1	1	KUWAMOTO, RUSSELL G DC	12/31/1983	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2384 E GETTYSBURG AVE	None	FRESNO	CA	93726	0320	10	06019	36.80128652	-119.782764	Fresno County
43950	Fee-for-Service	1922578822	1922578822	1	1	KERN COUNTY HOSPITAL AUTHORI	11/14/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3551 Q ST	None	BAKERSFIELD	CA	93301	1657	15	06029	35.392059	-119.010556	Kern County
43956	Fee-for-Service	1407299530	1407299530	1	1	KHAKI, ALI R MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133860	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
43977	Fee-for-Service	1477870863	1477870863	1	1	KIM, EUGENE MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117816	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
43993	Fee-for-Service	1740569219	1740569219	1	1	KRAPIVINSKY, EVGENIYA MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138190	41	Internal Medicine	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	91447	1079	38	06075	37.7738933	-122.4544685	San Francisco County
44018	Fee-for-Service	1487099974	1487099974	1	1	KO, MYUNG S MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134055	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44034	Fee-for-Service	1245466929	1245466929	1	1	KOPER, CATHERINE M MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131999	41	Internal Medicine	0	In state provider	None	2752 HARRISON AVE	SUITE A	EUREKA	CA	95501	4738	12	06023	40.7831071	-124.139684	Humboldt County
44075	Fee-for-Service	1962769620	1962769620	1	1	KELIL, TATIANA MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145771	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44088	Fee-for-Service	1811263833	1811263833	1	1	KUMAR, USHA R MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128886	18	Ophthalmology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
44093	Fee-for-Service	1346306214	1346306214	1	1	KIM, ELIZABETH M MD	1/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113260	24	Plastic Surgery	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
44182	Fee-for-Service	1417554528	1417554528	1	1	KECK MEDICAL CENTER OF USC	1/1/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
44183	Fee-for-Service	1861497372	1861497372	1	1	KHETAN, SHISHIR K MD	10/20/2022	207R00000X	NA	Other	026	PHYSICIANS	177796	None	None	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
44185	Fee-for-Service	1366520173	1366520173	1	1	KOH, YOOJIN MD	8/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82797	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
44193	Fee-for-Service	1700824844	1700824844	1	1	KERN AMBULANCE SERVICE	4/27/2006	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	KERN EMERGENCY MED TRANS	2324 7TH ST	None	WASCO	CA	93280	1585	15	06029	35.59431649	-119.352141	Kern County
44201	Fee-for-Service	1306036975	1306036975	1	1	KELLY, THOMAS J MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132640	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
44204	Fee-for-Service	1861548448	1861548448	1	1	KARCH, MICHAEL M MD	3/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63160	02	General Surgery	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0660	26	06051	37.64575895	-118.9638914	Mono County
44237	Fee-for-Service	1922578822	1922578822	1	1	KERN COUNTY HOSPITAL AUTHORI	9/10/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3551 Q ST	None	BAKERSFIELD	CA	93301	1657	15	06029	35.392059	-119.010556	Kern County
44238	Fee-for-Service	1790714319	1790714319	1	1	KING, ISABELLE N MD	8/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92166	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
44285	Fee-for-Service	1063707784	1063707784	1	1	KISSLING, CHASE A MD	4/8/2022	207L00000X	NA	Other	026	PHYSICIANS	173328	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
44364	Fee-for-Service	1487896585	1487896585	1	1	KROOPF, LISA R MD	11/16/2017	225400000X	NA	Other	026	PHYSICIANS	117523	25	Physical Medicine and Rehabilitation	0	In state provider	None	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	27	06053	36.66192801	-121.6413283	Monterey County
44399	Fee-for-Service	1376785006	1376785006	1	1	KHALED, SAMER M MD	8/19/2009	207R00000X	NA	Other	026	PHYSICIANS	109031	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
44411	Fee-for-Service	1386899631	1386899631	1	1	KOHARA, EUNICE M DO	7/29/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	11347	18	Ophthalmology	0	In state provider	None	2865 ATLANTIC AVE	SUITE 109	LONG BEACH	CA	90806	7404	19	06037	33.809418	-118.185058	Los Angeles County
44424	Fee-for-Service	1861139362	1861139362	1	2	KEVIN ALAN COX, DPM, PODIATR	9/11/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	Y CORPORATION	8851 CENTER DR	406	LA MESA	CA	91942	3017	37	06073	32.78189749	-117.0075062	San Diego County
44426	Fee-for-Service	1104141993	1104141993	1	1	KUPPERMAN, ASHER I MD	1/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118689	20	Orthopedic Surgery	0	In state provider	None	511 BATH STREET	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
44471	Fee-for-Service	1417554528	1417554528	1	1	KECK MEDICAL CENTER OF USC	1/1/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
44487	Fee-for-Service	1710921440	1710921440	1	1	KIM, HYUNG O MD INC	12/23/2003	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	35664	None	None	0	In state provider	None	2621 S BRISTOL ST	STE 300-302	SANTA ANA	CA	92704	5766	30	06059	33.711876	-117.885371	Orange County
44488	Fee-for-Service	1306036975	1306036975	1	1	KELLY, THOMAS J MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132640	25	Physical Medicine and Rehabilitation	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
44495	Fee-for-Service	1861548448	1861548448	1	1	KARCH, MICHAEL M MD	3/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63160	20	Orthopedic Surgery	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0660	26	06051	37.64575895	-118.9638914	Mono County
44524	Fee-for-Service	1902416399	1902416399	1	1	KIM, RYON LAC	1/18/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	151 YORBA ST STE 100	None	TUSTIN	CA	92780	2960	30	06059	33.74659322	-117.8302199	Orange County
44532	Fee-for-Service	1780733048	1780733048	1	1	KPADUWA, JULIUS C MD AMC	4/1/1999	174400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	15913 AMAR RD	None	LA PUENTE	CA	91744	2202	19	06037	34.03634547	-117.9375775	Los Angeles County
44548	Fee-for-Service	1114335288	1114335288	1	1	KLARA, ERIKA LMFT	1/25/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
44561	Fee-for-Service	1265849772	1265849772	1	1	KRAUSE, PETER A MEDICAL	8/25/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	128885	01	General Practice	0	In state provider	CORPORATION	2151 SOUTH COLLEGE DRIVE	SUITE 203	SANTA MARIA	CA	93455	1305	42	06083	34.92165056	-120.4253905	Santa Barbara County
44572	Fee-for-Service	1578559084	1578559084	1	1	KINTNER, PHILLIP L MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88574	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11795 EDUCATION ST	STE 222	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
44574	Fee-for-Service	1881125573	1881125573	1	1	KUO, KEVIN	8/28/2020	390200000X	NA	Other	026	PHYSICIANS	165816	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
44578	Fee-for-Service	1447588926	1447588926	1	1	KHAN, SAIRA H MD	9/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110011	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
44621	Fee-for-Service	1134672736	1134672736	1	1	KWONG, VANESSA Y	11/14/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGAR AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
44646	Fee-for-Service	1639732258	1639732258	1	1	KHABIBULINA, ZARINA MD	10/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177764	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
44660	Fee-for-Service	1801864988	1801864988	1	1	KHAIRA, JAGMOHAN S MD	10/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81083	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
44672	Fee-for-Service	1528057957	1528057957	1	1	KAMYAR, ROKAY MD INC	10/26/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5119 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.77197494	-117.0059214	San Diego County
44697	Fee-for-Service	1891100822	1891100822	1	1	KHAIRALLAH, PASCALE MD	7/4/2024	163WE0003X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
44743	Fee-for-Service	1508397563	1508397563	1	1	KIM, JAEHYUN MD	4/3/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	169959	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
44746	Fee-for-Service	1083075691	1083075691	1	1	KARMARKAR, PREEYANKA PT	5/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
44749	Fee-for-Service	1033485057	1033485057	1	1	KANG, GUSON MD	8/20/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127411	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
44793	Fee-for-Service	1902865462	1902865462	1	1	KRISHNA, CHANDRIKA G MD	1/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	48125	41	Internal Medicine	0	In state provider	None	254 SAN JOSE ST	None	SALINAS	CA	93901	3900	27	06053	36.65812965	-121.6458796	Monterey County
44820	Fee-for-Service	1780733048	1780733048	1	1	KPADUWA, JULIUS C MD AMC	12/24/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	15913 AMAR RD	None	LA PUENTE	CA	91744	2202	19	06037	34.03634547	-117.9375775	Los Angeles County
44822	Fee-for-Service	1891299715	1891299715	1	1	KRASNY, SARAH MD	9/23/2021	207R00000X	NA	Other	026	PHYSICIANS	165947	None	None	0	In state provider	None	100A SAN PABLO TOWNE CTR	None	SAN PABLO	CA	94806	0000	07	06013	37.95446487	-122.3326626	Contra Costa County
44847	Fee-for-Service	1720753692	1720753692	1	1	KADENCE HEALTHCARE, INC	10/20/2021	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5816 SHIELDS	111	FRESNO	CA	93727	8064	10	06019	36.77931004	-119.6908778	Fresno County
44854	Fee-for-Service	1649483884	1649483884	1	1	KELLING, JONATHAN G MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97287	05	Anesthesiology	0	In state provider	None	11406 LOMA LINDA DRIVE	STE 300	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
44896	Fee-for-Service	1386994655	1386994655	1	1	KOVAC'S CARE RX INC	12/24/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14423 GILMORE ST	None	VAN NUYS	CA	91401	1430	19	06037	34.18766852	-118.447362	Los Angeles County
44908	Fee-for-Service	1871515650	1871515650	1	1	KING, BRIAN F MD	8/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66685	01	General Practice	0	In state provider	None	11620 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90025	6801	19	06037	34.05024415	-118.4598908	Los Angeles County
44914	Fee-for-Service	1114952165	1114952165	1	1	KELLY, WILLIAM M MD INC	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	34125	None	None	0	In state provider	None	72980 FRED WARING DR	# A	PALM DESERT	CA	92260	9339	33	06065	33.72881111	-116.3916077	Riverside County
44953	Fee-for-Service	1346276649	1346276649	1	1	KOSINSKI, MARTA V MD	10/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	75516	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
44959	Fee-for-Service	1528057957	1528057957	1	1	KAMYAR, ROKAY MD INC	10/26/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	5119 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.77197494	-117.0059214	San Diego County
45023	Fee-for-Service	1801237037	1801237037	1	1	KRYSTOFOVA, JANA MD	6/17/2020	2080P0203X	NA	Other	026	PHYSICIANS	141825	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
45033	Fee-for-Service	1508397563	1508397563	1	1	KIM, JAEHYUN MD	4/3/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	169959	10	Gastroenterology (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
45044	Fee-for-Service	1417075383	1417075383	1	1	KEARNY MESA MEDICAL GRP	2/28/1988	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	7525 LINDA VISTA RD	None	SAN DIEGO	CA	92111	5301	37	06073	32.79886738	-117.159264	San Diego County
45046	Fee-for-Service	1437709433	1437709433	1	1	KOMAR, COURTNEY M CNP	3/2/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
45109	Fee-for-Service	1780733048	1780733048	1	1	KPADUWA, JULIUS C MD AMC	4/1/1999	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15913 AMAR RD	None	LA PUENTE	CA	91744	2202	19	06037	34.03634547	-117.9375775	Los Angeles County
45136	Fee-for-Service	1548725195	1548725195	1	1	KANG, RANEE LCSW	6/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
45137	Fee-for-Service	1316937931	1316937931	1	1	KAL, MARK P MD	3/10/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56821	08	Family Practice	0	In state provider	None	1004 FOWLER WAY	STE 4	PLACERVILLE	CA	95667	5746	09	06017	38.72683597	-120.7921028	El Dorado County
45158	Fee-for-Service	1881023257	1881023257	1	1	KSB GASTROENTEROLOGY	2/7/2014	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	101486	10	Gastroenterology (M.D. only)	0	In state provider	None	33 CREEK RD	SUITE 380	IRVINE	CA	92604	7709	30	06059	33.67506955	-117.796973	Orange County
45191	Fee-for-Service	1740367093	1740367093	1	2	KURTZ, MICHELLE S	4/21/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	980 N ADLER AVE	None	CLOVIS	CA	93611	6731	10	06019	36.848448	-119.726897	Fresno County
45195	Fee-for-Service	1871515650	1871515650	1	1	KING, BRIAN F MD	8/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66685	30	Radiology	0	In state provider	None	11620 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90025	6801	19	06037	34.05024415	-118.4598908	Los Angeles County
45221	Fee-for-Service	1891204541	1891204541	1	1	KITT, GARRETT D CRNA	11/8/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
45241	Fee-for-Service	1881213833	1881213833	1	1	KUMAR, SEEMAL MD	11/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191032	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
45262	Fee-for-Service	1457411209	1457411209	1	1	KANG, SHIN WOOK MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	65577	41	Internal Medicine	0	In state provider	None	2727 W OLYMPIC BLVD	STE 206	LOS ANGELES	CA	90006	2640	19	06037	34.0527015	-118.2931155	Los Angeles County
45267	Fee-for-Service	1083642839	1083642839	1	1	KIM, JAE K MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75520	41	Internal Medicine	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
45295	Fee-for-Service	1386998219	1386998219	1	1	KELLY, WALTER	2/17/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	333 H STREET	STE 5000	CHULA VISTA	CA	91910	5561	37	06073	32.63411233	-117.0783636	San Diego County
45312	Fee-for-Service	1538236062	1538236062	1	1	KOVELMAN, ROZALIA MD	2/13/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	41643	01	General Practice	0	In state provider	None	7531 SANTA MONICA BLVD	STE 202	WEST HOLLYWOOD	CA	90046	6458	19	06037	34.09081315	-118.3541261	Los Angeles County
45318	Fee-for-Service	1437704178	1437704178	1	1	KASSER, SUSAN E LMFT	2/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
45335	Fee-for-Service	1598810509	1598810509	1	1	KAISER FOUNDATION HOSPITALS	5/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10605 BALBOA BLVD	SUITE 330	GRANADA HILLS	CA	91344	6342	19	06037	34.263378	-118.5022965	Los Angeles County
45351	Fee-for-Service	1346276052	1346276052	1	1	KLEMMER, HOWARD E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE EMERGENY GROUP INC	1301 PUNCHBOWL ST	STE 207	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
45363	Fee-for-Service	1841638699	1841638699	1	1	KIM, JUN DO	2/10/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	15480	20	Orthopedic Surgery	0	In state provider	None	820 S AKERS	STE 220	VISALIA	CA	93277	8309	54	06107	36.323757	-119.3491755	Tulare County
45398	Fee-for-Service	1689733214	1689733214	1	1	KOONINGS, PAUL P MD	11/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50794	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
45430	Fee-for-Service	1740361252	1740361252	1	1	KATHRYN L REED, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
45445	Fee-for-Service	1306818653	1306818653	1	1	KAISER, KENNETH J LCSW	7/1/2002	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3055 W ORANGE AVE	STE 206	ANAHEIM	CA	92804	3154	30	06059	33.8247435	-117.99621	Orange County
45460	Fee-for-Service	1093393472	1093393472	1	1	KAELINS HOME HEALTH INC	5/17/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 365	CANOGA PARK	CA	91303	3395	19	06037	34.203222	-118.605988	Los Angeles County
45468	Fee-for-Service	1164529830	1164529830	1	1	KHAKMAHD, OLIVER K MD	10/22/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48805	45	Nephrology (Renal-Kidney)	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
45490	Fee-for-Service	1114934452	1114934452	1	1	KENNETH ANDERSON TAYLOR, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
45545	Fee-for-Service	1306991062	1306991062	1	1	KULDA, CELIA ELAINE OD	5/8/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MONTCLAIR OPTOMETRIC CTR	8801 CENTRAL AVE	STE C	MONTCLAIR	CA	91763	1657	36	06071	34.09323242	-117.6895216	San Bernardino County
45552	Fee-for-Service	1588195671	1588195671	1	1	KIEMELE, ERICA R MD	3/30/2021	207P00000X	NA	Other	026	PHYSICIANS	157694	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
45600	Fee-for-Service	1538236062	1538236062	1	1	KOVELMAN, ROZALIA MD	2/13/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	41643	07	Dermatology	0	In state provider	None	7531 SANTA MONICA BLVD	STE 202	WEST HOLLYWOOD	CA	90046	6458	19	06037	34.09081315	-118.3541261	Los Angeles County
45640	Fee-for-Service	1700050689	1700050689	1	1	KHODAVERDIAN, REZA MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127413	33	Thoracic Surgery	0	In state provider	None	212 SAN JOSE ST	#301	SALINAS	CA	93901	3928	27	06053	36.65853377	-121.6476066	Monterey County
45682	Fee-for-Service	1487725248	1487725248	1	1	KROUS, HENRY F MD	3/1/1995	207ZP0101X	NA	Other	026	PHYSICIANS	28595	22	Pathology (M.D. only)	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
45686	Fee-for-Service	1689733214	1689733214	1	1	KOONINGS, PAUL P MD	11/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50794	78	Neoplastic Diseases/Oncology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
45733	Fee-for-Service	1306818653	1306818653	1	1	KAISER, KENNETH J LCSW	10/30/2002	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3055 W ORANGE AVE	STE 206	ANAHEIM	CA	92804	3154	30	06059	33.8247435	-117.99621	Orange County
45746	Fee-for-Service	1568434124	1568434124	1	1	KHAN, ILYAS M MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64507	30	Radiology	0	In state provider	None	740 E ARROW HWY	STE A	COVINA	CA	91722	2144	19	06037	34.10550087	-117.8764722	Los Angeles County
45750	Fee-for-Service	1811218035	1811218035	1	1	KUO, SHINIE L MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150567	41	Internal Medicine	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
45757	Fee-for-Service	1164529830	1164529830	1	1	KHAKMAHD, OLIVER K MD	10/22/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48805	08	Family Practice	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
45785	Fee-for-Service	1134107519	1134107519	1	1	KABLER, HEIDI A MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
45820	Fee-for-Service	1932157732	1932157732	1	1	KERR, STEWART M MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70484	20	Orthopedic Surgery	0	In state provider	None	7235 N FIRST STREET	SUITE 103	FRESNO	CA	93720	2837	10	06019	36.84157633	-119.7748355	Fresno County
45877	Fee-for-Service	1487920005	1487920005	1	1	KHODAYARI, BEHNOOD	3/26/2018	390200000X	NA	Other	026	PHYSICIANS	139873	30	Radiology	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
45889	Fee-for-Service	1982463550	1982463550	1	1	KRESSIN, JARED PT	2/16/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
45927	Fee-for-Service	1700050689	1700050689	1	1	KHODAVERDIAN, REZA MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127413	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	212 SAN JOSE ST	#301	SALINAS	CA	93901	3928	27	06053	36.65853377	-121.6476066	Monterey County
46006	Fee-for-Service	1750419552	1750419552	1	1	KAY, TRANG T NP	8/27/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
46016	Fee-for-Service	1750344735	1750344735	1	1	KIEU, CHAN MD	2/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	33128	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
46041	Fee-for-Service	1811218035	1811218035	1	1	KUO, SHINIE L MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150567	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
46066	Fee-for-Service	1942696711	1942696711	1	1	KEISER, ELIZABETH MD	7/25/2022	207ZP0105X	NA	Other	026	PHYSICIANS	146294	None	None	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
46068	Fee-for-Service	1033135983	1033135983	3	1	KROGER SPECIALTY INFUSION CA	6/25/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	19110 VAN NESS AVE	None	TORRANCE	CA	90501	1101	19	06037	33.85726358	-118.31771	Los Angeles County
46106	Fee-for-Service	1932542107	1932542107	1	1	KOENIG, JONATHAN H MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153127	20	Orthopedic Surgery	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
46115	Fee-for-Service	1851456354	1851456354	1	1	KELLEY, TAMARA C MD	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137498	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
46199	Fee-for-Service	1811524903	1811524903	1	1	KIRKIRE, LAKSHMI	1/2/2025	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
46218	Fee-for-Service	1417156936	1417156936	1	1	KOCHANSKA, MARTA MD	4/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95683	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
46219	Fee-for-Service	1255960308	1255960308	1	1	KWAN, KRISTI DO	9/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20270	None	None	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
46223	Fee-for-Service	1902480445	1902480445	1	1	KELLEY, TATIANA S MD	2/3/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191453	08	Family Practice	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
46240	Fee-for-Service	1447645783	1447645783	1	1	KNELL, JAMIE MD	8/22/2023	2086S0102X	NA	General Surgery	026	PHYSICIANS	179437	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
46288	Fee-for-Service	1568428324	1568428324	1	1	KLEYNBERG, VERA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76939	41	Internal Medicine	0	In state provider	None	6333 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90048	5724	19	06037	34.06355697	-118.366413	Los Angeles County
46332	Fee-for-Service	1043742018	1043742018	1	1	KUROSAWA, GENE H MD	8/1/2022	207L00000X	NA	Other	026	PHYSICIANS	157422	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
46345	Fee-for-Service	1962445858	1962445858	1	1	KHAZAENI, BABAK MD	4/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90471	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
46387	Fee-for-Service	1104503432	1104503432	1	1	KAMO, JEFFREY OD	9/11/2023	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
46400	Fee-for-Service	1063814580	1063814580	1	1	KASTEN, HEATHER M NP	2/13/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
46479	Fee-for-Service	1821004623	1821004623	1	1	KOVACS, BRUCE K MD INC	10/18/2005	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	42117	08	Family Practice	0	In state provider	None	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
46486	Fee-for-Service	1811524903	1811524903	1	1	KIRKIRE, LAKSHMI	1/2/2025	207P00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
46487	Fee-for-Service	1588431241	1588431241	1	1	KISHIMOTO, RICHARD K PT	2/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2100 SOLAR DRIVE	204	OXNARD	CA	93036	2602	56	06111	34.22156515	-119.14488	Ventura County
46490	Fee-for-Service	1437417201	1437417201	1	1	KIM, ISAAC MD	7/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123810	30	Radiology	0	In state provider	None	3161 L STREET	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
46503	Fee-for-Service	1265595003	1265595003	1	1	KREISS,JOCELYN H MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109427	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
46514	Fee-for-Service	1285685172	1285685172	1	1	KRAUTHAMER, RICHARD E MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	37721	30	Radiology	0	In state provider	None	23560 MADISON ST	STE 101	TORRANCE	CA	90505	4709	19	06037	33.81145007	-118.3479265	Los Angeles County
46522	Fee-for-Service	1144225301	1144225301	1	1	KIM, THOMAS C K MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79886	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	700 N TUSTIN AVE	None	SANTA ANA	CA	92705	3602	30	06059	33.75128487	-117.834205	Orange County
46561	Fee-for-Service	1548211022	1548211022	1	1	KULWIEC, ELIZABETH L. MD	4/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	504 21ST STREET	None	GLENWOOD SPRINGS	CO	81601	0000	00	None	39.53115672	-107.322255	Garfield County
46647	Fee-for-Service	1477689891	1477689891	1	1	KIM, LINDA U MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111331	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
46663	Fee-for-Service	1013233642	1013233642	1	1	KAPLAN, ALAN L MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122522	34	Urology and Urological Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
46699	Fee-for-Service	1558558239	1558558239	1	1	KAN, MEREDITH L MD	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104477	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46704	Fee-for-Service	1285787895	1285787895	1	1	KINGS CO OFFICE OF ED	11/30/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1144 W LACEY BLVD	None	HANFORD	CA	93230	5956	16	06031	36.32815296	-119.6635928	Kings County
46733	Fee-for-Service	1780841841	1780841841	1	3	KESANAPALLI PEDIATRICS PROFE	10/1/2024	2080A0000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	7910 FROST STREET	SUITE 335	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
46740	Fee-for-Service	1083781439	1083781439	1	1	KIBIRA, CATHARINE PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2294	07	06013	37.96119614	-122.070409	Contra Costa County
46767	Fee-for-Service	1487099743	1487099743	1	1	KING, ANGEL LAC	12/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
46771	Fee-for-Service	1821004623	1821004623	1	1	KOVACS, BRUCE K MD INC	10/18/2005	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	42117	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
46818	Fee-for-Service	1447663646	1447663646	1	1	KAWEWAT, CHANDRA B OD	8/11/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
46821	Fee-for-Service	1467719112	1467719112	1	1	KANTOR, MOLLY A MD	8/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126513	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
46851	Fee-for-Service	1669406013	1669406013	1	1	KIM, DAVID S MD	8/16/1977	207P00000X	NA	Other	026	PHYSICIANS	24994	66	Emergency Medicine (Urgent Care)	0	In state provider	None	45 ROBERTA DR	None	WOODSIDE	CA	94062	2524	41	06081	37.41892582	-122.2559831	San Mateo County
46914	Fee-for-Service	1588981914	1588981914	1	1	KARPOVA, VIOLETTA S MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142447	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46922	Fee-for-Service	1477577559	1477577559	1	1	KAHN, ROBERT M MD INC	1/1/1979	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18582	01	General Practice	0	In state provider	None	984 MONUMENT ST	STE 102	PACIFIC PALISADES	CA	90272	3858	19	06037	34.04674992	-118.5241507	Los Angeles County
46985	Fee-for-Service	1144213190	1144213190	1	1	KRAKOWER, JEFFERY M MD	2/8/2015	207RH0003X	NA	Oncology	026	PHYSICIANS	30387	41	Internal Medicine	0	In state provider	None	2900 WHIPPLE AVE	STE 115	REDWOOD CITY	CA	94062	2858	41	06081	37.4783072	-122.2551089	San Mateo County
46993	Fee-for-Service	1033670955	1033670955	1	1	KELLER, KEVIN M MD	6/4/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
46995	Fee-for-Service	1568230712	1568230712	1	1	KANG, AUSTIN PT	3/28/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
46998	Fee-for-Service	1396839577	1396839577	1	1	KEHL, ROBERT S MD	10/12/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	71068	01	General Practice	0	In state provider	None	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	01	06001	37.54845774	-121.9773463	Alameda County
47000	Fee-for-Service	1205865292	1205865292	1	1	KASL-GODLEY, JULIA E PSYD	9/5/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
47029	Fee-for-Service	1154580751	1154580751	1	1	KLEINER, MATTHEW T MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124762	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
47032	Fee-for-Service	1912915489	1912915489	1	1	KO, TIENHOA MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	76493	01	General Practice	0	In state provider	None	3430 GARFIELD AVE	None	COMMERCE	CA	90040	3104	19	06037	33.98408703	-118.1403554	Los Angeles County
47082	Fee-for-Service	1447290168	1447290168	1	1	KRUTZIK, MICHAEL N MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66632	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
47103	Fee-for-Service	1194985002	1194985002	1	1	KAMATH, SUNIL P MD	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100527	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
47160	Fee-for-Service	1750362075	1750362075	1	1	KUO, ALFRED C MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77121	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
47173	Fee-for-Service	1548425382	1548425382	1	1	KHEHRA, RAMAN D MD	8/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134697	10	Gastroenterology (M.D. only)	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
47191	Fee-for-Service	1962445098	1962445098	1	1	KASPER, JAMES C MD	6/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77616	20	Orthopedic Surgery	0	In state provider	None	862 MEINECKE AVE	STE 100	SAN LUIS OBISPO	CA	93405	3701	40	06079	35.29243951	-120.668652	San Luis Obispo County
47201	Fee-for-Service	1083276182	1083276182	1	1	KUNALKUMAR K. VYAS D.O. A PR	4/15/2021	207W00000X	NA	Ophthalmology	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	OFESSIONAL CORPORATION	24331 EL TORO RD	STE 360	LAGUNA WOODS	CA	92637	3134	30	06059	33.60928782	-117.7295058	Orange County
47202	Fee-for-Service	1740354851	1740354851	1	3	KAISER FOUNDATION	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL MANTECA	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5187	39	06077	37.79735946	-121.2461325	San Joaquin County
47225	Fee-for-Service	1356560627	1356560627	1	1	KIM, NAMJIN DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	15923 BEAR VALLEY RD	STE A210	HESPERIA	CA	92345	1750	36	06071	34.47065953	-117.316035	San Bernardino County
47261	Fee-for-Service	1306808241	1306808241	1	1	KNUTSEN, MARTHA C MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	0000	00	None	36.180999	-115.3174815	Clark County
47283	Fee-for-Service	1508820531	1508820531	1	1	KIM, SUZY MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86559	25	Physical Medicine and Rehabilitation	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
47284	Fee-for-Service	1255839791	1255839791	1	1	KEOUGH, PORTIA A NP	7/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
47335	Fee-for-Service	1205334380	1205334380	1	1	KHAN, ANAM MD	5/8/2020	207R00000X	NA	Other	026	PHYSICIANS	161215	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
47348	Fee-for-Service	1104973429	1104973429	1	1	KAISER PERMANENTE PHARM.	9/28/1990	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#063	12470 WHITTIER BLVD	None	WHITTIER	CA	90602	1017	19	06037	33.97081587	-118.04422	Los Angeles County
47349	Fee-for-Service	1881048239	1881048239	1	1	KATAKIA, TRISHNA C MD	9/24/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151911	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
47369	Fee-for-Service	1447290168	1447290168	1	1	KRUTZIK, MICHAEL N MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66632	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
47372	Fee-for-Service	1083145841	1083145841	1	1	KANEKO, MACHI MD	11/1/2023	390200000X	NA	Other	026	PHYSICIANS	191488	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
47389	Fee-for-Service	1184736290	1184736290	1	1	KORNRICH, RACHEL M J MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143842	01	General Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
47426	Fee-for-Service	1104904697	1104904697	1	1	KIM, JANICE J MD	6/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	47141	40	Pediatrics	0	In state provider	None	UCSF 505 PARNASSUS M696	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.7634502	-122.4579779	San Francisco County
47429	Fee-for-Service	1699875443	1699875443	1	1	KUYPERS, MARCUS E MD	4/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	38523	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 EAST WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
47431	Fee-for-Service	1609934629	1609934629	1	1	KELL, DONNA MD	12/1/1994	207ZP0102X	NA	Other	026	PHYSICIANS	76253	22	Pathology (M.D. only)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
47453	Fee-for-Service	1033210497	1033210497	1	1	KHOSA, RUPDEV S MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	54411	25	Physical Medicine and Rehabilitation	0	In state provider	None	416 W LAS TUNAS DR	STE 200	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
47460	Fee-for-Service	1427032572	1427032572	1	1	KEVIN J TURNEAU MD	9/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
47476	Fee-for-Service	1285011130	1285011130	1	1	KASPICK, STEVEN MD	9/13/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	149203	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
47501	Fee-for-Service	1316301989	1316301989	1	1	KIKAWA, HIROYASU MD	10/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159661	08	Family Practice	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
47513	Fee-for-Service	1578597332	1578597332	1	2	KHANDAKER, NURUN N MD	4/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51415	08	Family Practice	0	In state provider	None	300 OLD RIVER ROAD	SUITE 110	BAKERSFIELD	CA	93311	9506	15	06029	35.352648	-119.1122505	Kern County
47539	Fee-for-Service	1164552667	1164552667	1	1	KOENEN, DIANA S LMFT	12/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29919 SKIPJACK DR	None	CANYON LAKE	CA	92587	6900	33	06065	33.68450035	-117.2360637	Riverside County
47550	Fee-for-Service	1306808241	1306808241	1	1	KNUTSEN, MARTHA C MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	0000	00	None	36.180999	-115.3174815	Clark County
47563	Fee-for-Service	1184134348	1184134348	1	1	KAMINETSKAYA, MARINA PHD	9/10/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
47566	Fee-for-Service	1518074244	1518074244	1	1	KROGSTAD, PAUL	9/30/1992	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	45301	40	Pediatrics	0	In state provider	UCLA DEPT OF PEDIATRICS	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
47567	Fee-for-Service	1023395522	1023395522	1	1	KATSCHKE, SCOTT C CRNA	1/12/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
47584	Fee-for-Service	1659336543	1659336543	1	1	KANOMATA, THOMAS I MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130263	41	Internal Medicine	0	In state provider	None	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
47592	Fee-for-Service	1396198107	1396198107	1	1	KELSO, ALEX S	7/12/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	380 STEVENS AVE	314	SOLANA BEACH	CA	92075	2063	37	06073	32.99328265	-117.2619437	San Diego County
47596	Fee-for-Service	1851348247	1851348247	1	1	KOTLYAROV, EDUARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N PERRY ST	None	PONTIAC	MI	48342	2217	00	None	42.63848893	-83.29105587	Oakland County
47615	Fee-for-Service	1659767721	1659767721	1	1	KALISPELL REGIONAL MEDICAL C	11/5/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	PULMONOLOGY	350 HERITAGE WAY	2100	KALISPELL	MT	59901	3167	00	None	48.216645	-114.324948	Flathead County
47633	Fee-for-Service	1609193531	1609193531	1	1	KRAWITZKY, SAMANTHA E MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125930	08	Family Practice	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
47653	Fee-for-Service	1225765878	1225765878	1	1	KARP, LAUREN J NP	4/13/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
47687	Fee-for-Service	1225331051	1225331051	1	1	KALB, LAWRENCE PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
47707	Fee-for-Service	1083848949	1083848949	1	1	KIDO, MAYA M MD	6/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114676	None	None	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2083	19	06037	34.39696803	-118.5525278	Los Angeles County
47708	Fee-for-Service	1992169643	1992169643	1	1	KAMEL, BISHOY G MD	8/12/2019	390200000X	NA	Other	026	PHYSICIANS	156933	01	General Practice	0	In state provider	None	9808 VENICE BLVD	100	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
47729	Fee-for-Service	1427496710	1427496710	1	1	KHURANA, AMAN MD	5/25/2023	2085B0100X	NA	MRI Provider	026	PHYSICIANS	141049	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
47777	Fee-for-Service	1336241702	1336241702	1	1	KIM, KWAN MD	10/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	40634	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
47789	Fee-for-Service	1770647364	1770647364	1	1	KING, JENNIFER R	1/23/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	164591	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
47806	Fee-for-Service	1205989050	1205989050	1	1	KESWANI, RAHUL L OD	4/27/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11780 SAN PABLO AVE	STE B	EL CERRITO	CA	94530	7103	07	06013	37.92771491	-122.3199892	Contra Costa County
47807	Fee-for-Service	1134353766	1134353766	1	1	KAUFFMAN, KENNETH P	8/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25830 MCBEAN PKWY	None	VALENICIA	CA	91355	2004	19	06037	34.40360638	-118.5522028	Los Angeles County
47813	Fee-for-Service	1730256751	1730256751	1	1	KOROTZER, BRIAN S MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75184	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
47858	Fee-for-Service	1518074244	1518074244	1	1	KROGSTAD, PAUL	9/30/1992	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	45301	77	Infectious Disease	0	In state provider	UCLA DEPT OF PEDIATRICS	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
47875	Fee-for-Service	1184989386	1184989386	1	1	KNIGHT, AMBER N J MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127466	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
47878	Fee-for-Service	1104062173	1104062173	1	1	KOLOMEY, IRINA V DO	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10625	41	Internal Medicine	0	In state provider	None	2220 GLADSTONE DRIVE	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
47929	Fee-for-Service	1528306388	1528306388	1	1	KORTMAN, FRANCISCO C DO	8/20/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22923	15	Obstetrics (D.O. only)	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
47932	Fee-for-Service	1922184803	1922184803	1	1	KELSON, MONICA B PHD	8/12/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
47964	Fee-for-Service	1205005386	1205005386	1	1	KUMAR, NISHANT DO	12/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101814	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
47983	Fee-for-Service	1144208182	1144208182	1	1	KIM, GENE H MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104201	07	Dermatology	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
47988	Fee-for-Service	1366720245	1366720245	1	1	KIM, ERIN D MD	6/29/2023	2080P0210X	NA	Nephrology	026	PHYSICIANS	131325	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
48020	Fee-for-Service	1447205919	1447205919	1	1	KARROUM, GEORGE M MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	34648	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
48038	Fee-for-Service	1760475453	1760475453	1	2	KARAMITSOS, CAROL A	9/18/2017	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	69866	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	116 S PALISADE DR	STE 104	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
48039	Fee-for-Service	1871674358	1871674358	1	1	KAWEAH MANOR INC	3/16/2005	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3710 W TULARE AVE	None	VISALIA	CA	93277	1732	54	06107	36.320751	-119.3326425	Tulare County
48056	Fee-for-Service	1912439266	1912439266	1	1	KU, LAWRENCE C MD	7/17/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	157723	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
48064	Fee-for-Service	1336241702	1336241702	1	1	KIM, KWAN MD	10/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	40634	24	Plastic Surgery	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
48070	Fee-for-Service	1457588675	1457588675	1	1	KIEMENEY, MICHAEL J MD	4/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127276	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
48074	Fee-for-Service	1548765282	1548765282	1	1	KRAEBER, SHAWNICE T MD	8/13/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165879	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
48097	Fee-for-Service	1578620464	1578620464	1	1	KOCHAVI, ORI Y PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
48104	Fee-for-Service	1730256751	1730256751	1	1	KOROTZER, BRIAN S MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75184	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
48108	Fee-for-Service	1679590319	1679590319	1	1	KHOSLA, ANIL MD	8/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89500	None	None	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
48127	Fee-for-Service	1922173871	1922173871	1	1	KIM, PETER P DO	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	9617	36	Psychiatry	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
48138	Fee-for-Service	1528347515	1528347515	1	1	KAISER FOUNDATION	4/20/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH PLAN INC	6600 BRUCEVILLE RD	FL 1 SOUTH TOWER	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
48165	Fee-for-Service	1811031305	1811031305	1	1	KHETRAPAL, TARA F	10/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
48176	Fee-for-Service	1982669008	1982669008	1	1	KAMDAR, NEHA K MD	11/5/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	99716	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
48199	Fee-for-Service	1073544623	1073544623	1	1	KISHORE YALAMANCHILI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S COULTER ST	None	AMARILLO	TX	79106	1786	00	None	35.200422	-101.924559	Potter County
48206	Fee-for-Service	1457741571	1457741571	1	1	KOKO, KIAVASH R MD	8/26/2019	208600000X	NA	General Surgery	026	PHYSICIANS	159801	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
48221	Fee-for-Service	1528306388	1528306388	1	1	KORTMAN, FRANCISCO C DO	8/20/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22923	09	Gynecology (D.O. only)	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
48234	Fee-for-Service	1326433525	1326433525	1	1	KHAZAELI, AZIN MD	2/13/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154274	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
48243	Fee-for-Service	1457416620	1457416620	1	1	KERNVILLE UNION ELEMENTARY	10/29/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	3240 ERSKINE CREEK RD	None	LAKE ISABELLA	CA	93240	9608	15	06029	35.60975725	-118.4650869	Kern County
48266	Fee-for-Service	1578854824	1578854824	1	1	KIM, JAEHEE MD	6/20/2018	208M00000X	NA	Other	026	PHYSICIANS	153357	41	Internal Medicine	0	In state provider	None	900 HYDE STREET	None	SAN FRANCISCO	CA	94109	4899	38	06075	37.78956486	-122.417072	San Francisco County
48305	Fee-for-Service	1790912251	1790912251	1	1	KO, JUSTIN M MD	10/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120641	07	Dermatology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48309	Fee-for-Service	1447205919	1447205919	1	1	KARROUM, GEORGE M MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	34648	01	General Practice	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
48360	Fee-for-Service	1376672709	1376672709	1	1	KARSAN, PAYAL S MD	1/2/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	95754	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
48373	Fee-for-Service	1114075942	1114075942	1	1	KAISER-PERMANENTE PHCY	1/15/1981	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#259	8001 VENTURA CANYON AVE	None	PANORAMA CITY	CA	91402	6312	19	06037	34.21619623	-118.4287605	Los Angeles County
48384	Fee-for-Service	1932270691	1932270691	1	1	KUELBS, CYNTHIA MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	58415	40	Pediatrics	0	In state provider	None	3666 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1949	37	06073	32.80970214	-117.1513084	San Diego County
48400	Fee-for-Service	1023035995	1023035995	1	1	KEYSERLING, HAROLD F MD	2/21/2025	2085N0700X	NA	MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
48412	Fee-for-Service	1518931047	1518931047	1	1	KONG, LI K MD	10/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61940	77	Infectious Disease	0	In state provider	None	5565 W LAS POSITAS BLVD	STE 130	PLEASANTON	CA	94588	5805	01	06001	37.69215143	-121.8800337	Alameda County
48422	Fee-for-Service	1891721221	1891721221	1	2	KASHYAP, BHAVNA MD	2/8/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51667	40	Pediatrics	0	In state provider	None	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
48423	Fee-for-Service	1740518125	1740518125	1	1	KETCHUM, KATHRYN J	4/12/2017	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
48434	Fee-for-Service	1497894430	1497894430	1	1	KALOOSTIAN, PAUL E MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97161	14	Neurological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
48435	Fee-for-Service	1154357556	1154357556	1	1	KWACK, SUNYE MD	4/9/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68036	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
48452	Fee-for-Service	1609903970	1609903970	1	1	KACHHWAHA, PRIYA MD	10/7/2019	207L00000X	NA	Other	026	PHYSICIANS	158568	05	Anesthesiology	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
48454	Fee-for-Service	1780652040	1780652040	1	1	KOGAN, SETH A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49334	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	790 E WILLOW ST	STE 100	LONG BEACH	CA	90806	2714	19	06037	33.80426489	-118.1825796	Los Angeles County
48456	Fee-for-Service	1447712450	1447712450	1	1	KOROTKIN, SCOTT D MD	7/11/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180374	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
48489	Fee-for-Service	1164683769	1164683769	1	1	KOPARI, NICOLE M MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156128	02	General Surgery	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
48562	Fee-for-Service	1538145719	1538145719	1	1	KU, GRACE H MD	6/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92382	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
48574	Fee-for-Service	1639638547	1639638547	1	1	KUNG, TIFFANY H MD	8/16/2023	207L00000X	NA	Other	026	PHYSICIANS	185079	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48594	Fee-for-Service	1578649687	1578649687	1	1	KALISTHENICS INC	12/5/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1795 CONEY ISLAND AVE	None	BROOKLYN	NY	11230	6557	00	None	40.613598	-73.9628595	Kings County
48609	Fee-for-Service	1134308471	1134308471	1	1	KERBLESKI, JOSEPH F MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92640	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
48610	Fee-for-Service	1548798465	1548798465	1	1	KAHLON, ANGAD PAL S MD	2/3/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163506	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
48626	Fee-for-Service	1982781829	1982781829	1	1	KULKARNI, ANITA MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89448	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
48645	Fee-for-Service	1851775522	1851775522	1	1	KOENENMANN, NICOLE S	11/29/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41769 ENTERPRISE CIR N	STE 104	TEMECULA	CA	92590	5626	33	06065	33.51823541	-117.1701538	Riverside County
48658	Fee-for-Service	1386333151	1386333151	1	1	KIM, MIDEUM T NP	9/5/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3300 E SOUTH ST	STE 308	LONG BEACH	CA	90805	4598	19	06037	33.86018093	-118.1537163	Los Angeles County
48672	Fee-for-Service	1982642690	1982642690	1	1	KAPELOV, STEVEN R MD	10/1/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	64216	None	None	0	In state provider	None	465 N ROXBURY DR	None	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
48679	Fee-for-Service	1871505370	1871505370	1	1	KREITZER, HARVEY C MD	9/30/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	68036	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
48688	Fee-for-Service	1023035995	1023035995	1	1	KEYSERLING, HAROLD F MD	2/21/2025	2085N0700X	NA	MRI Provider	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
48717	Fee-for-Service	1639359946	1639359946	1	1	KOH, JASON R DO	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10104	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
48724	Fee-for-Service	1154357556	1154357556	1	1	KWACK, SUNYE MD	4/9/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68036	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
48729	Fee-for-Service	1013105527	1013105527	1	1	KIOURANAKIS, NIKOLAOS MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114132	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
48741	Fee-for-Service	1225490188	1225490188	1	1	KLIMBERG, NICHOLAS MD	7/16/2019	207R00000X	NA	Other	026	PHYSICIANS	152442	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
48767	Fee-for-Service	1386160919	1386160919	1	1	K-MOA HEALTHCARE INC	10/10/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12582 CENTRAL AVE	None	CHINO	CA	91710	3507	36	06071	34.024617	-117.6894795	San Bernardino County
48803	Fee-for-Service	1073091765	1073091765	1	1	KEANE, MELISSA L PHD	4/27/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
48813	Fee-for-Service	1922516020	1922516020	1	1	KAISER FOUNDATION HEALTH	7/6/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	26877 TOURNEY RD	MOB-2 1ST FL	SANTA CLARITA	CA	91355	1846	19	06037	34.411787	-118.5737185	Los Angeles County
48845	Fee-for-Service	1871832881	1871832881	1	1	KATANA, VIENNA G DO	6/20/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	13629	None	None	0	In state provider	None	6605 NANCY RIDGE DR	None	SAN DIEGO	CA	92121	2253	37	06073	32.88682438	-117.1796133	San Diego County
48863	Fee-for-Service	1386847531	1386847531	1	1	KASHANI, DARYOUSH Y MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66698	08	Family Practice	0	In state provider	None	12502 VAN NUYS BLVD	STE 104	PACOIMA	CA	91331	6719	19	06037	34.27830937	-118.4053092	Los Angeles County
48871	Fee-for-Service	1417164062	1417164062	1	1	KHAN, KHURRAM J MD	11/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113983	None	None	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
48884	Fee-for-Service	1992083943	1992083943	1	1	KAJI TATIANA SEDOR NAMA	7/20/2011	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	27922 BLACKHAWK RD	None	MENIFEE	CA	92585	9045	33	06065	33.70756451	-117.1725795	Riverside County
48897	Fee-for-Service	1538697115	1538697115	1	1	KRISHNAN, SHREYA	5/5/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
48920	Fee-for-Service	1790719623	1790719623	1	1	KAHLON, SURJIT KAUR MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	31422	01	General Practice	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
48941	Fee-for-Service	1841355500	1841355500	1	1	KIMBALL, DALE W OD	9/15/1976	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4575 LA JOLLA VILLAGE DR	None	SAN DIEGO	CA	92122	1203	37	06073	32.87371947	-117.2091769	San Diego County
48977	Fee-for-Service	1609091818	1609091818	1	1	KHAN, HUMAYON YOUSUF MD	7/23/1992	207VH0002X	NA	Obstetrics & Gynecology	026	PHYSICIANS	74748	40	Pediatrics	0	In state provider	None	12881 CHAPMAN AVE	None	GARDEN GROVE	CA	92840	4100	30	06059	33.78896063	-117.9071725	Orange County
49005	Fee-for-Service	1902112337	1902112337	1	1	KOGAN, ALEXANDER MD	3/12/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	147063	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
49014	Fee-for-Service	1568644987	1568644987	1	1	KALKAT, KARAMJIT LMFT	6/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
49062	Fee-for-Service	1982671533	1982671533	1	1	KIM, CHRISTINE M MD	11/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86183	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
49069	Fee-for-Service	1922739986	1922739986	1	1	KERKMAN, SARAH CCC-SLP	6/27/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
49083	Fee-for-Service	1740210301	1740210301	1	1	KROUSE, JOHN R MD	10/31/1986	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	45450	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 EL CERRO BLVD	STE 202	DANVILLE	CA	94526	1731	07	06013	37.82888506	-122.0021827	Contra Costa County
49084	Fee-for-Service	1376985887	1376985887	1	1	KHAN, MADHURY Y MD	3/7/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158939	None	None	0	In state provider	None	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
49123	Fee-for-Service	1346226800	1346226800	1	1	KEOCHEKIAN, ANNETTE A MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75248	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
49171	Fee-for-Service	1992083943	1992083943	1	1	KAJI TATIANA SEDOR NAMA	7/20/2011	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	27922 BLACKHAWK RD	None	MENIFEE	CA	92585	9045	33	06065	33.70756451	-117.1725795	Riverside County
49249	Fee-for-Service	1285928705	1285928705	1	1	KHAN, ADNAN MD	6/18/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	141739	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2800 N CALIFORNIA ST	STE 14	STOCKTON	CA	95204	3759	39	06077	37.97782434	-121.2919633	San Joaquin County
49253	Fee-for-Service	1033155346	1033155346	1	1	KIRBY, JOHN C DO	2/4/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	4275	30	Radiology	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
49260	Fee-for-Service	1841405909	1841405909	1	1	KIM, HAROLD K MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109495	None	None	0	In state provider	None	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
49265	Fee-for-Service	1609091818	1609091818	1	1	KHAN, HUMAYON YOUSUF MD	7/23/1992	207VH0002X	NA	Obstetrics & Gynecology	026	PHYSICIANS	74748	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12881 CHAPMAN AVE	None	GARDEN GROVE	CA	92840	4100	30	06059	33.78896063	-117.9071725	Orange County
49271	Fee-for-Service	1003922329	1003922329	1	1	KEOHANE, MARY E MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50535	22	Pathology (M.D. only)	0	In state provider	None	2420 J ST	None	SACRAMENTO	CA	95816	4806	34	06067	38.574738	-121.4738955	Sacramento County
49286	Fee-for-Service	1245269984	1245269984	1	1	KE, MALCOLM S MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73403	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA #450	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
49303	Fee-for-Service	1295813962	1295813962	1	1	KELLER, LIA C MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73552	07	Dermatology	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
49326	Fee-for-Service	1982634432	1982634432	1	1	KIRSCHNER, MICHAEL DO	7/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9562	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
49340	Fee-for-Service	1609806512	1609806512	1	1	KUEHNE, JONAS J MD	5/8/2006	2084P0805X	NA	Psychiatry	026	PHYSICIANS	88749	36	Psychiatry	0	In state provider	None	345 N ORANGE DR	None	LOS ANGELES	CA	90036	2613	19	06037	34.07754692	-118.341913	Los Angeles County
49349	Fee-for-Service	1780986463	1780986463	1	1	KIM, JUHYE L MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142448	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
49414	Fee-for-Service	1225298565	1225298565	1	1	KING, KEVIN G MD	6/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120773	None	None	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
49423	Fee-for-Service	1174636708	1174636708	1	1	KERN BONE AND JOINT SPECIALI	6/1/1989	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	STS, A MEDICAL GROUP INC	9330 STOCKDALE HWY	600	BAKERSFIELD	CA	93311	3614	15	06029	35.35452946	-119.106351	Kern County
49458	Fee-for-Service	1790980472	1790980472	1	1	KARL, BETHANY E DO	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10783	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
49511	Fee-for-Service	1003826298	1003826298	1	1	KALRA, JAGJEET S MD INC	10/30/1991	207RP1001X	NA	Pulmonology	026	PHYSICIANS	44804	41	Internal Medicine	0	In state provider	None	530 W EATON AVE	STE E	TRACY	CA	95376	3454	39	06077	37.74328351	-121.433886	San Joaquin County
49551	Fee-for-Service	1699034835	1699034835	1	1	KITA, KENNETH Y MD	11/17/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	129520	None	None	0	In state provider	None	660 W BROADWAY	None	GLENDALE	CA	91204	1008	19	06037	34.14675547	-118.269153	Los Angeles County
49556	Fee-for-Service	1609091818	1609091818	1	1	KHAN, HUMAYON YOUSUF MD	7/23/1992	207VH0002X	NA	Obstetrics & Gynecology	026	PHYSICIANS	74748	08	Family Practice	0	In state provider	None	12881 CHAPMAN AVE	None	GARDEN GROVE	CA	92840	4100	30	06059	33.78896063	-117.9071725	Orange County
49641	Fee-for-Service	1972733574	1972733574	1	1	KIM, ROBERT K MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
49652	Fee-for-Service	1114191194	1114191194	1	1	KOCHHAR, AMIT MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132816	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
49669	Fee-for-Service	1609342849	1609342849	1	1	KROPF, HANAH G PT	10/7/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2600 STANWELL DRIVE	SUITE 104	CONCORD	CA	94520	4862	07	06013	37.98689836	-122.047993	Contra Costa County
49698	Fee-for-Service	1346702578	1346702578	1	1	KREISMAN, ALEXANDER B MD	7/5/2023	390200000X	NA	Other	026	PHYSICIANS	185853	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
49764	Fee-for-Service	1609969005	1609969005	1	1	KESAVARAMANUJAM,	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96658	33	Thoracic Surgery	0	In state provider	SATISH MD	1064 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22323556	-119.3375072	Tulare County
49766	Fee-for-Service	1336216142	1336216142	1	1	KANTARTZIS, DEANA A MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78136	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
49797	Fee-for-Service	1629296181	1629296181	1	1	KIM, MIMI S MD	7/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108580	67	Endocrinology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
49798	Fee-for-Service	1003826298	1003826298	1	1	KALRA, JAGJEET S MD INC	10/30/1991	207RP1001X	NA	Pulmonology	026	PHYSICIANS	44804	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	530 W EATON AVE	STE E	TRACY	CA	95376	3454	39	06077	37.74328351	-121.433886	San Joaquin County
49828	Fee-for-Service	1306073184	1306073184	1	1	KHALSA, SAHIB S MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114295	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90074	0001	19	06037	34.07067	-118.4432445	Los Angeles County
49831	Fee-for-Service	1043759491	1043759491	1	1	KEMP INDIVIDUAL & FAMILY THE	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RAPY, INC.	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
49905	Fee-for-Service	1023010725	1023010725	1	1	KING PHARMACY CORPORATION	2/1/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2707 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1441	19	06037	34.03264707	-118.2117851	Los Angeles County
49929	Fee-for-Service	1760708283	1760708283	1	1	KO, ALEXANDER MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111332	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
49946	Fee-for-Service	1043417447	1043417447	1	1	KENYON, CHARLES D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23234	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
49992	Fee-for-Service	1306857982	1306857982	1	1	KELLY, DANIEL F MD	11/30/1992	207T00000X	NA	General Surgery	026	PHYSICIANS	77318	14	Neurological Surgery	0	In state provider	None	21840 NORMANDIE AVE	# 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
50007	Fee-for-Service	1902359748	1902359748	1	1	KNIGHT, JEREMIAH N LMFT	8/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
50021	Fee-for-Service	1881057271	1881057271	1	1	KHOSHCHEHREH JAMALI, MOHAMMA	6/1/2021	207ZP0102X	NA	Other	026	PHYSICIANS	162927	None	None	0	In state provider	D MAHDI MD	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
50024	Fee-for-Service	1104268945	1104268945	1	1	KAUL, NIDHI LCSW	4/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
50053	Fee-for-Service	1609969005	1609969005	1	1	KESAVARAMANUJAM,	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96658	89	Surgery-Traumatic	0	In state provider	SATISH MD	1064 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22323556	-119.3375072	Tulare County
50092	Fee-for-Service	1538292321	1538292321	1	1	KELSEN, KENNETH A MD	6/14/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	734 MOWRY AVE	None	FREMONT	CA	94536	4115	01	06001	37.56635225	-121.9749284	Alameda County
50095	Fee-for-Service	1902963200	1902963200	1	1	KAYS, LESLIE E LMFT	5/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2287 WASHINGTON AVE	None	SAN LEANDRO	CA	94566	7200	01	06001	37.71581555	-122.1504248	Alameda County
50119	Fee-for-Service	1043759491	1043759491	1	1	KEMP INDIVIDUAL & FAMILY THE	2/18/2020	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RAPY, INC.	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
50132	Fee-for-Service	1124569322	1124569322	1	1	KWAN, BRIAN J MD	8/20/2020	390200000X	NA	Other	026	PHYSICIANS	158977	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
50133	Fee-for-Service	1477709178	1477709178	1	1	KIM, RICHARD Y MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94965	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
50146	Fee-for-Service	1306873302	1306873302	1	1	KENT C SMITH DO	5/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	834 SHERIDAN ST	None	PORT TOWNSEND	WA	98368	2443	00	None	48.1060802	-122.7902963	Jefferson County
50152	Fee-for-Service	1184245862	1184245862	1	1	KAUR, GURLEEN MD	8/21/2023	207R00000X	NA	Other	026	PHYSICIANS	183999	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
50164	Fee-for-Service	1083187645	1083187645	1	1	KANYITA, ESTHER	3/26/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	34532 CRENSHAW	None	BEAUMONT	CA	92223	7449	33	06065	33.96031816	-117.0659125	Riverside County
50174	Fee-for-Service	1255565875	1255565875	1	1	KAPADIA, KEVIN M MD	11/10/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	167338	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
50191	Fee-for-Service	1114005998	1114005998	1	1	KORN, DANIEL G MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64272	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
50195	Fee-for-Service	1629200381	1629200381	1	1	KENDRICK, CHRISTINA E MD	7/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120151	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
50215	Fee-for-Service	1336116862	1336116862	1	1	KOKSHANIAN, ARTINE MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	30124	None	None	0	In state provider	A PROFESSIONAL CORP	1030 S GLENDALE AVE	STE 506	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
50248	Fee-for-Service	1588192389	1588192389	1	1	KUMMER, ANDREA A DO	9/19/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20033	None	None	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
50251	Fee-for-Service	1003011677	1003011677	1	1	KIM, JI YEON MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122377	22	Pathology (M.D. only)	0	In state provider	None	4670 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.0980897	-118.2912705	Los Angeles County
50253	Fee-for-Service	1235911199	1235911199	1	1	KING, MILDRED	2/12/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
50338	Fee-for-Service	1609969005	1609969005	1	1	KESAVARAMANUJAM,	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96658	02	General Surgery	0	In state provider	SATISH MD	1064 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22323556	-119.3375072	Tulare County
50339	Fee-for-Service	1598455040	1598455040	1	1	KINYUA, JOYCE WANGECHI	7/12/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1900 BLUE OAKS BLVD	APT 238	ROSEVILLE	CA	95747	8439	31	06061	38.7918135	-121.3533045	Placer County
50344	Fee-for-Service	1063647485	1063647485	1	1	KIKOLSKI, STEVEN G MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106307	30	Radiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
50367	Fee-for-Service	1467097303	1467097303	1	1	KALER, VANEET	5/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
50372	Fee-for-Service	1629184536	1629184536	1	1	KAZEMI, FERDOUS MD	7/5/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32367	40	Pediatrics	0	In state provider	None	1220 HEMLOCK WAY	STE 105B	SANTA ANA	CA	92707	3600	30	06059	33.70975375	-117.8842792	Orange County
50384	Fee-for-Service	1295743516	1295743516	1	1	KAR, RITA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52801	None	None	0	In state provider	None	500 S MAIN ST	STE 1210	ORANGE	CA	92868	4556	30	06059	33.77991974	-117.8674745	Orange County
50421	Fee-for-Service	1285353102	1285353102	1	1	KAISER FOUNDATION HEALTH PLA	4/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	318	2425 GEARY BLVD	LOBBY RM L104	SAN FRANCISCO	CA	94115	0000	38	06075	37.78272203	-122.4433297	San Francisco County
50435	Fee-for-Service	1891912374	1891912374	1	1	KORAS, NANCY L CRNA	6/9/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
50451	Fee-for-Service	1083187645	1083187645	1	1	KANYITA, ESTHER	3/26/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	34532 CRENSHAW	None	BEAUMONT	CA	92223	7449	33	06065	33.96031816	-117.0659125	Riverside County
50464	Fee-for-Service	1073860631	1073860631	1	1	KINGSLAND, KIM-PHOUNG	11/9/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
50518	Fee-for-Service	1588647036	1588647036	1	1	KAO, LEE CHUAN MD	1/1/2000	174400000X	NA	Other	026	PHYSICIANS	69376	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
50565	Fee-for-Service	1841340650	1841340650	1	1	KUO, JIMMY Y MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	82042	08	Family Practice	0	In state provider	None	245 TERRACINA BLVD	None	REDLANDS	CA	92373	4852	36	06071	34.03858912	-117.2066515	San Bernardino County
50609	Fee-for-Service	1588869598	1588869598	1	1	KARIN TRUJILLO	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA	None	OMAHA	NE	68198	0001	00	None	0	0	None
50623	Fee-for-Service	1821037011	1821037011	1	1	KENNETH KORTE M.D.	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
50628	Fee-for-Service	1598455040	1598455040	1	1	KINYUA, JOYCE WANGECHI	7/12/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1900 BLUE OAKS BLVD	APT 238	ROSEVILLE	CA	95747	8439	31	06061	38.7918135	-121.3533045	Placer County
50660	Fee-for-Service	1932268976	1932268976	1	1	KILKER, RICHARD D JR MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52520	01	General Practice	0	In state provider	None	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
50708	Fee-for-Service	1215376033	1215376033	1	1	KIM, CHRISTOPHER H MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133397	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
50754	Fee-for-Service	1508339201	1508339201	1	1	KYAW, THAN H MD INC	2/8/2019	193200000X	NA	Other	026	PHYSICIANS	148976	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 N GARFIELD AVE	STE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
50770	Fee-for-Service	1720129141	1720129141	1	1	KOTHANDARAMAN, VIKRAM MD	7/21/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	91809	08	Family Practice	0	In state provider	None	2400 W 7TH STREET	STE 114	LOS ANGELES	CA	90057	3121	19	06037	34.05794332	-118.2801774	Los Angeles County
50810	Fee-for-Service	1326230624	1326230624	1	1	KLEIN, ROBERT B MD INC	4/15/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	18350 ROSCOE BLVD	STE 701	NORTHRIDGE	CA	91325	4109	19	06037	34.22071855	-118.5341175	Los Angeles County
50813	Fee-for-Service	1811444599	1811444599	1	1	KUCAJ, SAMANTHA D PSYD	10/8/2019	225C00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
50837	Fee-for-Service	1528394855	1528394855	1	1	KIM, EUGENIA Y MD	9/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110902	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
50883	Fee-for-Service	1912341660	1912341660	1	1	KIM, JULIE E MD	7/25/2018	390200000X	NA	Other	026	PHYSICIANS	133400	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
50938	Fee-for-Service	1013096080	1013096080	1	1	KLEINMAN, ALAN M MD	7/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50609	01	General Practice	0	In state provider	None	374 W OLIVE AVE	STE A	MERCED	CA	95348	3127	24	06047	37.31914092	-120.4749911	Merced County
50956	Fee-for-Service	1336294040	1336294040	1	1	KAISER FOUNDATION HOSPITALS	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 S VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.7892965	-118.2937327	Los Angeles County
51033	Fee-for-Service	1467745950	1467745950	1	1	KING, COURTNEY L MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133018	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
51057	Fee-for-Service	1962031187	1962031187	1	1	KIZZEE, RICHARD L MD	10/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185077	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
51060	Fee-for-Service	1720129141	1720129141	1	1	KOTHANDARAMAN, VIKRAM MD	7/21/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	91809	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2400 W 7TH STREET	STE 114	LOS ANGELES	CA	90057	3121	19	06037	34.05794332	-118.2801774	Los Angeles County
51066	Fee-for-Service	1144516816	1144516816	1	1	KAMAL, AFRIN N MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156534	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51086	Fee-for-Service	1588841969	1588841969	1	1	KOENIG, MARK D MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96822	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
51087	Fee-for-Service	1225328610	1225328610	1	1	KUMAR, POOJA MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133070	41	Internal Medicine	0	In state provider	None	4477 W 118TH ST	STE 200	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
51121	Fee-for-Service	1497277123	1497277123	1	1	KHOLMATOV, ROOSTAM M MD	6/4/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
51152	Fee-for-Service	1568735991	1568735991	1	1	KAISER FOUNDATION HEALTH	4/20/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	1600 EUREKA RD	BLDG 1 FL 2	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
51164	Fee-for-Service	1518019983	1518019983	1	1	KALARIYA, SHITAL MD	3/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83751	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
51179	Fee-for-Service	1285717447	1285717447	1	1	KOLEGRAFF, DAVID W MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57524	02	General Surgery	0	In state provider	None	2428 CASTILLO ST	STE C	SANTA BARBARA	CA	93105	5310	42	06083	34.43122758	-119.7251364	Santa Barbara County
51182	Fee-for-Service	1780882258	1780882258	1	1	KIM, JEFFREY MD	3/14/2022	207L00000X	NA	Other	026	PHYSICIANS	103032	None	None	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
51192	Fee-for-Service	1932512233	1932512233	1	1	KREYSA, MARCELLA A PSYD	3/28/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 CAPITOL AVE	SUITE 206	SACRAMENTO	CA	95816	5755	34	06067	38.573073	-121.4788005	Sacramento County
51197	Fee-for-Service	1306853916	1306853916	1	1	KHACHI, GERALD J MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106654	24	Plastic Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
51198	Fee-for-Service	1558383091	1558383091	1	1	KWASMAN, ALAN MD	12/27/2018	174400000X	NA	Other	026	PHYSICIANS	39355	40	Pediatrics	0	In state provider	None	6950 BROCKTON AVE	5	RIVERSIDE	CA	92506	3831	33	06065	33.9474392	-117.3967287	Riverside County
51244	Fee-for-Service	1336294040	1336294040	1	1	KAISER FOUNDATION HOSPITALS	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 S VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.7892965	-118.2937327	Los Angeles County
51249	Fee-for-Service	1700240355	1700240355	1	1	KAMBOJ, AMRIT MD	7/20/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	186028	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
51256	Fee-for-Service	1487633103	1487633103	1	1	KRIPKE, DANIEL F MD	6/1/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	18150	36	Psychiatry	0	In state provider	UCSD DEPT OF PSYCHIATRY	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
51259	Fee-for-Service	1679735666	1679735666	1	1	KHONG, KATHLEEN A MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113032	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
51266	Fee-for-Service	1366852543	1366852543	1	1	KARABULUT, MERVE MD	10/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144406	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
51281	Fee-for-Service	1609954825	1609954825	1	1	KUO, CALVIN J MD	9/6/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86636	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51293	Fee-for-Service	1124656228	1124656228	1	1	KOU, ARETHA DO	4/12/2023	208M00000X	NA	Other	026	PHYSICIANS	20806	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
51305	Fee-for-Service	1306880679	1306880679	1	1	KONDA, SATYASREE S MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52175	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
51327	Fee-for-Service	1508880147	1508880147	2	1	KRAUT, JOSEPH W JR MD INC	12/24/2013	207R00000X	NA	Other	026	PHYSICIANS	74436	41	Internal Medicine	0	In state provider	None	18181 BUTTERFIELD BLVD	STE 180	MORGAN HILL	CA	95037	8112	43	06085	37.13904584	-121.6547035	Santa Clara County
51333	Fee-for-Service	1215183066	1215183066	1	1	KULIDJIAN, ANNA A MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97060	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
51335	Fee-for-Service	1912085671	1912085671	1	1	KRISHNAN, LALITA MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49327	22	Pathology (M.D. only)	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
51348	Fee-for-Service	1770605495	1770605495	1	1	KIENER, DAVID J MD	2/8/2015	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	29773	04	Otology, Laryngology, Rhinology	0	In state provider	None	2 MEDICAL PLAZA DR	STE 225	ROSEVILLE	CA	95661	3044	31	06061	38.76507948	-121.2477476	Placer County
51358	Fee-for-Service	1073069761	1073069761	1	1	KERN COUNTY CCS	3/15/2016	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4110 PLANZ ROAD	None	BAKERSFIELD	CA	93309	5993	15	06029	35.32503356	-119.04909	Kern County
51367	Fee-for-Service	1992200638	1992200638	2	1	KLEIER, ISABELLE MD	8/20/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182532	None	None	0	In state provider	None	1300 N. VERMONT AVENUE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
51378	Fee-for-Service	1043407844	1043407844	1	1	KY T. VU, M.D., INC.	8/29/2019	208M00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
51383	Fee-for-Service	1538815089	1538815089	1	1	KPC BIOTECH MOLECULAR LABORA	2/1/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	TORY	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
51411	Fee-for-Service	1538740618	1538740618	1	1	KOMAL DESAI MD INC	7/19/2021	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	4500 MORNING DR	SUITE 105	BAKERSFIELD	CA	93306	7276	15	06029	35.39343836	-118.9166214	Kern County
51413	Fee-for-Service	1427073402	1427073402	1	1	KIM, JOO R MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36757	40	Pediatrics	0	In state provider	None	2621 S BRISTOL ST	STE 104	SANTA ANA	CA	92704	5718	30	06059	33.711876	-117.885371	Orange County
51435	Fee-for-Service	1326612839	1326612839	1	1	KIM, EDWARD DO	10/9/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
51569	Fee-for-Service	1609954825	1609954825	1	1	KUO, CALVIN J MD	9/6/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86636	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51589	Fee-for-Service	1225072911	1225072911	1	1	KIM, CHEOG H	10/23/2008	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	FIT FOREVER PHYSICAL THE	12139 MT VERNON AVE	STE 110	GRAND TERRACE	CA	92313	5500	36	06071	34.033185	-117.313583	San Bernardino County
51614	Fee-for-Service	1992026496	1992026496	1	2	KHRAISHA, NESREEN MD	6/25/2023	208M00000X	NA	Other	026	PHYSICIANS	167650	None	None	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
51635	Fee-for-Service	1992150197	1992150197	1	1	KWAK, HANNAH J MD	3/24/2022	207R00000X	NA	Other	026	PHYSICIANS	169315	None	None	0	In state provider	None	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
51637	Fee-for-Service	1770605495	1770605495	1	1	KIENER, DAVID J MD	2/8/2015	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	29773	01	General Practice	0	In state provider	None	2 MEDICAL PLAZA DR	STE 225	ROSEVILLE	CA	95661	3044	31	06061	38.76507948	-121.2477476	Placer County
51653	Fee-for-Service	1255413431	1255413431	1	1	KENNIS, CAROLYN G CRNA	2/15/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
51698	Fee-for-Service	1669655817	1669655817	1	1	KANDPAL, SAURABH B MD	4/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134274	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	94505	4801	49	06097	38.443806	-122.701374	Sonoma County
51728	Fee-for-Service	1164572962	1164572962	1	1	KORKOWSKI, MARK J MD	11/9/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77926	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1316	42	06083	34.4458497	-119.779596	Santa Barbara County
51739	Fee-for-Service	1295017374	1295017374	1	1	KIM, KYUNG H CRNA	11/20/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
51817	Fee-for-Service	1679834667	1679834667	1	1	KITLOWSKI, MICHAEL D PHD	11/9/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27268 VIA INDUSTRIA	None	TEMECULA	CA	92590	3751	33	06065	33.50883542	-117.1833694	Riverside County
51844	Fee-for-Service	1730452806	1730452806	1	1	KUMAR, RAHI J MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123398	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51891	Fee-for-Service	1275065385	1275065385	1	1	KHANG, VANG KOU MD	10/3/2019	207R00000X	NA	Other	026	PHYSICIANS	157181	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
51902	Fee-for-Service	1457855462	1457855462	1	1	KOHAN, MITRA MD	5/14/2020	207R00000X	NA	Other	026	PHYSICIANS	164928	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
51926	Fee-for-Service	1770605495	1770605495	1	1	KIENER, DAVID J MD	2/8/2015	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	29773	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2 MEDICAL PLAZA DR	STE 225	ROSEVILLE	CA	95661	3044	31	06061	38.76507948	-121.2477476	Placer County
51956	Fee-for-Service	1528687555	1528687555	1	1	KHAN, ASSEES MD	9/5/2023	207R00000X	NA	Other	026	PHYSICIANS	185977	None	None	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
51990	Fee-for-Service	1538605167	1538605167	1	1	KEYSTONE HOME HEALTH CARE	3/28/2017	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	840 HINCKLEY ROAD	STE 125	BURLINGAME	CA	94010	1500	41	06081	37.59825831	-122.3684871	San Mateo County
52012	Fee-for-Service	1003899642	1003899642	1	1	KHATRI, VIJAY P MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68492	02	General Surgery	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
52031	Fee-for-Service	1689803025	1689803025	1	1	KUJALA, NICHOLAS G	9/4/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160503	30	Radiology	0	In state provider	None	3883 AIRWAY DR	100	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
52096	Fee-for-Service	1760545503	1760545503	1	5	KATUKOTA, VIJAY C MD INC	6/14/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9190 SIERRA AVE	STE 104	FONTANA	CA	92335	8613	36	06071	34.086879	-117.4357395	San Bernardino County
52115	Fee-for-Service	1871664813	1871664813	1	1	KANG, CAMBRIA L MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75006	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
52151	Fee-for-Service	1871578161	1871578161	1	1	KUMAMOTO, GRACE N MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61411	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
52172	Fee-for-Service	1497820831	1497820831	1	1	KIM, UN BONG LEE MD	7/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	38561	40	Pediatrics	0	In state provider	None	360 E 7TH ST	STE M	UPLAND	CA	91786	6701	36	06071	34.08880374	-117.6465151	San Bernardino County
52191	Fee-for-Service	1902984719	1902984719	1	1	KASSA, YEWONDWOSSEN B MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79803	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
52196	Fee-for-Service	1659056521	1659056521	1	1	KIM, SUZY PT	7/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8170 LAGUNA BLVD	STE 210	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
52200	Fee-for-Service	1013062769	1013062769	1	1	KAISER FOUNDATION HOSPITALS	11/18/1975	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
52210	Fee-for-Service	1902917883	1902917883	1	1	KOMSHIAN, SHAHE V MD	4/30/1991	207R00000X	NA	Other	026	PHYSICIANS	48567	41	Internal Medicine	0	In state provider	None	2585 SAMARITAN DR	None	SAN JOSE	CA	95124	4107	43	06085	37.25083752	-121.9503884	Santa Clara County
52247	Fee-for-Service	1891745865	1891745865	1	1	KEVIN GUSTAFSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
52261	Fee-for-Service	1881037703	1881037703	1	1	KARA S LOGAN	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1190 N STATE ST	STE 502	JACKSON	MS	39202	2414	00	None	32.31394076	-90.17812995	Hinds County
52276	Fee-for-Service	1497813968	1497813968	1	1	KUGEL, SAMUEL MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54412	36	Psychiatry	0	In state provider	None	5550 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2307	37	06073	32.74809744	-117.0773303	San Diego County
52284	Fee-for-Service	1154853869	1154853869	1	1	KIRK, RYAN DO	11/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18739	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
52285	Fee-for-Service	1467599910	1467599910	1	1	KAPLOWITZ, RIVKA PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
52305	Fee-for-Service	1174606255	1174606255	1	1	KRUEGER, ROBERT C PHD	2/14/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1652 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1602957	Los Angeles County
52321	Fee-for-Service	1043617897	1043617897	1	1	KALYANAM, SHEILA K MD	7/20/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	149799	40	Pediatrics	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
52339	Fee-for-Service	1386001238	1386001238	1	1	KINDCARE PHARMACY AND	2/16/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL SUPPLY	230 WALNUT STREET	SUITE B	CHICO	CA	95928	5280	04	06007	39.72365021	-121.8492286	Butte County
52368	Fee-for-Service	1982645438	1982645438	2	1	KANG, HUN K MD	12/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61497	40	Pediatrics	0	In state provider	None	2900 W 8TH STREET	None	LOS ANGELES	CA	90005	1524	19	06037	34.05771353	-118.2892832	Los Angeles County
52379	Fee-for-Service	1194837252	1194837252	1	1	KUO, ANDA K MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70855	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6E9	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
52418	Fee-for-Service	1063585495	1063585495	1	1	KORFF, GARY P MD	12/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69553	01	General Practice	0	In state provider	None	2562 STATE ST	STE D	CARLSBAD	CA	92008	1663	37	06073	33.1643004	-117.3525361	San Diego County
52427	Fee-for-Service	1407415037	1407415037	1	1	KAISER FOUNDATION HEALTH PLA	4/28/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	441	20000 RINALDI ST	None	PORTER RANCH	CA	91326	4900	19	06037	34.275244	-118.5717953	Los Angeles County
52437	Fee-for-Service	1336198183	1336198183	1	1	KAUL, RAJEEV MD	2/13/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	189895	None	None	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
52457	Fee-for-Service	1457409302	1457409302	1	1	KAISER PERMANENTE PHCY	2/7/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#376	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
52467	Fee-for-Service	1609336650	1609336650	1	1	KUPPER, VONNE L MD	8/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185730	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
52477	Fee-for-Service	1992755961	1992755961	1	1	KEBO, LARRY OD	9/7/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 JENSEN AVE	None	SANGER	CA	93657	2413	10	06019	36.7076405	-119.5578098	Fresno County
52498	Fee-for-Service	1487713004	1487713004	1	1	KAWABE, MILTON Y MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42793	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
52533	Fee-for-Service	1124038138	1124038138	1	1	KLIKA, KARIN L MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86733	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52545	Fee-for-Service	1225109127	1225109127	1	1	KIM, BRIAN P MD	5/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75617	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52582	Fee-for-Service	1245868934	1245868934	1	1	KUNDI, SURJEET	3/28/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	183230	13	Neurology (M.D. only)	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
52640	Fee-for-Service	1790985042	1790985042	1	1	KESSLER, MICHAEL LCSW	3/14/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
52656	Fee-for-Service	1982645438	1982645438	2	1	KANG, HUN K MD	12/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61497	08	Family Practice	0	In state provider	None	2900 W 8TH STREET	None	LOS ANGELES	CA	90005	1524	19	06037	34.05771353	-118.2892832	Los Angeles County
52704	Fee-for-Service	1366874034	1366874034	1	1	KOU, SANDRA U OD	8/6/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
52738	Fee-for-Service	1851501548	1851501548	1	1	KOTIKIAN, SYLVIA MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103145	None	None	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
52781	Fee-for-Service	1710142492	1710142492	1	1	KIM, MARIAN S MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116278	40	Pediatrics	0	In state provider	None	710 N LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
52819	Fee-for-Service	1467751529	1467751529	1	1	KEMP, BENJAMIN M DO	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15182	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
52824	Fee-for-Service	1578198099	1578198099	1	1	KATHRYN NAJAFI TAGOL MD A PR	6/30/2021	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4000 CIVIC CENTER DR	STE 200A	SAN RAFAEL	CA	94903	5233	21	06041	38.0041783	-122.538861	Marin County
52840	Fee-for-Service	1336382662	1336382662	1	1	KAUR, RAVNEET R MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132910	07	Dermatology	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
52867	Fee-for-Service	1013311448	1013311448	1	1	KOREAN HEALTH EDUCATION	5/5/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INFORMATION & RESEARCH	3255 WILSHIRE BLVD	STE 120	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
52871	Fee-for-Service	1780810606	1780810606	1	1	KIELEY, KRISTEN W MD	1/16/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	130814	30	Radiology	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
52894	Fee-for-Service	1326122391	1326122391	1	1	KOIDA, DAVID M MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73828	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
52903	Fee-for-Service	1649327958	1649327958	1	1	KAISER FOUNDATION HEALTH	4/22/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN MANTECA PHARM #491	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
52925	Fee-for-Service	1689350274	1689350274	1	1	KENNY QUACH	9/11/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11100 WARNER AVE	STE 306	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
52947	Fee-for-Service	1922066075	1922066075	1	1	KIM, DAVID W MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65349	84	Surgery-Head and Neck	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
52957	Fee-for-Service	1215055140	1215055140	1	1	KEYASHIAN, KIAN MD	7/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	103886	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52968	Fee-for-Service	1487699641	1487699641	1	1	KENNEY, RICK DB DO	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7292	41	Internal Medicine	0	In state provider	None	1441 AVOCADO AVE	STE 702	NEWPORT BEACH	CA	92660	7708	30	06059	33.61338536	-117.8693961	Orange County
52979	Fee-for-Service	1083813661	1083813661	1	1	KIRKLAND, STEPHANIE A NP	7/10/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
52984	Fee-for-Service	1205441599	1205441599	1	1	KUIKEN, KRISTI L NP	4/13/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
52998	Fee-for-Service	1790305902	1790305902	1	1	KAUR, TARNPREET MD	7/24/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183669	None	None	0	In state provider	None	4770 W HERNDON AVE	STE 107	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
53005	Fee-for-Service	1962668749	1962668749	1	1	KRISTIN CHENAULT	1/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
53010	Fee-for-Service	1851439848	1851439848	1	1	KWAN, JEFFREY W MD	2/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81934	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
53023	Fee-for-Service	1366824690	1366824690	1	1	KETTELHAKE, GREGORY A	12/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
53038	Fee-for-Service	1245318096	1245318096	1	1	KLEIN, DANIEL B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	28140	41	Internal Medicine	0	In state provider	None	2900 WHIPPLE AVE	None	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
53065	Fee-for-Service	1528276888	1528276888	1	1	KODANI, ANN M DO	10/31/2007	207R00000X	NA	Other	026	PHYSICIANS	9394	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
53078	Fee-for-Service	1538100391	1538100391	1	1	KHATRI, RAKHI MD	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94271	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
53092	Fee-for-Service	1720136518	1720136518	1	1	KOLAHDOUZ-ISFAHANI, AMIR	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78449	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
53155	Fee-for-Service	1013311448	1013311448	1	1	KOREAN HEALTH EDUCATION	5/5/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INFORMATION & RESEARCH	3255 WILSHIRE BLVD	STE 120	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
53167	Fee-for-Service	1962907014	1962907014	1	1	KUO, ERIC J MD	9/9/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	163941	70	Clinic (mixed specialty)	0	In state provider	None	50 S SAN MATEO DR	SUITE 120	SAN MATEO	CA	94401	3857	41	06081	37.56634141	-122.3261145	San Mateo County
53216	Fee-for-Service	1063850808	1063850808	1	1	KHANDAN, SARA MD	5/14/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	155828	18	Ophthalmology	0	In state provider	None	835 THIRD AVE	SUITE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
53227	Fee-for-Service	1699795849	1699795849	1	1	KING, DONALD P MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	25125	01	General Practice	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
53236	Fee-for-Service	1932181682	1932181682	1	1	KORNBLIT, MURRAY J MD	11/8/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	31027	41	Internal Medicine	0	In state provider	None	5555 RESERVOIR DR	STE 205	SAN DIEGO	CA	92120	5148	37	06073	32.77628471	-117.0563688	San Diego County
53238	Fee-for-Service	1922066075	1922066075	1	1	KIM, DAVID W MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65349	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
53249	Fee-for-Service	1770082455	1770082455	1	1	KIM, BRIAN CRNA	5/30/2018	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
53260	Fee-for-Service	1649835661	1649835661	1	1	KIM, ESTHER DO	1/5/2024	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
53313	Fee-for-Service	1548556665	1548556665	1	1	KIM, KI H MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13381	01	General Practice	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
53327	Fee-for-Service	1518046648	1518046648	1	1	KATZ, DAVID A MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74094	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
53328	Fee-for-Service	1154339539	1154339539	1	1	KAUFMAN, KARL M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11714 N CREEK PKWY N	None	BOTHELL	WA	98011	8250	00	None	47.77467892	-122.1838257	King County
53330	Fee-for-Service	1962415182	1962415182	1	1	KHAYAT, RAMI N MD	9/11/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	161252	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
53331	Fee-for-Service	1457522567	1457522567	1	1	KD MEDICAL GROUP, INC	12/31/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	311 W I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
53335	Fee-for-Service	1902367642	1902367642	1	1	KO, SEBASTIAN J MD	12/2/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
53336	Fee-for-Service	1083926232	1083926232	1	1	KHOURY, PHILIP MD	10/5/2021	207L00000X	NA	Other	026	PHYSICIANS	14690	None	None	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
53349	Fee-for-Service	1902113483	1902113483	1	1	KASIM, SAMERA A DO	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11647	20	Orthopedic Surgery	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	7821	27	06053	36.57482436	-121.8101797	Monterey County
53350	Fee-for-Service	1124288493	1124288493	1	1	KIM, ALYN J E MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126002	04	Otology, Laryngology, Rhinology	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
53393	Fee-for-Service	1326758236	1326758236	1	1	KAYTSNER, NICOLLE PT	2/15/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
53416	Fee-for-Service	1902194657	1902194657	1	1	KOONTZ, JOHN D MD	11/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117522	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
53426	Fee-for-Service	1275870842	1275870842	1	1	KIM, JAMIE DPM	8/16/2017	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
53442	Fee-for-Service	1013311448	1013311448	1	1	KOREAN HEALTH EDUCATION	1/4/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INFORMATION & RESEARCH	3255 WILSHIRE BLVD	STE 120	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
53459	Fee-for-Service	1962907014	1962907014	1	1	KUO, ERIC J MD	9/9/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	163941	68	Hematology	0	In state provider	None	50 S SAN MATEO DR	SUITE 120	SAN MATEO	CA	94401	3857	41	06081	37.56634141	-122.3261145	San Mateo County
53468	Fee-for-Service	1417185497	1417185497	1	1	KURDMAN, KAMIRAN MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120046	41	Internal Medicine	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	1767	37	06073	32.8002375	-117.1546269	San Diego County
53469	Fee-for-Service	1396708756	1396708756	1	1	KHATEEB, MAZIN A MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56111	02	General Surgery	0	In state provider	None	9600 CUYAMACA ST	SUITE 201	SANTEE	CA	92071	2692	37	06073	32.85158542	-116.9835131	San Diego County
53472	Fee-for-Service	1184181281	1184181281	1	1	KIM, ANDREW S	11/15/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
53503	Fee-for-Service	1013178102	1013178102	1	1	KOZLOWSKI, ROBERT MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126369	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
53504	Fee-for-Service	1316046378	1316046378	1	1	KANDIL, SHERIF H MD	3/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53619	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
53511	Fee-for-Service	1538359799	1538359799	1	1	KWON, OH P MD	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98871	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
53512	Fee-for-Service	1699795849	1699795849	1	1	KING, DONALD P MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	25125	30	Radiology	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
53513	Fee-for-Service	1043407844	1043407844	1	2	KY T. VU, M.D., INC.	8/29/2019	208M00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
53522	Fee-for-Service	1922066075	1922066075	1	1	KIM, DAVID W MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65349	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
53547	Fee-for-Service	1346511235	1346511235	1	1	KHONGPHATTHANAYOTHIN	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	49997	35	Pediatric Cardiology (M.D. only)	0	In state provider	APICHAI MD	1200 NORTH STATE STREET	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
53592	Fee-for-Service	1225482532	1225482532	1	1	KOO, RACHEL MD	12/5/2022	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
53617	Fee-for-Service	1962415182	1962415182	1	1	KHAYAT, RAMI N MD	9/11/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	161252	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
53648	Fee-for-Service	1366453011	1366453011	1	1	KESSLER, TODD S MD	9/19/2016	207R00000X	NA	Other	026	PHYSICIANS	88555	41	Internal Medicine	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
53662	Fee-for-Service	1548801012	1548801012	1	1	KIRSCHENMANN, RYAN T PT	11/18/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1723 27TH ST	None	BAKERSFIELD	CA	93301	2807	15	06029	35.38383629	-119.0218323	Kern County
53673	Fee-for-Service	1184113029	1184113029	1	1	KONJA, SANDRA A PSYD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
53729	Fee-for-Service	1013311448	1013311448	1	1	KOREAN HEALTH EDUCATION	5/5/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INFORMATION & RESEARCH	3255 WILSHIRE BLVD	STE 120	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
53740	Fee-for-Service	1013062769	1013062769	1	7	KAISER FOUNDATION HOSPITALS	2/24/2020	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA DR	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
53744	Fee-for-Service	1962907014	1962907014	1	1	KUO, ERIC J MD	9/9/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	163941	41	Internal Medicine	0	In state provider	None	50 S SAN MATEO DR	SUITE 120	SAN MATEO	CA	94401	3857	41	06081	37.56634141	-122.3261145	San Mateo County
53756	Fee-for-Service	1790039576	1790039576	1	1	KANG, SARAH S LMFT	8/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
53792	Fee-for-Service	1568119410	1568119410	1	1	KAUR, PRABHJOT DC	4/22/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	10 HARRIS CT	STE A2	MONTEREY	CA	93940	7823	27	06053	36.58063559	-121.820025	Monterey County
53810	Fee-for-Service	1104988708	1104988708	1	1	KWON, JOHN PT	8/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
53848	Fee-for-Service	1366467730	1366467730	1	1	KANE, EDWARD W MD	3/1/1996	207L00000X	NA	Other	026	PHYSICIANS	22257	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
53849	Fee-for-Service	1801464896	1801464896	1	1	KANG, JANE	3/13/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22242	08	Family Practice	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
53937	Fee-for-Service	1366453011	1366453011	1	1	KESSLER, TODD S MD	9/19/2016	207R00000X	NA	Other	026	PHYSICIANS	88555	01	General Practice	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
53949	Fee-for-Service	1144228396	1144228396	1	2	KURERA, HEATHER M DO	11/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	12214	-	NOT APPLICABLE	0	In state provider	None	831 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09030767	-117.7353578	Los Angeles County
53955	Fee-for-Service	1114099272	1114099272	1	1	KAMP, AMY D PT	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7520 ARROYO CR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
53962	Fee-for-Service	1922282870	1922282870	1	1	KAO, MING-CHIH J MD	12/29/2008	390200000X	NA	Other	026	PHYSICIANS	105859	41	Internal Medicine	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
53972	Fee-for-Service	1750365144	1750365144	1	1	KEENAN, CRAIG R MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80806	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
53979	Fee-for-Service	1952643595	1952643595	1	1	KATZ, MATTHEW H MD	7/10/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175815	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
54005	Fee-for-Service	1003975681	1003975681	1	1	KAPLAN, RICHARD A MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60168	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
54018	Fee-for-Service	1417930603	1417930603	2	1	KOSSUTH, SARA R DO	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	8025	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
54033	Fee-for-Service	1386741320	1386741320	1	1	KAHLON, RAVINDER MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50823	13	Neurology (M.D. only)	0	In state provider	None	662 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
54034	Fee-for-Service	1013062769	1013062769	1	7	KAISER FOUNDATION HOSPITALS	2/24/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA DR	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
54067	Fee-for-Service	1346205663	1346205663	1	1	KELLY,RICHARD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80029	05	Anesthesiology	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
54083	Fee-for-Service	1497894224	1497894224	3	1	KNOLLMANN, FRIEDRICH D MD	9/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131721	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
54091	Fee-for-Service	1003348921	1003348921	1	1	KAUR, GURSHARNJIT MD	11/22/2019	390200000X	NA	Other	026	PHYSICIANS	163713	08	Family Practice	0	In state provider	None	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	54	06107	36.359649	-119.331567	Tulare County
54158	Fee-for-Service	1003991761	1003991761	1	1	KATO, BLYTHE M MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86538	04	Otology, Laryngology, Rhinology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
54161	Fee-for-Service	1871753848	1871753848	1	1	KAMENY, REBECCA J MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117072	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
54165	Fee-for-Service	1043290828	1043290828	1	1	KERLEY, SUZANNE M MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	52606	24	Plastic Surgery	0	In state provider	None	1001 POTRERO AVE	# 3A	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
54197	Fee-for-Service	1295806057	1295806057	1	1	KAUFHOLD, MARILYN J MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	33767	40	Pediatrics	0	In state provider	CTR. FOR CHILD PROTECT.	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
54198	Fee-for-Service	1194259754	1194259754	1	1	KEIL, LUKAS G MD	8/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	184662	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
54213	Fee-for-Service	1720160203	1720160203	1	1	KIM, JIN KWAN MD	3/22/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38184	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3300 WEBSTER ST	STE 1105	OAKLAND	CA	94609	3118	01	06001	37.82132826	-122.2621843	Alameda County
54252	Fee-for-Service	1144648833	1144648833	1	1	KOUANDA, ABDUL-AZIZ M MD	6/5/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	141110	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
54289	Fee-for-Service	1972715183	1972715183	1	1	KANCHWALA, SABIHA F MD	11/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121897	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
54302	Fee-for-Service	1033578513	1033578513	1	1	KIM, SEON NAM LAC	8/10/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1140 W LA VETA AVE	SUITE 580	ORANGE	CA	92868	4225	30	06059	33.7802984	-117.8651669	Orange County
54306	Fee-for-Service	1417930603	1417930603	2	1	KOSSUTH, SARA R DO	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	8025	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
54322	Fee-for-Service	1386741320	1386741320	1	1	KAHLON, RAVINDER MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50823	36	Psychiatry	0	In state provider	None	662 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
54327	Fee-for-Service	1265640387	1265640387	1	1	KWAN, RITA O	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95757	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
54332	Fee-for-Service	1871908616	1871908616	1	1	KARIMIAN, AMIR MD	10/9/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	179666	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
54342	Fee-for-Service	1255867826	1255867826	1	1	KWONG, AARON MD	7/25/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	159103	None	None	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
54350	Fee-for-Service	1992048417	1992048417	1	1	KIM, ALBERT H	6/3/2020	208800000X	NA	Other	026	PHYSICIANS	167959	34	Urology and Urological Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
54356	Fee-for-Service	1619958626	1619958626	1	1	KAHN, CLIFFORD R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34659	20	Orthopedic Surgery	0	In state provider	None	16311 VENTURA BLVD	STE 800	ENCINO	CA	91436	2140	19	06037	34.15706864	-118.4885978	Los Angeles County
54357	Fee-for-Service	1063762797	1063762797	1	1	KIRK, SARAH E MFT	8/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
54386	Fee-for-Service	1033641220	1033641220	1	1	KITAGAWA, KRISTIN M LMFT	9/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	937 VIA LATA	SUITE 400	COLTON	CA	92324	3958	36	06071	34.0553925	-117.3070187	San Bernardino County
54449	Fee-for-Service	1811068455	1811068455	1	2	KAYE, DAVID B MD INC	7/25/2011	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2514 JENSEN AVE	SUITE 103	SANGER	CA	93657	2451	10	06019	36.70681323	-119.5724219	Fresno County
54491	Fee-for-Service	1063626711	1063626711	1	1	KUTTOTHARA, SYNA M MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117903	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
54505	Fee-for-Service	1760421432	1760421432	2	1	KELLY, THOMAS J MD	1/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73741	None	None	0	In state provider	None	612 W DURATE RD	STE 101	ARCADIA	CA	91007	9220	19	06037	34.12647805	-118.051994	Los Angeles County
54516	Fee-for-Service	1528176500	1528176500	1	1	KERR, LYNN A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71333	41	Internal Medicine	0	In state provider	CENTRAL CA FACULTY MED	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
54550	Fee-for-Service	1386746477	1386746477	1	1	KRALL, VICTOR G DPM	11/29/2023	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
54563	Fee-for-Service	1023115672	1023115672	1	1	KOLODZIEJ, CRAIG T MD	12/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111087	30	Radiology	0	In state provider	None	1901 OUTLET CENTER DR	STE 120	OXNARD	CA	93036	0664	56	06111	34.21965581	-119.1491337	Ventura County
54615	Fee-for-Service	1265640387	1265640387	1	1	KWAN, RITA O	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95757	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
54624	Fee-for-Service	1083781934	1083781934	1	1	KIM, CECILIA Y	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71619	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
54632	Fee-for-Service	1417369414	1417369414	1	1	KISHORE, SANDEEP P MD	8/30/2021	208M00000X	NA	Other	026	PHYSICIANS	174602	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
54640	Fee-for-Service	1366443533	1366443533	1	1	KERBER, CHARLES W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30735	30	Radiology	0	In state provider	None	200 W ARBOR DR	DEPT 8501	SAN DIEGO	CA	92103	8501	37	06073	32.7537975	-117.1658298	San Diego County
54676	Fee-for-Service	1104357102	1104357102	1	1	KOOBAMO LLC	3/6/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5472 FOOTHILL BLVD	None	OAKLAND	CA	94601	5516	01	06001	37.77265019	-122.1966463	Alameda County
54680	Fee-for-Service	1962694927	1962694927	1	1	KAURA, SAMANTHA H MD	9/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	102186	30	Radiology	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
54707	Fee-for-Service	1235152885	1235152885	1	1	KRUMMEN, DAVID E MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81261	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
54737	Fee-for-Service	1811068455	1811068455	1	2	KAYE, DAVID B MD INC	7/25/2011	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2514 JENSEN AVE	SUITE 103	SANGER	CA	93657	2451	10	06019	36.70681323	-119.5724219	Fresno County
54763	Fee-for-Service	1114001856	1114001856	1	1	KOSTISHACK, AMY L MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79345	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
54768	Fee-for-Service	1649317140	1649317140	1	1	KINGSLEY, CHARLA ELAINE	7/23/2005	163WH0200X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	22690 HIGHVIEW LN	None	MORENO VALLEY	CA	92557	0800	33	06065	33.99099984	-117.2674882	Riverside County
54776	Fee-for-Service	1790963726	1790963726	1	1	KANCHERLA, DEEPIKA MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102562	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
54780	Fee-for-Service	1225118979	1225118979	1	1	KIM, JASON H MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75011	84	Surgery-Head and Neck	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
54828	Fee-for-Service	1245674241	1245674241	1	1	KAGAN, IGOR MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132630	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
54832	Fee-for-Service	1427159458	1427159458	1	1	KHABAZ, FARHAN MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69690	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
54849	Fee-for-Service	1881125672	1881125672	1	1	KIM, MARK H MD	6/16/2021	390200000X	NA	Other	026	PHYSICIANS	172119	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
54866	Fee-for-Service	1699441014	1699441014	1	1	KIM, EUNYOUNG L	5/6/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3733 SAN DIMAS ST	STE 104	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
54882	Fee-for-Service	1912926890	1912926890	1	1	KADO, DEBORAH M MD	6/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76662	41	Internal Medicine	0	In state provider	None	200 MED PLAZA #365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
54921	Fee-for-Service	1104021963	1104021963	1	1	KAYMAN, JOSHUA E MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108111	None	None	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
54928	Fee-for-Service	1588075857	1588075857	1	1	KIM, PAUL MD	5/24/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	142925	13	Neurology (M.D. only)	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
54930	Fee-for-Service	1588126288	1588126288	1	1	KO, CAROLINE J DPM	10/28/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
54941	Fee-for-Service	1437737327	1437737327	1	1	KARUNARATNE, KUMARI DO	7/30/2024	207R00000X	NA	Other	026	PHYSICIANS	20532	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
54958	Fee-for-Service	1942436324	1942436324	1	1	KIM, ROBIN A MD	7/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97165	05	Anesthesiology	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93612	6800	10	06019	36.83745149	-119.6604315	Fresno County
54966	Fee-for-Service	1407513427	1407513427	1	1	K&F LLC	12/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6359 ARNOLD WAY	None	BUENA PARK	CA	90620	1503	30	06059	33.85370705	-118.0223111	Orange County
54968	Fee-for-Service	1760545503	1760545503	1	6	KATUKOTA, VIJAY C MD INC	9/14/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	459 S AZUSA AVENUE	SUITE F	AZUSA	CA	91702	4945	19	06037	34.114581	-117.9077475	Los Angeles County
54978	Fee-for-Service	1023096443	1023096443	1	1	KRAKOVSKY, ALEXANDER A	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81711	05	Anesthesiology	0	In state provider	MD	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
54989	Fee-for-Service	1336306323	1336306323	1	1	KEMPER, DAN D MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116677	20	Orthopedic Surgery	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
55001	Fee-for-Service	1477844629	1477844629	1	1	KIM, WOOSUNG MD	3/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123395	05	Anesthesiology	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
55020	Fee-for-Service	1023098738	1023098738	1	1	KOHLI, PARUL MD	9/2/2020	207R00000X	NA	Other	026	PHYSICIANS	84849	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
55026	Fee-for-Service	1023697307	1023697307	1	1	KHINE, SU T MD	9/10/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
55033	Fee-for-Service	1376514026	1376514026	1	1	KELMAN, CHAD G MD	1/5/2023	2085R0204X	NA	Other	026	PHYSICIANS	183227	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
55056	Fee-for-Service	1649317140	1649317140	1	1	KINGSLEY, CHARLA ELAINE	7/23/2005	163WH0200X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	22690 HIGHVIEW LN	None	MORENO VALLEY	CA	92557	0800	33	06065	33.99099984	-117.2674882	Riverside County
55074	Fee-for-Service	1770967382	1770967382	1	1	KANG, ALISON S MD	8/15/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	144306	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
55092	Fee-for-Service	1881698702	1881698702	1	2	KAPLAN, KARL J MD	10/21/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	46045	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
55144	Fee-for-Service	1235190513	1235190513	1	1	KEEFE, JAMES F MD INC	12/4/2003	207ZP0102X	NA	Other	026	PHYSICIANS	36906	None	None	0	In state provider	None	1050 LINDEN AVE	DEPT OF PATH	LONG BEACH	CA	90813	3393	19	06037	33.78003775	-118.1866604	Los Angeles County
55177	Fee-for-Service	1346261039	1346261039	1	1	KLASS, ALLAN H MD INC	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	12168	41	Internal Medicine	0	In state provider	None	16133 VENTURA BLVD	STE 400	ENCINO	CA	91436	2429	19	06037	34.15656164	-118.4849569	Los Angeles County
55212	Fee-for-Service	1740545987	1740545987	1	1	KERNER, LISA M NP	5/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
55215	Fee-for-Service	1063647774	1063647774	1	1	KAO, GARY CHINGHUEI MD	6/5/2009	207L00000X	NA	Other	026	PHYSICIANS	53740	05	Anesthesiology	0	In state provider	INC	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
55227	Fee-for-Service	1215277017	1215277017	1	1	KIMBELL, LAURA M PSYD	6/15/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
55249	Fee-for-Service	1114489481	1114489481	1	1	KASTNER, MICHAEL MD	12/1/2023	207P00000X	NA	Other	026	PHYSICIANS	189039	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	54	06107	36.327888	-119.294919	Tulare County
55260	Fee-for-Service	1922309442	1922309442	1	1	KAISER, STEFANIE K MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113646	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
55281	Fee-for-Service	1598854978	1598854978	1	1	KALANTAR, NADER MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115578	04	Otology, Laryngology, Rhinology	0	In state provider	None	547 EAST UNION ST	None	PASADENA	CA	91101	1743	19	06037	34.1472385	-118.139094	Los Angeles County
55323	Fee-for-Service	1851572366	1851572366	1	1	KALTHIA, RUPESH H MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120048	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55442	Fee-for-Service	1134488299	1134488299	1	1	KAM, TRACY DO	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13123	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
55458	Fee-for-Service	1558411595	1558411595	1	1	KAHANA, MADELYN D MD	6/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53680	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
55465	Fee-for-Service	1508303025	1508303025	1	1	KOOKLAN, FARIBA LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
55470	Fee-for-Service	1295050466	1295050466	1	1	KULKARNI, HRISHIKESH S MD	12/16/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
55475	Fee-for-Service	1972651842	1972651842	1	1	KAISER PERMANENTE PHARM	9/17/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#515	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
55509	Fee-for-Service	1629126420	1629126420	1	1	KAISER FOUNDATION HEALTH	9/17/1990	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY #3	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
55532	Fee-for-Service	1861561276	1861561276	1	1	KLINE, DANIEL C MD	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97882	18	Ophthalmology	0	In state provider	None	1211 W LA PALMA AVE	STE 201	ANAHEIM	CA	92801	2810	30	06059	33.84718298	-117.933758	Orange County
55547	Fee-for-Service	1922309442	1922309442	1	1	KAISER, STEFANIE K MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113646	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
55548	Fee-for-Service	1770577967	1770577967	1	1	KRISTIN HERMANSON	8/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	1521	00	None	43.535484	-96.7428585	Minnehaha County
55555	Fee-for-Service	1184068991	1184068991	1	1	KAHLON, AMITPAL S MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139514	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
55563	Fee-for-Service	1841357712	1841357712	1	1	KITTREDGE-GIULIANO, LINDSAY	8/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	A PHD	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
55609	Fee-for-Service	1578861399	1578861399	1	1	KIM, MYUNGJIN	5/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12139 MOUNT VERNON AVE	STE 110	GRAND TERRACE	CA	92313	5500	36	06071	34.033185	-117.313583	San Bernardino County
55627	Fee-for-Service	1073798617	1073798617	1	1	KOLAWOLE, OLATOKUNBO O MD	8/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167485	08	Family Practice	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
55632	Fee-for-Service	1366426587	1366426587	1	1	KOHLI, SUMIT MD	11/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75849	10	Gastroenterology (M.D. only)	0	In state provider	None	1210 SONOMA AVE	STE B	SANTA ROSA	CA	95405	6648	49	06097	38.440404	-122.6983185	Sonoma County
55672	Fee-for-Service	1427023407	1427023407	1	1	KUROHARA, JONATHAN K MD	6/18/2010	305R00000X	NA	Other	026	PHYSICIANS	55913	08	Family Practice	0	In state provider	None	2876 SYCAMORE DR	STE 101	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
55724	Fee-for-Service	1033420476	1033420476	1	1	KLEE LOPES, VINICIUS MD	6/15/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	160836	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
55742	Fee-for-Service	1558411595	1558411595	1	1	KAHANA, MADELYN D MD	6/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53680	05	Anesthesiology	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
55758	Fee-for-Service	1295050466	1295050466	1	1	KULKARNI, HRISHIKESH S MD	12/16/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
55766	Fee-for-Service	1598729931	1598729931	1	1	KUMAR, GUBBANNA V MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53441	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
55767	Fee-for-Service	1265518153	1265518153	1	1	KEN TRANSPORTATION SERV	9/26/2005	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	1220 KOCH LN	None	SAN JOSE	CA	95125	4107	43	06085	37.28119862	-121.8867288	Santa Clara County
55803	Fee-for-Service	1720067283	1720067283	1	1	KOONCE,EDWARD D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	708 W FOREST AVE	None	JACKSON	TN	38301	0000	00	None	35.63557288	-88.83180943	Madison County
55872	Fee-for-Service	1043313992	1043313992	1	1	KIM, STEVEN S MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69347	08	Family Practice	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
55901	Fee-for-Service	1467980482	1467980482	1	1	KIM, YOUNG MI LCSW	10/8/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2676	19	06037	34.17245599	-118.5633517	Los Angeles County
55919	Fee-for-Service	1023225802	1023225802	1	1	KAM, JUSTUS H MD	9/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131154	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
55926	Fee-for-Service	1972607216	1972607216	1	1	KITTLESON, MICHELLE M MD	8/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95438	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 UCLA MEDICAL PLZ S	#630	LOS ANGELES	CA	90095	0001	19	06037	34.0651473	-118.4458393	Los Angeles County
55940	Fee-for-Service	1013000447	1013000447	1	1	KUO, YU-CHIIN MD	1/8/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66920	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
55949	Fee-for-Service	1275792533	1275792533	1	1	KAPLAN, KARLY A MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121117	24	Plastic Surgery	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
55950	Fee-for-Service	1225126998	1225126998	1	1	KLEIN, JAMES C MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	22960	02	General Surgery	0	In state provider	None	2100 WEBSTER ST	STE 202	SAN FRANCISCO	CA	94115	2375	38	06075	37.7904826	-122.4324477	San Francisco County
55954	Fee-for-Service	1053734905	1053734905	1	1	KAUNITZ, GENEVIEVE J MD	8/9/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	172778	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
55958	Fee-for-Service	1164790432	1164790432	1	1	KOPERSKI, KRISTIN L PHD	10/3/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
56032	Fee-for-Service	1023733656	1023733656	1	1	KIVO MEDICAL CA PC	8/13/2023	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	980 9TH ST	STE 1600	SACRAMENTO	CA	95814	2736	34	06067	38.581146	-121.4950365	Sacramento County
56038	Fee-for-Service	1659654598	1659654598	1	1	KOZMA, BONITA D MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137074	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	STE 365 120 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
56076	Fee-for-Service	1649576166	1649576166	1	1	KARAGEORGE, JASON P PHD	8/19/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
56079	Fee-for-Service	1780941914	1780941914	1	1	KAPUR, VARUN MD	10/10/2023	208600000X	NA	General Surgery	026	PHYSICIANS	190090	None	None	0	In state provider	None	807 ILLINOIS AVENUE	None	LOS BANOS	CA	93635	3512	24	06047	37.064394	-120.857788	Merced County
56121	Fee-for-Service	1528256427	1528256427	1	1	KOOMALSINGH, KEVIN J MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131256	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
56126	Fee-for-Service	1164939781	1164939781	1	1	KIM, ANNA E CRNA	3/29/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
56132	Fee-for-Service	1851752760	1851752760	1	1	KANG, HOBIN DO	10/14/2022	208600000X	NA	General Surgery	026	PHYSICIANS	20178	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
56148	Fee-for-Service	1861405029	1861405029	1	1	KANGELARIS, KIRSTEN N MD	11/14/2007	207R00000X	NA	Other	026	PHYSICIANS	100554	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
56177	Fee-for-Service	1225434962	1225434962	1	1	KIM, GINA S OT	6/24/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
56190	Fee-for-Service	1861570343	1861570343	1	1	KATSUYAMA, STEVEN S MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63449	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2809 OLIVE HWY	STE 220	OROVILLE	CA	95966	6133	04	06007	39.50386798	-121.5410203	Butte County
56193	Fee-for-Service	1083450357	1083450357	1	1	KUWAYE-TAMANAHA, REN T PT	8/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9080 IRVINE CENTER DRIVE	None	IRVINE	CA	92618	4658	30	06059	33.63644038	-117.7392454	Orange County
56207	Fee-for-Service	1538893219	1538893219	1	1	KAO, BRANDON A OD	8/17/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
56215	Fee-for-Service	1467428516	1467428516	1	1	KEPPLE, JEFFREY G MD	2/3/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76431	08	Family Practice	0	In state provider	None	1060 VALLEY VIEW DR	None	QUINCY	CA	95971	9510	32	06063	39.94051434	-120.9614275	Plumas County
56217	Fee-for-Service	1972607216	1972607216	1	1	KITTLESON, MICHELLE M MD	8/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95438	41	Internal Medicine	0	In state provider	None	100 UCLA MEDICAL PLZ S	#630	LOS ANGELES	CA	90095	0001	19	06037	34.0651473	-118.4458393	Los Angeles County
56220	Fee-for-Service	1942066220	1942066220	1	1	KEALOHA LLC	3/13/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	31	06061	0	0	None
56239	Fee-for-Service	1225126998	1225126998	1	1	KLEIN, JAMES C MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	22960	04	Otology, Laryngology, Rhinology	0	In state provider	None	2100 WEBSTER ST	STE 202	SAN FRANCISCO	CA	94115	2375	38	06075	37.7904826	-122.4324477	San Francisco County
56255	Fee-for-Service	1639556855	1639556855	1	1	KINAHAN, CONSUELO A MD	2/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146054	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
56275	Fee-for-Service	1336220581	1336220581	1	1	KARNEGES, FRANK G DO	6/24/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	6221	66	Emergency Medicine (Urgent Care)	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
56293	Fee-for-Service	1508844648	1508844648	1	1	KLIS, GREGORY R	12/1/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83369	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
56341	Fee-for-Service	1649252396	1649252396	1	1	KOLBECK, PETER C MD	12/15/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78120	22	Pathology (M.D. only)	0	In state provider	None	2420 J ST	None	SACRAMENTO	CA	95816	4806	34	06067	38.574738	-121.4738955	Sacramento County
56349	Fee-for-Service	1649238163	1649238163	1	2	KIRALY, JOHN F III MD	4/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	24190	78	Neoplastic Diseases/Oncology	0	In state provider	None	801 SOUTH HAM LANE	None	LODI	CA	95242	7503	39	06077	38.124495	-121.2882875	San Joaquin County
56371	Fee-for-Service	1821029059	1821029059	1	1	KO, NERISSA U MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62792	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
56401	Fee-for-Service	1972754927	1972754927	1	2	KESHAVARZI, SASSAN MD	7/14/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	99882	14	Neurological Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
56413	Fee-for-Service	1083879274	1083879274	1	1	KONG, BO Y MD	2/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103792	40	Pediatrics	0	In state provider	None	77 CADILLAC DR	STE 200	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
56420	Fee-for-Service	1699232454	1699232454	1	1	KWANG HE WON HEALTH CENTER	3/8/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	815 S ARDMORE AVE	FIRST FLOOR	LOS ANGELES	CA	90005	2597	19	06037	34.05717	-118.3020395	Los Angeles County
56432	Fee-for-Service	1659724391	1659724391	1	1	KAREN G. BLACK, MARRIAGE AND	10/7/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	28465 OLD TOWN FRONT ST	STE 221	TEMECULA	CA	92590	1822	33	06065	33.49566437	-117.1516462	Riverside County
56433	Fee-for-Service	1730716416	1730716416	1	1	KENISTON, KAREN A MD	7/18/2023	208M00000X	NA	Other	026	PHYSICIANS	187857	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
56459	Fee-for-Service	1205439395	1205439395	1	1	KERSTEIN, KAILEY R PT	7/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 E THOUSAND OAKS BLVD	None	THOUSAND OAKS	CA	91360	1985	56	06111	34.17919939	-118.8745721	Ventura County
56466	Fee-for-Service	1881883734	1881883734	1	1	KOKKALERA, UTHAIAH MD INC	1/10/2011	193400000X	NA	Other	026	PHYSICIANS	100600	02	General Surgery	0	In state provider	None	18250 ROSCOE BLVD	SUITE 335	NORTHRIDGE	CA	91325	4282	19	06037	34.22076142	-118.5313223	Los Angeles County
56474	Fee-for-Service	1992931190	1992931190	1	1	KROHN, TYLER D MD	6/8/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	106309	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12-436 MDCC	LOS ANGELES	CA	90095	7001	19	06037	34.06373445	-118.443537	Los Angeles County
56495	Fee-for-Service	1386816262	1386816262	1	1	KIM, DONG W MD	8/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104479	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
56526	Fee-for-Service	1013987072	1013987072	1	1	KHAN, HABIB U. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1653 E MCMURRAY BLVD	STE 139	CASA GRANDE	AZ	85222	6010	00	None	32.8842	-111.716514	Pinal County
56551	Fee-for-Service	1821275926	1821275926	1	1	KWONG, BERNICE YU JING MD	10/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109243	07	Dermatology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56564	Fee-for-Service	1336220581	1336220581	1	1	KARNEGES, FRANK G DO	6/24/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	6221	41	Internal Medicine	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
56579	Fee-for-Service	1043244577	1043244577	1	1	KNOTT, JODIE M PHD	3/13/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7872 WALKER ST	STE 200	LA PALMA	CA	90623	4703	30	06059	33.84787056	-118.0372511	Orange County
56631	Fee-for-Service	1760492391	1760492391	1	1	KALDAS, NADER R	9/30/1992	207R00000X	NA	Other	026	PHYSICIANS	50637	41	Internal Medicine	0	In state provider	None	87 FENTON STREET	SUITE 100	LIVERMORE	CA	94550	4183	01	06001	37.676565	-121.7834555	Alameda County
56633	Fee-for-Service	1891242442	1891242442	1	1	KELMAN, JULIE MD	6/26/2023	207P00000X	NA	Other	026	PHYSICIANS	186158	None	None	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4304	37	06073	32.63282707	-117.0829101	San Diego County
56638	Fee-for-Service	1649238163	1649238163	1	2	KIRALY, JOHN F III MD	4/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	24190	68	Hematology	0	In state provider	None	801 SOUTH HAM LANE	None	LODI	CA	95242	7503	39	06077	38.124495	-121.2882875	San Joaquin County
56643	Fee-for-Service	1710350244	1710350244	1	1	KEENAN, DANIELLE A	5/6/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
56663	Fee-for-Service	1033296967	1033296967	1	1	KIM, RUBIN W MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91441	18	Ophthalmology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
56673	Fee-for-Service	1225058712	1225058712	1	1	KO, TINGTING C MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78139	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2151 APPIAN WAY	None	PINOLE	CA	94564	2514	07	06013	37.99738125	-122.3013414	Contra Costa County
56674	Fee-for-Service	1639794134	1639794134	1	1	KOSOFSKY, MICHAEL E MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	186156	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
56706	Fee-for-Service	1215372297	1215372297	1	1	KHAREL, NIRMAL MD	9/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187677	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
56708	Fee-for-Service	1699232454	1699232454	1	1	KWANG HE WON HEALTH CENTER	11/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	815 S ARDMORE AVE	FIRST FLOOR	LOS ANGELES	CA	90005	2597	19	06037	34.05717	-118.3020395	Los Angeles County
56713	Fee-for-Service	1225185549	1225185549	1	1	KAISER FOUNDATION HEALTH	3/13/1996	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #322	4141 GEARY BLVD	FL 1	SAN FRANCISCO	CA	94118	3118	38	06075	37.78096053	-122.4637512	San Francisco County
56726	Fee-for-Service	1982655155	1982655155	1	1	KONSTANTARAKIS, JOSEPH	6/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83087	30	Radiology	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
56739	Fee-for-Service	1477045755	1477045755	1	1	KIIRU, ESTHER W	9/26/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7310 HICKORY AVE	None	ORANGEVALE	CA	95662	2427	34	06067	38.698839	-121.2340905	Sacramento County
56753	Fee-for-Service	1417962366	1417962366	1	1	KESZLER, ROBERT T MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70896	05	Anesthesiology	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
56762	Fee-for-Service	1750498564	1750498564	1	1	KIMBERLY J RIEHLE MD	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
56804	Fee-for-Service	1659691699	1659691699	1	1	KOTAY, ANUPAMA S PSYD	9/7/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
56817	Fee-for-Service	1174601272	1174601272	1	1	KAHN, JONATHAN MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	57117	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
56827	Fee-for-Service	1235461666	1235461666	1	1	KIM, ANDREW C MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110012	30	Radiology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
56862	Fee-for-Service	1821386962	1821386962	1	1	KUTTY, GEETA R MD	3/4/2019	207R00000X	NA	Other	026	PHYSICIANS	158918	10	Gastroenterology (M.D. only)	0	In state provider	None	2331 MONTPELIER DRIVE	SUITE B	SAN JOSE	CA	95116	1622	43	06085	37.3649965	-121.8479359	Santa Clara County
56872	Fee-for-Service	1811488315	1811488315	1	1	KOST, STEPHANIE DO	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
56877	Fee-for-Service	1235118936	1235118936	1	1	KHUSHU, SHIPRA MD	7/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89766	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
56900	Fee-for-Service	1700031648	1700031648	1	1	KENNISON, YAJAIRA M LCSW	5/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
56902	Fee-for-Service	1023020286	1023020286	1	1	KHAN, OONA A MD	12/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88791	67	Endocrinology	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
56915	Fee-for-Service	1649236522	1649236522	1	1	KIM, YOUNG M MD	9/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51136	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3724 LONE TREE WAY	STE A	ANTIOCH	CA	94509	6018	07	06013	37.98362677	-121.8058276	Contra Costa County
56958	Fee-for-Service	1821054453	1821054453	1	1	KHAN, AZHAR U MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3366 NW EXPRESSWAY	SUITE 660	OKLAHOMA CITY	OK	73112	0000	00	None	35.53096894	-97.57699723	Oklahoma County
56968	Fee-for-Service	1710382551	1710382551	1	1	KHESIN-SHPOLYANSKY, KSENIYA	5/17/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
56974	Fee-for-Service	1013988922	1013988922	1	1	KELLER, DARREN B MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54900	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
56990	Fee-for-Service	1023300019	1023300019	1	1	KALOOSTIAN, CAROLYN L MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114172	01	General Practice	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
56996	Fee-for-Service	1699232454	1699232454	1	1	KWANG HE WON HEALTH CENTER	11/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	815 S ARDMORE AVE	FIRST FLOOR	LOS ANGELES	CA	90005	2597	19	06037	34.05717	-118.3020395	Los Angeles County
57027	Fee-for-Service	1477045755	1477045755	1	1	KIIRU, ESTHER W	9/26/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7310 HICKORY AVE	None	ORANGEVALE	CA	95662	2427	34	06067	38.698839	-121.2340905	Sacramento County
57035	Fee-for-Service	1669511002	1669511002	1	1	KLEPPE, STEPHANIE A LCSW	11/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
57071	Fee-for-Service	1205452398	1205452398	1	1	KURRE, LEENA DO	1/10/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	22660	36	Psychiatry	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
57083	Fee-for-Service	1376054569	1376054569	1	1	KLAIN, PHILIP J CRNA	12/15/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
57120	Fee-for-Service	1790927564	1790927564	1	1	KAUR, SUNPREET MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136836	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
57183	Fee-for-Service	1154690774	1154690774	1	1	KALAYTA, RONALD A MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	22824	18	Ophthalmology	0	In state provider	MEDICAL CORPORATION	901 MAPLE AVE	None	YUBA CITY	CA	95991	3323	51	06101	39.14226664	-121.6223232	Sutter County
57188	Fee-for-Service	1023020286	1023020286	1	1	KHAN, OONA A MD	12/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88791	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
57264	Fee-for-Service	1376586644	1376586644	1	1	KALLAH, AFRAM S MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69375	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
57277	Fee-for-Service	1285293191	1285293191	1	1	KRISHNA, VANI MD	4/23/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1175 E ARROWY HWY	UNIT M	UPLAND	CA	91786	5525	36	06071	34.09981647	-117.636003	San Bernardino County
57287	Fee-for-Service	1407915093	1407915093	1	1	KILLION, DOUGLAS J MD	10/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56214	08	Family Practice	0	In state provider	None	25825 S VERMONT ST	None	HARBOR CITY	CA	90710	0000	19	06037	33.7892965	-118.2937327	Los Angeles County
57300	Fee-for-Service	1578941712	1578941712	1	1	KINRICH, ALANA M MD	10/11/2019	207P00000X	NA	Other	026	PHYSICIANS	155880	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
57329	Fee-for-Service	1306913744	1306913744	1	1	KARPF, DAVID B MD	4/1/1998	207RE0101X	NA	Endocrinology	026	PHYSICIANS	45513	67	Endocrinology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
57336	Fee-for-Service	1598124752	1598124752	1	1	KHADEMI, TALAKSOON DO INC	5/25/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9077	09	Gynecology (D.O. only)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
57408	Fee-for-Service	1790927564	1790927564	1	1	KAUR, SUNPREET MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136836	10	Gastroenterology (M.D. only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
57418	Fee-for-Service	1538181086	1538181086	1	1	KIMES, DONALD M DO PC	9/19/2018	207R00000X	NA	Other	026	PHYSICIANS	6775	40	Pediatrics	0	In state provider	None	41880 KALMIA ST STE 100	None	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
57419	Fee-for-Service	1013096056	1013096056	1	1	KLAMATH RADIOLOGY ASSOCS	12/1/1998	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	1	Border provider	None	2900 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	7101	00	None	42.2526295	-121.788099	Klamath County
57453	Fee-for-Service	1417046913	1417046913	1	1	KINGS VIEW CORPORATION	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1393 BAILEY DRIVE	None	HANFORD	CA	93230	5922	16	06031	36.32726257	-119.6663418	Kings County
57461	Fee-for-Service	1962799825	1962799825	1	1	KIBBLE, MAXINE L LMFT	4/28/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52669	-	NOT APPLICABLE	0	In state provider	None	2300 E 7TH ST	None	NATIONAL CITY	CA	91950	2852	37	06073	32.68320013	-117.0838567	San Diego County
57483	Fee-for-Service	1104143395	1104143395	1	1	KEYS, AUBREY P SR LMFT	1/15/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3750 AUBURN BLVD	SUITE C	AUBURN	CA	95821	2134	34	06067	38.639331	-121.3762275	Sacramento County
57502	Fee-for-Service	1376873323	1376873323	1	1	KFOURY, ROSETTE N MD	12/27/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	176325	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
57508	Fee-for-Service	1376573113	1376573113	1	1	KALTHOFF, KATHERINE L	9/22/2005	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	7601 HOSPITAL DR	STE 104A	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
57524	Fee-for-Service	1972572980	1972572980	1	1	KAZEMI, ISABEL OD	1/31/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
57533	Fee-for-Service	1275314874	1275314874	1	1	KUESTER, JUSTIN NP	6/4/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95027526	-	NOT APPLICABLE	0	In state provider	None	11027 BURBANK BLVD	None	NORTH HOLLYWOOD	CA	91601	2431	19	06037	34.17218853	-118.371609	Los Angeles County
57534	Fee-for-Service	1144243361	1144243361	2	1	KEALEY, KRIS C MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75586	41	Internal Medicine	0	In state provider	None	901 CAMPUS DR	STE 208	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
57552	Fee-for-Service	1306373808	1306373808	1	1	KAZE DJOU, ARNAUD MD	1/27/2025	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
57586	Fee-for-Service	1740388891	1740388891	1	1	KONG, GARY-KOK-HONG MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51276	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
57593	Fee-for-Service	1114157450	1114157450	1	1	KONOSKE, RYAN M MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116417	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
57624	Fee-for-Service	1881999373	1881999373	1	1	KHASHWJI, HASANALI Z MD	9/10/2018	390200000X	NA	Other	026	PHYSICIANS	156212	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
57639	Fee-for-Service	1316920895	1316920895	1	1	KELLY, ANDREW P MD	4/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	66498	None	None	0	In state provider	None	5525 W SLAUSON AVE	None	LOS ANGELES	CA	90056	1047	19	06037	33.98912847	-118.3784926	Los Angeles County
57655	Fee-for-Service	1467907675	1467907675	1	1	KRUGER, THERESA D LMFT	7/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1921 S CATALINA AVE	SUITE 1	REDONDO BEACH	CA	90277	5516	19	06037	33.81545027	-118.3866495	Los Angeles County
57671	Fee-for-Service	1427060680	1427060680	1	1	KOURSH, EVAN B MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60424	40	Pediatrics	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
57682	Fee-for-Service	1164017257	1164017257	1	1	KOLIBA, LYNDA LMFT	6/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
57707	Fee-for-Service	1538181086	1538181086	1	1	KIMES, DONALD M DO PC	9/19/2018	207R00000X	NA	Other	026	PHYSICIANS	6775	41	Internal Medicine	0	In state provider	None	41880 KALMIA ST STE 100	None	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
57709	Fee-for-Service	1649234931	1649234931	1	1	KIM, BENJAMIN B MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73275	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
57717	Fee-for-Service	1447525613	1447525613	1	1	KELLY, THOMAS R MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122376	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
57752	Fee-for-Service	1760483549	1760483549	1	1	KADEL, FRANK J DO	4/28/2020	208600000X	NA	General Surgery	026	PHYSICIANS	13459	02	General Surgery	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
57783	Fee-for-Service	1720098155	1720098155	1	1	KARVER-CHRISTENSON, ELYS	9/1/2001	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
57868	Fee-for-Service	1497856827	1497856827	1	1	KWOK, VICTOR MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114875	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
57875	Fee-for-Service	1740388891	1740388891	1	1	KONG, GARY-KOK-HONG MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51276	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
57894	Fee-for-Service	1619025665	1619025665	1	1	KENNEDY, PETER L MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76991	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
57924	Fee-for-Service	1871641696	1871641696	1	1	KAISER FOUNDATION HLTH	7/11/1983	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
57961	Fee-for-Service	1427060680	1427060680	1	1	KOURSH, EVAN B MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60424	01	General Practice	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
57967	Fee-for-Service	1720129141	1720129141	1	2	KOTHANDARAMAN, VIKRAM MD	9/24/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	91809	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2226 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	1825	19	06037	34.04750576	-118.2093968	Los Angeles County
57990	Fee-for-Service	1114346202	1114346202	1	1	KIM, ETHAN S MD	8/12/2022	207L00000X	NA	Other	026	PHYSICIANS	155758	None	None	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
57997	Fee-for-Service	1861479768	1861479768	1	1	KAZEMI, MUSTAFA M MD	12/31/1988	207R00000X	NA	Other	026	PHYSICIANS	61310	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
57999	Fee-for-Service	1720165673	1720165673	1	1	KURAMKOTE, SUMANGALA MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84092	05	Anesthesiology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
58048	Fee-for-Service	1659790624	1659790624	1	2	KELADA, ANTHONY Y MD	1/24/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	146017	36	Psychiatry	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
58095	Fee-for-Service	1679111637	1679111637	1	1	KINMONT, ERIN CNM	10/29/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
58154	Fee-for-Service	1194565416	1194565416	1	1	KUWABARA, YUKI LCSW	1/27/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 DEEP VALLEY DRIVE	100	ROLLING HILLS EST	CA	90274	7606	19	06037	33.77279445	-118.3748253	Los Angeles County
58155	Fee-for-Service	1942573258	1942573258	1	1	KIEFER, MATTHEW V E MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
58163	Fee-for-Service	1760233647	1760233647	1	1	KINOTI, LINET N	4/24/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8151 SHELDON RD	APT 204	ELK GROVE	CA	95758	1283	34	06067	38.440215	-121.40487	Sacramento County
58165	Fee-for-Service	1205092582	1205092582	1	1	KAISER FOUNDATION HEALTH	2/24/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #041	3280 FOOTHILL BLVD	1ST FLOR, STE 16	PASADENA	CA	91107	3103	19	06037	34.15004066	-118.08327	Los Angeles County
58224	Fee-for-Service	1104910595	1104910595	1	1	KITZIS, VANESSA MD	11/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97373	None	None	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
58240	Fee-for-Service	1659920197	1659920197	1	1	KARANJA, LOICE W	11/27/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8025 OAK AVENUE	None	ROSEVILLE	CA	95747	9210	31	06061	38.75131574	-121.3287945	Placer County
58247	Fee-for-Service	1427060680	1427060680	1	1	KOURSH, EVAN B MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60424	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
58260	Fee-for-Service	1225116056	1225116056	1	1	KRASNER, JULIA R MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	67181	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
58289	Fee-for-Service	1215036215	1215036215	2	1	KARIMI, ARDESHIR MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50980	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	207 S SANTA ANITA ST	STE 338	SAN GABRIEL	CA	91776	1160	19	06037	34.10072807	-118.1066296	Los Angeles County
58313	Fee-for-Service	1821263419	1821263419	1	1	KHANDABI, DAVID S MD	12/9/2010	207L00000X	NA	Other	026	PHYSICIANS	92761	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
58341	Fee-for-Service	1679651764	1679651764	1	1	KELLER, WALTER MD	6/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51098	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1580 VALENCIA ST	None	SAN FRANCISCO	CA	94110	4423	38	06075	37.74746923	-122.4202583	San Francisco County
58347	Fee-for-Service	1750564506	1750564506	1	1	KOVELMAN, ROZALIA MD INC	5/22/2002	193400000X	NA	Other	026	PHYSICIANS	41643	01	General Practice	0	In state provider	None	7531 SANTA MONICA BLVD	STE 202	WEST HOLLYWOOD	CA	90046	6458	19	06037	34.09081315	-118.3541261	Los Angeles County
58384	Fee-for-Service	1609283746	1609283746	1	1	KIM, DIANA J MD	8/31/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	142498	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
58409	Fee-for-Service	1801027289	1801027289	1	1	KARKI, NISHU MD	4/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122424	41	Internal Medicine	0	In state provider	None	3288 BELL ROAD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
58413	Fee-for-Service	1821521360	1821521360	1	1	KUANG, HEIDE MD	3/25/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159897	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
58442	Fee-for-Service	1306078050	1306078050	1	1	KAPLAN, ADAM G MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114706	34	Urology and Urological Surgery	0	In state provider	None	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
58446	Fee-for-Service	1295880912	1295880912	1	1	KAISER FOUNDATION HOSP	4/25/1986	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
58451	Fee-for-Service	1760233647	1760233647	1	1	KINOTI, LINET N	4/24/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8151 SHELDON RD	APT 204	ELK GROVE	CA	95758	1283	34	06067	38.440215	-121.40487	Sacramento County
58482	Fee-for-Service	1801132477	1801132477	1	1	KURWA, R R MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33214	01	General Practice	0	In state provider	None	5365 WALNUT AVE	STE H1	CHINO	CA	91710	2622	36	06071	34.02626051	-117.6883155	San Bernardino County
58491	Fee-for-Service	1235217712	1235217712	1	1	KAUFMAN, DOUGLAS A MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	31653	78	Neoplastic Diseases/Oncology	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
58523	Fee-for-Service	1649720236	1649720236	1	1	KALFOUNTZOS, CATHERINE A	9/25/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7098	34	06067	38.56554	-121.4664615	Sacramento County
58530	Fee-for-Service	1659920197	1659920197	1	1	KARANJA, LOICE W	11/27/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8025 OAK AVENUE	None	ROSEVILLE	CA	95747	9210	31	06061	38.75131574	-121.3287945	Placer County
58551	Fee-for-Service	1790945616	1790945616	1	1	KUNNAVATANA, SERMSIN S MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105569	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
58557	Fee-for-Service	1255420824	1255420824	1	1	KAMINSKI, ANDREW MD INC	10/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64871	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
58578	Fee-for-Service	1386099216	1386099216	1	1	KADABA, PRIYANKA MD	8/29/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176566	None	None	0	In state provider	None	3883 AIRWAY DR	100	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
58606	Fee-for-Service	1710045935	1710045935	1	1	KLETTER, HILIT PHD	1/22/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
58633	Fee-for-Service	1114951167	1114951167	1	1	KEROLES, NANCY S MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64710	30	Radiology	0	In state provider	None	3320 N LOS COYOTES DIAGO	None	LONG BEACH	CA	90808	3918	19	06037	33.8173793	-118.1104908	Los Angeles County
58639	Fee-for-Service	1750564506	1750564506	1	1	KOVELMAN, ROZALIA MD INC	5/22/2002	193400000X	NA	Other	026	PHYSICIANS	41643	07	Dermatology	0	In state provider	None	7531 SANTA MONICA BLVD	STE 202	WEST HOLLYWOOD	CA	90046	6458	19	06037	34.09081315	-118.3541261	Los Angeles County
58684	Fee-for-Service	1427010255	1427010255	1	1	KELSEY, JOHN H MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55124	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
58702	Fee-for-Service	1750598348	1750598348	1	1	KHERA, TANVIR S MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114496	41	Internal Medicine	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
58705	Fee-for-Service	1215089594	1215089594	1	1	KISLINGER, MARK B MD INC	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40962	18	Ophthalmology	0	In state provider	None	210 S GRAND AVE	STE 106	GLENDORA	CA	91741	4276	19	06037	34.133859	-117.872523	Los Angeles County
58714	Fee-for-Service	1477581239	1477581239	1	1	KOHANIM, MOOSA MD	2/28/1980	174400000X	NA	Other	026	PHYSICIANS	35085	20	Orthopedic Surgery	0	In state provider	None	14516 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	1519	19	06037	33.899472	-118.3523735	Los Angeles County
58733	Fee-for-Service	1609862960	1609862960	1	1	KAM, LORI D OD	5/6/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2248 SUNRISE BLVD	None	RANCHO CORDOVA	CA	95670	4342	34	06067	38.620575	-121.268826	Sacramento County
58740	Fee-for-Service	1396036646	1396036646	1	1	KHAN, OMER M MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112831	45	Nephrology (Renal-Kidney)	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
58745	Fee-for-Service	1780159087	1780159087	1	1	KANG, DANNY D	11/16/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3130 WILSHIRE BLVD	STE 409	LOS ANGELES	CA	90010	1206	19	06037	34.06179944	-118.2899676	Los Angeles County
58771	Fee-for-Service	1982774337	1982774337	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
58773	Fee-for-Service	1861480261	1861480261	2	1	KURAITIS, KESTUTIS V MD	7/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60362	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	205 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.96000025	-115.5530125	Imperial County
58780	Fee-for-Service	1982680310	1982680310	1	1	KING, RANDALL S MD	4/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1409 E LAKE MEAD BLVD	None	NORTH LAS VEGAS	NV	89030	7120	00	None	36.19579448	-115.1228925	Clark County
58793	Fee-for-Service	1245759745	1245759745	1	1	KETCHUM, RENEE LMFT	11/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
58811	Fee-for-Service	1801068812	1801068812	1	1	KEENEY, DEBBIE MFT	6/1/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	412 E MAIN ST	STE H	GRASS VALLEY	CA	95945	6533	29	06057	39.2215704	-121.0543391	Nevada County
58844	Fee-for-Service	1255420824	1255420824	1	1	KAMINSKI, ANDREW MD INC	10/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64871	01	General Practice	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
58855	Fee-for-Service	1053310490	1053310490	1	1	KERNS, KRISTIN G	9/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	145 HODEN CAMP ROAD	None	THOUSAND OAKS	CA	91360	5810	56	06111	34.1802034	-118.868502	Ventura County
58900	Fee-for-Service	1568477024	1568477024	1	1	KRISTIN, NARTIN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
58925	Fee-for-Service	1447604806	1447604806	1	1	KAMAT, RUJVI D PHD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
58947	Fee-for-Service	1164840054	1164840054	1	1	KIM, REBECCA G MD	10/16/2017	208M00000X	NA	Other	026	PHYSICIANS	140540	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
58954	Fee-for-Service	1376065425	1376065425	1	1	KIND HOMECARE INC	4/17/2018	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	3705 HAVEN AVE 104	None	MENLO PARK	CA	94025	1011	41	06081	37.48539797	-122.1819768	San Mateo County
58955	Fee-for-Service	1144378100	1144378100	1	1	KAINTH, HARPAL S MD	11/22/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39338	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
58972	Fee-for-Service	1659566065	1659566065	1	1	KAROLIA, ZIBYA	2/20/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
58983	Fee-for-Service	1821472994	1821472994	1	1	KIM, TAE SU LAC	6/19/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2787 E DEL AMO BLVD	STE H5-C	RANCHO DOMINGUEZ	CA	90221	6005	19	06037	33.84676946	-118.2123279	Los Angeles County
59008	Fee-for-Service	1003991159	1003991159	1	1	KIM, JOHN S MD	6/30/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66684	08	Family Practice	0	In state provider	None	11911 ARTESIA BLVD	STE 101	CERRITOS	CA	90703	4065	19	06037	33.87314847	-118.079649	Los Angeles County
59009	Fee-for-Service	1487898847	1487898847	1	1	KAVCIOGLU, RUTH E MD	4/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116537	None	None	0	In state provider	None	11600 INDIAN HILL RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
59028	Fee-for-Service	1396036646	1396036646	1	1	KHAN, OMER M MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112831	41	Internal Medicine	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
59113	Fee-for-Service	1689635088	1689635088	1	1	KIM, SALLY MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78043	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	SAN DIEGO	CA	92128	3498	37	06073	32.89687721	-117.2418677	San Diego County
59116	Fee-for-Service	1528561305	1528561305	1	1	KRAUSE, AMANDA J	4/8/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	173892	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
59131	Fee-for-Service	1265964423	1265964423	1	1	KUSWANTO, WILSON F MD	10/27/2022	207RR0500X	NA	Other	026	PHYSICIANS	157140	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59137	Fee-for-Service	1801059555	1801059555	1	2	KHAN, TIPU V MD	8/21/2019	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	110206	-	NOT APPLICABLE	0	In state provider	None	845 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09032048	-117.734769	Los Angeles County
59196	Fee-for-Service	1073686572	1073686572	1	1	KERSCHMANN, RUSSELL L MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	57159	22	Pathology (M.D. only)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
59208	Fee-for-Service	1306588587	1306588587	1	1	KAGUANJA, FLORENCE W	5/12/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	85 PLAZA AVILA	None	LAKE ELSINORE	CA	92532	0134	33	06065	33.67457556	-117.2785425	Riverside County
59219	Fee-for-Service	1912358086	1912358086	1	1	KING, ELIZABETH G	7/18/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	STE 120	HUNTINGTON BEACH	CA	92648	2030	30	06059	33.69070037	-117.9886896	Orange County
59275	Fee-for-Service	1447639869	1447639869	1	1	KASHANI, SAM MD	6/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151737	08	Family Practice	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
59312	Fee-for-Service	1851478697	1851478697	1	1	KHUU,NANCY A N OD	7/15/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4848 SAN FELIPE RD	STE 140	SAN JOSE	CA	95135	1273	43	06085	37.30004393	-121.7719065	Santa Clara County
59314	Fee-for-Service	1578981387	1578981387	1	1	KRAJICEK, SARAH E MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156490	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
59338	Fee-for-Service	1568719052	1568719052	1	1	KAHWAJIAN, HOURY A MD	7/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128432	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
59399	Fee-for-Service	1992168298	1992168298	1	1	KSHIRSAGAR, RIJUL S MD	6/26/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	151198	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
59450	Fee-for-Service	1265632343	1265632343	1	1	KARAMAT, SARAH LCSW	5/28/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
59465	Fee-for-Service	1477948859	1477948859	1	1	KIM, NA EUN MD	5/26/2022	208600000X	NA	General Surgery	026	PHYSICIANS	178238	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
59498	Fee-for-Service	1306588587	1306588587	1	1	KAGUANJA, FLORENCE W	5/12/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	85 PLAZA AVILA	None	LAKE ELSINORE	CA	92532	0134	33	06065	33.67457556	-117.2785425	Riverside County
59539	Fee-for-Service	1609096536	1609096536	1	1	KRAMES, ELLIOTT S MD	5/1/1995	208VP0014X	NA	Other	026	PHYSICIANS	23073	01	General Practice	0	In state provider	None	1 DANIEL BURNHAM CT	STE 350-C	SAN FRANCISCO	CA	94109	5455	38	06075	37.78693724	-122.4225429	San Francisco County
59543	Fee-for-Service	1780942375	1780942375	1	1	KIM, KENNETH I MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129890	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PARKWA	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
59564	Fee-for-Service	1447639869	1447639869	1	1	KASHANI, SAM MD	6/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151737	01	General Practice	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
59581	Fee-for-Service	1588392286	1588392286	1	1	KIMANI, ESTHER W	11/17/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	30414 TOWN CENTER DR	APT 124	MENIFEE	CA	92584	6871	33	06065	33.679026	-117.179871	Riverside County
59584	Fee-for-Service	1447323787	1447323787	1	1	KIM, FRANCES S MD	12/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85949	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25470 MEDICAL CENTER DR	STE 205	MURRIETA	CA	92562	4901	33	06065	33.55723646	-117.1859554	Riverside County
59585	Fee-for-Service	1386772317	1386772317	1	1	KHANEJA, NEERJA DO	3/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8843	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
59635	Fee-for-Service	1841247384	1841247384	1	1	KAHN, ANDREW M MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78646	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
59637	Fee-for-Service	1821298357	1821298357	1	1	KRISTI LYNN KINDER D.O.	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2401 GILLHAM RD	None	KANSAS CITY	MO	64108	4619	00	None	39.08346695	-94.57884975	Jackson County
59661	Fee-for-Service	1407066111	1407066111	1	1	KENE, MAMATA V MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89638	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
59665	Fee-for-Service	1326246018	1326246018	1	1	KHITRI, AVINASH R MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128322	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4940 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
59708	Fee-for-Service	1528096500	1528096500	1	1	KLINE, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 JEFFORDS ST	None	CLEARWATER	FL	33756	3825	00	None	27.95360943	-82.80313838	Pinellas County
59722	Fee-for-Service	1972578524	1972578524	1	1	KIM, TERRY MD	4/29/2022	207L00000X	NA	Other	026	PHYSICIANS	172779	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
59798	Fee-for-Service	1952324485	1952324485	1	1	KITTERMAN, JOSEPH A MD	1/1/1990	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	10657	40	Pediatrics	0	In state provider	U C MED CTR	650 MOFFITT HOSP	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.73743268	-122.4331132	San Francisco County
59822	Fee-for-Service	1205042173	1205042173	1	1	KARIA, VIJAY R MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116826	83	Rheumatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
59828	Fee-for-Service	1609096536	1609096536	1	1	KRAMES, ELLIOTT S MD	5/1/1995	208VP0014X	NA	Other	026	PHYSICIANS	23073	05	Anesthesiology	0	In state provider	None	1 DANIEL BURNHAM CT	STE 350-C	SAN FRANCISCO	CA	94109	5455	38	06075	37.78693724	-122.4225429	San Francisco County
59843	Fee-for-Service	1659429264	1659429264	1	1	KAISER FOUNDATION HEALTH	4/7/1997	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #442	710 LAWRENCE EXPY	FL 1	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
59844	Fee-for-Service	1780046946	1780046946	1	1	KO, OLIVER S MD	7/1/2022	208800000X	NA	Other	026	PHYSICIANS	175833	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
59867	Fee-for-Service	1588392286	1588392286	1	1	KIMANI, ESTHER W	11/17/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	30414 TOWN CENTER DR	APT 124	MENIFEE	CA	92584	6871	33	06065	33.679026	-117.179871	Riverside County
59897	Fee-for-Service	1356502520	1356502520	1	1	KUMAR, SOMA MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140223	10	Gastroenterology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
59902	Fee-for-Service	1811499221	1811499221	1	1	KUO, CHRISTOPHER MD	3/16/2023	390200000X	NA	Other	026	PHYSICIANS	160105	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
59908	Fee-for-Service	1508371857	1508371857	1	1	KABIRO-TITO, WANJIKU M	3/16/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1425 POPPY HILLS LANE	None	TRACY	CA	95377	8702	39	06077	37.69685054	-121.4426272	San Joaquin County
59909	Fee-for-Service	1881632925	1881632925	1	1	KRIEGER, LORI MD INC	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70792	40	Pediatrics	0	In state provider	None	1360 W 6TH ST	STE 300	SAN PEDRO	CA	90732	3576	19	06037	33.73886546	-118.3075065	Los Angeles County
59914	Fee-for-Service	1013363589	1013363589	1	1	KIM, JAMES D MD	7/24/2019	207P00000X	NA	Other	026	PHYSICIANS	158780	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
59966	Fee-for-Service	1144274168	1144274168	1	1	KERNS, ROBERT E MD	1/31/1991	207P00000X	NA	Other	026	PHYSICIANS	38677	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
59975	Fee-for-Service	1194989418	1194989418	1	1	KHAN, UZMA A MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100425	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
60024	Fee-for-Service	1194837138	1194837138	1	1	KRISHEL, SCOTT JAY MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70623	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
60064	Fee-for-Service	1639812019	1639812019	1	1	KONDERIK, JUSTINE I	7/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
60091	Fee-for-Service	1497232730	1497232730	1	1	KOSMACH, TINA	7/24/2019	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	1	Border provider	None	7330 EASTGATE RD	#130	HENDERSON	NV	89011	4048	00	None	36.05429542	-115.0198424	Clark County
60109	Fee-for-Service	1205042173	1205042173	1	1	KARIA, VIJAY R MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116826	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
60130	Fee-for-Service	1144312505	1144312505	1	1	KIM-PARK, LISA H MD	3/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65500	40	Pediatrics	0	In state provider	None	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
60151	Fee-for-Service	1104191022	1104191022	1	1	KOEGEL, LYNN K	6/27/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60162	Fee-for-Service	1609558915	1609558915	1	1	KOPPLIN, DANIELLE A AU	8/28/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
60175	Fee-for-Service	1982931838	1982931838	2	1	KANANI, DAVID J MD	4/16/2019	208M00000X	NA	Other	026	PHYSICIANS	116888	41	Internal Medicine	0	In state provider	None	8167 WEST 3RD ST	None	LOS ANGELES	CA	90048	4314	19	06037	34.07239454	-118.367635	Los Angeles County
60183	Fee-for-Service	1356502520	1356502520	1	1	KUMAR, SOMA MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140223	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
60193	Fee-for-Service	1508371857	1508371857	1	1	KABIRO-TITO, WANJIKU M	3/16/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1425 POPPY HILLS LANE	None	TRACY	CA	95377	8702	39	06077	37.69685054	-121.4426272	San Joaquin County
60195	Fee-for-Service	1447722392	1447722392	1	1	KELLY, BRIAN H RCP	10/5/2020	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
60210	Fee-for-Service	1902587108	1902587108	1	1	KAUR, RAMANDIP NP	10/1/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
60251	Fee-for-Service	1396744819	1396744819	1	1	KUNTZ, CHARLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10500 MONTGOMERY RD	None	CINCINNATI	OH	45242	4402	00	None	39.252267	-84.3413535	Hamilton County
60257	Fee-for-Service	1548239098	1548239098	1	1	KHANIJOU, RAJESH MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34416	02	General Surgery	0	In state provider	None	1201 W LA VETA AVE	STE 204	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
60270	Fee-for-Service	1255401865	1255401865	1	1	KEANE, PATRICIA A	12/31/1985	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6221 WILSHIRE BLVD	STE 517	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
60279	Fee-for-Service	1881607695	1881607695	1	1	KANG, JASBIR S MD	3/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	46605	22	Pathology (M.D. only)	0	In state provider	None	481 PLUMAS BLVD	STE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
60290	Fee-for-Service	1437203957	1437203957	1	1	KIM, JULIANN L MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72972	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
60301	Fee-for-Service	1902123789	1902123789	1	1	KIM, ABRAHAM D MD	3/29/2021	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	118721	None	None	0	In state provider	None	18785 BROOKHURST	None	FOUNTAIN VALLEY	CA	92708	7300	30	06059	33.68987636	-117.9542321	Orange County
60341	Fee-for-Service	1023165784	1023165784	1	1	KHAN, RASHEED CRNA	12/27/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
60343	Fee-for-Service	1033472311	1033472311	1	1	KERESTEDJIAN, LISA N MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138488	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
60351	Fee-for-Service	1285859249	1285859249	1	1	KINGSLEY PLACE ADULT DAY	8/16/2001	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE	548 S KINGSLEY DR	None	LOS ANGELES	CA	90020	3506	19	06037	34.06396735	-118.3028287	Los Angeles County
60363	Fee-for-Service	1871798280	1871798280	1	1	KALINICH, ALEKSANDRA O PHD	1/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	6968	19	06037	34.07067	-118.4432445	Los Angeles County
60410	Fee-for-Service	1053592055	1053592055	1	1	KARUMAN, PHILIP M MD	7/12/2022	208600000X	NA	General Surgery	026	PHYSICIANS	178865	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
60426	Fee-for-Service	1467624908	1467624908	1	1	KEEFER, BRIAN P MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93396	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
60472	Fee-for-Service	1457320905	1457320905	1	1	KHOUZAM, HANI R MD	2/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50701	36	Psychiatry	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
60488	Fee-for-Service	1376543413	1376543413	1	1	KARIPINENI, RAMESH C MD	8/8/2008	208600000X	NA	General Surgery	026	PHYSICIANS	33814	02	General Surgery	0	In state provider	None	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1730	01	06001	37.55887933	-121.9797796	Alameda County
60511	Fee-for-Service	1578720934	1578720934	1	1	KOKESH, MARLA G MD	4/19/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	65188	36	Psychiatry	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
60515	Fee-for-Service	1629497185	1629497185	1	1	KONOPINSKI, JONATHAN MD	8/28/2024	207ZP0102X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
60519	Fee-for-Service	1083636294	1083636294	1	1	KANE, CHRISTOPHER J MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69249	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
60544	Fee-for-Service	1730296542	1730296542	1	1	KOVACS, BRENT J MD	11/30/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	51416	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
60561	Fee-for-Service	1497183271	1497183271	1	1	KAISER FOUNDATION HEALTH	2/4/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	3600 BROADWAY	FLOOR 1	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
60562	Fee-for-Service	1386837532	1386837532	1	1	KATZ, KRISTIN M PHD	1/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1320 STANDIFORD AVENUE	SUITE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
60566	Fee-for-Service	1881607695	1881607695	1	1	KANG, JASBIR S MD	3/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	46605	41	Internal Medicine	0	In state provider	None	481 PLUMAS BLVD	STE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
60615	Fee-for-Service	1053355099	1053355099	1	1	KUCHTA, KENNETH F MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68071	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
60642	Fee-for-Service	1548586050	1548586050	1	1	KENNETH TOMPKINS	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
60664	Fee-for-Service	1710478250	1710478250	1	1	KIM, HYUNJOONG W MD	5/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185835	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
60669	Fee-for-Service	1518529635	1518529635	1	2	KID FUNDAMENTALS THERAPY CEN	12/22/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	TER, INC.	12900B GARDEN GROVE BLVD	STE. 235	GARDEN GROVE	CA	92843	2018	30	06059	33.77433148	-117.9075735	Orange County
60672	Fee-for-Service	1952478976	1952478976	1	1	KAUFMAN, JEFFREY G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37678	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.03781261	-118.3755101	Los Angeles County
60683	Fee-for-Service	1326426636	1326426636	1	1	KUEHL, CHELSEA LMFT	7/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
60695	Fee-for-Service	1033555164	1033555164	1	1	KU, JEONG-HEE MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141622	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
60701	Fee-for-Service	1346745981	1346745981	1	1	KIM PHYSICAL THERAPY ASSOCIA	2/14/2023	225100000X	NA	Physical Therapist	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	Y	12925 EL CAMINO REAL	SUITE J27	SAN DIEGO	CA	92130	1048	37	06073	32.9521702	-117.2338715	San Diego County
60714	Fee-for-Service	1508970146	1508970146	1	1	KUNITA, TOMOKO LMFT	3/9/2020	261QM0850X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
60746	Fee-for-Service	1275243255	1275243255	1	1	KAUR, INDERJEET NP	1/21/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
60765	Fee-for-Service	1982879987	1982879987	1	1	KANG, THOMAS T MD	2/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97505	01	General Practice	0	In state provider	None	191 S BUENA VISTA	STE 150	BURBANK	CA	91505	4563	19	06037	34.15872557	-118.3283863	Los Angeles County
60776	Fee-for-Service	1104021963	1104021963	1	3	KAYMAN, JOSHUA	5/7/2024	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	108111	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
60799	Fee-for-Service	1043655855	1043655855	1	1	KHAN-SERRANO, ALIYAH A MD	12/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	135192	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
60857	Fee-for-Service	1578009676	1578009676	1	1	KAUR, PARMINDER NP	11/14/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
60866	Fee-for-Service	1114649985	1114649985	1	1	KARIM, SHAYAN A PT	10/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14682 CENTRAL AVE	None	CHINO	CA	91710	9505	36	06071	33.986601	-117.689039	San Bernardino County
60878	Fee-for-Service	1952668063	1952668063	1	2	KHADE, JOHN	4/10/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	159495	None	None	0	In state provider	None	1406 PARK	400	ALAMEDA	CA	94501	4558	01	06001	37.76447173	-122.2425877	Alameda County
60895	Fee-for-Service	1396308359	1396308359	1	1	KEIL, DAYLEY S	7/17/2023	207L00000X	NA	Other	026	PHYSICIANS	187453	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
60921	Fee-for-Service	1922016971	1922016971	1	1	KASUGA, ALBERT R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33162	40	Pediatrics	0	In state provider	None	1750 EL CAMINO REAL	STE 106	BURLINGAME	CA	94010	3210	41	06081	37.59392355	-122.3819595	San Mateo County
60954	Fee-for-Service	1013472893	1013472893	1	1	KIM, ALAN CRNA	12/5/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
60966	Fee-for-Service	1457408775	1457408775	1	1	KAISER FNDTN HEALTH PLAN	2/13/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PRMNT PHRMCY #514	36450 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9583	33	06065	33.591168	-117.2367715	Riverside County
61000	Fee-for-Service	1811401474	1811401474	1	1	KERENDIAN, SABA LMFT	4/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 W OLYMPIC BLVD	STE 815E	LOS ANGELES	CA	90404	3650	19	06037	34.03273663	-118.4516927	Los Angeles County
61024	Fee-for-Service	1184718215	1184718215	1	1	KAMAL, BINDU M MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68308	45	Nephrology (Renal-Kidney)	0	In state provider	None	3650 SOUTH ST	STE 301	LAKEWOOD	CA	90712	1513	19	06037	33.86019847	-118.149255	Los Angeles County
61031	Fee-for-Service	1134998875	1134998875	1	1	KOULAKIS, CAITLIN NP	4/8/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
61035	Fee-for-Service	1922290758	1922290758	1	1	KOURDONI, HAMID R MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97883	08	Family Practice	0	In state provider	None	460 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
61093	Fee-for-Service	1447589692	1447589692	1	1	KIM, JEANNE PHD	12/29/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
61095	Fee-for-Service	1730345299	1730345299	1	1	KOE, LILLIAN MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	104910	40	Pediatrics	0	In state provider	None	6501 SOUTH GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	19	06037	33.97292523	-118.1475473	Los Angeles County
61100	Fee-for-Service	1578553335	1578553335	1	1	KOKORIS, SAM P MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81519	None	None	0	In state provider	None	1530 BESSIE AVE	STE 108	TRACY	CA	95376	3080	39	06077	37.74570848	-121.4330255	San Joaquin County
61102	Fee-for-Service	1902911902	1902911902	1	1	KIM, JANE E MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100886	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
61125	Fee-for-Service	1336668284	1336668284	1	1	KERN COUNTY HOSPITAL AUTHORI	2/4/2020	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2920 F ST STE B1	None	BAKERSFIELD	CA	93301	1829	15	06029	35.385984	-119.023444	Kern County
61126	Fee-for-Service	1841651767	1841651767	1	1	KHADER, WISAM M DO	8/7/2019	207R00000X	NA	Other	026	PHYSICIANS	16388	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
61133	Fee-for-Service	1528245818	1528245818	1	1	KARPMAN, JENNIFER LMFT	7/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24018 SAINT MORITZ DRIVE	None	VALENCIA	CA	91355	2033	19	06037	34.40179849	-118.5548862	Los Angeles County
61190	Fee-for-Service	1841427028	1841427028	1	1	KAISER FOUNDATION HEALTH	7/27/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #054	9333 IMPERIAL HWY	FLR 1	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
61193	Fee-for-Service	1861888125	1861888125	1	1	KIM, DAYNA A DPM	1/15/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13690 E 14TH ST	SUITE 220	SAN LEANDRO	CA	94578	2582	01	06001	37.71615361	-122.1438999	Alameda County
61229	Fee-for-Service	1003301284	1003301284	1	1	KOEHN, JANA L CRNA	10/21/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
61230	Fee-for-Service	1639126105	1639126105	1	1	KYPRIANOU, ANDREAS C. MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
61255	Fee-for-Service	1154566248	1154566248	1	1	KERMANI, CYRUS MD	6/1/2010	174400000X	NA	Other	026	PHYSICIANS	106653	05	Anesthesiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
61257	Fee-for-Service	1295188795	1295188795	1	1	KRKOSKA, MALLORY L CCC-SLP	7/5/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
61273	Fee-for-Service	1962428300	1962428300	1	1	KWAW, ISIDORE K MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66583	41	Internal Medicine	0	In state provider	None	9542 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87472553	-118.1294775	Los Angeles County
61276	Fee-for-Service	1144530932	1144530932	1	1	KAR, RENUKA R MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118234	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVENUE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
61294	Fee-for-Service	1962977843	1962977843	1	1	KUYKENDALL, DANIELLE M CRNA	12/4/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
61317	Fee-for-Service	1063233641	1063233641	1	1	KIM, PRISCA NP	2/25/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
61377	Fee-for-Service	1063532778	1063532778	1	1	KIM, WARREN T MD	5/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91921	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
61382	Fee-for-Service	1144784000	1144784000	1	1	KAYLA BENZ	1/6/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	414 N 7TH ST	None	BISMARCK	ND	58501	4423	00	None	46.808883	-100.781991	Burleigh County
61398	Fee-for-Service	1588189757	1588189757	1	1	KHAN, HADIA PSYD	5/22/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
61420	Fee-for-Service	1528062874	1528062874	1	1	KHAFAJA, ISSAM MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	54280	41	Internal Medicine	0	In state provider	None	6330 VAN NUYS BLVD	None	VAN NUYS	CA	91401	2610	19	06037	34.18546095	-118.4487065	Los Angeles County
61468	Fee-for-Service	1114036753	1114036753	1	1	KESLER, PAMELA J LMFT	12/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	152 MAPLE ST	SUITE C	AUBURN	CA	95603	5042	31	06061	38.89704552	-121.077198	Placer County
61474	Fee-for-Service	1063269819	1063269819	1	1	KOENIG, YOLANDA BIRTH DOULA	2/28/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	45	06089	0	0	None
61478	Fee-for-Service	1851573554	1851573554	1	1	KNIGHT, MARK A MD	12/4/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	94460	-	NOT APPLICABLE	0	In state provider	None	200 MICHIGAN AVE	None	VISTA	CA	92084	5424	37	06073	33.2038743	-117.2421678	San Diego County
61519	Fee-for-Service	1134763527	1134763527	1	1	KOLB, DANIELLE T CCC-SLP	3/23/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7090 MIRATECH DR	None	SAN DIEGO	CA	92121	3109	37	06073	32.89821825	-117.1711874	San Diego County
61542	Fee-for-Service	1649209230	1649209230	1	1	KING HOSP PUBLIC HOSP	12/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	VALLEY MEDICAL CENTER	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
61560	Fee-for-Service	1962428300	1962428300	1	1	KWAW, ISIDORE K MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66583	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9542 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87472553	-118.1294775	Los Angeles County
61612	Fee-for-Service	1649468802	1649468802	1	1	KURZER, JASON H MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105341	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
61625	Fee-for-Service	1962829002	1962829002	1	1	KING, ERIC C MD	2/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137952	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
61627	Fee-for-Service	1720288251	1720288251	1	1	KHAN, SAADIA I MD	8/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106577	40	Pediatrics	0	In state provider	None	3132 WEST MARCH LANE	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
61656	Fee-for-Service	1073867396	1073867396	1	1	KIRSCHNER, JORDAN S LMFT	8/16/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 303	ENCINO	CA	91436	2914	19	06037	34.15524484	-118.4756687	Los Angeles County
61660	Fee-for-Service	1265550909	1265550909	1	1	KLEIN, LINA LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
61666	Fee-for-Service	1063532778	1063532778	1	1	KIM, WARREN T MD	5/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91921	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
61694	Fee-for-Service	1447231618	1447231618	1	1	KWOK, ERIC R MD	3/31/1987	207R00000X	NA	Other	026	PHYSICIANS	24444	41	Internal Medicine	0	In state provider	None	3838 CALIFORNIA ST	RM 310	SAN FRANCISCO	CA	94118	1505	38	06075	37.78591809	-122.4575439	San Francisco County
61709	Fee-for-Service	1306926084	1306926084	1	1	KWOK, TSING TONG MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	31586	41	Internal Medicine	0	In state provider	None	4140 E CLINTON AVE	None	FRESNO	CA	93703	2520	10	06019	36.77229255	-119.754909	Fresno County
61733	Fee-for-Service	1295882520	1295882520	1	1	KAISER FOUND HEALTH PLAN	6/5/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY A & B	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
61749	Fee-for-Service	1538714431	1538714431	1	1	KELLY ORCHARD, MARRIAGE AND	8/12/2019	261QM0850X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY THERAPIST, INC.	32605 TEMECULA PKWY	STE 207	TEMECULA	CA	92592	6839	33	06065	33.48367403	-117.088031	Riverside County
61777	Fee-for-Service	1669523734	1669523734	1	1	KHAN, SHAMEEM B OD	5/11/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13788 ROSWELL	STE 106	CHINO	CA	91710	1414	36	06071	34.00313001	-117.721863	San Bernardino County
61830	Fee-for-Service	1649209230	1649209230	1	1	KING HOSP PUBLIC HOSP	12/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	VALLEY MEDICAL CENTER	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
61851	Fee-for-Service	1558080861	1558080861	1	1	KAISER FOUNDATION HOSPITALS	10/11/2023	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	360 RUSH DR	None	SAN MARCOS	CA	92078	7901	37	06073	33.13051263	-117.1677764	San Diego County
61857	Fee-for-Service	1851818975	1851818975	1	1	KOLTON, DEBORAH M CCC-SLP	8/30/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
61864	Fee-for-Service	1659396158	1659396158	1	1	KRAMER, MICHAEL J JR MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
61871	Fee-for-Service	1952821555	1952821555	1	1	KHAN, IMAN S MD	5/16/2023	174400000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	760 GOLF VIEW DRIVE	SUITE 200	MEDFORD	OR	97504	9685	00	None	42.315228	-122.8230985	Jackson County
61947	Fee-for-Service	1609364991	1609364991	1	1	KATZ, ARON M PHD	5/6/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
61950	Fee-for-Service	1669506473	1669506473	1	1	KENGLA, ALICE T MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83097	68	Hematology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
62025	Fee-for-Service	1710531959	1710531959	1	1	KOCH, JAKE PT	8/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
62040	Fee-for-Service	1942244579	1942244579	1	1	KELLY, TIMOTHY A CRNA	2/8/2015	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	THREE RIVERS ANESTHESIA	900 S AUBURN STREET	None	KENNEWICK	WA	99336	5621	00	None	46.19896647	-119.11855	Benton County
62062	Fee-for-Service	1609337377	1609337377	1	1	KINNE MARRIAGE AND FAMILY TH	10/31/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	65 MAIN ST	None	QUINCY	CA	95971	9494	32	06063	39.93769446	-120.9389523	Plumas County
62100	Fee-for-Service	1245420009	1245420009	1	1	KOEPPEN, KATHY A LMFT	1/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2620 CENTRAL AVE	None	MCKINLEYVILLE	CA	95519	3619	12	06023	40.953492	-124.1008795	Humboldt County
62117	Fee-for-Service	1609025170	1609025170	1	1	KANG, STEPHEN J OD	11/18/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
62123	Fee-for-Service	1205826237	1205826237	1	1	KLEIN, MICHAEL V MD	7/1/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	75234	None	None	0	In state provider	None	65 N MADISON AVE	STE MEZZ	PASADENA	CA	91101	2040	19	06037	34.14705803	-118.1384317	Los Angeles County
62152	Fee-for-Service	1013091958	1013091958	1	1	KINSLEY, KELLY A MD	12/5/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	77600	07	Dermatology	0	In state provider	None	4715 VALLEY EAST BLVD	STE. 3	ARCATA	CA	95521	3586	12	06023	40.90112023	-124.0814061	Humboldt County
62166	Fee-for-Service	1497160097	1497160097	1	1	KWOK, BONNIE H MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139759	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
62178	Fee-for-Service	1417219379	1417219379	1	1	KROW, SOLOMON K MD	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148553	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
62187	Fee-for-Service	1780909242	1780909242	1	1	KESTLER, RANDI JILL MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126330	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
62219	Fee-for-Service	1184101693	1184101693	1	1	KUMAR, DOREEN L NP	12/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
62240	Fee-for-Service	1669506473	1669506473	1	1	KENGLA, ALICE T MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83097	78	Neoplastic Diseases/Oncology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
62253	Fee-for-Service	1619047016	1619047016	1	1	KAISER FOUNDATION HOSPITAL	10/24/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	4TH FLOOR	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
62297	Fee-for-Service	1043349301	1043349301	1	1	KISS, DAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39835	None	None	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
62353	Fee-for-Service	1609337377	1609337377	1	1	KINNE MARRIAGE AND FAMILY TH	10/31/2019	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	65 MAIN ST	None	QUINCY	CA	95971	9494	32	06063	39.93769446	-120.9389523	Plumas County
62381	Fee-for-Service	1205961349	1205961349	1	1	KHACHATRYAN, TATEVIK LPCC	4/1/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	SUITE 210	SAN DIEGO	CA	92108	3104	37	06073	32.76632791	-117.1616245	San Diego County
62386	Fee-for-Service	1184069296	1184069296	1	1	KIM, YOUNGHO P	7/15/2019	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	159497	08	Family Practice	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
62399	Fee-for-Service	1477800928	1477800928	1	1	KIRK, KELLE A LMFT	3/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
62466	Fee-for-Service	1962057562	1962057562	1	1	KJOLBY, NICOLE CRNA	5/22/2023	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
62522	Fee-for-Service	1023367141	1023367141	1	1	KELLY, KERRY-ANN A MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126079	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94557	4201	01	06001	37.706364	-122.165163	Alameda County
62526	Fee-for-Service	1821354770	1821354770	1	1	KIM, BRANDON J MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146999	04	Otology, Laryngology, Rhinology	0	In state provider	None	1450 SAN PABLO STREET	SUITE 2000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
62531	Fee-for-Service	1750814182	1750814182	1	1	KIMBALL, JEFF S MD	9/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	157125	None	None	0	In state provider	None	341 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3331	33	06065	33.85291987	-117.5664344	Riverside County
62535	Fee-for-Service	1932490703	1932490703	1	1	KAROW, DAVID S MD	5/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96935	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
62566	Fee-for-Service	1609190354	1609190354	1	1	KIM, ALEXANDER H DO	9/18/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	15607	None	None	0	In state provider	None	1199 BUSH ST	STE 650	SAN FRANCISCO	CA	94109	5975	38	06075	37.7891291	-122.4167087	San Francisco County
62570	Fee-for-Service	1356502264	1356502264	1	1	KETEFIAN, ALINE MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90253	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
62573	Fee-for-Service	1700319837	1700319837	1	1	KIM, MATTHEW S DO	7/5/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	16814	None	None	0	In state provider	None	808 S FAIR OAKS AVE	None	PASADENA	CA	91105	2601	19	06037	34.131942	-118.1503315	Los Angeles County
62595	Fee-for-Service	1447517255	1447517255	1	1	KOFF, RICHARD ANDREW MD	3/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129433	30	Radiology	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3124	19	06037	33.795261	-118.125222	Los Angeles County
62596	Fee-for-Service	1104389873	1104389873	1	1	KROMNICK, ELLEN S PT	4/12/2022	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7313 WHITTIER AVE	None	WHITTIER	CA	90602	1132	19	06037	33.975027	-118.043219	Los Angeles County
62639	Fee-for-Service	1053517490	1053517490	1	1	KHAN, UZMA MD	4/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100026	36	Psychiatry	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
62658	Fee-for-Service	1144424417	1144424417	1	1	KOSHNER-LEVEY, JULIE A LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
62669	Fee-for-Service	1962118919	1962118919	1	1	KATRINA NIERE MARRIAGE AND F	6/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AMILY THERAPY, INC.	43537 RIDGE PARK DR	STE 100	TEMECULA	CA	92590	3613	33	06065	33.49569085	-117.159969	Riverside County
62684	Fee-for-Service	1417499963	1417499963	1	1	KERN VALLEYIDENCE OPCO	12/16/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	3601 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1405	15	06029	35.392851	-119.008239	Kern County
62711	Fee-for-Service	1407925928	1407925928	1	1	KAISER FOUNDATION HOSP	4/18/1990	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SANTA ROSA	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
62747	Fee-for-Service	1861055188	1861055188	1	1	KHAN, SOPHIA J CNP	1/18/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
62762	Fee-for-Service	1952460511	1952460511	1	1	KATONA, ZOLTAN MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	72038	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
62766	Fee-for-Service	1346292307	1346292307	1	1	KHOURY, GEORGE M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 SE STRATUS AVE	None	MCMINNVILLE	OR	97128	6255	00	None	45.20010494	-123.1656951	Yamhill County
62786	Fee-for-Service	1619389780	1619389780	1	1	KARCZEWSKI, SABRINA A PHY	9/1/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
62793	Fee-for-Service	1992779060	1992779060	1	1	KAHN, DEBRA R MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80389	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
62812	Fee-for-Service	1932115771	1932115771	1	1	KRILICH, CHAD B MD	1/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146989	01	General Practice	0	In state provider	None	500 DOYLE PARK DR	STE 304	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
62828	Fee-for-Service	1306905112	1306905112	1	1	KIM, KUM SON MD	10/1/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39454	40	Pediatrics	0	In state provider	None	1433 W MERCED AVE	STE 217	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
62843	Fee-for-Service	1285793893	1285793893	1	1	KASHANI, NADER A MD	12/1/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	66680	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
62881	Fee-for-Service	1104925015	1104925015	1	1	KIM, YOUNG S MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31584	41	Internal Medicine	0	In state provider	None	2405 W 8TH ST	STE 201	LOS ANGELES	CA	90057	5016	19	06037	34.05634309	-118.2810868	Los Angeles County
62924	Fee-for-Service	1033522719	1033522719	1	1	KINGSLEY, THOMAS C MD	7/15/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
62978	Fee-for-Service	1760460471	1760460471	1	1	KAMINSKY, DAVID B MD	12/31/1982	207ZP0102X	NA	Other	026	PHYSICIANS	28903	22	Pathology (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
62981	Fee-for-Service	1083676688	1083676688	1	1	KLUWE, SANDRA W MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	56547	05	Anesthesiology	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
62998	Fee-for-Service	1841499332	1841499332	1	1	KIM, SUSAN Y OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12501 IMPERIAL HWY	STE 400	NORWALK	CA	90650	1419	19	06037	33.91723852	-118.065834	Los Angeles County
63007	Fee-for-Service	1942373253	1942373253	1	1	KIM, GWANG M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66217	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
63009	Fee-for-Service	1194491548	1194491548	1	1	KWON, JENNY Y OT	3/26/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
63016	Fee-for-Service	1588612899	1588612899	1	1	KRETCHMAR, LARRY H MD	8/7/1975	208800000X	NA	Other	026	PHYSICIANS	22535	34	Urology and Urological Surgery	0	In state provider	None	205 SOUTH DR	None	MOUNTAIN VIEW	CA	94040	4323	43	06085	37.36723252	-122.0797125	Santa Clara County
63045	Fee-for-Service	1013117795	1013117795	1	1	KAHEN-BITON, TANAZ MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95753	41	Internal Medicine	0	In state provider	None	501 WASHINGTON ST	STE 600	SAN DIEGO	CA	92103	2239	37	06073	32.74986289	-117.1599343	San Diego County
63061	Fee-for-Service	1225083041	1225083041	1	1	KYAW, RICHARD S MD	12/16/2009	207R00000X	NA	Other	026	PHYSICIANS	44805	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
63088	Fee-for-Service	1336335793	1336335793	1	1	KUNDARGI, RONALD S MD INC	5/11/2009	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	25743	77	Infectious Disease	0	In state provider	None	12780 HESPERIA RD	None	VICTORVILLE	CA	92395	4796	36	06071	34.4833646	-117.2904386	San Bernardino County
63112	Fee-for-Service	1306807987	1306807987	1	1	KING, BRIAN S MD	11/4/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	153648	10	Gastroenterology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
63141	Fee-for-Service	1356654446	1356654446	1	1	KOH, HENRY S MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117951	01	General Practice	0	In state provider	None	4100 REDWOOD ROAD	#328	OAKLAND	CA	94619	2363	01	06001	37.79783782	-122.1832794	Alameda County
63194	Fee-for-Service	1669425054	1669425054	1	1	KUICH, KEVIN W MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53296	26	Psychiatry (child)	0	In state provider	None	1200 EL CAMINO REAL	None	SAN MATEO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo
63208	Fee-for-Service	1841225497	1841225497	1	1	KAZE, JAY PAUL	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	180 STARR AVE	None	TURLOCK	CA	95380	3323	50	06099	37.50241157	-120.8467744	Stanislaus County
63232	Fee-for-Service	1255379681	1255379681	1	1	KANGAH, RICHARD MD	11/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	55122	02	General Surgery	0	In state provider	None	2 W VERN	None	REDLANDS	CA	92373	5916	36	06071	34.056792	-117.2273918	San Bernardino County
63273	Fee-for-Service	1760596712	1760596712	1	1	KERN WOMENS HEALTH	8/22/2007	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	2005 17TH STREET	None	BAKERSFIELD	CA	93301	4203	15	06029	35.37431347	-119.0249415	Kern County
63286	Fee-for-Service	1750301073	1750301073	1	1	KAUFMAN, BETH D MD	1/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55584	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
63310	Fee-for-Service	1952369159	1952369159	1	1	KLINE, MARK E MD	9/20/2020	2085R0204X	NA	Other	026	PHYSICIANS	128219	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
63342	Fee-for-Service	1952469264	1952469264	1	1	KYAN, FEE S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64593	41	Internal Medicine	0	In state provider	COVENANT MEDICAL GROUP	16900 LAKEWOOD BLVD	STE 308	BELLFLOWER	CA	90706	5580	19	06037	33.880725	-118.142603	Los Angeles County
63363	Fee-for-Service	1659642767	1659642767	1	1	KYAW, THAN H MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148976	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 N GARFIELD AVE	STE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
63372	Fee-for-Service	1467484675	1467484675	1	1	KAREN CUTTS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 WALLACE BLVD	None	AMARILLO	TX	79106	1708	00	None	35.19848589	-101.9168363	Potter County
63376	Fee-for-Service	1730504416	1730504416	1	1	KONYE, GEOFFREY MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127278	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
63385	Fee-for-Service	1366000614	1366000614	1	1	KAZOURRA, SHADI MD	9/19/2023	208M00000X	NA	Other	026	PHYSICIANS	183473	None	None	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
63421	Fee-for-Service	1003168626	1003168626	1	1	KIM, PETER C DPM INC	8/28/2014	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	62 CORPORATE PARK	STE 245	IRVINE	CA	92606	3127	30	06059	33.69197468	-117.8247858	Orange County
63436	Fee-for-Service	1629593090	1629593090	1	1	KARKOSKA, PAUL D LMFT	10/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6777 N WILLOW AVE	None	FRESNO	CA	93710	5900	10	06019	36.83465436	-119.7311422	Fresno County
63469	Fee-for-Service	1669538526	1669538526	1	1	KERR, JAMES H MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50682	07	Dermatology	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
63474	Fee-for-Service	1851320162	1851320162	1	1	KANG, STEVEN MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72811	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	365 HAWTHORNE AVE	STE 201	OAKLAND	CA	94609	3114	01	06001	37.82079728	-122.2633226	Alameda County
63536	Fee-for-Service	1568541357	1568541357	1	1	KUAN, TIMOTHY H T CA	12/1/1984	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	813 S DORA ST	None	UKIAH	CA	95482	5710	23	06045	39.14140764	-123.2104499	Mendocino County
63550	Fee-for-Service	1912260092	1912260092	1	1	KINNAIRD, PATRICK B MD	11/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147948	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
63554	Fee-for-Service	1528138088	1528138088	1	4	KAISER FOUNDATION HOSP	7/1/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SOUTH SACRAMENTO	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
63592	Fee-for-Service	1356323828	1356323828	1	1	KANTOR, JASON C MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40284	None	None	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
63597	Fee-for-Service	1376084012	1376084012	1	1	KING, CHRISTOPHER T DO	4/24/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
63599	Fee-for-Service	1902196256	1902196256	1	1	KERN RURAL WELLNESS CENTERS	10/18/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INC	146 N HILL ROAD	None	ARVIN	CA	93203	1014	15	06029	35.210097	-118.8309345	Kern County
63631	Fee-for-Service	1952469264	1952469264	1	1	KYAN, FEE S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64593	40	Pediatrics	0	In state provider	COVENANT MEDICAL GROUP	16900 LAKEWOOD BLVD	STE 308	BELLFLOWER	CA	90706	5580	19	06037	33.880725	-118.142603	Los Angeles County
63640	Fee-for-Service	1376730127	1376730127	1	1	KEH, CHRIS E MD	1/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104634	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63643	Fee-for-Service	1326854514	1326854514	1	1	KNO'QOTI NATIVE WELLNESS, IN	1/16/2025	171M00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	C.	809 SOUTH MAIN ST	None	LAKEPORT	CA	95453	5510	17	06033	39.03642982	-122.9154133	Lake County
63654	Fee-for-Service	1689741548	1689741548	1	1	KO, MICHAEL D MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81518	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
63675	Fee-for-Service	1043482938	1043482938	1	1	KIM, ANNE C MD	11/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111428	30	Radiology	0	In state provider	None	1425 S. MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
63678	Fee-for-Service	1881973626	1881973626	1	1	KAYKHA, AMIR MD INC	10/15/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	95626	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	105 N BASCOM AVE	SUITE 204	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
63681	Fee-for-Service	1285165704	1285165704	1	1	KUMAR, VINAY MD	11/9/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167042	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
63696	Fee-for-Service	1952179350	1952179350	1	1	KETAN SHAH MD INC	12/27/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
63744	Fee-for-Service	1811900145	1811900145	1	1	KELLY, GREGORY MD	6/11/1998	207L00000X	NA	Other	026	PHYSICIANS	57057	05	Anesthesiology	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
63747	Fee-for-Service	1265449136	1265449136	1	1	KACZMER, THEODORE JR MD	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	54638	14	Neurological Surgery	0	In state provider	None	220 SANSOME ST	None	SALINAS	CA	93907	2136	27	06053	36.68346104	-121.6579245	Monterey County
63771	Fee-for-Service	1053492843	1053492843	1	1	KADISH, HOWARD A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
63777	Fee-for-Service	1295942696	1295942696	1	1	KOBASHI, LUUS I MD INC	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	21727	34	Urology and Urological Surgery	0	In state provider	None	1140 W LA VETA AVE	STE 750	ORANGE	CA	92868	4217	30	06059	33.7802984	-117.8651669	Orange County
63792	Fee-for-Service	1881956316	1881956316	1	1	KLARIN, DEREK MD	8/16/2021	208600000X	NA	General Surgery	026	PHYSICIANS	171421	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
63811	Fee-for-Service	1952725707	1952725707	1	1	KUROIWA, JOSHUA MD	2/9/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18420	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
63819	Fee-for-Service	1720152507	1720152507	1	1	KIM, CHANG OOK	5/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82792	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
63860	Fee-for-Service	1982788055	1982788055	1	1	KHARKAR, ALPANA	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63706	08	Family Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
63867	Fee-for-Service	1083844146	1083844146	1	1	KIRCHNER, VARVARA A MD	12/21/2021	204F00000X	NA	General Surgery	026	PHYSICIANS	175512	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
63868	Fee-for-Service	1437739174	1437739174	1	1	KIM, SUE Y MD	12/7/2022	390200000X	NA	Other	026	PHYSICIANS	182976	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
63884	Fee-for-Service	1427103035	1427103035	1	1	KAWACHI, MILDRED M MD	2/15/2021	207R00000X	NA	Other	026	PHYSICIANS	30058	None	None	0	In state provider	None	5915 HOLLIS	SUITE B	EMERYVILLE	CA	94608	2002	01	06001	37.84148798	-122.2898215	Alameda County
63894	Fee-for-Service	1295813822	1295813822	1	1	KAYMAZ, HULYA MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56489	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
63897	Fee-for-Service	1457614497	1457614497	1	1	KURZBARD ROACH, NICOLE E MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127985	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63905	Fee-for-Service	1356699342	1356699342	1	1	KEATS, LAUREN PSYD	4/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
63913	Fee-for-Service	1164478814	1164478814	1	1	KENTER, MARK E MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65536	05	Anesthesiology	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
63919	Fee-for-Service	1265481949	1265481949	1	1	KAUFMANN, JOHN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66401	77	Infectious Disease	0	In state provider	None	1667 DOMINICAN WAY	STE 134	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
63929	Fee-for-Service	1952613697	1952613697	1	1	KISHORE, SIRISH A MD	4/28/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	133506	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
63938	Fee-for-Service	1427178961	1427178961	1	1	KERR-LEWIS, JAIME D	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
63966	Fee-for-Service	1497130462	1497130462	1	1	KOPCZYNSKI, JENNIFER A LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E DAILY DR	STE 210	CAMARILLO	CA	93010	5839	56	06111	34.21906637	-119.0621709	Ventura County
63971	Fee-for-Service	1841446630	1841446630	1	1	KAMINSKI, ANNA K DO	6/21/2019	207L00000X	NA	Other	026	PHYSICIANS	17212	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
64003	Fee-for-Service	1780851899	1780851899	1	1	KOBASHI, BRENT G MD	1/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103699	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64087	Fee-for-Service	1750330932	1750330932	1	1	KHAN, ANDREW S DO	7/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6501	66	Emergency Medicine (Urgent Care)	0	In state provider	None	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
64088	Fee-for-Service	1205365798	1205365798	1	1	KIRKLAND, PATRICK J MD	8/5/2022	2086S0120X	NA	General Surgery	026	PHYSICIANS	157458	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
64091	Fee-for-Service	1720229602	1720229602	1	1	KAISER FOUNDATION HOSPITALS	6/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10917 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3044	33	06065	33.90499038	-117.4738429	Riverside County
64096	Fee-for-Service	1902833395	1902833395	1	1	KIM, SUNGHOON MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	60075	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
64098	Fee-for-Service	1326481292	1326481292	1	1	KAUL, DIVIYA MD	8/7/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	149263	13	Neurology (M.D. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
64162	Fee-for-Service	1962258970	1962258970	1	1	KIM, BORAM NP	8/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	24241 HAWTHORNE BLVD	SUITE 201	TORRANCE	CA	90505	6504	19	06037	33.802578	-118.351229	Los Angeles County
64166	Fee-for-Service	1568442697	1568442697	1	1	KULDAU, JOHN G MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75102	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
64171	Fee-for-Service	1730421173	1730421173	1	1	KATS, MICHAEL S MD	7/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141393	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
64196	Fee-for-Service	1760132617	1760132617	1	1	KRISHNA RX INC	7/20/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	246 W COLLEGE ST	STE 101	COVINA	CA	91723	1910	19	06037	34.08747217	-117.8936025	Los Angeles County
64209	Fee-for-Service	1265481949	1265481949	1	1	KAUFMANN, JOHN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66401	41	Internal Medicine	0	In state provider	None	1667 DOMINICAN WAY	STE 134	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
64211	Fee-for-Service	1568790558	1568790558	1	1	KELLY MARVIN JEPPESEN	11/30/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	380 WEST 100 NORTH	None	MONTICELLO	UT	84535	0308	00	None	37.8739348	-109.3499061	San Juan County
64214	Fee-for-Service	1316098205	1316098205	1	1	KRISHNAMOORTHI, MD INC	4/1/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	A PROFESSIONAL MED CORP	324 F ST	None	WATERFORD	CA	95386	9013	50	06099	37.64136989	-120.7622809	Stanislaus County
64239	Fee-for-Service	1841550647	1841550647	1	1	KISSI, DORA	7/19/2016	363LX0001X	NA	Nurse Practitioner	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1428 N WATERMAN AVE	STE B	SAN BERNARDINO	CA	92404	5382	36	06071	34.125714	-117.2788165	San Bernardino County
64242	Fee-for-Service	1164951240	1164951240	1	1	KOHL, LEAH D CCC-SLP	11/3/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
64289	Fee-for-Service	1831679349	1831679349	1	1	KHA, NICKEY PT	8/16/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
64341	Fee-for-Service	1013945328	1013945328	1	1	KEY, PAUL H MD	2/8/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	26127	01	General Practice	0	In state provider	None	9808 VENICE BLVD	STE 503	CULVER CITY	CA	90232	6804	19	06037	34.0236396	-118.3980847	Los Angeles County
64347	Fee-for-Service	1477617496	1477617496	1	1	KAM, GALEN S MD	12/9/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	82714	None	None	0	In state provider	None	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
64378	Fee-for-Service	1720229602	1720229602	1	1	KAISER FOUNDATION HOSPITALS	6/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10917 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3044	33	06065	33.90499038	-117.4738429	Riverside County
64387	Fee-for-Service	1902833395	1902833395	1	1	KIM, SUNGHOON MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	60075	85	Surgery-Pediatric	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
64396	Fee-for-Service	1477729002	1477729002	1	1	KAUR, BERNEET MD	11/1/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	105828	13	Neurology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
64442	Fee-for-Service	1811072572	1811072572	1	1	KRETZSCHMAR, KAREL M MD	6/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51623	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
64451	Fee-for-Service	1184660169	1184660169	1	1	KIDNEY CENTER VAN	1/29/1998	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NUYS, INC	14624 SHERMAN WAY	STE 106	VAN NUYS	CA	91405	2287	19	06037	34.20078354	-118.450843	Los Angeles County
64490	Fee-for-Service	1356583033	1356583033	1	1	KHOSRAVI, ABTIN H MD	9/7/2017	208600000X	NA	General Surgery	026	PHYSICIANS	142491	02	General Surgery	0	In state provider	None	17542 17TH ST	STE 410	TUSTIN	CA	92780	1978	30	06059	33.75969746	-117.8261777	Orange County
64501	Fee-for-Service	1316098205	1316098205	1	1	KRISHNAMOORTHI, MD INC	4/1/2007	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	A PROFESSIONAL MED CORP	324 F ST	None	WATERFORD	CA	95386	9013	50	06099	37.64136989	-120.7622809	Stanislaus County
64515	Fee-for-Service	1225340243	1225340243	1	1	KASSAM, ZANITA MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130674	None	None	0	In state provider	None	1100 N PALM CANYON DR	SUITE 212	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
64548	Fee-for-Service	1801820394	1801820394	1	1	KORNGUTH, DAVID G MD	2/3/2009	2085R0001X	NA	Other	026	PHYSICIANS	104635	78	Neoplastic Diseases/Oncology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
64566	Fee-for-Service	1053353748	1053353748	2	1	KMB INVESTMENTS INC	3/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THE CORNER DRUG STORE	2087 E FLORIDA AVE	None	HEMET	CA	92544	4730	33	06065	33.74756549	-116.950833	Riverside County
64580	Fee-for-Service	1104345818	1104345818	1	1	KATTLEYA HOSPICE AND	3/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	4959 PALO VERDE ST	STE 106-B	MONTCLAIR	CA	91763	2331	36	06071	34.08129954	-117.6966135	San Bernardino County
64581	Fee-for-Service	1730108689	1730108689	1	1	KIM, TAE EUNG J MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	# A108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
64589	Fee-for-Service	1356664205	1356664205	1	2	KAS-OSOKA, ORIAKU A MD	7/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PARKWAY	315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
64595	Fee-for-Service	1700931896	1700931896	1	1	KWON, CEDRIC MD	9/5/2023	207L00000X	NA	Other	026	PHYSICIANS	70537	None	None	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
64597	Fee-for-Service	1831260090	1831260090	1	1	KATOW,JEAN	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50632	18	Ophthalmology	0	In state provider	None	420 E 3RD ST	STE 603	LOS ANGELES	CA	90013	1645	19	06037	34.04702011	-118.241912	Los Angeles County
64605	Fee-for-Service	1558472589	1558472589	1	1	KHORSANDI,MEHRAN J MD	11/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61809	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8635 W 3RD ST	STE 695W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
64618	Fee-for-Service	1477579480	1477579480	1	1	KIRK, SHANNON R MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54578	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
64625	Fee-for-Service	1063652386	1063652386	1	1	KIM, BENJAMIN MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94562	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64628	Fee-for-Service	1164512281	1164512281	1	1	KANAKRIYEH, MOHAMMAD S MD	2/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42526	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	SUITE 329	SAN BERNARDINO	CA	92404	3861	36	06071	34.1358627	-117.2757898	San Bernardino County
64647	Fee-for-Service	1629348305	1629348305	1	1	KELSCH, MARHYA J LCSW	4/7/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	01	06001	37.54662058	-121.9736002	Alameda County
64652	Fee-for-Service	1558710863	1558710863	1	1	KAUR, AMANDEEP MD	6/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158246	08	Family Practice	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95340	6242	24	06047	37.29309532	-120.4748791	Merced County
64656	Fee-for-Service	1881929859	1881929859	1	1	KRAUS, MIRIAM A NP	7/28/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	751512	-	NOT APPLICABLE	0	In state provider	None	12402 INDUSTRIAL BLVD	STE B-6	VICTORVILLE	CA	92395	5095	36	06071	34.47628904	-117.2829923	San Bernardino County
64667	Fee-for-Service	1740392885	1740392885	1	1	KELLER, ARLENE MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65574	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
64697	Fee-for-Service	1164783049	1164783049	1	1	KEENE, KYLE R DO	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12461	01	General Practice	0	In state provider	None	1301 MISSION STREET	None	SANTA CRUZ	CA	95060	3530	44	06087	36.96817615	-122.0381947	Santa Cruz County
64720	Fee-for-Service	1912080094	1912080094	1	1	KELLY, ELEANOR M MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64544	41	Internal Medicine	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
64724	Fee-for-Service	1528252384	1528252384	1	1	KANAI, KUNIYOSHI OD	1/14/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5163 LONE TREE WAY	None	ANTIOCH	CA	94531	8689	07	06013	37.96179103	-121.7556082	Contra Costa County
64733	Fee-for-Service	1811072572	1811072572	1	1	KRETZSCHMAR, KAREL M MD	6/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51623	05	Anesthesiology	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
64747	Fee-for-Service	1780030718	1780030718	1	1	KUMURA, NIKKI D MD	9/26/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	188506	None	None	0	In state provider	None	815 POLLARD ROAD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
64754	Fee-for-Service	1841858040	1841858040	1	1	KIM, CHANG YOON MD	10/18/2022	207R00000X	NA	Other	026	PHYSICIANS	176091	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
64792	Fee-for-Service	1780714105	1780714105	1	1	KIM, HANNA LMFT	1/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
64797	Fee-for-Service	1003190489	1003190489	1	1	KATOA, CANDY PSYD	11/23/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64806	Fee-for-Service	1275858391	1275858391	1	1	KUNDER, REBECCA S MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117902	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
64825	Fee-for-Service	1902041676	1902041676	1	1	KLAMATH OPHTHALMOLOGY PC	7/25/2023	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	629 MAIN ST	None	KLAMATH FALLS	OR	97601	6007	00	None	42.2250778	-121.7822384	Klamath County
64835	Fee-for-Service	1801820394	1801820394	1	1	KORNGUTH, DAVID G MD	2/3/2009	2085R0001X	NA	Other	026	PHYSICIANS	104635	30	Radiology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
64841	Fee-for-Service	1962807446	1962807446	1	1	KARBALIVAND, HODA MD	6/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185776	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
64866	Fee-for-Service	1104345818	1104345818	1	1	KATTLEYA HOSPICE AND	3/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	4959 PALO VERDE ST	STE 106-B	MONTCLAIR	CA	91763	2331	36	06071	34.08129954	-117.6966135	San Bernardino County
64902	Fee-for-Service	1558472589	1558472589	1	1	KHORSANDI,MEHRAN J MD	11/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61809	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 695W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
64927	Fee-for-Service	1144327248	1144327248	1	1	KU, CHRISTINE W MD	3/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51152	18	Ophthalmology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
65020	Fee-for-Service	1811072572	1811072572	1	1	KRETZSCHMAR, KAREL M MD	6/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51623	40	Pediatrics	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
65027	Fee-for-Service	1679270581	1679270581	1	1	KAWEAH DELTA HEALTH CARE DIS	1/2/2025	261QM1300X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	TER - TULARE	938 N CHERRY ST	None	TULARE	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
65031	Fee-for-Service	1154487734	1154487734	1	1	KULICK, ANDREW DC	7/25/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	5123 W. SUNSET BLVD.	#202	LOS ANGELES	CA	90027	5779	19	06037	34.0981773	-118.3013882	Los Angeles County
65041	Fee-for-Service	1588759898	1588759898	1	1	KIM, YONHUI	6/1/1996	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3000 W OLYMPIC BLVD	STE 307	LOS ANGELES	CA	90006	6513	19	06037	34.05260947	-118.3003335	Los Angeles County
65062	Fee-for-Service	1275515728	1275515728	1	1	KRISHNAN, MADHAVAN MD	5/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87502	30	Radiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
65099	Fee-for-Service	1346624285	1346624285	1	1	KAHLON, JASON MD	5/31/2023	207R00000X	NA	Other	026	PHYSICIANS	143960	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
65104	Fee-for-Service	1790839538	1790839538	1	1	KAGAN, ARKADY B MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	76135	18	Ophthalmology	0	In state provider	None	5455 WILSHIRE BLVD	STE 1714	LOS ANGELES	CA	90036	4217	19	06037	34.06231513	-118.3475493	Los Angeles County
65109	Fee-for-Service	1972231793	1972231793	1	1	KUIZON, STEFANIE OT	10/13/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
65112	Fee-for-Service	1902041676	1902041676	1	1	KLAMATH OPHTHALMOLOGY PC	7/25/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	1	Border provider	None	629 MAIN ST	None	KLAMATH FALLS	OR	97601	6007	00	None	42.2250778	-121.7822384	Klamath County
65116	Fee-for-Service	1063451086	1063451086	1	1	KIM, DAVID HYUN-MIN MD	8/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92002	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
65123	Fee-for-Service	1336171990	1336171990	1	1	KIM, MYUNG MD	4/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79970	01	General Practice	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
65125	Fee-for-Service	1184702920	1184702920	1	1	KAU, ELAINE MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74424	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
65153	Fee-for-Service	1740746916	1740746916	1	1	KAMILA HOME HEALTH INC	3/10/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12862 GARDEN GROVE BLVD	SUITE 280	GARDEN GROVE	CA	92843	2015	30	06059	33.77433351	-117.908199	Orange County
65189	Fee-for-Service	1376616094	1376616094	1	1	KOJIMA, KRYSS Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 S KING ST	None	HONOLULU	HI	96813	3009	00	None	21.30218603	-157.8505732	Honolulu County
65200	Fee-for-Service	1144616970	1144616970	1	1	KLATMAN, SAMUEL H MD	9/1/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	166831	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
65210	Fee-for-Service	1275096489	1275096489	1	1	KIM, ERIC T MD	8/4/2022	390200000X	NA	Other	026	PHYSICIANS	19826	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
65211	Fee-for-Service	1659522852	1659522852	1	1	KEEGAN, MOLLY P MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102279	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
65248	Fee-for-Service	1467510743	1467510743	1	1	KAUAI VETERANS MEMORIAL HOSP	12/25/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4643 WAIMEA CANYON DR	None	WAIMEA	HI	96796	0337	00	None	21.96005283	-159.6701199	Kauai County
65256	Fee-for-Service	1891804803	1891804803	1	1	KALEB, VANESSA M MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71452	01	General Practice	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
65263	Fee-for-Service	1992722839	1992722839	1	1	KUON, CARLA P MD	3/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89882	41	Internal Medicine	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
65267	Fee-for-Service	1427202456	1427202456	1	1	KIM, SUSAN Y	11/6/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
65286	Fee-for-Service	1801150800	1801150800	1	1	KINKEAD, JANET J DO	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14705	01	General Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
65291	Fee-for-Service	1518529635	1518529635	1	1	KID FUNDAMENTALS THERAPY CEN	1/31/2020	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	TER, INC.	12900A GARDEN GROVE BLVD	STE 220	GARDEN GROVE	CA	92843	2023	30	06059	33.77433148	-117.9075735	Orange County
65305	Fee-for-Service	1437584828	1437584828	1	1	KIRTIKANT VISHAL DOSHI	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
65313	Fee-for-Service	1144377466	1144377466	1	1	KAISER FOUND HLTH PLAN	9/30/1983	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
65315	Fee-for-Service	1134612468	1134612468	1	1	KAISER FOUNDATION HOSPITAL	11/9/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SANTA CLARA	1721 TECHNOLOGY DR	SUITE 245	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
65344	Fee-for-Service	1578611430	1578611430	1	1	KUMAR, MAHESH G MD	7/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55432	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
65346	Fee-for-Service	1720340169	1720340169	1	1	KOLLER, PAUL B MD	9/4/2019	207RH0000X	NA	Hematology	026	PHYSICIANS	164997	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
65361	Fee-for-Service	1922234285	1922234285	1	1	KANGELARIS, GERALD T MD	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107993	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	RM 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
65381	Fee-for-Service	1962564260	1962564260	1	1	KESSLER, NADINE S	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
65384	Fee-for-Service	1154090017	1154090017	1	1	KIESCHNICK, DUSTIN W	12/22/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
65397	Fee-for-Service	1124117452	1124117452	1	1	KASHANI, HOOMAN R DO	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8543	41	Internal Medicine	0	In state provider	None	16133 VENTURA BLVD	STE 360	ENCINO	CA	91436	2426	19	06037	34.15656164	-118.4849569	Los Angeles County
65422	Fee-for-Service	1427356294	1427356294	1	1	KNB PHARMACY INC	5/31/2011	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1091 S MT VERNON AVE	#J	COLTON	CA	92324	4253	36	06071	34.050303	-117.3092765	San Bernardino County
65433	Fee-for-Service	1609165992	1609165992	1	1	KALMAN, LESLIE M MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	21059	01	General Practice	0	In state provider	None	3430 GARFIELD AVE	None	COMMERCE	CA	90040	3104	19	06037	33.98408703	-118.1403554	Los Angeles County
65437	Fee-for-Service	1053088799	1053088799	1	1	KIM, EDWARD D CNP	9/30/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
65463	Fee-for-Service	1396823167	1396823167	1	1	KAO, SUSAN Y MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86836	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
65464	Fee-for-Service	1932122355	1932122355	1	1	KESH, SUMANA MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95915	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
65481	Fee-for-Service	1114945144	1114945144	1	1	KOSARAJU, RADHIKA MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55683	41	Internal Medicine	0	In state provider	None	255 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.3639177	-121.8490241	Santa Clara County
65500	Fee-for-Service	1639191455	1639191455	1	1	KHANNA,GAYATRI MD	2/1/2001	207R00000X	NA	Other	026	PHYSICIANS	64577	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
65505	Fee-for-Service	1801069877	1801069877	1	1	KIM, PAGGIE P MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108930	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
65536	Fee-for-Service	1467510743	1467510743	1	1	KAUAI VETERANS MEMORIAL HOSP	12/25/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4643 WAIMEA CANYON DR	None	WAIMEA	HI	96796	0337	00	None	21.96005283	-159.6701199	Kauai County
65551	Fee-for-Service	1952743775	1952743775	1	1	KALDANI, BERNADET LMFT	3/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
65553	Fee-for-Service	1588760870	1588760870	2	1	KIDS KORNER MEDICAL SUPPLY	11/20/2012	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	165 LEWIS RD	STE 10	SAN JOSE	CA	95111	2194	43	06085	37.29445683	-121.8457355	Santa Clara County
65591	Fee-for-Service	1710975669	1710975669	1	1	KAO, SIMON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSP & CLNS	200 HAWKINS DR	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
65596	Fee-for-Service	1407925928	1407925928	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SANTA ROSA	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
65632	Fee-for-Service	1720340169	1720340169	1	1	KOLLER, PAUL B MD	9/4/2019	207RH0000X	NA	Hematology	026	PHYSICIANS	164997	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
65644	Fee-for-Service	1891115440	1891115440	1	1	KRYSS-PEAK, GRETCHEN L PSYD	3/9/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
65686	Fee-for-Service	1124117452	1124117452	1	1	KASHANI, HOOMAN R DO	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8543	45	Nephrology (Renal-Kidney)	0	In state provider	None	16133 VENTURA BLVD	STE 360	ENCINO	CA	91436	2426	19	06037	34.15656164	-118.4849569	Los Angeles County
65689	Fee-for-Service	1982266847	1982266847	1	1	KITSINIAN, ANI LMFT	9/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6739 ODESSA AVE	None	VAN NUYS	CA	91406	5747	19	06037	34.19284735	-118.4902713	Los Angeles County
65693	Fee-for-Service	1063689941	1063689941	1	1	KHANDELWAL, ABHA MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126558	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
65732	Fee-for-Service	1619044427	1619044427	1	1	KO, YIUKI MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44309	30	Radiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
65744	Fee-for-Service	1639246457	1639246457	1	1	KATZ, TERI S MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83411	30	Radiology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
65788	Fee-for-Service	1689866311	1689866311	1	1	KAO, KATHERINE MD	1/4/2019	207R00000X	NA	Other	026	PHYSICIANS	90032	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
65790	Fee-for-Service	1124313671	1124313671	1	1	KULIFAJ, STEVE CO	5/28/2013	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 CASS ST	#112	MONTEREY	CA	93940	4542	27	06053	36.59201772	-121.8966282	Monterey County
65844	Fee-for-Service	1215020649	1215020649	1	1	KAJU PHARMACY INC	12/28/1990	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8887 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92844	1249	30	06059	33.77400105	-117.9765782	Orange County
65863	Fee-for-Service	1619951290	1619951290	1	1	KHALIL, AHMED A MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48948	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	#209	SAN BERNARDINO	CA	92404	3848	36	06071	34.1358627	-117.2757898	San Bernardino County
65868	Fee-for-Service	1003979337	1003979337	1	1	KAMALI, AZIZULAH MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	38	Geriatrics	0	In state provider	AZIZ KAMALI MD, INC	4505 PRECISSI LN	# A	STOCKTON	CA	95207	6205	39	06077	37.98851034	-121.3149434	San Joaquin County
65869	Fee-for-Service	1932887759	1932887759	1	1	KASSEL, HOPE CRNA	1/31/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
65903	Fee-for-Service	1265415764	1265415764	1	1	KINCHEN, ERNEST W MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86155	None	None	0	In state provider	None	100 OCEANGATE	STE 1000	LONG BEACH	CA	90802	4347	19	06037	33.76655046	-118.1989306	Los Angeles County
65907	Fee-for-Service	1366947095	1366947095	1	1	KRIVITSKIY, IGOR MD	1/31/2022	207P00000X	NA	Other	026	PHYSICIANS	165883	None	None	0	In state provider	None	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
65917	Fee-for-Service	1780864504	1780864504	1	1	KIM, EUGENE K MD	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99140	02	General Surgery	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
65972	Fee-for-Service	1942358759	1942358759	1	1	KRASTEIN, GREGORY MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70211	01	General Practice	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
66017	Fee-for-Service	1790810059	1790810059	1	1	KHANEGHAHI, LADAN LMFT	10/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
66021	Fee-for-Service	1619044427	1619044427	1	1	KO, YIUKI MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44309	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
66031	Fee-for-Service	1174602817	1174602817	1	1	KIM, JIM MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86557	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
66038	Fee-for-Service	1326102708	1326102708	1	1	KHALILI, AFNEH MD	11/13/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63303	41	Internal Medicine	0	In state provider	None	8111 CANOGA AVE	None	CANOGA PARK	CA	91304	4103	19	06037	34.217262	-118.5975465	Los Angeles County
66043	Fee-for-Service	1194897678	1194897678	1	1	KIM, PETER J MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	80326	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
66070	Fee-for-Service	1881176436	1881176436	1	1	KOZEL, KELLIE NP	11/14/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66077	Fee-for-Service	1740200575	1740200575	1	1	KWAN, ABEL S LAC	7/3/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	750 W GONZALES RD	STE 260	OXNARD	CA	93036	0708	56	06111	34.21907131	-119.1858729	Ventura County
66087	Fee-for-Service	1275319782	1275319782	1	1	KOBERT, REBEKAH NP	2/5/2025	207N00000X	NA	Dermatology	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	33	06065	33.4799323	-117.1033702	Riverside County
66091	Fee-for-Service	1093127573	1093127573	1	1	KEA, BELINDA MD	11/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144617	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
66100	Fee-for-Service	1013335900	1013335900	1	1	KUO, KAREN Y MD	7/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137849	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
66124	Fee-for-Service	1083982987	1083982987	1	2	KOPEC, KORNELIA A NP	2/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	37	06073	32.77510996	-117.1277427	San Diego County
66155	Fee-for-Service	1003979337	1003979337	1	1	KAMALI, AZIZULAH MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	AZIZ KAMALI MD, INC	4505 PRECISSI LN	# A	STOCKTON	CA	95207	6205	39	06077	37.98851034	-121.3149434	San Joaquin County
66226	Fee-for-Service	1194802041	1194802041	1	1	KIANG, PHINE MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69346	22	Pathology (M.D. only)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
66249	Fee-for-Service	1912492216	1912492216	1	1	KWON, JI Y CNP	8/22/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66256	Fee-for-Service	1164721601	1164721601	1	1	KRIVCHENIA, KATELYN E MD	10/3/2018	2080P0214X	NA	Pulmonology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
66259	Fee-for-Service	1942358759	1942358759	1	1	KRASTEIN, GREGORY MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70211	41	Internal Medicine	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
66284	Fee-for-Service	1528138088	1528138088	1	1	KAISER FOUNDATION HOSP	10/29/1985	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SOUTH SACRAMENTO	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
66301	Fee-for-Service	1184842197	1184842197	1	1	KALOOSTIAN, WILLIAM MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40261	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
66325	Fee-for-Service	1861630022	1861630022	1	1	KWON, SAMANTHA A PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2008 MORSE AVENUE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
66330	Fee-for-Service	1194897678	1194897678	1	1	KIM, PETER J MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	80326	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
66336	Fee-for-Service	1689745432	1689745432	1	1	KANEGAYE, JOHN T MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67670	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
66339	Fee-for-Service	1902324528	1902324528	1	1	KOLLIMUTTATHUILLAM, SUDARSAN	8/26/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	169385	None	None	0	In state provider	MD	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
66346	Fee-for-Service	1104052919	1104052919	1	1	KONOR, LINDSEY MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140950	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
66348	Fee-for-Service	1992896286	1992896286	1	1	KWOK, HANSEN MD	6/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82223	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
66349	Fee-for-Service	1053494914	1053494914	1	1	KYAW, RAMONA M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	74713	32	Radiation Therapy (D.O. only)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
66353	Fee-for-Service	1720050156	1720050156	1	1	KNECHT, STEPHEN MD	11/18/2022	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	161422	None	None	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
66444	Fee-for-Service	1003979337	1003979337	1	1	KAMALI, AZIZULAH MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	AZIZ KAMALI MD, INC	4505 PRECISSI LN	# A	STOCKTON	CA	95207	6205	39	06077	37.98851034	-121.3149434	San Joaquin County
66456	Fee-for-Service	1942428271	1942428271	2	1	KIM, CHARLTON	3/30/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	89367	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	0300	19	06037	34.13489987	-118.0424069	Los Angeles County
66457	Fee-for-Service	1134207285	1134207285	1	1	KRAISOSKY, ALISSA J MD	4/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88627	36	Psychiatry	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
66463	Fee-for-Service	1669011151	1669011151	1	1	KIM, HEATHER H NP	10/18/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
66466	Fee-for-Service	1831112366	1831112366	1	1	KINSELLA, KRIS G DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	KINSELLA CHIROPRACTIC	4501 MISSION BAY DR	STE 3H	SAN DIEGO	CA	92109	4926	37	06073	32.80307971	-117.2166446	San Diego County
66476	Fee-for-Service	1164050167	1164050167	1	1	KOLAR, MATTHEW J	6/25/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	183532	07	Dermatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
66536	Fee-for-Service	1477032969	1477032969	1	1	KOO, DAVID J RCP	9/24/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
66538	Fee-for-Service	1730465931	1730465931	1	1	KANNAN, RAMESH LAC	5/20/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
66546	Fee-for-Service	1942358759	1942358759	1	1	KRASTEIN, GREGORY MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70211	45	Nephrology (Renal-Kidney)	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
66578	Fee-for-Service	1114188372	1114188372	1	1	KANNO,KILOLE DO	4/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20010 CENTURY BLVD	STE 200	GERMANTOWN	MD	20874	0000	00	None	39.18560725	-77.25950536	Montgomery County
66584	Fee-for-Service	1154761096	1154761096	1	1	KOPALD, BRANDON E PSYD	9/22/2023	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66615	Fee-for-Service	1013224401	1013224401	1	1	KURLINKUS, CHARLES E MD	10/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118607	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
66620	Fee-for-Service	1558071308	1558071308	1	1	KINGSWAY INTERNATIONAL LLC	4/27/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9732 NORTHSTAR COURT	None	STOCKTON	CA	95209	5183	39	06077	38.040003	-121.3585815	San Joaquin County
66638	Fee-for-Service	1053494914	1053494914	1	1	KYAW, RAMONA M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	74713	78	Neoplastic Diseases/Oncology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
66667	Fee-for-Service	1770661480	1770661480	1	1	KOPECKY, KIMBERLY M MD	12/13/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81520	None	None	0	In state provider	None	5301 F ST	STE 10	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
66668	Fee-for-Service	1376122861	1376122861	1	1	KIM, EUNHYE	8/25/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
66671	Fee-for-Service	1306026034	1306026034	1	1	KAYEKJIAN, GARABED MD	7/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	54072	40	Pediatrics	0	In state provider	INC	18250 ROSCOE BLVD	STE 130	NORTHRIDGE	CA	91325	4264	19	06037	34.22076142	-118.5313223	Los Angeles County
66691	Fee-for-Service	1659875433	1659875433	1	1	KANJI, ZAHARA A MD	8/31/2021	207R00000X	NA	Other	026	PHYSICIANS	173555	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
66733	Fee-for-Service	1003044892	1003044892	1	1	KHORASANEE, JACQUELINE A MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124704	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
66736	Fee-for-Service	1144355066	1144355066	1	1	KELSEYVILLE UNIFIED SD	6/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	5065 KONOCTI RD	None	KELSEYVILLE	CA	95451	9329	17	06033	38.972574	-122.820687	Lake County
66741	Fee-for-Service	1063550747	1063550747	1	1	KAPP, DANIEL S MD	5/1/1984	2085R0001X	NA	Other	026	PHYSICIANS	27048	42	Nuclear Medicine	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
66751	Fee-for-Service	1972984409	1972984409	1	1	KEVIN E BOYLE	7/12/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
66793	Fee-for-Service	1730111774	1730111774	1	1	KUREK, JORGE J MD	1/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50263	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
66797	Fee-for-Service	1205241445	1205241445	1	1	KUMAR, ARATHI MD	2/2/2022	208600000X	NA	General Surgery	026	PHYSICIANS	169610	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
66803	Fee-for-Service	1023643459	1023643459	1	1	KERUBO, DAPHNE	7/3/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2708 N. RONO ST	None	VISALIA	CA	93291	8359	54	06107	36.354591	-119.338353	Tulare County
66816	Fee-for-Service	1679795942	1679795942	1	1	KIM, ESTHER A MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110978	24	Plastic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
66863	Fee-for-Service	1326579715	1326579715	1	1	KINZEL, ADAM J MD	5/25/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158323	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
66875	Fee-for-Service	1417152307	1417152307	1	1	KURZ, ALFRED A	6/2/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DR	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
66908	Fee-for-Service	1295711539	1295711539	1	1	KALHA, ISHAAH S MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72491	10	Gastroenterology (M.D. only)	0	In state provider	None	3737 SAN DIMAS ST	STE 102	BAKERSFIELD	CA	93301	5733	15	06029	35.39412578	-119.0082617	Kern County
66951	Fee-for-Service	1770580243	1770580243	1	1	KIM RICHARD U MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79477	18	Ophthalmology	0	In state provider	None	622 ABBOTT ST	None	SALINAS	CA	93901	4315	27	06053	36.66170619	-121.6412319	Monterey County
67025	Fee-for-Service	1306896428	1306896428	1	1	KERMEN, JOHN DO	1/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6669	05	Anesthesiology	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
67027	Fee-for-Service	1063550747	1063550747	1	1	KAPP, DANIEL S MD	5/1/1984	2085R0001X	NA	Other	026	PHYSICIANS	27048	30	Radiology	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
67077	Fee-for-Service	1952372765	1952372765	2	1	KAILATH, ELIZABETH J MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41552	77	Infectious Disease	0	In state provider	None	6614 MERCY COURT	SUITE A	FAIR OAKS	CA	95628	3167	34	06067	38.665863	-121.3103205	Sacramento County
67089	Fee-for-Service	1023643459	1023643459	1	1	KERUBO, DAPHNE	7/3/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2708 N. RONO ST	None	VISALIA	CA	93291	8359	54	06107	36.354591	-119.338353	Tulare County
67105	Fee-for-Service	1679795942	1679795942	1	1	KIM, ESTHER A MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110978	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
67121	Fee-for-Service	1912948258	1912948258	1	1	KOPACZ, MACIEJ J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30344	05	Anesthesiology	0	In state provider	None	127 SYDNEY LN	None	REDWOOD CITY	CA	94063	5503	41	06081	37.49725747	-122.2242637	San Mateo County
67163	Fee-for-Service	1922030261	1922030261	1	1	KAHN, DANIEL A MD	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	842 E MAIN STREET	None	MEDFORD	OR	97504	7155	00	None	42.32787853	-122.863311	Jackson County
67179	Fee-for-Service	1992715437	1992715437	1	1	KASEY, KIM MD INC	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83569	41	Internal Medicine	0	In state provider	None	10802 COLLEGE PL	None	CERRITOS	CA	90703	1505	19	06037	33.88484554	-118.102932	Los Angeles County
67182	Fee-for-Service	1821233958	1821233958	1	1	KAPLAN, HARVEY S MD	2/28/1986	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CHOPE HOSP	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	41	06081	37.47644946	-122.2110919	San Mateo County
67186	Fee-for-Service	1467840876	1467840876	1	1	KORBEL, DELINA C	4/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
67190	Fee-for-Service	1003339193	1003339193	1	1	KANIKA DIALYSIS LLC	12/1/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7230 MEDICAL CENTER DR	SUITE 101-102	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
67227	Fee-for-Service	1275981425	1275981425	1	1	KOOHIAN, BOBAK A MD	8/17/2023	207L00000X	NA	Other	026	PHYSICIANS	155320	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
67237	Fee-for-Service	1043614183	1043614183	1	1	KARIE A. PRUDY, PNP	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KARIE A. PRUDY, PNPC	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
67242	Fee-for-Service	1073636957	1073636957	1	1	KUNZE, ROLF E	4/16/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INTERNATIONAL SERVICES	11665 FIRESTONE BLVD	None	NORWALK	CA	90650	2806	19	06037	33.91421008	-118.0843522	Los Angeles County
67315	Fee-for-Service	1114450004	1114450004	1	1	KIM, CYNTHIA DO	2/6/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	17077	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
67362	Fee-for-Service	1942592563	1942592563	1	1	KAVECANSKY, JURAJ MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148318	68	Hematology	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
67363	Fee-for-Service	1952372765	1952372765	2	1	KAILATH, ELIZABETH J MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41552	41	Internal Medicine	0	In state provider	None	6614 MERCY COURT	SUITE A	FAIR OAKS	CA	95628	3167	34	06067	38.665863	-121.3103205	Sacramento County
67367	Fee-for-Service	1952572711	1952572711	1	1	KANWAR, AARTI MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98002	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
67382	Fee-for-Service	1922095439	1922095439	1	1	KOBAYASHI, KRISTINE M	7/31/1990	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
67404	Fee-for-Service	1811164577	1811164577	1	1	KANG, JIMMY J MD	9/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112923	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
67429	Fee-for-Service	1598998999	1598998999	1	1	KELLEY-QUON, LORRAINE I MD	11/2/2010	390200000X	NA	Other	026	PHYSICIANS	110478	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
67442	Fee-for-Service	1750723524	1750723524	1	1	KIM, SUEJIN MD	8/28/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	149384	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
67449	Fee-for-Service	1235251661	1235251661	1	1	KAMALAKAR RAMBHATLA, MD, INC	5/25/2004	193200000X	NA	Other	026	PHYSICIANS	32691	None	None	0	In state provider	APC	3580 SANTA ANITA AVE	STE B	EL MONTE	CA	91731	2455	19	06037	34.07443832	-118.0414722	Los Angeles County
67464	Fee-for-Service	1821314675	1821314675	1	1	KRYSTEK, CRISTINA R LMFT	3/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
67511	Fee-for-Service	1235423682	1235423682	1	1	KHAN, SCHEHREZADE S	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130266	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
67526	Fee-for-Service	1487828471	1487828471	1	1	KANG, SHARON Y MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91918	45	Nephrology (Renal-Kidney)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
67538	Fee-for-Service	1093799959	1093799959	1	1	KOTELES JR, MICHAEL R MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55542	67	Endocrinology	0	In state provider	None	2175 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7024	09	06017	38.91234551	-119.9972565	El Dorado County
67539	Fee-for-Service	1720540289	1720540289	1	1	KOKROKO, JOLENE MD	9/8/2023	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	179433	None	None	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
67546	Fee-for-Service	1538228119	1538228119	1	1	KENIGSBERG, EUGENE M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34017	03	Allergy	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
67555	Fee-for-Service	1629125943	1629125943	1	1	KAISER PERMANENTE PHCY	6/26/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#383	5 CENTERPOINTE DR	None	LA PALMA	CA	90623	2504	30	06059	33.86168254	-118.0308375	Orange County
67579	Fee-for-Service	1669483749	1669483749	1	1	KARAGIANES, THOMAS G MD	6/30/1994	207L00000X	NA	Other	026	PHYSICIANS	38093	05	Anesthesiology	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
67587	Fee-for-Service	1104960335	1104960335	1	1	KHOINY, AMIR S MD	3/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84088	13	Neurology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
67614	Fee-for-Service	1215085204	1215085204	1	1	KIM, JEONG-AH J OD	1/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27107 TOURNEY RD	None	SANTA CLARITA	CA	91355	1860	19	06037	34.41607441	-118.5761057	Los Angeles County
67646	Fee-for-Service	1942592563	1942592563	1	1	KAVECANSKY, JURAJ MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148318	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
67665	Fee-for-Service	1376553123	1376553123	1	1	KIMBALL, GREGORY R MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	76520	01	General Practice	0	In state provider	None	1198 PACIFIC COAST HWY	STE I	SEAL BEACH	CA	90740	9278	30	06059	33.74325823	-118.1004531	Orange County
67666	Fee-for-Service	1114792454	1114792454	1	1	KANDATHIL, NIMY LCSW	2/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
67667	Fee-for-Service	1679780969	1679780969	1	1	KALYAN AKKINENI	4/11/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
67709	Fee-for-Service	1487843207	1487843207	1	1	KELLY, HOLLY C MD INC	10/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72149	25	Physical Medicine and Rehabilitation	0	In state provider	None	4000 CIVIC CENTER DR	STE 205	SAN RAFAEL	CA	94903	5233	21	06041	38.0041783	-122.538861	Marin County
67711	Fee-for-Service	1649461286	1649461286	1	1	KUMMER, ROBERT OD APC	6/1/1995	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1421 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3401	19	06037	34.05409489	-118.3838638	Los Angeles County
67719	Fee-for-Service	1962933572	1962933572	1	1	KLUFAS, DANIEL M MD	8/3/2022	207NS0135X	NA	Dermatology	026	PHYSICIANS	161515	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67794	Fee-for-Service	1831291400	1831291400	1	1	KARIMI, AFSANEH MD INC	10/1/2000	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52974	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 116	LOS ANGELES	CA	90045	3819	19	06037	33.96022076	-118.3961982	Los Angeles County
67807	Fee-for-Service	1134493406	1134493406	1	1	KALMBACH, KAREN PSYD	4/7/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
67818	Fee-for-Service	1093799959	1093799959	1	1	KOTELES JR, MICHAEL R MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55542	41	Internal Medicine	0	In state provider	None	2175 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7024	09	06017	38.91234551	-119.9972565	El Dorado County
67841	Fee-for-Service	1497826242	1497826242	1	1	KONZEN, KATHERINE M MD	6/11/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49512	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
67854	Fee-for-Service	1285130237	1285130237	1	1	KANG, JEANNEY MD	3/23/2021	208M00000X	NA	Other	026	PHYSICIANS	164809	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
67855	Fee-for-Service	1801152129	1801152129	1	1	KOTHARI, ABBAS H MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144302	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
67874	Fee-for-Service	1013528488	1013528488	1	1	KHROBUST, YEVHENIYA CNP	12/8/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	683 LOMAS SANTA FE DR	None	SOLANA BEACH	CA	92075	1412	37	06073	32.99596006	-117.2594441	San Diego County
67881	Fee-for-Service	1245408731	1245408731	1	1	KRISHNAMOORTHY, SABITHA	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97566	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
67912	Fee-for-Service	1407000953	1407000953	1	1	KAKAR, NANDITA DO	3/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9550	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
67933	Fee-for-Service	1366809527	1366809527	1	1	KEEHN, EMILY C LCSW	3/29/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
67964	Fee-for-Service	1932211950	1932211950	1	1	KOMMAREDDY, SUMITHRA MD	1/8/1997	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	43689	78	Neoplastic Diseases/Oncology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
67976	Fee-for-Service	1659688182	1659688182	1	1	KO, LISA KIT YI OPTOMETRIST	3/10/2011	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	618 BLOSSOM HILL RD	STE 100	SAN JOSE	CA	95123	3048	43	06085	37.25052736	-121.8422415	Santa Clara County
67977	Fee-for-Service	1720097983	1720097983	1	1	KILBANE, KEVIN M LMFT	6/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3815 ATLANTIC AVE	STE 2	LONG BEACH	CA	90807	3500	19	06037	33.827346	-118.1851085	Los Angeles County
67995	Fee-for-Service	1730321993	1730321993	1	1	KOA, KALY MD	10/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114330	None	None	0	In state provider	None	2911 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98821335	-121.978125	Santa Cruz County
68007	Fee-for-Service	1265454375	1265454375	1	1	KERMAN, BARRY M MD	9/23/1996	207W00000X	NA	Ophthalmology	026	PHYSICIANS	21061	18	Ophthalmology	0	In state provider	CENTURY CITY EYE MED	21675 REDWOOD RD	None	CASTRO VALLEY	CA	94546	6431	01	06001	37.6896228	-122.0737778	Alameda County
68018	Fee-for-Service	1164509097	1164509097	1	1	KIM, SUE MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79478	68	Hematology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
68021	Fee-for-Service	1790205631	1790205631	1	1	KAVAFYAN, TALAR MD	6/22/2023	207R00000X	NA	Other	026	PHYSICIANS	157166	None	None	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
68032	Fee-for-Service	1932141884	1932141884	1	1	KOGAN, SCOTT C MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76590	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
68037	Fee-for-Service	1154620664	1154620664	1	1	KRAUTER, ROSEANNE R NP	5/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68052	Fee-for-Service	1194190736	1194190736	1	1	KIM, HYUN SU MD	1/13/2025	207L00000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
68055	Fee-for-Service	1346757812	1346757812	1	1	KAHALI, MANA LCSW	4/24/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
68061	Fee-for-Service	1528016243	1528016243	1	1	KWON, OSUN MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53158	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
68100	Fee-for-Service	1134364748	1134364748	1	1	KOH, SANDY S MD INC	1/31/1981	193400000X	NA	Other	026	PHYSICIANS	34583	None	None	0	In state provider	None	2727 N PECK RD	None	EL MONTE	CA	91733	2434	19	06037	34.060311	-118.0306097	Los Angeles County
68101	Fee-for-Service	1154586675	1154586675	1	1	KREPS-FALK, RACHEL H MD	7/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102047	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
68130	Fee-for-Service	1497826242	1497826242	1	1	KONZEN, KATHERINE M MD	6/11/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49512	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
68137	Fee-for-Service	1649210808	1649210808	1	1	KELTY, LISA A MD	2/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143642	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINTAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
68162	Fee-for-Service	1104266600	1104266600	1	1	KHAULI, SAMIH L MD	6/9/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	186818	None	None	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
68199	Fee-for-Service	1801813662	1801813662	1	1	KAMMEN, PAMELA L MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53704	83	Rheumatology	0	In state provider	None	6331 N FRESNO ST	STE 101	FRESNO	CA	93710	5283	10	06019	36.82888312	-119.7814145	Fresno County
68210	Fee-for-Service	1508226465	1508226465	1	1	KIM, ERIC D DO	11/4/2021	207L00000X	NA	Other	026	PHYSICIANS	18222	None	None	0	In state provider	None	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
68216	Fee-for-Service	1225133846	1225133846	1	1	KOH, CHESTER J MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	63707	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
68258	Fee-for-Service	1154508414	1154508414	1	1	KAMEL, KAMEL L MD INC	1/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42118	None	None	0	In state provider	None	4199 CAMPUS DRIVE	SUITE 550	IRVINE	CA	92612	4694	30	06059	33.650775	-117.838296	Orange County
68275	Fee-for-Service	1033596739	1033596739	2	1	KGSS ,INC	5/21/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	424 ARNEILL RD	STE D	CAMARILLO	CA	93010	6433	56	06111	34.221492	-119.0389245	Ventura County
68305	Fee-for-Service	1164509097	1164509097	1	1	KIM, SUE MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79478	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
68308	Fee-for-Service	1821297797	1821297797	1	1	KIM, JIN K Y MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77677	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
68314	Fee-for-Service	1477631133	1477631133	1	1	KHURANA, ANURADHA MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85485	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
68319	Fee-for-Service	1932141884	1932141884	1	1	KOGAN, SCOTT C MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76590	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
68324	Fee-for-Service	1285663138	1285663138	1	1	KIDO, TAMIKO H MD	1/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145492	None	None	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
68348	Fee-for-Service	1528016243	1528016243	1	1	KWON, OSUN MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53158	45	Nephrology (Renal-Kidney)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
68356	Fee-for-Service	1578577813	1578577813	1	1	KANDALAFT, NAJI MD DO	5/1/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	46044	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
68379	Fee-for-Service	1669635538	1669635538	1	1	KAO, CYNTHIA L MD	1/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103030	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
68421	Fee-for-Service	1225348006	1225348006	1	1	KHACHARTIAN MEDICAL	7/30/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69378	01	General Practice	0	In state provider	CORPORATION	12643 SHERMAN WAY	UNIT I	NORTH HOLLYWOOD	CA	91605	5272	19	06037	34.20123149	-118.408464	Los Angeles County
68438	Fee-for-Service	1174639462	1174639462	1	1	KING, SHERYL M PT	6/20/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
68439	Fee-for-Service	1215960612	1215960612	1	2	KURWA, BADRUDIN R	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	36590	None	None	0	In state provider	None	123 N GARFIELD AVE	STE C	ALHAMBRA	CA	91801	3564	19	06037	34.09636542	-118.127778	Los Angeles County
68441	Fee-for-Service	1023283124	1023283124	1	1	KACHIKWU, EVELYN L MD	7/25/2012	2086X0206X	NA	General Surgery	026	PHYSICIANS	94067	None	None	0	In state provider	None	39-700 BOB HOPE DR	SUITE 110	RANCHO MIRAGE	CA	92270	7108	33	06065	33.78398109	-116.4059049	Riverside County
68444	Fee-for-Service	1245268549	1245268549	1	1	KOCH, RAYMOND A MD	1/1/1982	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	29777	20	Orthopedic Surgery	0	In state provider	None	2630 HARRISON AVE	None	EUREKA	CA	95501	3223	12	06023	40.78400467	-124.1396845	Humboldt County
68454	Fee-for-Service	1225062292	1225062292	1	1	KUSUM PRABHAKAR	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1336 WYOMING BLVD NE	STE F	ALBUQUERQUE	NM	87112	5066	00	None	35.09357923	-106.5505961	Bernalillo County
68474	Fee-for-Service	1043679285	1043679285	1	1	KAN, CAROLINE G MD	9/17/2019	207L00000X	NA	Other	026	PHYSICIANS	140094	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
68489	Fee-for-Service	1801813662	1801813662	1	1	KAMMEN, PAMELA L MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53704	41	Internal Medicine	0	In state provider	None	6331 N FRESNO ST	STE 101	FRESNO	CA	93710	5283	10	06019	36.82888312	-119.7814145	Fresno County
68512	Fee-for-Service	1629412846	1629412846	1	1	KAUR, MANMEET MD	4/19/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	175893	None	None	0	In state provider	None	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	34	06067	38.567007	-121.468068	Sacramento County
68524	Fee-for-Service	1801539127	1801539127	1	1	KWAK, JOANNE OT	11/24/2023	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
68548	Fee-for-Service	1427019397	1427019397	1	1	KATCHEM, LIONEL B DO	3/4/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	4524	01	General Practice	0	In state provider	None	1246 E ARROW HWY	STE B	UPLAND	CA	91786	4955	36	06071	34.09974849	-117.634842	San Bernardino County
68595	Fee-for-Service	1598728735	1598728735	1	1	KAMINSKI, STEPHEN S MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	82149	02	General Surgery	0	In state provider	None	725 E SANTA CLARA ST	STE 303	SAN JOSE	CA	95112	1938	43	06085	37.34328626	-121.8756374	Santa Clara County
68607	Fee-for-Service	1932141884	1932141884	1	1	KOGAN, SCOTT C MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76590	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
68621	Fee-for-Service	1780846873	1780846873	1	1	KASIM, KASIM M MD	6/20/2022	208M00000X	NA	Other	026	PHYSICIANS	138825	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
68622	Fee-for-Service	1548500994	1548500994	1	1	KAUFMAN, LAURA A LMFT	5/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
68625	Fee-for-Service	1477626448	1477626448	1	1	KERN REGIONAL CENTER	4/1/1999	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3200 SILLECT AVE	None	BAKERSFIELD	CA	93308	6333	15	06029	35.3861687	-119.0408974	Kern County
68638	Fee-for-Service	1215429824	1215429824	1	1	KSHIRSAGAR, MIHIR A	5/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17750	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
68641	Fee-for-Service	1942286349	1942286349	1	1	KUNG,SHIRLEY MD	9/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2551 W 84TH AVE	None	WESTMINISTER	CO	80030	3807	00	None	39.84905501	-105.0182452	Adams County
68642	Fee-for-Service	1578577813	1578577813	1	1	KANDALAFT, NAJI MD DO	5/1/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	46044	41	Internal Medicine	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
68681	Fee-for-Service	1720147481	1720147481	1	1	KANG, JUSTIN S MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61530	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
68717	Fee-for-Service	1497814008	1497814008	1	1	KIM, SANDRA D MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63396	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
68745	Fee-for-Service	1750624193	1750624193	1	1	KAPOOR, RIDHIMA MD	4/23/2022	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162742	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
68752	Fee-for-Service	1316234693	1316234693	1	1	KAZZAZ, NAYEF M MD	12/8/2020	207RR0500X	NA	Other	026	PHYSICIANS	153572	None	None	0	In state provider	None	6180 BROCKTON AVE	SUITE 204	RIVERSIDE	CA	92506	2233	33	06065	33.958692	-117.3967415	Riverside County
68772	Fee-for-Service	1801949664	1801949664	1	1	KULKA, WILLIAM E MD	11/14/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	86280	-	NOT APPLICABLE	0	In state provider	None	81-557 DR CARREON BLVD	SUITE C-10	INDIO	CA	92201	5517	33	06065	33.70743317	-116.2302643	Riverside County
68823	Fee-for-Service	1861495301	1861495301	1	1	KAUFMAN, JEFFREY E MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35977	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
68828	Fee-for-Service	1356683247	1356683247	1	1	KARBINOVSKAYA, YELENA MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150134	40	Pediatrics	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
68837	Fee-for-Service	1972862613	1972862613	1	1	KILDAY, PATRICK S MD	5/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123938	34	Urology and Urological Surgery	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
68872	Fee-for-Service	1306940705	1306940705	1	1	KIM, STANLEY I MD	4/30/1988	207RH0003X	NA	Oncology	026	PHYSICIANS	42574	41	Internal Medicine	0	In state provider	None	981 W FOOTHILL BLVD	None	CLAREMONT	CA	91711	3304	19	06037	34.10713449	-117.733491	Los Angeles County
68875	Fee-for-Service	1780694430	1780694430	1	1	KEDDINGTON AND KALRA	5/30/2003	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRISTS	1481 E PLAZA BLVD	None	NATIONAL CITY	CA	91950	3613	37	06073	32.6768163	-117.0909096	San Diego County
68876	Fee-for-Service	1275702458	1275702458	1	1	KUZNIK, JENNIFER	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
68881	Fee-for-Service	1588288211	1588288211	1	1	KAHN, ASHLEY M OT	6/17/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	414 E SAN BERNARDINO RD	None	COVINA	CA	91723	1704	19	06037	34.09060121	-117.8831282	Los Angeles County
68884	Fee-for-Service	1063777084	1063777084	1	1	KAUSHAL, RICHA MD	12/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138603	40	Pediatrics	0	In state provider	None	2335 KASHIAN LANE	STE 260	FRESNO	CA	93701	2227	10	06019	36.74333844	-119.7831874	Fresno County
68905	Fee-for-Service	1366621914	1366621914	1	1	KHORSHIDI, SHAHRAM MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101047	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
68931	Fee-for-Service	1053466953	1053466953	1	4	KAISER FOUNDATION HOSPITALS	2/9/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	25975 NORMANDIE AVE	None	HARBOR CITY	CA	90710	3416	19	06037	33.78690131	-118.2975558	Los Angeles County
68934	Fee-for-Service	1447754353	1447754353	1	1	KIM, TERESA H MD	4/25/2023	207ZC0500X	NA	Other	026	PHYSICIANS	167121	None	None	0	In state provider	None	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
68948	Fee-for-Service	1508360256	1508360256	1	1	KONERU, HARSHA MD	11/27/2023	207L00000X	NA	Other	026	PHYSICIANS	165057	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
68969	Fee-for-Service	1356496772	1356496772	1	4	KAISER FOUNDATION HOSPITALS	2/20/2017	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2295 S VINEYARD AVE	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
68992	Fee-for-Service	1215081575	1215081575	1	1	KOVACS, SZABOLCS G MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34788	41	Internal Medicine	0	In state provider	None	31852 COAST HWY	STE 301	LAGUNA BEACH	CA	92651	6766	30	06059	33.49997237	-117.7425025	Orange County
69011	Fee-for-Service	1629034566	1629034566	1	1	KAGEYAMA, DANA MD	2/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6200 N LA CHOLLA BLVD	None	TUCSON	AZ	85741	3529	00	None	32.320323	-111.009951	Pima County
69077	Fee-for-Service	1205927266	1205927266	1	1	KOH, JOON Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23614	01	General Practice	0	In state provider	A MEDICAL CORP	4220 W 3RD ST	STE 208	LOS ANGELES	CA	90020	3450	19	06037	34.0689595	-118.306251	Los Angeles County
69095	Fee-for-Service	1346225844	1346225844	1	1	KAPIL B CHOPRA M.D.	1/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3471 5TH AVE	STE 900	PITTSBURGH	PA	15213	3221	00	None	40.44032894	-79.96049407	Allegheny County
69125	Fee-for-Service	1497716781	1497716781	1	1	KELLY, DOUGLAS	4/1/2024	2085R0001X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
69130	Fee-for-Service	1033168810	1033168810	1	1	KABONGO, MARTIN L MD	10/18/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55012	08	Family Practice	0	In state provider	None	995 GATEWAY CENTER WAY	STE 201	SAN DIEGO	CA	92102	4545	37	06073	32.71405516	-117.1158459	San Diego County
69139	Fee-for-Service	1508179607	1508179607	1	1	KODALI, DHEERAJ MD	8/1/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	172284	None	None	0	In state provider	None	2626 N CALIFORNIA ST	STE B	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
69151	Fee-for-Service	1578527453	1578527453	1	1	KIM, DAI JUNG MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	34120	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2101 FOREST AVE	STE 102	SAN JOSE	CA	95128	1472	43	06085	37.3270795	-121.93731	Santa Clara County
69152	Fee-for-Service	1366936890	1366936890	1	1	KANTZOS, ANDREW J MD	11/6/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	101B 102B 104B 106B 108B	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
69156	Fee-for-Service	1457701765	1457701765	1	1	KYUPELYAN, LEVON MD	7/15/2020	207L00000X	NA	Other	026	PHYSICIANS	156660	05	Anesthesiology	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
69160	Fee-for-Service	1306940705	1306940705	1	1	KIM, STANLEY I MD	4/30/1988	207RH0003X	NA	Oncology	026	PHYSICIANS	42574	68	Hematology	0	In state provider	None	981 W FOOTHILL BLVD	None	CLAREMONT	CA	91711	3304	19	06037	34.10713449	-117.733491	Los Angeles County
69162	Fee-for-Service	1487785036	1487785036	1	1	KREGELOH, MARION	3/19/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
69169	Fee-for-Service	1306053905	1306053905	1	1	KRONGOLD, KAREN PSYD	5/15/2023	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
69189	Fee-for-Service	1003342023	1003342023	1	1	KABOBEL, OLYMPIA DO	9/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16677	08	Family Practice	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
69216	Fee-for-Service	1235675901	1235675901	1	1	KEOHANE, JENNA NP	6/20/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
69218	Fee-for-Service	1053466953	1053466953	1	4	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	25975 NORMANDIE AVE	None	HARBOR CITY	CA	90710	3416	19	06037	33.78690131	-118.2975558	Los Angeles County
69244	Fee-for-Service	1427076702	1427076702	1	1	KHORRAMIAN, ROBERT DPM	7/6/1994	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	APC	2222 SANTA MONICA BLVD	STE 305	SANTA MONICA	CA	90404	2307	19	06037	34.03052319	-118.4776873	Los Angeles County
69255	Fee-for-Service	1356496772	1356496772	1	4	KAISER FOUNDATION HOSPITALS	2/20/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2295 S VINEYARD AVE	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
69271	Fee-for-Service	1184617763	1184617763	1	1	KASSABIAN, LEO MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74898	22	Pathology (M.D. only)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
69330	Fee-for-Service	1467654061	1467654061	1	1	KOUYOUMJIAN, PAUL B MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116239	None	None	0	In state provider	None	500 N CENTRAL AVE	4TH FLOOR	GLENDALE	CA	91203	1928	19	06037	34.15321627	-118.2578985	Los Angeles County
69362	Fee-for-Service	1205927266	1205927266	1	1	KOH, JOON Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23614	20	Orthopedic Surgery	0	In state provider	A MEDICAL CORP	4220 W 3RD ST	STE 208	LOS ANGELES	CA	90020	3450	19	06037	34.0689595	-118.306251	Los Angeles County
69367	Fee-for-Service	1801270244	1801270244	1	1	KAPOOR, SMITA LMFT	2/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1881 COMMERCENTER DRIVE	SUITE 232	SAN BERNARDINO	CA	92408	3479	36	06071	34.06789529	-117.2822533	San Bernardino County
69392	Fee-for-Service	1952483406	1952483406	1	1	KARUK TRIBE	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	C	64109 HILLSIDE ROAD	None	HAPPY CAMP	CA	96039	1016	47	06093	41.7941043	-123.3753767	Siskiyou County
69435	Fee-for-Service	1427412220	1427412220	1	1	KUMAR, KEVIN K MD	6/26/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	151844	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
69444	Fee-for-Service	1962638700	1962638700	1	1	KENKEL, LAURA E MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116412	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
69452	Fee-for-Service	1336379874	1336379874	1	1	KVALE, JOHN J	6/21/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1495 VICTOR AVE	SUITE D	REDDING	CA	96003	4093	45	06089	40.586022	-122.338834	Shasta County
69500	Fee-for-Service	1124858972	1124858972	1	1	KUCICH, ALEXANDER PT	9/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13019 STOCKDALE HWY	500	BAKERSFIELD	CA	93314	9570	15	06029	35.35418947	-119.147103	Kern County
69505	Fee-for-Service	1578025151	1578025151	1	1	KORAKAVI, GAUTAM R MD	4/10/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
69525	Fee-for-Service	1699871699	1699871699	1	1	KHAN, IMRAN A MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91758	20	Orthopedic Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
69552	Fee-for-Service	1285029256	1285029256	1	1	KARLIN, JENNIFER T MD	5/1/2018	390200000X	NA	Other	026	PHYSICIANS	144397	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
69553	Fee-for-Service	1922154699	1922154699	1	1	KELMINSON, KAREN L MD	11/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13123 E 16TH	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
69566	Fee-for-Service	1629545876	1629545876	1	1	KARIM, MICHAEL I PT	2/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 MISSION INN AVE	B	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
69573	Fee-for-Service	1720084098	1720084098	1	1	KAPLAN, BRUCE D MD	2/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
69624	Fee-for-Service	1063704963	1063704963	1	1	KUCHTA, ALISON L MD	6/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126236	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
69631	Fee-for-Service	1285680934	1285680934	1	1	KLEIN, MICHAEL K MD APC	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	37496	30	Radiology	0	In state provider	None	555 S 7TH AVE	None	BARSTOW	CA	92311	3043	36	06071	34.894062	-117.0196215	San Bernardino County
69676	Fee-for-Service	1346356961	1346356961	1	1	KEILLER, DANNY L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32092	34	Urology and Urological Surgery	0	In state provider	None	233 A ST	STE 608	SAN DIEGO	CA	92101	4007	37	06073	32.71880449	-117.162324	San Diego County
69677	Fee-for-Service	1073691713	1073691713	1	1	KELLY, JULIE MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61216	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
69680	Fee-for-Service	1952483406	1952483406	1	1	KARUK TRIBE	4/28/2006	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	C	64109 HILLSIDE ROAD	None	HAPPY CAMP	CA	96039	1016	47	06093	41.7941043	-123.3753767	Siskiyou County
69719	Fee-for-Service	1346332293	1346332293	1	1	KAY, ROSANNE MD	11/30/1994	207P00000X	NA	Other	026	PHYSICIANS	80428	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
69750	Fee-for-Service	1033678248	1033678248	1	1	KOAM PHARMACY LTC INC	3/4/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18102 PIONEER BLVD	102	ARTESIA	CA	90701	3953	19	06037	33.86654413	-118.0821405	Los Angeles County
69752	Fee-for-Service	1114977717	1114977717	1	1	KNOPOFF, RACHEL ANNE MD	3/31/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	76330	30	Radiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
69762	Fee-for-Service	1932271780	1932271780	1	1	KONSTAN, ZAHAROFF JR	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	57749	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
69797	Fee-for-Service	1083243190	1083243190	1	1	KEHR, WILLIAM P MD	7/17/2023	207P00000X	NA	Other	026	PHYSICIANS	178116	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
69843	Fee-for-Service	1073611778	1073611778	1	1	KOVACS, ANDREA MD	12/31/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	41428	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
69844	Fee-for-Service	1427050871	1427050871	1	1	KENI, ARUN MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	36822	08	Family Practice	0	In state provider	None	511 W COLUMBUS ST	None	BAKERSFIELD	CA	93301	1201	15	06029	35.39718795	-119.0060452	Kern County
69880	Fee-for-Service	1609063387	1609063387	1	1	KIM, JIN-YON J MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99274	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
69888	Fee-for-Service	1487840443	1487840443	1	1	KUO, CHRISTIN S MD	7/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93730	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
69929	Fee-for-Service	1487670485	1487670485	1	1	KHAN, MOHAMMAD Q MD	3/22/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	31322	41	Internal Medicine	0	In state provider	None	1535 W MERCED AVE	STE 302	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
69934	Fee-for-Service	1588860951	1588860951	1	1	KAISER FND HLTH PLAN	8/23/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #572	4501 SAND CREEK RD	1ST FLR RM 1125	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
69966	Fee-for-Service	1952483406	1952483406	1	1	KARUK TRIBE	9/1/2002	207Q00000X	NA	Adult Primary Care	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	C	64109 HILLSIDE ROAD	None	HAPPY CAMP	CA	96039	1016	47	06093	41.7941043	-123.3753767	Siskiyou County
70087	Fee-for-Service	1518130103	1518130103	1	1	KNOPF, MICHELLE D LCSW	3/16/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	23950 PRADO LN	None	COLTON	CA	92324	9734	36	06071	34.0408913	-117.2816613	San Bernardino County
70090	Fee-for-Service	1942490230	1942490230	1	1	KING, BRIAN PSYD	7/25/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1330 LINCOLN AVE	STE 106B	SAN RAFAEL	CA	94901	2141	21	06041	37.97629089	-122.5226851	Marin County
70176	Fee-for-Service	1487840443	1487840443	1	1	KUO, CHRISTIN S MD	7/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93730	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
70180	Fee-for-Service	1265640007	1265640007	1	1	KHANIJOU, PRITI P MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97736	41	Internal Medicine	0	In state provider	None	15 MAREBLU	STE 100	ALISO VIEJO	CA	92656	3046	30	06059	33.5729913	-117.703431	Orange County
70183	Fee-for-Service	1356393656	1356393656	1	1	KELLER, DAVID L MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77409	41	Internal Medicine	0	In state provider	None	3524 TORRANCE BLVD	STE 100	TORRANCE	CA	90503	4821	19	06037	33.8355	-118.3472955	Los Angeles County
70188	Fee-for-Service	1063459477	1063459477	1	1	KAHN,WAYMOST,CHALISON,	5/31/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	JASPER, MD'S. INC	201 S ALVARADO ST	STE 828	LOS ANGELES	CA	90057	2395	19	06037	34.06417777	-118.2719543	Los Angeles County
70233	Fee-for-Service	1801149802	1801149802	1	1	KIM, JAMES K MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118604	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
70236	Fee-for-Service	1902997554	1902997554	1	1	KIMBERLY MARTINI	12/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
70284	Fee-for-Service	1780115790	1780115790	1	1	KWON, MATTHEW Y MD	12/13/2022	207P00000X	NA	Other	026	PHYSICIANS	175875	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
70303	Fee-for-Service	1427199496	1427199496	1	1	KREUTZER, CARIN BUJOLD	7/1/2004	133VN1004X	NA	Other	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	CMS NUTRITION CONSULTANT	5632 WISH AVE	None	ENCINO	CA	91316	1408	19	06037	34.17338848	-118.5059305	Los Angeles County
70309	Fee-for-Service	1760671549	1760671549	1	1	KIM, SUSIE MD	8/22/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	103623	40	Pediatrics	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
70321	Fee-for-Service	1629437629	1629437629	1	1	KINCAID, ADAM J MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144749	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
70336	Fee-for-Service	1053687038	1053687038	1	1	KAFER, ILANA A MD	10/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
70345	Fee-for-Service	1124381470	1124381470	1	1	KATHERINE JOSEPH MD	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3001 SANFORD PKWY	None	THIEF RVR FLS	MN	56701	2700	00	None	48.09048226	-96.19641455	Pennington County
70352	Fee-for-Service	1730239617	1730239617	1	1	KAMAYA, AYA MD	9/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87496	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
70358	Fee-for-Service	1780818005	1780818005	1	1	KRALL, PETER J MD	4/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130270	18	Ophthalmology	0	In state provider	None	2067 W VISTA WAY	STE 120	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
70370	Fee-for-Service	1699549113	1699549113	1	1	KIHARA, BRENDAN PT	1/22/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
70427	Fee-for-Service	1902898059	1902898059	1	1	KAHAN, DAVID LAWRENCE	1/31/1995	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6130 FAIR OAKS BLVD	STE C	CARMICHAEL	CA	95608	4859	34	06067	38.612763	-121.328388	Sacramento County
70433	Fee-for-Service	1831480276	1831480276	1	1	KEELING, TRAVIS N MD	10/2/2018	207P00000X	NA	Other	026	PHYSICIANS	141383	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
70434	Fee-for-Service	1518595826	1518595826	1	1	KRUCKENBERG, KATHERINE M MD	8/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	184317	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
70468	Fee-for-Service	1558624957	1558624957	1	1	KWON, JAE W DO	7/3/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16207	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
70472	Fee-for-Service	1356393656	1356393656	1	1	KELLER, DAVID L MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77409	08	Family Practice	0	In state provider	None	3524 TORRANCE BLVD	STE 100	TORRANCE	CA	90503	4821	19	06037	33.8355	-118.3472955	Los Angeles County
70483	Fee-for-Service	1720302763	1720302763	1	1	KHUC, MONIKA H LMFT	8/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3711 LONG BEACH BLVD	601	LONG BEACH	CA	90807	3315	19	06037	33.824583	-118.1893785	Los Angeles County
70497	Fee-for-Service	1932238607	1932238607	1	2	KAPADIA, MITUL R MD	3/1/2021	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1595 QUINTARA ST	None	SAN FRANCISCO	CA	94116	1273	38	06075	37.74829578	-122.4824422	San Francisco County
70524	Fee-for-Service	1467611988	1467611988	1	1	KURYLO, JOHN C MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142617	20	Orthopedic Surgery	0	In state provider	None	2826 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047614	-124.1355056	Humboldt County
70572	Fee-for-Service	1922043710	1922043710	1	1	KAYEM, MARC J MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49693	01	General Practice	0	In state provider	None	3831 HUGHES AVE	None	CULVER CITY	CA	90232	2751	19	06037	34.02243278	-118.3981492	Los Angeles County
70576	Fee-for-Service	1992091979	1992091979	1	1	KAPADIA, AMI R MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117708	41	Internal Medicine	0	In state provider	None	395 HICKEY BOULEVARD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
70584	Fee-for-Service	1295994689	1295994689	1	1	KRATZERT, WOLF B	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	97168	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
70642	Fee-for-Service	1003987124	1003987124	1	1	KLIMA, KATHRYN A MD	1/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122013	30	Radiology	0	In state provider	None	411 30TH ST	STE 508	OAKLAND	CA	94609	3303	01	06001	37.81903474	-122.2649444	Alameda County
70672	Fee-for-Service	1235196296	1235196296	1	1	KHANAFSHAR, ELHAM MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76213	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
70685	Fee-for-Service	1518963032	1518963032	1	1	KUMAR, ASHOK MD	4/30/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	38582	41	Internal Medicine	0	In state provider	None	4477 W 118TH ST	STE 200	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
70703	Fee-for-Service	1881819837	1881819837	2	1	KINGSLEY PLACE ADULT HEALTH	11/30/2009	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	DAY CARE II	1225 JAMES M WOOD BLVD	None	LOS ANGELES	CA	90015	1231	19	06037	34.04875467	-118.2684606	Los Angeles County
70705	Fee-for-Service	1275657454	1275657454	1	1	KO, GRANT N MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	49179	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
70721	Fee-for-Service	1124476270	1124476270	1	3	KHADER, WASEEM M DO	6/14/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	16567	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
70724	Fee-for-Service	1669775227	1669775227	1	1	KOENIG, MARLA M MFT	10/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	78639	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
70829	Fee-for-Service	1528632692	1528632692	1	1	KIRCALIOGLU, GAMZE CNP	10/13/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
70861	Fee-for-Service	1942618905	1942618905	1	1	KOTLA, NISHITHA R MD	7/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148723	41	Internal Medicine	0	In state provider	None	11795 EDUCATION ST	SUITE 100	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
70869	Fee-for-Service	1407353501	1407353501	1	1	KOHLER, ELSPETH L OT	9/16/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
70902	Fee-for-Service	1538121140	1538121140	1	1	KIM, EUGENE S MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128878	85	Surgery-Pediatric	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
70948	Fee-for-Service	1235265844	1235265844	1	1	KISKILA, NATHAN MD	12/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104532	70	Clinic (mixed specialty)	0	In state provider	None	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
70955	Fee-for-Service	1174544472	1174544472	1	1	KOE, NELSON E MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75682	05	Anesthesiology	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
70961	Fee-for-Service	1235196296	1235196296	1	1	KHANAFSHAR, ELHAM MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76213	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
70973	Fee-for-Service	1477564607	1477564607	1	1	KIM, CHIN SE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46079	01	General Practice	0	In state provider	None	1736 W MEDICAL CENTER DR	STE B	ANAHEIM	CA	92801	1854	30	06059	33.8517485	-117.9431595	Orange County
70975	Fee-for-Service	1497021976	1497021976	1	1	KANE, PHILIPPE PSYD	10/28/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
70976	Fee-for-Service	1518963032	1518963032	1	1	KUMAR, ASHOK MD	4/30/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	38582	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4477 W 118TH ST	STE 200	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
70993	Fee-for-Service	1427648179	1427648179	1	1	KARWAT, ARIEL CNP	7/1/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
71001	Fee-for-Service	1386315992	1386315992	1	1	KIM, JANET H NP	12/16/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
71014	Fee-for-Service	1568647501	1568647501	1	1	KRUEGER, MICHAEL L DO	10/1/2001	193400000X	NA	Other	026	PHYSICIANS	6760	20	Orthopedic Surgery	0	In state provider	INC	7033 N FRESNO ST	STE 301	FRESNO	CA	93720	2979	10	06019	36.838044	-119.7813175	Fresno County
71022	Fee-for-Service	1952360364	1952360364	1	1	KAABIPOUR, EMAD MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95231	22	Pathology (M.D. only)	0	In state provider	None	2625 COFFEE RD	None	MODESTO	CA	95355	2005	50	06099	37.67888506	-120.9759048	Stanislaus County
71056	Fee-for-Service	1255156600	1255156600	1	1	K & S SILVERSTEIN INC	1/4/2025	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2112 N GLENOAKS BLVD	None	BURBANK	CA	91504	2827	19	06037	34.19806822	-118.3265669	Los Angeles County
71078	Fee-for-Service	1255497434	1255497434	1	1	KEHOE, NICOLE H MD	7/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82016	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
71124	Fee-for-Service	1740380633	1740380633	1	1	KELLY, KIM E LMFT	7/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 S JUNIPER ST	STE 115	ESCONDIDO	CA	92025	4924	37	06073	33.12052612	-117.0770162	San Diego County
71143	Fee-for-Service	1144378951	1144378951	1	1	KAISER FOUND. HOSPITAL	6/13/1995	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	OUTPATIENT PHARMACY	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
71161	Fee-for-Service	1265807119	1265807119	1	1	KENDIS, DAVID PHD	10/26/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2115 S CENTERPOINTE PARK	None	SANTA MARIA	CA	93455	1334	42	06083	34.92292048	-120.428709	Santa Barbara County
71165	Fee-for-Service	1861834921	1861834921	1	1	KALRA, SIMRUN J MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145759	36	Psychiatry	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
71188	Fee-for-Service	1538121140	1538121140	1	1	KIM, EUGENE S MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128878	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
71229	Fee-for-Service	1033560677	1033560677	1	1	KRISTIN LOISELLE RICH	8/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
71234	Fee-for-Service	1770149502	1770149502	1	1	KALAYDJIAN, ARSINE LMFT	7/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVE	114	SAN FERNANDO	CA	91340	2989	19	06037	34.28449525	-118.4396137	Los Angeles County
71235	Fee-for-Service	1790929602	1790929602	1	1	KIM, CHARLES MD	6/10/2010	207L00000X	NA	Other	026	PHYSICIANS	101698	05	Anesthesiology	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94039	7025	43	06085	37.36893518	-122.0779448	Santa Clara County
71246	Fee-for-Service	1083639181	1083639181	1	1	KIM, CHANG H OD	12/16/1990	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7100 VAN NUYS BLVD	SUITE 208	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
71248	Fee-for-Service	1235196296	1235196296	1	1	KHANAFSHAR, ELHAM MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76213	47	Miscellaneous	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
71256	Fee-for-Service	1538202726	1538202726	1	1	KELADA, MERVAT G AMC	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	48353	08	Family Practice	0	In state provider	None	207 E BARIONI ST	None	IMPERIAL	CA	92251	0000	13	06025	32.8475283	-115.5685362	Imperial County
71267	Fee-for-Service	1336725316	1336725316	1	1	KO, TAE WUK	5/6/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	179880	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
71285	Fee-for-Service	1215312111	1215312111	1	1	KATSIKOS, ASHLEY M OD	10/19/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
71293	Fee-for-Service	1063251007	1063251007	1	1	KAHN, ERIK V LMFT	6/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
71302	Fee-for-Service	1447687272	1447687272	1	1	KIM, MIN H CRNA	12/9/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.85429451	-117.8446551	Orange County
71304	Fee-for-Service	1568647501	1568647501	1	1	KRUEGER, MICHAEL L DO	10/1/2001	193400000X	NA	Other	026	PHYSICIANS	6760	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	7033 N FRESNO ST	STE 301	FRESNO	CA	93720	2979	10	06019	36.838044	-119.7813175	Fresno County
71326	Fee-for-Service	1922061308	1922061308	1	1	KAMMERMAN, MICHAEL R	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	58291	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
71332	Fee-for-Service	1942372693	1942372693	1	1	KHAN, ASMINA MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79732	05	Anesthesiology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
71336	Fee-for-Service	1801056700	1801056700	1	1	KHAN, SONIA F MD	2/1/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	49044	-	NOT APPLICABLE	0	In state provider	None	39155 LIBERTY ST	E500	FREMONT	CA	94537	5006	01	06001	37.55123907	-121.9828956	Alameda County
71348	Fee-for-Service	1770649071	1770649071	1	1	KELLY, PETER D MD	4/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84618	30	Radiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
71349	Fee-for-Service	1689701229	1689701229	1	1	KAMENETSKY, DIANNE MD	5/29/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	75315	07	Dermatology	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
71420	Fee-for-Service	1487159901	1487159901	1	1	KAPUR, SHIVANI MD	2/3/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	173661	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
71436	Fee-for-Service	1154694354	1154694354	1	1	KWAN, CORINA M DO	6/23/2023	207ZP0102X	NA	Other	026	PHYSICIANS	11306	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
71437	Fee-for-Service	1235444068	1235444068	1	1	KALTGRAD, JULIE E MD	12/11/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	118201	01	General Practice	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
71441	Fee-for-Service	1174155808	1174155808	1	1	KB DRUGS INC	4/4/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17822 BEACH BLVD	1	HUNTINGTON BEACH	CA	92647	7101	30	06059	33.70331388	-117.9890471	Orange County
71446	Fee-for-Service	1205571734	1205571734	1	1	KUNJ GOVIND PATEL MD PC	6/12/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4879 MISSION ST	None	SAN FRANCISCO	CA	94112	3413	38	06075	37.72038542	-122.4380576	San Francisco County
71449	Fee-for-Service	1437934155	1437934155	1	1	KIM, CHRISTINA NP	1/15/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	77 ROLLING OAKS DR	#201	THOUSAND OAKS	CA	91361	1018	56	06111	34.17577423	-118.8748925	Ventura County
71457	Fee-for-Service	1053559732	1053559732	1	1	KASEM, AMANDA J MD	12/10/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
71462	Fee-for-Service	1174885859	1174885859	1	1	KURTIS WAYNE BRADLEY DO	10/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
71570	Fee-for-Service	1932911815	1932911815	1	1	KITCHENS, JAKE CRNA	3/3/2025	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
71587	Fee-for-Service	1285781500	1285781500	1	1	KAISER FOUNDATION HOSP	6/10/1971	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #305	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1700	19	06037	34.03781261	-118.3755101	Los Angeles County
71592	Fee-for-Service	1568647501	1568647501	1	1	KRUEGER, MICHAEL L DO	10/1/2001	193400000X	NA	Other	026	PHYSICIANS	6760	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	7033 N FRESNO ST	STE 301	FRESNO	CA	93720	2979	10	06019	36.838044	-119.7813175	Fresno County
71594	Fee-for-Service	1275816654	1275816654	1	1	KUMAR, SUNEEL MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143266	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
71614	Fee-for-Service	1922061308	1922061308	1	1	KAMMERMAN, MICHAEL R	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	58291	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
71624	Fee-for-Service	1801836606	1801836606	1	1	KACHHI, PRANAV N MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
71677	Fee-for-Service	1720576705	1720576705	1	1	KRONENBERG, DANIEL G MD	9/12/2023	208800000X	NA	Other	026	PHYSICIANS	164470	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
71728	Fee-for-Service	1467441006	1467441006	1	1	KOUTNIK, DEBRA L MD	3/1/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	555 BLACK OAK DR	None	MEDFORD	OR	97504	8447	00	None	42.318873	-122.835653	Jackson County
71766	Fee-for-Service	1053427328	1053427328	1	1	KANWIT, ELIZABETH D MD	3/19/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	47722	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
71814	Fee-for-Service	1629237045	1629237045	1	1	KUNHI VEEDU, HARI PRASAD MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133140	13	Neurology (M.D. only)	0	In state provider	None	1700 MT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
71817	Fee-for-Service	1851971428	1851971428	1	1	KHUNKHUN, PRABHDEEP K MD	3/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
71869	Fee-for-Service	1538571856	1538571856	1	1	KHALILZADEH, OMID MD	6/4/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159409	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
71886	Fee-for-Service	1104881523	1104881523	1	1	KUMARATNE, MOHAN	6/9/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35327	40	Pediatrics	0	In state provider	None	17692 BEACH BLVD	STE 200	HUNTINGTON BEACH	CA	92647	6810	30	06059	33.705462	-117.9890701	Orange County
71912	Fee-for-Service	1801836606	1801836606	1	1	KACHHI, PRANAV N MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67961	40	Pediatrics	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
72014	Fee-for-Service	1841951548	1841951548	1	1	KABUITU, PERIS W	10/25/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4394 MOUNT KISCO WAY	None	RANCHO CORDOVA	CA	95742	8098	34	06067	38.544993	-121.2369075	Sacramento County
72073	Fee-for-Service	1417690280	1417690280	1	1	KERNIE, CATHERINE G MD	3/28/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	190663	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
72082	Fee-for-Service	1265580112	1265580112	1	1	KUNIN-RIDA, TERI L MD	9/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80071	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
72087	Fee-for-Service	1093758617	1093758617	1	1	KRONEN, FREDERICK MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	51034	None	None	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
72104	Fee-for-Service	1710514849	1710514849	1	1	KUPFERMAN, JUDAH Z MD	6/26/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
72117	Fee-for-Service	1407147044	1407147044	1	1	KOPEC, MARCIN MD	6/16/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186337	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
72129	Fee-for-Service	1932240710	1932240710	1	1	KHANDELWAL, ANUPAM MD	9/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98697	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
72135	Fee-for-Service	1477084283	1477084283	1	1	KINGDON, TYLER C MD	8/1/2023	2080P0203X	NA	Other	026	PHYSICIANS	169524	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
72172	Fee-for-Service	1689100927	1689100927	1	1	KOENIG, JUSTIN S	10/10/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
72174	Fee-for-Service	1104881523	1104881523	1	1	KUMARATNE, MOHAN	6/9/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35327	01	General Practice	0	In state provider	None	17692 BEACH BLVD	STE 200	HUNTINGTON BEACH	CA	92647	6810	30	06059	33.705462	-117.9890701	Orange County
72176	Fee-for-Service	1871712273	1871712273	1	1	KIMBALL, ANTHONY E DPM	8/29/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
72177	Fee-for-Service	1154619393	1154619393	1	1	KAUR, NATASHA MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120285	05	Anesthesiology	0	In state provider	None	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
72179	Fee-for-Service	1659459261	1659459261	1	1	KURTZMAN, KATHRYN N MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66524	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
72187	Fee-for-Service	1821197112	1821197112	1	1	KLEIN, ROBERT R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
72191	Fee-for-Service	1104142736	1104142736	1	1	KHATTAK, AISHA B MD	6/9/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
72217	Fee-for-Service	1831327972	1831327972	1	1	KAMALPOUR, FARI G DO	9/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11842	41	Internal Medicine	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
72263	Fee-for-Service	1316438815	1316438815	1	1	KIRKMAN-LIFF, EMMA LCSW	3/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
72294	Fee-for-Service	1760922017	1760922017	1	1	KNEIR, GENEVIE NP	11/22/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
72302	Fee-for-Service	1841951548	1841951548	1	1	KABUITU, PERIS W	10/25/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4394 MOUNT KISCO WAY	None	RANCHO CORDOVA	CA	95742	8098	34	06067	38.544993	-121.2369075	Sacramento County
72354	Fee-for-Service	1467526095	1467526095	1	1	KAISER FOUNDATION HOSPITAL-	10/8/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOME HEALTH HAYWARD	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	01	06001	37.60846354	-122.0715526	Alameda County
72391	Fee-for-Service	1972600427	1972600427	1	1	KNIPPER, ROBERT C CRNA	10/7/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
72403	Fee-for-Service	1619342003	1619342003	1	1	KAZER, MAX R MD	5/25/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	178491	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
72417	Fee-for-Service	1932240710	1932240710	1	1	KHANDELWAL, ANUPAM MD	9/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98697	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
72435	Fee-for-Service	1508022997	1508022997	1	1	KIM, WON MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115612	14	Neurological Surgery	0	In state provider	None	300 STEIN PLAZA	STE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
72502	Fee-for-Service	1033537014	1033537014	1	1	KHAN, SAAHIR MD	5/17/2019	390200000X	NA	Other	026	PHYSICIANS	139996	77	Infectious Disease	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
72521	Fee-for-Service	1891070066	1891070066	1	1	KALPARI, KAMRAN MD A MEDICAL	10/25/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75275	41	Internal Medicine	0	In state provider	CORPORATION	8797 BEVERLY BLVD	STE 315	WEST HOLLYWOOD	CA	90048	1862	19	06037	34.07720377	-118.3835422	Los Angeles County
72576	Fee-for-Service	1952128159	1952128159	1	1	KEYHANI, SANNAZ K CD	10/30/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
72584	Fee-for-Service	1740276989	1740276989	1	1	KIM, GRACE L MD	12/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48699	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DRIVE	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
72593	Fee-for-Service	1164734489	1164734489	1	1	KHAN, MUTAHIR U MD	7/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112898	41	Internal Medicine	0	In state provider	None	1401 SPANOS COURT	SUITE 230	MODESTO	CA	95355	2816	50	06099	37.66975543	-120.9724048	Stanislaus County
72605	Fee-for-Service	1700119609	1700119609	1	1	KERNUTT, TIFFANY K LCSW	3/9/2020	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
72609	Fee-for-Service	1023692035	1023692035	1	1	KAPADIA, ANKUR MD	9/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
72624	Fee-for-Service	1487100459	1487100459	1	1	KLANIECKI, CINDY LCSW	5/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	210 COON HEIGHTS RD	None	BEN LOMOND	CA	95005	9711	44	06087	37.07318343	-122.0864707	Santa Cruz County
72631	Fee-for-Service	1679929871	1679929871	1	1	KELLY, SEAN C MD	8/28/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	160318	20	Orthopedic Surgery	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
72643	Fee-for-Service	1619695608	1619695608	1	1	KIM, ELLIE NP	7/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
72652	Fee-for-Service	1932242062	1932242062	1	1	KAO, JELENA M MD	4/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83980	78	Neoplastic Diseases/Oncology	0	In state provider	None	13847 EAST 14TH ST	STE 217	SAN LEANDRO	CA	94578	2626	01	06001	37.71457844	-122.1418551	Alameda County
72706	Fee-for-Service	1629170006	1629170006	1	1	KUHLMAN, CHRISTOPHER D	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71808	None	None	0	In state provider	MD	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
72775	Fee-for-Service	1215175856	1215175856	1	1	KAWAI, MAKOTO MD	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54396	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
72789	Fee-for-Service	1821146184	1821146184	1	1	KISHORE, ANJALI M PT	4/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
72800	Fee-for-Service	1861717548	1861717548	1	1	KELLAR, JESSE Z MD	6/21/2019	207P00000X	NA	Other	026	PHYSICIANS	117898	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
72828	Fee-for-Service	1508891029	1508891029	1	1	KILGORE, WILLIAM B MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94844	20	Orthopedic Surgery	0	In state provider	None	2826 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047614	-124.1355056	Humboldt County
72833	Fee-for-Service	1548573215	1548573215	1	1	KHODADOUST, MICHAEL S MD	12/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118295	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
72838	Fee-for-Service	1992291975	1992291975	1	1	KENDALL, ALLISON I OD	8/3/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	SUITE 401	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
72864	Fee-for-Service	1003001157	1003001157	1	1	KIM, DAVID C MD	7/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82018	40	Pediatrics	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
72896	Fee-for-Service	1821063603	1821063603	1	1	KHAN, ARSHAD MD	2/8/2022	207L00000X	NA	Other	026	PHYSICIANS	72493	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
72900	Fee-for-Service	1700058963	1700058963	1	1	KUMAR, MONICA P MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103086	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
72925	Fee-for-Service	1336275007	1336275007	1	1	KHOSHSAR, ROSTAM MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88430	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
72938	Fee-for-Service	1831151992	1831151992	2	1	KHEHAR, BHUPINDER S MD	8/22/2010	207R00000X	NA	Other	026	PHYSICIANS	61891	41	Internal Medicine	0	In state provider	None	4060 4TH AVE	STE 335	SAN DIEGO	CA	92103	2143	37	06073	32.75053673	-117.1616539	San Diego County
72943	Fee-for-Service	1932242062	1932242062	1	1	KAO, JELENA M MD	4/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83980	68	Hematology	0	In state provider	None	13847 EAST 14TH ST	STE 217	SAN LEANDRO	CA	94578	2626	01	06001	37.71457844	-122.1418551	Alameda County
73044	Fee-for-Service	1669761151	1669761151	1	1	KIDDER, WESLEY A MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125085	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
73045	Fee-for-Service	1144971912	1144971912	1	2	KNB TRANSPORTATION INC	10/24/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4100 ALAMEDA AVE	387	BURBANK	CA	91505	4195	19	06037	34.1526111	-118.3447742	Los Angeles County
73083	Fee-for-Service	1235319500	1235319500	1	1	KHANNA, GAURAV MD	6/30/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	167024	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
73089	Fee-for-Service	1871504530	1871504530	1	1	KOPS, RICHARD S MD	8/26/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30623	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 311	CONCORD	CA	94520	1814	07	06013	37.98507961	-122.034189	Contra Costa County
73096	Fee-for-Service	1255809117	1255809117	1	1	KWON, HANNAH LMFT	9/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSO	#300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
73123	Fee-for-Service	1548573215	1548573215	1	1	KHODADOUST, MICHAEL S MD	12/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118295	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
73130	Fee-for-Service	1588837660	1588837660	1	1	KAUR, GURINDER NP	3/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1245 E HERNDON AVE	None	FRESNO	CA	93720	3235	10	06019	36.83626267	-119.7674845	Fresno County
73134	Fee-for-Service	1154372423	1154372423	1	1	KROEGER, KEVIN R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85712	13	Neurology (M.D. only)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
73170	Fee-for-Service	1881822682	1881822682	1	1	KANSAGRA, AKASH P	3/25/2022	2085N0700X	NA	MRI Provider	026	PHYSICIANS	114756	None	None	0	In state provider	None	9834 GENESEE AVE	411	LA JOLLA	CA	92037	1223	37	06073	32.884074	-117.225855	San Diego County
73172	Fee-for-Service	1760424600	1760424600	1	1	KNAUSS, ROBIN P MD	1/18/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80549	None	None	0	In state provider	None	700 ALAMO PINTADO RD	None	SOLVANG	CA	93463	2269	42	06083	34.60203	-120.1262085	Santa Barbara County
73202	Fee-for-Service	1184688061	1184688061	1	1	KAY, JOHNSON C S DO	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	83	Rheumatology	1	Border provider	None	1707 W CHARLESTON BLVD	STE 220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
73204	Fee-for-Service	1275890923	1275890923	1	1	KAN, KATHLEEN M MD	9/9/2019	2088P0231X	NA	Other	026	PHYSICIANS	149133	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
73219	Fee-for-Service	1932238607	1932238607	1	1	KAPADIA, MITUL R MD	1/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117813	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
73230	Fee-for-Service	1033972815	1033972815	1	1	KELLY, LI CNP	3/15/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
73239	Fee-for-Service	1013060888	1013060888	1	2	KOZART, MICHAEL MD	1/3/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	80689	-	NOT APPLICABLE	0	In state provider	None	2245 CHALLENGER WAY	STE 100	SANTA ROSA	CA	95407	5418	49	06097	38.42559	-122.751243	Sonoma County
73276	Fee-for-Service	1083971014	1083971014	1	1	KADHIM, AHMAD A MD	10/31/2022	208M00000X	NA	Other	026	PHYSICIANS	166082	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
73298	Fee-for-Service	1285220491	1285220491	1	1	KHOSRAWI, SWEETA	6/1/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
73317	Fee-for-Service	1831356518	1831356518	1	1	KARANDIKAR, KALYANI V MD	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110574	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	STE 4TH FLOOR	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
73343	Fee-for-Service	1992970800	1992970800	1	1	KHANKARI, SHWETA K MD	2/5/2024	207R00000X	NA	Other	026	PHYSICIANS	170159	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
73347	Fee-for-Service	1700821972	1700821972	1	1	KERN RADIOLOGY MED GRP	4/1/1999	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3838 SAN DIMAS ST	STE A120	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
73368	Fee-for-Service	1902932676	1902932676	1	1	KUWAMOTO, MARTIN K DC	7/6/1979	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2384 E GETTYSBURG AVE	None	FRESNO	CA	93726	0320	10	06019	36.80128652	-119.782764	Fresno County
73379	Fee-for-Service	1871504530	1871504530	1	1	KOPS, RICHARD S MD	8/26/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30623	41	Internal Medicine	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 311	CONCORD	CA	94520	1814	07	06013	37.98507961	-122.034189	Contra Costa County
73387	Fee-for-Service	1740349489	1740349489	1	1	KAHWAJI, JOSEPH M MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84085	45	Nephrology (Renal-Kidney)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
73388	Fee-for-Service	1225116114	1225116114	1	1	KIRCHER, JOHN MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	72653	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
73406	Fee-for-Service	1700096351	1700096351	1	1	KRAVETZ, JOSHUA E DO	1/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13710	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
73408	Fee-for-Service	1548573215	1548573215	1	1	KHODADOUST, MICHAEL S MD	12/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118295	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
73421	Fee-for-Service	1154372423	1154372423	1	1	KROEGER, KEVIN R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85712	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
73434	Fee-for-Service	1619353042	1619353042	1	4	KAWEAH DELTA HEALTH CARE INC	11/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5530 AVENUE DE LOS ROBLE	None	VISALIA	CA	93291	5174	54	06107	36.328365	-119.3525775	Tulare County
73453	Fee-for-Service	1609132299	1609132299	1	1	KAVETI, PUNITA MD	10/7/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	173212	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
73480	Fee-for-Service	1720660525	1720660525	1	1	KUDALKAR, PRAJAKTA PT	3/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 LENNON LN	202	WALNUT CREEK	CA	94598	2483	07	06013	37.92672613	-122.0291022	Contra Costa County
73541	Fee-for-Service	1285822445	1285822445	1	1	KIM, MAY A MD	7/23/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	97289	02	General Surgery	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	4606	19	06037	34.06269295	-118.2030006	Los Angeles County
73570	Fee-for-Service	1336442888	1336442888	1	1	KOUPERSCHMIDT, LARISA A MD	5/25/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171669	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
73572	Fee-for-Service	1871722132	1871722132	1	1	KASSELS, BARRY P MD INC	7/20/2009	193400000X	NA	Other	026	PHYSICIANS	78198	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
73590	Fee-for-Service	1174818140	1174818140	1	1	KIM, JENNIFER J MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142744	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
73627	Fee-for-Service	1023387420	1023387420	1	1	KARIMI, SANAZ MD	7/18/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	134145	13	Neurology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
73646	Fee-for-Service	1992881403	1992881403	1	1	KWONG, MYRON S MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86563	78	Neoplastic Diseases/Oncology	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
73671	Fee-for-Service	1740349489	1740349489	1	1	KAHWAJI, JOSEPH M MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84085	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
73694	Fee-for-Service	1932421344	1932421344	1	1	KWOK, JEFFREY C DO	9/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10697	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
73708	Fee-for-Service	1154372423	1154372423	1	1	KROEGER, KEVIN R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85712	30	Radiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
73711	Fee-for-Service	1194135780	1194135780	1	1	KO, STEVEN Y MD	4/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141088	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
73712	Fee-for-Service	1063094225	1063094225	1	1	KRAK, MICHAEL MD	9/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
73721	Fee-for-Service	1427034115	1427034115	1	1	KINGSTON, RONALD S MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36787	30	Radiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
73726	Fee-for-Service	1295880912	1295880912	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
73737	Fee-for-Service	1184887846	1184887846	1	1	KRISTI T LOPEZ MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
73763	Fee-for-Service	1689969412	1689969412	1	1	KENNARD, ANNE K	8/29/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13574	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1941 JOHNSON AVE	STE 301	SAN LUIS OBISPO	CA	93401	4157	40	06079	35.27804785	-120.649711	San Luis Obispo County
73800	Fee-for-Service	1932390390	1932390390	1	1	KIM, IRENE K MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111330	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
73832	Fee-for-Service	1285822445	1285822445	1	1	KIM, MAY A MD	7/23/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	97289	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	4606	19	06037	34.06269295	-118.2030006	Los Angeles County
73852	Fee-for-Service	1326241415	1326241415	1	1	KAMAL, JAHED MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117208	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
73862	Fee-for-Service	1972789782	1972789782	1	1	KIDCARE EXPRESS II	5/26/2005	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
73884	Fee-for-Service	1013547447	1013547447	1	1	KITILYA, REDISTARD G	1/29/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7891 EL DORADO ST	None	FONTANA	CA	92336	3734	36	06071	34.10976935	-117.4976809	San Bernardino County
73887	Fee-for-Service	1942458229	1942458229	1	1	KOHN, GEOFFREY P MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10883	02	General Surgery	0	In state provider	None	1520 SAN PABLO STREET	SUITE 4300	LOS ANGELES	CA	90033	5330	19	06037	34.06269295	-118.2030006	Los Angeles County
73900	Fee-for-Service	1730690728	1730690728	1	1	KNICKERBOCKER, SANDRA L LMFT	10/18/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	108057	-	NOT APPLICABLE	0	In state provider	None	3988 VISTA WAY	STE E	OCEANSIDE	CA	92056	4514	37	06073	33.18377028	-117.2932059	San Diego County
73905	Fee-for-Service	1184034175	1184034175	1	1	KENNEDY, THOMAS P DO	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15465	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
73938	Fee-for-Service	1992881403	1992881403	1	1	KWONG, MYRON S MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86563	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
73984	Fee-for-Service	1790863777	1790863777	1	1	KRAIG ARTHUR WHITE MD	3/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 S MAIN ST	None	MOSCOW	ID	83843	3056	00	None	46.728594	-117.0013525	Latah County
73986	Fee-for-Service	1124547278	1124547278	1	1	KOBARA, SAMANTHA K CCC-SLP	11/13/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
73998	Fee-for-Service	1619353042	1619353042	1	6	KAWEAH DELTA HEALTH CARE INC	6/20/2017	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	938 N CHERRY ST	None	TULARE	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
74015	Fee-for-Service	1861563827	1861563827	1	1	KHAN, AHSAN M MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90254	18	Ophthalmology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
74036	Fee-for-Service	1366426470	1366426470	1	1	KONG, JAMES S MD	10/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84509	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
74059	Fee-for-Service	1083780027	1083780027	1	1	KWAN, SHARON W Y LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD ROAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
74131	Fee-for-Service	1770635831	1770635831	1	1	KAISER, KENNETH L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	215 2ND ST	None	EUREKA	CA	95501	0319	12	06023	40.80404901	-124.1693977	Humboldt County
74140	Fee-for-Service	1326241415	1326241415	1	1	KAMAL, JAHED MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117208	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
74170	Fee-for-Service	1013547447	1013547447	1	1	KITILYA, REDISTARD G	1/29/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7891 EL DORADO ST	None	FONTANA	CA	92336	3734	36	06071	34.10976935	-117.4976809	San Bernardino County
74177	Fee-for-Service	1598767501	1598767501	1	1	KWPH ENTERPRISES, INC	1/1/1979	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AMERICAN AMBULANCE	2911 E TULARE ST	None	FRESNO	CA	93721	1502	10	06019	36.74323101	-119.7756095	Fresno County
74184	Fee-for-Service	1073741039	1073741039	1	1	KAGWA-NYANZI, J PEDIATRICS	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	45809	40	Pediatrics	0	In state provider	CLINIC INC	117 W WILLOW STREET	SUITE B	POMONA	CA	91768	1829	19	06037	34.07882297	-117.7530397	Los Angeles County
74203	Fee-for-Service	1306248976	1306248976	1	1	KIM, SUNOK NP	2/19/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
74215	Fee-for-Service	1508944331	1508944331	1	1	KIRSTEN, MARKHAM I MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37959	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
74222	Fee-for-Service	1992881403	1992881403	1	1	KWONG, MYRON S MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86563	68	Hematology	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
74233	Fee-for-Service	1992792063	1992792063	1	1	KENNETH LUTSCHG MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	23900 KATY FWY	None	KATY	TX	77494	1323	00	None	29.78594112	-95.78613398	Harris County
74249	Fee-for-Service	1558542696	1558542696	1	2	KURTH, DONALD J JR MD	6/23/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	43963	-	NOT APPLICABLE	0	In state provider	None	510 S SECOND AVE	STE 6 & 7	COVINA	CA	91723	3017	19	06037	34.0805013	-117.8878213	Los Angeles County
74263	Fee-for-Service	1295298339	1295298339	1	1	KIM, JOSEPH H MD	7/21/2023	390200000X	NA	Other	026	PHYSICIANS	181274	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
74315	Fee-for-Service	1780847806	1780847806	1	1	KIM, SARAH MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95235	40	Pediatrics	0	In state provider	None	11980 SAN VICENTE BLVD	STE 102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
74325	Fee-for-Service	1366426470	1366426470	1	1	KONG, JAMES S MD	10/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84509	03	Allergy	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
74338	Fee-for-Service	1194786426	1194786426	1	1	KASRAVI, BABAK MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71710	41	Internal Medicine	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
74389	Fee-for-Service	1437685146	1437685146	1	1	KHOUBIAN, STEVEN H MD	8/6/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170853	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
74426	Fee-for-Service	1588852610	1588852610	1	1	KLUGH III, ARNETT MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	86867	14	Neurological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
74443	Fee-for-Service	1508807462	1508807462	1	1	KUNWAR, SANDEEP M MD	5/18/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81422	14	Neurological Surgery	0	In state provider	None	39500 FREMONT BLVD	STE 100	FREMONT	CA	94538	2119	01	06001	37.5448266	-121.9802588	Alameda County
74471	Fee-for-Service	1922035559	1922035559	1	1	KOLARCZYK, ROBERT A MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41910	18	Ophthalmology	0	In state provider	None	1801 STATE ST	None	SANTA BARBARA	CA	93101	2482	42	06083	34.4290846	-119.7123436	Santa Barbara County
74508	Fee-for-Service	1720023997	1720023997	1	1	KERN RADIOLOGY MED GRP	8/8/1990	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2301 BAHAMAS DR	None	BAKERSFIELD	CA	93309	0663	15	06029	35.37447628	-119.0453594	Kern County
74543	Fee-for-Service	1144221953	1144221953	1	1	KUDARAVALLI, PADMAVATHI	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67964	41	Internal Medicine	0	In state provider	None	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1730	01	06001	37.55887933	-121.9797796	Alameda County
74573	Fee-for-Service	1770739716	1770739716	1	1	KIM, RYAN M DO	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13487	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
74603	Fee-for-Service	1780847806	1780847806	1	1	KIM, SARAH MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95235	41	Internal Medicine	0	In state provider	None	11980 SAN VICENTE BLVD	STE 102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
74624	Fee-for-Service	1558541284	1558541284	1	1	KINDER, MOLLY	5/11/2018	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
74706	Fee-for-Service	1275509135	1275509135	1	1	KATAGIHARA, ELTON S MD	1/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70694	66	Emergency Medicine (Urgent Care)	0	In state provider	None	444 N ALTADENA DR	STE 100	PASADENA	CA	91107	2541	19	06037	34.1539266	-118.0984391	Los Angeles County
74714	Fee-for-Service	1922150234	1922150234	1	1	KIM, INJIB J MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75233	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
74716	Fee-for-Service	1033639273	1033639273	1	1	KIRSCH, ALYSSA K MD	12/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182605	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74731	Fee-for-Service	1508807462	1508807462	1	1	KUNWAR, SANDEEP M MD	5/18/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81422	01	General Practice	0	In state provider	None	39500 FREMONT BLVD	STE 100	FREMONT	CA	94538	2119	01	06001	37.5448266	-121.9802588	Alameda County
74736	Fee-for-Service	1760612931	1760612931	1	1	KEEDY, JACQUELINE R MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127305	41	Internal Medicine	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
74757	Fee-for-Service	1124057922	1124057922	1	1	KUZNIEWICZ, MICHAEL W MD	5/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82488	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
74780	Fee-for-Service	1588743181	1588743181	1	1	KAISER FOUNDATION HOSPITALS	8/18/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3900 FREEDOM CIRCLE	SUITE 201	SANTA CLARA	CA	95054	1222	43	06085	37.38769057	-121.9700955	Santa Clara County
74785	Fee-for-Service	1225105117	1225105117	1	1	KEN'S OPTICAL	9/21/1981	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	2022 N CHESTER AVE	None	BAKERSFIELD	CA	93308	2653	15	06029	35.424999	-119.020893	Kern County
74839	Fee-for-Service	1982058384	1982058384	1	1	KURZWEIL, AMI MD	5/8/2019	390200000X	NA	Other	026	PHYSICIANS	160117	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
74842	Fee-for-Service	1821137175	1821137175	1	1	KUEHNE, TABITHA	10/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	518 S SCHOOL ST	STE 203	UKIAH	CA	95482	5479	23	06045	39.14644789	-123.2079137	Mendocino County
74862	Fee-for-Service	1487772331	1487772331	1	1	KIM, CHIN H LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3251 W 6TH ST	STE 100	LOS ANGELES	CA	90020	5019	19	06037	34.06363872	-118.2931949	Los Angeles County
74883	Fee-for-Service	1346593027	1346593027	1	1	KRUGMAN, AARON B LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD RD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
74917	Fee-for-Service	1962675223	1962675223	1	1	KRANSDORF, LISA N MD	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111918	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
74993	Fee-for-Service	1275509135	1275509135	1	1	KATAGIHARA, ELTON S MD	1/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70694	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	444 N ALTADENA DR	STE 100	PASADENA	CA	91107	2541	19	06037	34.1539266	-118.0984391	Los Angeles County
75001	Fee-for-Service	1922150234	1922150234	1	1	KIM, INJIB J MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75233	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
75026	Fee-for-Service	1922462043	1922462043	1	1	KORNBERG, DANIEL L MD	5/20/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168361	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
75032	Fee-for-Service	1063590859	1063590859	1	1	KELLY, JASON F MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61299	78	Neoplastic Diseases/Oncology	0	In state provider	None	301 PROFESSIONAL CENTER	None	ROHNERT PARK	CA	94928	2152	49	06097	38.35471913	-122.7076253	Sonoma County
75045	Fee-for-Service	1629020482	1629020482	1	1	KNILANS,TIMOTHY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	0000	00	None	39.14105892	-84.50040782	Hamilton County
75072	Fee-for-Service	1417132572	1417132572	1	1	KANG, JENNIFER A MD	10/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125872	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2216 BUENAVENTURA BLVD	SUITE B	REDDING	CA	96001	3838	45	06089	40.55453352	-122.3904825	Shasta County
75109	Fee-for-Service	1316965429	1316965429	1	1	KUHN, REBECCA M MD	4/1/1999	207R00000X	NA	Other	026	PHYSICIANS	65185	41	Internal Medicine	0	In state provider	None	1040 ELM AVE	STE 204	LONG BEACH	CA	90813	3266	19	06037	33.779799	-118.1879535	Los Angeles County
75168	Fee-for-Service	1740547751	1740547751	1	1	KLASSEN, LINDSEY J DPM	8/14/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
75201	Fee-for-Service	1962675223	1962675223	1	1	KRANSDORF, LISA N MD	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111918	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
75205	Fee-for-Service	1083292684	1083292684	1	1	KERTZNER, ALEXANDER E MD	6/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187762	08	Family Practice	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
75212	Fee-for-Service	1386745594	1386745594	1	1	KIM, IN SOO MD	7/12/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38727	20	Orthopedic Surgery	0	In state provider	None	14600 SHERMAN WAY	STE 280	VAN NUYS	CA	91405	2269	19	06037	34.20025916	-118.4500763	Los Angeles County
75226	Fee-for-Service	1417607623	1417607623	1	1	KOTA, NAGAMANI NP	3/12/2025	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	151 CLAYDELLE AVE	None	EL CAJON	CA	92020	4505	37	06073	32.794155	-116.958763	San Diego County
75240	Fee-for-Service	1881691764	1881691764	1	1	KAUFMAN, BRYAN L MD	10/29/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	71486	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
75243	Fee-for-Service	1467776260	1467776260	1	1	KOH, EUNICE Y MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147028	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
75244	Fee-for-Service	1114215845	1114215845	1	1	KREMER, MALLORY E MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137565	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2210 E ILLINOIS AVENUE	STE 408	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
75258	Fee-for-Service	1063774610	1063774610	1	1	KERN, ANNE R MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126416	01	General Practice	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
75271	Fee-for-Service	1144755638	1144755638	1	1	KIEMA, JEDIDAH W	9/7/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6387 POMEGRANATE COURT	None	CORONA	CA	92880	7203	33	06065	33.97212	-117.560838	Riverside County
75279	Fee-for-Service	1750894986	1750894986	1	1	KHAN, MASHAAL LMFT	3/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
75287	Fee-for-Service	1679513659	1679513659	1	1	KUMAR, ANUPAMA MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76522	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
75295	Fee-for-Service	1023356623	1023356623	1	1	KOSAKYAN, TINA MD	12/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134696	41	Internal Medicine	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
75304	Fee-for-Service	1043359979	1043359979	1	1	KOPACZEWSKI, NOREEN LCSW	8/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
75305	Fee-for-Service	1053722363	1053722363	1	1	KIDAMBI, SUMANTH MD	7/13/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	137936	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75310	Fee-for-Service	1457771578	1457771578	1	1	KOU, ELBERT MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156027	05	Anesthesiology	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
75317	Fee-for-Service	1588636492	1588636492	1	1	KNAPP, JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	INTERNATIONAL HEART INST	500 W. BROADWAY	SUITE 320	MISSOULA	MT	59802	0000	00	None	46.874889	-114.000444	Missoula County
75320	Fee-for-Service	1063590859	1063590859	1	1	KELLY, JASON F MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61299	30	Radiology	0	In state provider	None	301 PROFESSIONAL CENTER	None	ROHNERT PARK	CA	94928	2152	49	06097	38.35471913	-122.7076253	Sonoma County
75350	Fee-for-Service	1073543542	1073543542	1	1	KETELAAR, DAVID A MD	8/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77236	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PLAZA DR	None	SANTA MARIA	CA	93454	6907	42	06083	34.93736276	-120.4298781	Santa Barbara County
75357	Fee-for-Service	1053705368	1053705368	1	1	KHALSA, UPTEJ K MD	9/26/2022	2080P0216X	NA	Other	026	PHYSICIANS	154686	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
75379	Fee-for-Service	1205859329	1205859329	1	2	KATZMAN, HAROLD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13945	18	Ophthalmology	0	In state provider	None	8635 W 3RD ST	STE 390W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
75412	Fee-for-Service	1982960985	1982960985	1	1	KNOX, BRADLEY C MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120640	None	None	0	In state provider	None	1100 LAS TABLES ROAD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
75421	Fee-for-Service	1558713636	1558713636	1	1	KINSEY, KELLY ELIZABETH T MD	6/3/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	175876	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
75559	Fee-for-Service	1144755638	1144755638	1	1	KIEMA, JEDIDAH W	9/7/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6387 POMEGRANATE COURT	None	CORONA	CA	92880	7203	33	06065	33.97212	-117.560838	Riverside County
75576	Fee-for-Service	1316988348	1316988348	1	1	KIM, LOUIS T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS-359110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
75579	Fee-for-Service	1013968957	1013968957	1	1	KIM, DANIEL S MD	4/30/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	29336	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
75651	Fee-for-Service	1194119545	1194119545	1	1	KUO, TERESA MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144307	41	Internal Medicine	0	In state provider	None	2238 GEARY BOULEVARD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
75660	Fee-for-Service	1740416346	1740416346	1	1	KIM, MICHELLE M DO	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12346	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
75664	Fee-for-Service	1699162842	1699162842	1	1	KHANKHANIAN, JESSICA L DO	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15117	40	Pediatrics	0	In state provider	None	184 BIMINI PLACE	None	LOS ANGELES	CA	90004	5903	19	06037	34.07060546	-118.290517	Los Angeles County
75684	Fee-for-Service	1871664003	1871664003	1	1	KLEIN, STEFAN F MD	7/20/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	75514	20	Orthopedic Surgery	0	In state provider	None	3143 PAUL SWEET RD	None	SANTA CRUZ	CA	95065	1521	44	06087	36.98906826	-121.9854242	Santa Cruz County
75687	Fee-for-Service	1568626000	1568626000	1	1	KYLE RAY PERRY, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
75688	Fee-for-Service	1316950942	1316950942	1	1	KENNETH BERRY	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 PARK ST	None	HONESDALE	PA	18431	1445	00	None	41.5763098	-75.25979468	Wayne County
75724	Fee-for-Service	1073041927	1073041927	1	1	KAUR, AMANDEEP LMFT	4/26/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	13386 MARENGO RD	None	GALT	CA	95632	8429	34	06067	38.26647	-121.2836535	Sacramento County
75743	Fee-for-Service	1184764615	1184764615	1	1	KIM, HENRY Y MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91015	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
75759	Fee-for-Service	1851402259	1851402259	1	1	KUNOVAC, JELENA MD	5/4/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	66135	36	Psychiatry	0	In state provider	None	3998 VISTA WAY	STE 100	OCEANSIDE	CA	92056	4514	37	06073	33.18370179	-117.292963	San Diego County
75767	Fee-for-Service	1457347411	1457347411	1	1	KIM, DANIEL J MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66568	08	Family Practice	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
75775	Fee-for-Service	1780751735	1780751735	1	1	KHOKHAR, JASWANT MD	8/27/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50719	None	None	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
75803	Fee-for-Service	1821153453	1821153453	1	1	KUMAR, KEERAN MD	5/13/2009	207L00000X	NA	Other	026	PHYSICIANS	95239	05	Anesthesiology	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
75851	Fee-for-Service	1962555938	1962555938	1	1	KINGDOM MEDICAL SUPPLY, INC	10/2/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	KINGDOM MEDICAL SUPPLY	3900 GEARY BLVD	SUITE 104	SAN FRANCISCO	CA	94118	3251	38	06075	37.78125174	-122.4612618	San Francisco County
75857	Fee-for-Service	1619946266	1619946266	1	1	KASOW, MARK MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	39116	01	General Practice	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
75861	Fee-for-Service	1093956013	1093956013	1	1	KNIGHT, O'RESE J MD	2/6/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	184030	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
75905	Fee-for-Service	1164976585	1164976585	1	1	KHAN, RANA S MD	9/4/2018	208600000X	NA	General Surgery	026	PHYSICIANS	149876	02	General Surgery	0	In state provider	SPECIALIST	8120 TIMBERLAKE WAY	SUITE 212	SACRAMENTO	CA	95823	5412	34	06067	38.461023	-121.41414	Sacramento County
75908	Fee-for-Service	1033274238	1033274238	1	1	KHOWONG, ANTOINETTE T MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5 MEDICAL PLAZA DR	STE 250	ROSEVILLE	CA	95661	2868	31	06061	38.76604411	-121.2466761	Placer County
75920	Fee-for-Service	1568504686	1568504686	1	1	KAO, PETER N MD	5/31/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	67731	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
75965	Fee-for-Service	1740882430	1740882430	1	1	KWONG, LINDSAY M NP	6/20/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75971	Fee-for-Service	1871664003	1871664003	1	1	KLEIN, STEFAN F MD	7/20/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	75514	46	Hand Surgery	0	In state provider	None	3143 PAUL SWEET RD	None	SANTA CRUZ	CA	95065	1521	44	06087	36.98906826	-121.9854242	Santa Cruz County
75972	Fee-for-Service	1891172169	1891172169	1	1	KIM, GENE Y MD	11/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172512	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75985	Fee-for-Service	1184772790	1184772790	1	1	KAISER FOUNDATION HE	8/15/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #060	9353 IMPERIAL HWY	FL 1	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
76108	Fee-for-Service	1023101888	1023101888	1	1	KHOURY, ADNAN E MD	2/15/2013	2084F0202X	NA	Psychiatry	026	PHYSICIANS	68659	36	Psychiatry	0	In state provider	None	9449 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
76124	Fee-for-Service	1467878249	1467878249	1	1	KHANJIAN, HAROUT OD	6/18/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 N BROADWAY	None	LOS ANGELES	CA	90031	2219	19	06037	34.07360257	-118.2166466	Los Angeles County
76153	Fee-for-Service	1780775312	1780775312	1	1	KIM, DORAN A MD	1/1/1999	207R00000X	NA	Other	026	PHYSICIANS	81839	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
76192	Fee-for-Service	1528014610	1528014610	1	1	KENSING,KELLY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3610 24TH	None	LUBBOCK	TX	79410	0000	00	None	33.5723535	-101.8938375	Lubbock County
76205	Fee-for-Service	1033193297	1033193297	1	1	KETTING, CASE H MD	7/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	71886	78	Neoplastic Diseases/Oncology	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
76231	Fee-for-Service	1053305680	1053305680	1	1	KAMPLAIN, TREY MD	6/4/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
76254	Fee-for-Service	1417009630	1417009630	1	1	KWON, ANNETTE Y MD	12/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90599	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
76272	Fee-for-Service	1306378369	1306378369	1	1	KHELA, SATVEET	10/11/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16830	None	None	0	In state provider	None	1805 N CALIFORNIA ST	201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
76280	Fee-for-Service	1528440658	1528440658	1	1	KIM, SAMUEL	8/21/2020	207P00000X	NA	Other	026	PHYSICIANS	155420	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
76286	Fee-for-Service	1336200443	1336200443	1	1	KO, SYNG-WAN AC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	SUNNY HILLS WELLNESS	1901 SUNNYCREST DR	None	FULLERTON	CA	92835	3626	30	06059	33.89261987	-117.9316747	Orange County
76304	Fee-for-Service	1215016985	1215016985	1	2	KANG, DIANA C PSYD	4/27/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3939 ATLANTIC AVE	SUITE 102	LONG BEACH	CA	90807	3535	19	06037	33.830073	-118.1851065	Los Angeles County
76323	Fee-for-Service	1417018219	1417018219	1	1	KELLEY, DAVID M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59774	41	Internal Medicine	0	In state provider	A MEDICAL CORP	8950 W OLYMPIC BLVD	STE 262	BEVERLY HILLS	CA	90211	3561	19	06037	34.05930952	-118.3872645	Los Angeles County
76342	Fee-for-Service	1093738932	1093738932	1	1	KIM, SUN I MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69380	34	Urology and Urological Surgery	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
76362	Fee-for-Service	1124310263	1124310263	1	1	KIM, JIN H MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115125	41	Internal Medicine	0	In state provider	None	6109 W RAMSEY STREET	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
76409	Fee-for-Service	1760557110	1760557110	1	1	KELLER, LAURA E	7/18/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
76421	Fee-for-Service	1598877698	1598877698	1	1	KLEIN, LOUIS A MD	10/6/1997	174400000X	NA	Other	026	PHYSICIANS	21120	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	106 LA CASA VIA	STE 260	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
76425	Fee-for-Service	1740567981	1740567981	1	1	KASSARDJIAN, MICHAEL DO	10/15/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	11896	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
76436	Fee-for-Service	1902241573	1902241573	1	1	KIM, BRIAN A MD	8/5/2019	207LP2900X	NA	Other	026	PHYSICIANS	134093	25	Physical Medicine and Rehabilitation	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
76445	Fee-for-Service	1093562589	1093562589	1	1	KOREAN HEALTH, EDUCATION, IN	7/29/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3255 WILSHIRE BLVD	110	LOS ANGELES	CA	90010	1405	19	06037	34.0618166	-118.2932612	Los Angeles County
76464	Fee-for-Service	1891968384	1891968384	1	1	KAO, AMY W MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112376	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76494	Fee-for-Service	1033193297	1033193297	1	1	KETTING, CASE H MD	7/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	71886	30	Radiology	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
76505	Fee-for-Service	1447925615	1447925615	1	2	KNAPP, WYATT	10/31/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9846 MISSION GORGE RD	None	SANTEE	CA	92071	3834	37	06073	32.842395	-116.982477	San Diego County
76545	Fee-for-Service	1770961195	1770961195	1	1	KWACK, JIN G	1/29/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3000 W 6TH ST	STE 315	LOS ANGELES	CA	90020	1566	19	06037	34.06369155	-118.2874502	Los Angeles County
76551	Fee-for-Service	1659496339	1659496339	1	1	KIM, JEFFREY D MD	2/12/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161734	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
76582	Fee-for-Service	1386270361	1386270361	1	1	KIM, SEEWAN MD	10/20/2023	208M00000X	NA	Other	026	PHYSICIANS	184715	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
76586	Fee-for-Service	1104061407	1104061407	1	1	KENI, JYOTSNA MD	12/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98869	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
76612	Fee-for-Service	1417018219	1417018219	1	1	KELLEY, DAVID M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59774	29	Pulmonary Diseases (M.D. only)	0	In state provider	A MEDICAL CORP	8950 W OLYMPIC BLVD	STE 262	BEVERLY HILLS	CA	90211	3561	19	06037	34.05930952	-118.3872645	Los Angeles County
76634	Fee-for-Service	1972987345	1972987345	1	1	KONECNY, DANA MD	3/23/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	151721	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
76647	Fee-for-Service	1285786640	1285786640	1	1	KHODADADI, NASTARAN MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71876	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
76656	Fee-for-Service	1073262689	1073262689	1	1	KROLL, HILLARY	9/3/2024	390200000X	NA	Other	026	PHYSICIANS	191142	09	Gynecology (D.O. only)	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
76687	Fee-for-Service	1194125211	1194125211	1	1	KALEBJIAN, ROUSHIG G NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
76690	Fee-for-Service	1538749494	1538749494	1	1	KONG, NIWEN MD	4/7/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
76695	Fee-for-Service	1659459741	1659459741	1	1	KAYSER,JEAN K MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67637	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
76701	Fee-for-Service	1003849621	1003849621	1	1	KAZI, MANZOOR MEDICAL	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64106	41	Internal Medicine	0	In state provider	ASSOCIATES INC	73345 HIGHWAY 111	STE 202	PALM DESERT	CA	92260	4215	33	06065	33.72092199	-116.384896	Riverside County
76722	Fee-for-Service	1902101678	1902101678	1	1	KERNION, JEREMY J LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
76747	Fee-for-Service	1417953795	1417953795	1	1	KENYHERZ,GREGORY E MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	5250 NEIL RD	STE 103	RENO	NV	89502	6546	00	None	39.47416458	-119.7784756	Washoe County
76748	Fee-for-Service	1821209925	1821209925	1	1	KYLE ANDREW PERRY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	410 W 10TH AVE	None	COLUMBUS	OH	43210	1240	00	None	39.99445991	-83.01733882	Franklin County
76775	Fee-for-Service	1790701670	1790701670	1	1	KATAOKA, SHERYL H MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	80028	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
76781	Fee-for-Service	1801253398	1801253398	1	1	KOLPIN, THIERRY G PHD	2/29/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
76807	Fee-for-Service	1942770151	1942770151	1	1	KAWECKI, LUCINE CRNA	6/12/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
76837	Fee-for-Service	1609978279	1609978279	1	1	KING A MARY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	NE STE # 100	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
76915	Fee-for-Service	1770516197	1770516197	1	1	KOPLYAY,PETER D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 N BOISE AVE	None	LOVELAND	CO	80538	0000	00	None	40.41340296	-105.0535746	Larimer County
76932	Fee-for-Service	1922531649	1922531649	1	1	KELLNER, POLLY OT	8/29/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 MARENGO STREET	600	LOS ANGELES	CA	90033	1036	19	06037	34.05946374	-118.213356	Los Angeles County
76937	Fee-for-Service	1083970057	1083970057	1	1	KLEIN, JENNIFER L PT	9/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
76946	Fee-for-Service	1073262689	1073262689	1	1	KROLL, HILLARY	9/3/2024	390200000X	NA	Other	026	PHYSICIANS	191142	15	Obstetrics (D.O. only)	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
77028	Fee-for-Service	1215390703	1215390703	1	1	KIPPER, BENJAMIN MD	10/5/2022	111NR0200X	NA	Other	026	PHYSICIANS	154442	None	None	0	In state provider	None	6305 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
77145	Fee-for-Service	1669404562	1669404562	1	1	KNOLWLES, ANN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3015 SQUALICUM PKWY	STE 120	BELLINGHAM	WA	98225	1906	00	None	48.77235634	-122.471231	Whatcom County
77208	Fee-for-Service	1912160896	1912160896	1	1	KASPER, ERICA N MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103374	77	Infectious Disease	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
77230	Fee-for-Service	1861574725	1861574725	1	1	KING, GREGORY A DPM	6/1/1996	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	35400 BOB HOPE DRIVE	SUITE 204	RANCHO MIRAGE	CA	92270	2747	33	06065	33.7914	-116.4058625	Riverside County
77262	Fee-for-Service	1568540466	1568540466	1	1	KIMZEY, DONALD E MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	58072	01	General Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
77269	Fee-for-Service	1710987953	1710987953	2	1	KRAUS, DAVID J MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	86373	30	Radiology	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
77303	Fee-for-Service	1578775391	1578775391	1	1	KURLAND, JONATHAN MD	12/1/1998	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	46049	20	Orthopedic Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
77309	Fee-for-Service	1962999649	1962999649	1	1	KAUR, AMANDEEP MD	10/11/2021	207R00000X	NA	Other	026	PHYSICIANS	174050	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
77316	Fee-for-Service	1790839785	1790839785	1	1	KAPLINSKY, JEAN LMFT	3/10/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 CAMBRIDGE AVE	STE 23	PALO ALTO	CA	94306	1608	43	06085	37.42674123	-122.1457921	Santa Clara County
77333	Fee-for-Service	1265767842	1265767842	1	1	KEEDY, ALEXANDER W MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111593	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
77348	Fee-for-Service	1417982737	1417982737	1	1	KOSNIK, ROBERT E MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87699	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
77352	Fee-for-Service	1992761654	1992761654	1	1	KENNEDY, JOHN S MD	12/31/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	63673	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
77365	Fee-for-Service	1427136829	1427136829	1	1	KOLKEBECK, THOMAS MD	12/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 MADISON OAK DR	None	SAN ANTONIO	TX	78258	3913	00	None	29.62127927	-98.49119067	Bexar County
77394	Fee-for-Service	1184662975	1184662975	1	1	KERR, RANDALL H MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82548	05	Anesthesiology	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
77398	Fee-for-Service	1659523975	1659523975	1	1	KHAMOOSHIAN, KOUROSH MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110901	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
77402	Fee-for-Service	1073701785	1073701785	1	1	KHALSA, SIRI ATMA S MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87526	None	None	0	In state provider	None	1400 E CHURCH STREET	None	SANTA MARIA	CA	93545	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
77418	Fee-for-Service	1033188289	1033188289	1	1	KIM, KITAE MD	10/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
77462	Fee-for-Service	1205275815	1205275815	1	1	KIM, JINHEE LCSW	10/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
77499	Fee-for-Service	1912160896	1912160896	1	1	KASPER, ERICA N MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103374	41	Internal Medicine	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
77509	Fee-for-Service	1538217369	1538217369	1	1	KAISER FOUNDATION HOSPIT	1/12/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER FND HOS PHYC #401	5601 DE SOTO AVE	RM 0	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
77522	Fee-for-Service	1306836077	1306836077	1	1	KONRAD, DONALD J. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	645 E 5TH ST	None	WEISER	ID	83672	2202	00	None	44.248716	-116.9617265	Washington County
77550	Fee-for-Service	1508360108	1508360108	1	1	KEMBOI, STEPHEN K	8/8/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13728 HIDDEN RIVER	None	EASTVALE	CA	92880	8901	33	06065	33.96033153	-117.5827437	Riverside County
77574	Fee-for-Service	1912034240	1912034240	1	1	KNOX, SUSAN J MD	8/31/1990	2085R0001X	NA	Other	026	PHYSICIANS	58623	30	Radiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
77597	Fee-for-Service	1457370959	1457370959	1	1	KENNEDY, RICHARD J MD	2/28/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62092	None	None	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
77600	Fee-for-Service	1659459154	1659459154	1	1	KARAKOZOVA, NELLIE P MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94668	08	Family Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
77616	Fee-for-Service	1073953469	1073953469	1	1	KIM, SAMUEL S DO	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12759	01	General Practice	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
77634	Fee-for-Service	1528564226	1528564226	1	1	KEMP, OWEN D MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	167452	None	None	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
77635	Fee-for-Service	1417982737	1417982737	1	1	KOSNIK, ROBERT E MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87699	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
77640	Fee-for-Service	1750794947	1750794947	1	1	KOHL, JUSTIN MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149781	01	General Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
77699	Fee-for-Service	1134517444	1134517444	1	1	KHANGURA, SARWINDER S MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149501	41	Internal Medicine	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
77740	Fee-for-Service	1083720130	1083720130	1	1	KRUPP, JASON	3/13/2024	207R00000X	NA	Other	026	PHYSICIANS	192052	None	None	0	In state provider	None	6236 THORNTON AVE	None	NEWARK	CA	94560	3732	01	06001	37.53514287	-122.0319492	Alameda County
77747	Fee-for-Service	1730438037	1730438037	1	1	KARANJAWALA, BURZEEN E MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142182	28	Proctology (colon and rectal)	0	In state provider	None	1020 29TH STREET	STE 350	SACRAMENTO	CA	95816	1054	34	06067	38.572803	-121.4685	Sacramento County
77770	Fee-for-Service	1619353042	1619353042	1	5	KAWEAH DELTA HEALTH CARE INC	11/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5333 W HILLSDALE AVE	None	VISALIA	CA	93291	5143	54	06107	36.329265	-119.3505975	Tulare County
77798	Fee-for-Service	1477552016	1477552016	1	1	KARLIN, DAVID MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83944	None	None	0	In state provider	None	1100 W STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
77831	Fee-for-Service	1245745579	1245745579	1	1	KARASOZEN, YIGIT MD	3/27/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	180285	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
77839	Fee-for-Service	1508360108	1508360108	1	1	KEMBOI, STEPHEN K	8/8/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13728 HIDDEN RIVER	None	EASTVALE	CA	92880	8901	33	06065	33.96033153	-117.5827437	Riverside County
77848	Fee-for-Service	1467498188	1467498188	1	1	KOJIAN, BEDROS MD INC	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	33708	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 W STEWART DR	STE 308	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
77861	Fee-for-Service	1033197652	1033197652	1	1	KESSLER, LARRY S MD	9/27/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	88239	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
77894	Fee-for-Service	1487114047	1487114047	1	1	KIM, GRACE	8/17/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	185740	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
77901	Fee-for-Service	1134334550	1134334550	1	2	KURKJIAN, AZAD P MD	11/6/2024	2084P0804X	NA	Psychiatry	086	MEDICAL DIRECTORS	99007	-	NOT APPLICABLE	0	In state provider	None	540 S EREMLAND DRIVE	STE A-E	COVINA	CA	91723	3186	19	06037	34.079904	-117.8863235	Los Angeles County
77936	Fee-for-Service	1912020785	1912020785	1	1	KHAVARI, RAZ MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94272	41	Internal Medicine	0	In state provider	None	15243 VANOWEN ST	STE 306	VAN NUYS	CA	91405	3649	19	06037	34.19394848	-118.4654115	Los Angeles County
77937	Fee-for-Service	1891866703	1891866703	1	1	KUNIYOSHI, DIANE L MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56149	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
77947	Fee-for-Service	1295025948	1295025948	1	1	KOSCHEKA, BROOKE M CCC-SLP	11/12/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	28991 OLD TOWN FRONT STR	SUITE 101	TEMECULA	CA	92590	2530	33	06065	33.48435441	-117.1437755	Riverside County
77964	Fee-for-Service	1588659247	1588659247	1	1	KAUL, SANJIV M DO	7/5/2011	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	11357	25	Physical Medicine and Rehabilitation	0	In state provider	None	840 S AKERS	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
77992	Fee-for-Service	1376747394	1376747394	1	1	KORBIN, WALLACE M MD AMC	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	18692	14	Neurological Surgery	0	In state provider	None	15243 VANOWEN ST	STE 209	VAN NUYS	CA	91405	3642	19	06037	34.19394848	-118.4654115	Los Angeles County
78063	Fee-for-Service	1104984442	1104984442	1	1	KLAPPER, ROBERT C MD	4/13/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	53861	20	Orthopedic Surgery	0	In state provider	None	8737 BEVERLY BLVD	STE 303	LOS ANGELES	CA	90048	1839	19	06037	34.07687959	-118.381876	Los Angeles County
78087	Fee-for-Service	1063949501	1063949501	1	1	KIM, ERICA J MD	8/7/2020	208M00000X	NA	Other	026	PHYSICIANS	165626	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
78100	Fee-for-Service	1467559062	1467559062	1	1	KARAPETIAN, MICHAEL Y MD	2/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63531	01	General Practice	0	In state provider	MICHAEL Y KARAPETIAN MED	5220 SANTA MONICA BLVD	STE E	LOS ANGELES	CA	90029	1234	19	06037	34.0907695	-118.304154	Los Angeles County
78105	Fee-for-Service	1407910490	1407910490	1	1	KERN HIGH SCHOOL DIST	2/21/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SPECIAL EDUCATION	5801 SUNDALE AVE	None	BAKERSFIELD	CA	93309	2924	15	06029	35.34387226	-119.0654328	Kern County
78131	Fee-for-Service	1740666304	1740666304	1	1	KERN COUNTY MENTAL HEALTH	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	DEPARTMENT	928 F STREET	None	WASCO	CA	93280	2040	15	06029	35.59100106	-119.3337015	Kern County
78148	Fee-for-Service	1407890742	1407890742	1	1	KRISHNA, GANESH MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63163	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
78159	Fee-for-Service	1841290590	1841290590	1	1	KINGSTON, ROBERT J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
78161	Fee-for-Service	1588261317	1588261317	1	1	KARANJA, ELIZABETH W	10/20/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	31036 BUNKER DR	None	TEMECULA	CA	92591	3904	33	06065	33.51150961	-117.1181327	Riverside County
78175	Fee-for-Service	1063846772	1063846772	1	1	KANG, STEPHANIE A	7/24/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
78216	Fee-for-Service	1013209105	1013209105	1	1	KIMN, EUGENE MD	4/21/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	115852	-	NOT APPLICABLE	0	In state provider	None	503 OCEAN FRONT WALK	None	VENICE	CA	90291	2403	19	06037	33.99316887	-118.4791801	Los Angeles County
78223	Fee-for-Service	1912020785	1912020785	1	1	KHAVARI, RAZ MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94272	83	Rheumatology	0	In state provider	None	15243 VANOWEN ST	STE 306	VAN NUYS	CA	91405	3649	19	06037	34.19394848	-118.4654115	Los Angeles County
78227	Fee-for-Service	1891866703	1891866703	1	1	KUNIYOSHI, DIANE L MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56149	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
78235	Fee-for-Service	1194890632	1194890632	1	1	KHAN, BASEER M MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67344	30	Radiology	0	In state provider	None	2224 MEDICAL CENTER DR	None	PERRIS	CA	92571	2638	33	06065	33.8123212	-117.2217309	Riverside County
78321	Fee-for-Service	1962615732	1962615732	1	1	KAFUUMA, ROLAND MD	10/28/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
78328	Fee-for-Service	1487702312	1487702312	1	1	KHATOD, MONTI MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64271	20	Orthopedic Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
78342	Fee-for-Service	1154693786	1154693786	1	1	KAVIPURAPU, KIRAN DO	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12892	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
78345	Fee-for-Service	1962724856	1962724856	1	2	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	ANAHEIM HOSPICE	17542 E 17TH ST	SUITE 300	TUSTIN	CA	92780	1960	30	06059	33.75966953	-117.8261065	Orange County
78364	Fee-for-Service	1134247174	1134247174	1	1	KHITERER, JENNY NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6650 ALTON PKWY	None	IRVINE	CA	92618	3734	30	06059	33.65911992	-117.7737909	Orange County
78415	Fee-for-Service	1922156751	1922156751	1	1	KHCHIRIAN, JACQUELINE MD	7/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62487	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
78431	Fee-for-Service	1881639052	1881639052	1	1	KATZ, JOEL A MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63938	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
78439	Fee-for-Service	1720261282	1720261282	1	1	KAISER FOUNDATION HEALTH	1/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER P. PHARMACY	309 VENTURA BLVD	STE B	CAMARILLO	CA	93010	8378	56	06111	34.21680782	-119.0752997	Ventura County
78448	Fee-for-Service	1588261317	1588261317	1	1	KARANJA, ELIZABETH W	10/20/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	31036 BUNKER DR	None	TEMECULA	CA	92591	3904	33	06065	33.51150961	-117.1181327	Riverside County
78458	Fee-for-Service	1114996212	1114996212	1	1	KLEINERMAN, DAVID I MD	8/31/1996	208800000X	NA	Other	026	PHYSICIANS	83293	None	None	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
78495	Fee-for-Service	1568951150	1568951150	1	1	KHAN, ANUM S MD	10/17/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
78503	Fee-for-Service	1346495421	1346495421	1	1	KHANDWALA, SHEFALI B DO	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10613	08	Family Practice	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
78539	Fee-for-Service	1326634890	1326634890	1	1	KOROGODSKI, ANNA NP	3/24/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
78540	Fee-for-Service	1184750341	1184750341	1	1	KROES, ANNETTE PHD	7/13/2009	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5051 CAMPO ROAD	None	WOODLAND HILLS	CA	91364	1924	19	06037	34.15996253	-118.5977863	Los Angeles County
78593	Fee-for-Service	1134494305	1134494305	1	1	KASHANI, BANAFSHEH N MD	2/22/2018	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	120548	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
78595	Fee-for-Service	1790201929	1790201929	1	1	KAISER FOUNDATION HEALTH	4/19/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	3782 W MARTIN LUTHER	KING JR BLVD 1ST FLR	LOS ANGELES	CA	90008	0000	19	06037	34.01256774	-118.338339	Los Angeles County
78609	Fee-for-Service	1114566049	1114566049	1	1	KRAMER, AMBER L PT	7/26/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
78626	Fee-for-Service	1568780468	1568780468	1	1	KAO, JOHN MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117555	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
78636	Fee-for-Service	1962724856	1962724856	1	2	KAISER FOUNDATION HOSPITALS	2/9/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	ANAHEIM HOSPICE	17542 E 17TH ST	SUITE 300	TUSTIN	CA	92780	1960	30	06059	33.75966953	-117.8261065	Orange County
78638	Fee-for-Service	1285808691	1285808691	1	1	KNOTT, HAYDEE M MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117344	07	Dermatology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
78648	Fee-for-Service	1982929428	1982929428	1	1	KHERA, SOFIA Y MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172650	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
78657	Fee-for-Service	1649327966	1649327966	1	1	KAISER FND HLTH PLAN INC	3/15/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #281	27107 TOURNEY RD	FL 1	SANTA CLARITA	CA	91355	1860	19	06037	34.41607441	-118.5761057	Los Angeles County
78681	Fee-for-Service	1356391726	1356391726	1	1	KENNEY, BRIAN D MD	9/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	85	Surgery-Pediatric	2	Out of state provider	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
78683	Fee-for-Service	1164718367	1164718367	1	1	KHALAFIAN, VLADIMIR K MD	4/10/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	124417	36	Psychiatry	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
78691	Fee-for-Service	1255317715	1255317715	1	1	KREIS, PAUL MD	10/3/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	51033	05	Anesthesiology	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
78697	Fee-for-Service	1245447937	1245447937	1	1	KIM, CHRISTINE M NP	3/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
78704	Fee-for-Service	1104051515	1104051515	1	1	KONDA, SAILESH MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129744	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	SUITE 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
78722	Fee-for-Service	1659388338	1659388338	1	1	KING, TALMADGE E JR MD	3/1/1998	207R00000X	NA	Other	026	PHYSICIANS	84197	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
78735	Fee-for-Service	1821167321	1821167321	1	1	KO, ANITA L OD	11/8/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	3191	07	06013	38.00771973	-122.1331484	Contra Costa County
78738	Fee-for-Service	1952483406	1952483406	1	2	KARUK TRIBE	3/4/2024	208D00000X	NA	Adult Primary Care	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	64100 HILLSIDE ROAD	None	HAPPY CAMP	CA	96039	8053	47	06093	41.79417713	-123.3752295	Siskiyou County
78773	Fee-for-Service	1003045600	1003045600	1	1	KANG, MINA R MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	114952	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
78776	Fee-for-Service	1841458163	1841458163	1	1	KLONER, DAIN C LMFT	6/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14011 VENTURA BLVD.	STE. 203A	SHERMAN OAKS	CA	91423	5233	19	06037	34.14915291	-118.4378798	Los Angeles County
78790	Fee-for-Service	1184169781	1184169781	1	1	KAWEAH DELTA HEALTH CARE DIS	9/23/2017	332B00000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	TER	820 S AKERS ST	SUITE 130	VISALIA	CA	93277	8346	54	06107	36.323757	-119.3491755	Tulare County
78816	Fee-for-Service	1033597190	1033597190	1	1	KURAOKA, ONDINE B LCSW	7/28/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
78845	Fee-for-Service	1932454980	1932454980	1	1	KANTAMNENI, TRISHNA MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153256	79	Neurology-Child	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
78889	Fee-for-Service	1912326836	1912326836	1	1	KOCH, NICHOLAS J MD	8/29/2022	207P00000X	NA	Other	026	PHYSICIANS	179538	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
78936	Fee-for-Service	1972986651	1972986651	1	1	KANG, MICHELLE DO	5/23/2022	207R00000X	NA	Other	026	PHYSICIANS	18077	None	None	0	In state provider	None	12710 CARMEL COUNTRY RD	None	SAN DIEGO	CA	92130	2153	37	06073	32.95313829	-117.2290312	San Diego County
78972	Fee-for-Service	1407872344	1407872344	1	1	KINNEY, JOHN J OD	6/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
78979	Fee-for-Service	1255317715	1255317715	1	1	KREIS, PAUL MD	10/3/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	51033	08	Family Practice	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
79008	Fee-for-Service	1083071716	1083071716	1	1	KIM, JOHN M LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE	UNIT 6	MISSION HILLS	CA	91345	3205	19	06037	34.25726849	-118.4664285	Los Angeles County
79009	Fee-for-Service	1659388338	1659388338	1	1	KING, TALMADGE E JR MD	3/1/1998	207R00000X	NA	Other	026	PHYSICIANS	84197	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
79024	Fee-for-Service	1578792107	1578792107	1	1	KING, MARY M OD	9/25/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1481 E PLAZA BLVD	None	NATIONAL CITY	CA	91950	3613	37	06073	32.6768163	-117.0909096	San Diego County
79027	Fee-for-Service	1952483406	1952483406	1	2	KARUK TRIBE	3/4/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	64100 HILLSIDE ROAD	None	HAPPY CAMP	CA	96039	8053	47	06093	41.79417713	-123.3752295	Siskiyou County
79050	Fee-for-Service	1003045600	1003045600	1	1	KANG, MINA R MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	114952	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
79080	Fee-for-Service	1184169781	1184169781	1	1	KAWEAH DELTA HEALTH CARE DIS	9/23/2017	332B00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	TER	820 S AKERS ST	SUITE 130	VISALIA	CA	93277	8346	54	06107	36.323757	-119.3491755	Tulare County
79096	Fee-for-Service	1649348996	1649348996	1	1	KEVLY, GEORGE O MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88135	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5427 E WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	19	06037	34.01965704	-118.1535896	Los Angeles County
79116	Fee-for-Service	1215918602	1215918602	2	1	KOPELOW, STANLEY MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	14728	18	Ophthalmology	0	In state provider	None	16311 VENTURA BLVD	SUITE 750	ENCINO	CA	91436	4325	19	06037	34.15706864	-118.4885978	Los Angeles County
79179	Fee-for-Service	1518919430	1518919430	1	1	KWON, MANON MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
79224	Fee-for-Service	1902984446	1902984446	1	1	KHANDHAR, SUKETHU M MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88428	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
79231	Fee-for-Service	1679139117	1679139117	1	1	KUTSURIS, CATHERINE A DO	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	20030	None	None	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
79244	Fee-for-Service	1376920116	1376920116	1	1	KARIMI, KOOHZAD DO	7/16/2018	390200000X	NA	Other	026	PHYSICIANS	15597	08	Family Practice	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
79272	Fee-for-Service	1952861205	1952861205	1	1	KAUR, KAMALMEET MD	12/7/2022	207R00000X	NA	Other	026	PHYSICIANS	178715	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
79293	Fee-for-Service	1629430590	1629430590	1	1	KUMAR, JASWINDER MD	3/13/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155300	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
79315	Fee-for-Service	1396008389	1396008389	1	1	KIANMAJD, MAJID DO	8/7/2020	208600000X	NA	General Surgery	026	PHYSICIANS	17427	02	General Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
79319	Fee-for-Service	1336260348	1336260348	3	1	KDJ HEALTHCARE INC	12/16/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2781-2783 WEST OLYMPIC B	None	LOS ANGELES	CA	90006	2632	19	06037	34.05269749	-118.294083	Los Angeles County
79368	Fee-for-Service	1184169781	1184169781	1	1	KAWEAH DELTA HEALTH CARE DIS	9/23/2017	332B00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	TER	820 S AKERS ST	SUITE 130	VISALIA	CA	93277	8346	54	06107	36.323757	-119.3491755	Tulare County
79397	Fee-for-Service	1548378136	1548378136	1	1	KROGER, KENNETH J MD	4/14/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73864	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
79485	Fee-for-Service	1780221317	1780221317	1	1	KN THERAPY LCSW GROUP	8/5/2020	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVE	114	SAN FERNANDO	CA	91340	2989	19	06037	34.28449525	-118.4396137	Los Angeles County
79532	Fee-for-Service	1629752969	1629752969	1	1	KENZO OTSUJI OPTOMETRIC CORP	12/2/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18204 S WESTERN AVE	None	GARDENA	CA	90248	3819	19	06037	33.86533455	-118.3091053	Los Angeles County
79579	Fee-for-Service	1265673297	1265673297	1	1	KIM, PAUL H MD	5/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134000	None	None	0	In state provider	None	18 BON AIR ROAD	None	LARKSPUR	CA	94939	1123	21	06041	37.94413684	-122.5391261	Marin County
79607	Fee-for-Service	1679969760	1679969760	1	1	KRYZMAN, NAHUM I MD	3/26/2021	207L00000X	NA	Other	026	PHYSICIANS	162223	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
79640	Fee-for-Service	1225462211	1225462211	1	1	KEMPER, CHRISTINA N LCSW	11/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
79660	Fee-for-Service	1184169781	1184169781	1	1	KAWEAH DELTA HEALTH CARE DIS	9/23/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	TER	820 S AKERS ST	SUITE 130	VISALIA	CA	93277	8346	54	06107	36.323757	-119.3491755	Tulare County
79669	Fee-for-Service	1073963989	1073963989	1	1	KAKIGI, CAITLIN L MD	8/29/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168674	18	Ophthalmology	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
79681	Fee-for-Service	1912281783	1912281783	1	1	KLASSEN, R BRYAN S MD	8/15/2017	207R00000X	NA	Other	026	PHYSICIANS	126332	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	FL 6	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
79702	Fee-for-Service	1801026992	1801026992	1	1	KEACHIE, KRISTA N MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113957	22	Pathology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
79772	Fee-for-Service	1780221317	1780221317	1	1	KN THERAPY LCSW GROUP	8/5/2020	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVE	114	SAN FERNANDO	CA	91340	2989	19	06037	34.28449525	-118.4396137	Los Angeles County
79845	Fee-for-Service	1699857565	1699857565	1	1	KURIAN, SEIRA MD	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96294	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
79861	Fee-for-Service	1902078686	1902078686	1	2	KRALIK, STEPHEN F MD	11/1/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
79924	Fee-for-Service	1821160631	1821160631	1	1	KUMAR, JUHI	1/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78142	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
79947	Fee-for-Service	1699976159	1699976159	1	1	KIM, GENE Y MD	6/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96720	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
80005	Fee-for-Service	1053703348	1053703348	1	1	KRISTENSEN, MARISSA A NP	8/9/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
80012	Fee-for-Service	1437440484	1437440484	1	1	KWAN, KENT K MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111040	None	None	0	In state provider	None	3001 SILLECT AVENUE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
80013	Fee-for-Service	1174556351	1174556351	1	1	KUKREJA, JASLEEN MD	8/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	60435	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
80071	Fee-for-Service	1093776338	1093776338	1	1	KAWEAH DELTA HEALTH CARE	10/24/1989	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SNF/DP	1633 S COURT ST	None	VISALIA	CA	93277	4945	54	06107	36.315972	-119.292237	Tulare County
80094	Fee-for-Service	1619488681	1619488681	1	1	KHOURY, OULA PHD	8/9/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
80141	Fee-for-Service	1013357102	1013357102	1	1	KUO, TIM S DO	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
80151	Fee-for-Service	1952473274	1952473274	1	1	KIM, KENNETH K MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81964	24	Plastic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
80153	Fee-for-Service	1689673840	1689673840	1	1	KUO, CHENG-LONG MD	10/31/1980	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31619	40	Pediatrics	0	In state provider	None	1533 LOMITA BLVD	None	HARBOR CITY	CA	90710	2024	19	06037	33.79784346	-118.3038885	Los Angeles County
80168	Fee-for-Service	1760587570	1760587570	1	1	KHAMBATTA, SHANAZ F DO	7/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8085	None	None	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
80181	Fee-for-Service	1679710610	1679710610	1	1	KAISER FDN HEALTH PLAN	1/23/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARMCY #266	1600 EUREKA RD	MOB 2 FLR 1	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
80188	Fee-for-Service	1982833133	1982833133	1	1	KADAN, ABDULLAH MD	6/17/2022	207R00000X	NA	Other	026	PHYSICIANS	178935	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
80195	Fee-for-Service	1295721686	1295721686	1	1	KANTOR, SCOTT G MD	2/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80215	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
80248	Fee-for-Service	1326044025	1326044025	1	1	KATES, MARC DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PHOENIX BAPTIST HOSPITAL	6205 N 20TH AVE	None	PHOENIX	AZ	85015	0000	00	None	33.5282122	-112.1023033	Maricopa County
80288	Fee-for-Service	1265798680	1265798680	1	1	KAPOOR, ANUBHAV MD	8/1/2017	207L00000X	NA	Other	026	PHYSICIANS	148593	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
80307	Fee-for-Service	1770891277	1770891277	1	1	KOCIOL, BRETT E PHD	1/15/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
80312	Fee-for-Service	1942312186	1942312186	1	1	KHEHRA, BALRAM S MD	8/22/2008	207R00000X	NA	Other	026	PHYSICIANS	54731	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
80319	Fee-for-Service	1245766088	1245766088	1	1	KIM, EMILY MD	6/2/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	162339	None	None	0	In state provider	None	28078 BAXTER RD	SUITE 320	MURRIETA	CA	92563	1404	33	06065	33.615	-117.1670265	Riverside County
80371	Fee-for-Service	1871785188	1871785188	1	1	KRUEGER, CASEY E PHD	12/22/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
80393	Fee-for-Service	1609826288	1609826288	1	1	KARABALA, M THABET MD	7/31/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	35322	06	Cardiovascular Disease (M.D. only)	0	In state provider	A PROFESSIONAL CORP	940 N CENTER ST	STE A	STOCKTON	CA	95202	1326	39	06077	37.96225098	-121.2937336	San Joaquin County
80430	Fee-for-Service	1962834663	1962834663	1	1	KWON, EUNICE E DO	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13857	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
80444	Fee-for-Service	1992852214	1992852214	1	1	KAISER PHARMACY #356	5/19/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18081 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	1304	30	06059	33.69987737	-117.9892394	Orange County
80484	Fee-for-Service	1518991322	1518991322	1	1	KAPLAN, MATTHEW S MD	2/21/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61677	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
80564	Fee-for-Service	1255430005	1255430005	1	1	KYU, AYE MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71669	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
80600	Fee-for-Service	1073839874	1073839874	1	1	KARIMABADI, MARJAN MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120192	08	Family Practice	0	In state provider	None	29472 AVENIDA DE LAS	BANDERA	RANCHO SANTA MARG	CA	92688	2651	30	06059	33.61980987	-117.6107148	Orange County
80611	Fee-for-Service	1356425193	1356425193	1	1	KOLDERUP, LINDSAY B MD	8/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55454	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2520 SAMARITAN DR	None	SAN JOSE	CA	95124	4106	43	06085	37.25213274	-121.9501476	Santa Clara County
80612	Fee-for-Service	1346377975	1346377975	1	1	KUNDARIA, BHANJI D MD	8/4/1980	174400000X	NA	Other	026	PHYSICIANS	35703	47	Miscellaneous	0	In state provider	INC	1505 S SHEPARD DR	STE 106	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
80624	Fee-for-Service	1740516376	1740516376	1	1	KANG, HELEN H MD APMC	8/12/2010	208600000X	NA	General Surgery	026	PHYSICIANS	103988	02	General Surgery	0	In state provider	None	520 S VIRGIL AVE	SUITE 505	LOS ANGELES	CA	90020	1416	19	06037	34.064487	-118.2870305	Los Angeles County
80630	Fee-for-Service	1205975240	1205975240	1	1	KIM, JUNE MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88217	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
80635	Fee-for-Service	1629149554	1629149554	1	1	KAUFFMAN, LEE	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
80660	Fee-for-Service	1285782888	1285782888	1	1	KAISER FOUNDATION HEALTH	4/8/1996	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #635	276 INTERNATIONAL CIR	FL 1	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
80679	Fee-for-Service	1396104865	1396104865	1	1	KETABCHI, MONA S PSYD	3/22/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	SUITE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
80680	Fee-for-Service	1083987655	1083987655	1	1	KAUR, RITIKA	8/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
80684	Fee-for-Service	1124105069	1124105069	1	1	KOLLA, SRIDEVI MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72048	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
80686	Fee-for-Service	1205907227	1205907227	1	1	KIRBY, KEVIN A	6/13/1987	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	PACIFIC HEALTH CENTER	8118 E STOCKTON BLVD	# 110	SACRAMENTO	CA	95823	0000	34	06067	38.46181048	-121.4126382	Sacramento County
80709	Fee-for-Service	1114938875	1114938875	1	1	KERSH, EDWARD S MD	8/31/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22240	41	Internal Medicine	0	In state provider	SF CENTRAL YMCA	220 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3706	38	06075	37.78184696	-122.4142203	San Francisco County
80711	Fee-for-Service	1801152772	1801152772	1	1	KOO, PATRICK K MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136521	41	Internal Medicine	0	In state provider	None	1847 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89240254	-117.9314841	Orange County
80720	Fee-for-Service	1689956195	1689956195	1	1	KASALLIS, IVY L CRNA	1/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
80723	Fee-for-Service	1720885742	1720885742	1	1	KAZIMOTO, RITHALORINE BIRTH	5/16/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
80768	Fee-for-Service	1487776548	1487776548	1	1	KLEMPERER, ERIKA MD	6/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76204	07	Dermatology	0	In state provider	None	2936 DE LA VINA ST	STE 200	SANTA BARBARA	CA	93105	3376	42	06083	34.4383104	-119.7278207	Santa Barbara County
80770	Fee-for-Service	1588056113	1588056113	1	1	KELLER, ERIC J MD	7/22/2022	2085R0204X	NA	Other	026	PHYSICIANS	163722	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
80785	Fee-for-Service	1669485397	1669485397	1	1	KAO, ALEXANDER MD	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75717	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
80791	Fee-for-Service	1598226300	1598226300	1	1	KHAN, ALIYA N MD	1/31/2023	207R00000X	NA	Other	026	PHYSICIANS	181528	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
80801	Fee-for-Service	1760761613	1760761613	1	1	KENISTON, DIERDRE V CRNA	11/19/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
80802	Fee-for-Service	1407821424	1407821424	1	1	KENNEDY, STEPHEN MD	9/19/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191844	30	Radiology	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
80804	Fee-for-Service	1720166382	1720166382	1	1	KLINGER, LEAH A MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79479	41	Internal Medicine	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
80822	Fee-for-Service	1740447416	1740447416	1	1	KELTNER, JOHN R MD	10/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	71514	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
80832	Fee-for-Service	1104833383	1104833383	1	1	KATTIH, MOHAMED Z MD	3/25/2024	225400000X	NA	Other	026	PHYSICIANS	81609	None	None	0	In state provider	None	219 W BADILLO ST	SUITE B	COVINA	CA	91723	1907	19	06037	34.0863333	-117.8928703	Los Angeles County
80836	Fee-for-Service	1306846969	1306846969	1	1	KANNAN, SUBHASRI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
80895	Fee-for-Service	1073839874	1073839874	1	1	KARIMABADI, MARJAN MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120192	01	General Practice	0	In state provider	None	29472 AVENIDA DE LAS	BANDERA	RANCHO SANTA MARG	CA	92688	2651	30	06059	33.61980987	-117.6107148	Orange County
80928	Fee-for-Service	1427089150	1427089150	1	1	KINGS COMPREHENSIVE WOMEN'S	4/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	HEALTHCARE MEDICAL GROUP	460 GREENFIELD AVE	STE 1	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
80939	Fee-for-Service	1013960228	1013960228	1	1	KILLAM, RONALD W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	15055 EAST FWY	STE C-10	CHANNELVIEW	TX	77530	4142	00	None	29.775285	-95.1456915	Harris County
80959	Fee-for-Service	1952385510	1952385510	1	1	KOMPALA, SUSHILA D MD	1/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	49708	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
80990	Fee-for-Service	1548627078	1548627078	1	1	KLEINBERG, ALEXANDER L LMFT	3/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
80997	Fee-for-Service	1801152772	1801152772	1	1	KOO, PATRICK K MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136521	10	Gastroenterology (M.D. only)	0	In state provider	None	1847 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89240254	-117.9314841	Orange County
80999	Fee-for-Service	1114938875	1114938875	1	1	KERSH, EDWARD S MD	8/31/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22240	06	Cardiovascular Disease (M.D. only)	0	In state provider	SF CENTRAL YMCA	220 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3706	38	06075	37.78184696	-122.4142203	San Francisco County
81019	Fee-for-Service	1538195367	1538195367	1	1	KNIGHT, SHARON K	8/17/2000	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	72852	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3838 CALIFORNIA ST	STE 305	SAN FRANCISCO	CA	94118	1505	38	06075	37.78591809	-122.4575439	San Francisco County
81029	Fee-for-Service	1518962505	1518962505	1	1	KIENZLE,GREGERY D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
81045	Fee-for-Service	1194081943	1194081943	1	1	KIM, JEA-HYOUN MD	8/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127209	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
81116	Fee-for-Service	1477596864	1477596864	1	1	KOO, HELEN S MD	10/31/1980	174400000X	NA	Other	026	PHYSICIANS	26756	40	Pediatrics	0	In state provider	None	265 E BEVERLY BLVD	FL 2	MONTEBELLO	CA	90640	3776	19	06037	34.01488548	-118.095183	Los Angeles County
81145	Fee-for-Service	1629717657	1629717657	1	1	KENNY, KRISTINA N PT	8/5/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
81157	Fee-for-Service	1083891543	1083891543	1	1	KORAH, MARIAM P MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115921	78	Neoplastic Diseases/Oncology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
81158	Fee-for-Service	1770079626	1770079626	1	1	KVASNICKA, MARION A LCSW	10/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
81166	Fee-for-Service	1184725624	1184725624	1	1	KEITH, BRADLEY J MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56088	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
81193	Fee-for-Service	1104169119	1104169119	1	1	KIM, VIRGINIA H MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132693	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
81214	Fee-for-Service	1427089150	1427089150	1	1	KINGS COMPREHENSIVE WOMEN'S	5/15/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	HEALTHCARE MEDICAL GROUP	460 GREENFIELD AVE	STE 1	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
81218	Fee-for-Service	1699791160	1699791160	1	2	KELLEY, NEIL R DPM INC	12/19/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SPECIALIST PODIATRY CTR	1730 MAIN STREET	None	FORTUNA	CA	95540	2451	12	06023	40.59765205	-124.14804	Humboldt County
81221	Fee-for-Service	1548694367	1548694367	1	1	KANG, MELODY H PSYD	2/19/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
81238	Fee-for-Service	1720607112	1720607112	1	1	KAISER FOUNDATION HEALTH PLA	4/28/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	206R	6911 CONVOY CT FL 1 RM 1	None	SAN DIEGO	CA	92111	1014	37	06073	32.8346185	-117.1660095	San Diego County
81263	Fee-for-Service	1720573850	1720573850	1	1	KAMATH, DIPTI HUNDI MD	9/3/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174061	40	Pediatrics	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
81274	Fee-for-Service	1689864522	1689864522	1	1	KANAAN, SAMER A MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87174	02	General Surgery	0	In state provider	None	3421 VILLA LN	STE 2A	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
81292	Fee-for-Service	1760572622	1760572622	1	1	KELLEY,ROBERT BRANCH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
81314	Fee-for-Service	1043798598	1043798598	1	1	KARIM, MATTHEW M CRNA	5/14/2019	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
81326	Fee-for-Service	1538620927	1538620927	1	1	KARIMI, SAMAN S MD	6/12/2024	207ZP0102X	NA	Other	026	PHYSICIANS	191253	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
81379	Fee-for-Service	1447563184	1447563184	1	1	KRANITZ, HEATHER M DO	5/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11295	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
81403	Fee-for-Service	1306998968	1306998968	1	1	KAI-SIANG LOW	4/18/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
81405	Fee-for-Service	1760561401	1760561401	1	1	KIM, JIN K MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62489	25	Physical Medicine and Rehabilitation	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
81414	Fee-for-Service	1073576161	1073576161	1	1	KOENIGSBERG, RICHARD DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	500 E REMINGTON DR	STE 12	SUNNYVALE	CA	94087	2611	43	06085	37.35898474	-122.0281716	Santa Clara County
81434	Fee-for-Service	1558449280	1558449280	1	1	KOTAK, DINESH MD	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82222	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
81444	Fee-for-Service	1497702872	1497702872	1	1	KRISHNAMURTHY, VIDYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3586 OLD MILTON PKWY	None	ALPHARETTA	GA	30005	4465	00	None	34.06566353	-84.25567724	Fulton County
81445	Fee-for-Service	1083891543	1083891543	1	1	KORAH, MARIAM P MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115921	30	Radiology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
81452	Fee-for-Service	1184725624	1184725624	1	1	KEITH, BRADLEY J MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56088	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
81465	Fee-for-Service	1679689863	1679689863	1	1	KIM, EMILY M OD	7/22/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19871 YORBA LINDA BLVD	STE 101	YORBA LINDA	CA	92886	2811	30	06059	33.8897307	-117.7877423	Orange County
81531	Fee-for-Service	1770985012	1770985012	1	1	KENNEDY, MEGAN K NP	11/10/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
81540	Fee-for-Service	1477713030	1477713030	1	1	KIM, BRIAN T MD	5/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111328	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
81557	Fee-for-Service	1689864522	1689864522	1	1	KANAAN, SAMER A MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87174	33	Thoracic Surgery	0	In state provider	None	3421 VILLA LN	STE 2A	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
81608	Fee-for-Service	1538166202	1538166202	1	1	KELLY VOKOUN	4/19/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
81644	Fee-for-Service	1134392020	1134392020	1	1	KHAYAT, FAWZI S MD	8/20/2009	208600000X	NA	General Surgery	026	PHYSICIANS	91291	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
81652	Fee-for-Service	1386643294	1386643294	1	1	KENT COUNTY MEM HOSPITAL	9/22/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	455 TOLLGATE RD	None	WARWICK	RI	02886	2759	00	None	41.70484367	-71.47855402	Kent County
81663	Fee-for-Service	1467577965	1467577965	1	1	KANG, KAREN D OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1511 W GARVEY AVE NORTH	None	WEST COVINA	CA	91790	2138	19	06037	34.07275848	-117.938241	Los Angeles County
81674	Fee-for-Service	1417367517	1417367517	1	1	KOLLER, DAVID MD	11/7/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	182814	02	General Surgery	0	In state provider	None	23451 MADISON ST	340	TORRANCE	CA	90505	4737	19	06037	33.81197627	-118.3478154	Los Angeles County
81722	Fee-for-Service	1558449280	1558449280	1	1	KOTAK, DINESH MD	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82222	68	Hematology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
81748	Fee-for-Service	1366570772	1366570772	1	1	KINGS FOOT AND ANKLE	3/4/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CENTER INC	806 W 7TH ST	None	HANFORD	CA	93230	4926	16	06031	36.32523151	-119.657079	Kings County
81771	Fee-for-Service	1518089507	1518089507	1	1	KARTHIKEYA DEVIREDDY MD	4/23/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INC	311 W I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
81800	Fee-for-Service	1134285547	1134285547	1	1	KURIAN, LEONARD S MD AMC	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	70489	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1331 W AVENUE J	STE 102	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
81827	Fee-for-Service	1629067509	1629067509	3	1	KUNDU, NIRVANA MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	101808	05	Anesthesiology	0	In state provider	None	10121 PINE AVENUE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
81872	Fee-for-Service	1023143302	1023143302	2	1	KERR, JASON ROLFE MD	10/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	116890	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
81939	Fee-for-Service	1386643294	1386643294	1	1	KENT COUNTY MEM HOSPITAL	9/22/2004	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	455 TOLLGATE RD	None	WARWICK	RI	02886	2759	00	None	41.70484367	-71.47855402	Kent County
81948	Fee-for-Service	1669826798	1669826798	1	1	KIM, KEVIN H DO	6/30/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	19643	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
81949	Fee-for-Service	1720068448	1720068448	1	1	KERMANI, TANAZ A MD	2/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118919	83	Rheumatology	0	In state provider	None	200 MED PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
81951	Fee-for-Service	1134750359	1134750359	1	1	KOVITPRAKORNKUL, KAY JIRAPOR	6/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	N G PT	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
81955	Fee-for-Service	1700886777	1700886777	1	1	KATZ, FRANK A MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85415	36	Psychiatry	0	In state provider	None	9911 W PICO BLVD	#1430	LOS ANGELES	CA	90035	2715	19	06037	34.05336328	-118.4040952	Los Angeles County
81968	Fee-for-Service	1548317167	1548317167	1	1	KAMBOJ, VIRENDER J MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	36755	41	Internal Medicine	0	In state provider	None	2522 GRAND CANAL BLVD	STE 8	STOCKTON	CA	95207	8213	39	06077	37.98353982	-121.3388944	San Joaquin County
81972	Fee-for-Service	1306913116	1306913116	1	1	KESSLER, JEFFREY I MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52267	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
82033	Fee-for-Service	1316014319	1316014319	1	1	KESSLER, BRIAN D MD	7/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86785	34	Urology and Urological Surgery	0	In state provider	None	8631 W 3RD ST	# 915E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
82050	Fee-for-Service	1073089074	1073089074	1	1	KAUR, SUKHDEEP NP	10/30/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
82059	Fee-for-Service	1518089507	1518089507	1	1	KARTHIKEYA DEVIREDDY MD	6/24/2005	207R00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INC	311 W I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
82101	Fee-for-Service	1306812508	1306812508	1	1	KERN CARDIOLOGY MEDICAL	1/31/1997	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	4000 PHYSICIANS BLVD	BLD E STE 101	BAKERSFIELD	CA	93301	1284	15	06029	35.39685986	-119.0093834	Kern County
82116	Fee-for-Service	1629067509	1629067509	3	1	KUNDU, NIRVANA MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	101808	02	General Surgery	0	In state provider	None	10121 PINE AVENUE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
82133	Fee-for-Service	1568747855	1568747855	1	1	KAWABE, ASHTEN Y PT	10/21/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2013	19	06037	33.78982251	-118.1462265	Los Angeles County
82180	Fee-for-Service	1790765022	1790765022	1	1	KAO, LUKE S MD	7/14/2010	208800000X	NA	Other	026	PHYSICIANS	32679	34	Urology and Urological Surgery	0	In state provider	None	10230 ARTESIA BLVD	STE 105	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
82245	Fee-for-Service	1649615576	1649615576	1	1	KAMATH, ANDREA M PSY	10/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798889	-117.150826	San Diego County
82305	Fee-for-Service	1366411613	1366411613	1	1	KIM, JOYCE Y OD	10/1/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1021 S WOLFE RD	STE 145	SUNNYVALE	CA	94086	8880	43	06085	37.355274	-122.0141665	Santa Clara County
82327	Fee-for-Service	1356392575	1356392575	1	1	KATHERINE MANASSON M.D., INC	10/8/2018	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	.	24422 AVENIDA DE LA CARL	272	LAGUNA HILLS	CA	92653	3648	30	06059	33.56726005	-117.705397	Orange County
82345	Fee-for-Service	1518089507	1518089507	1	1	KARTHIKEYA DEVIREDDY MD	6/24/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INC	311 W I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
82353	Fee-for-Service	1386871168	1386871168	1	1	KIM, OK KYUNG MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111229	13	Neurology (M.D. only)	0	In state provider	None	400 TAYLOR BLVD	SUITE 301	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
82376	Fee-for-Service	1699732636	1699732636	1	1	KINO, RUSS MD	6/30/1993	193400000X	NA	Other	026	PHYSICIANS	48071	None	None	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
82402	Fee-for-Service	1629067509	1629067509	3	1	KUNDU, NIRVANA MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	101808	01	General Practice	0	In state provider	None	10121 PINE AVENUE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
82413	Fee-for-Service	1144514191	1144514191	1	1	KHATIBI, TALAYEH MD	11/11/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	116761	None	None	0	In state provider	None	18102 IRVINE BLVD	SUITE 103 & 105	TUSTIN	CA	92780	3402	30	06059	33.74819092	-117.816792	Orange County
82416	Fee-for-Service	1134119894	1134119894	1	1	KHAN, ASHRAF A MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	64107	77	Infectious Disease	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
82511	Fee-for-Service	1053512186	1053512186	1	1	KARAMLOU, TARA B MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122317	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
82548	Fee-for-Service	1679511828	1679511828	1	1	KIM L COLEMAN M.D.	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	555 S 70TH ST	None	LINCOLN	NE	68510	2462	00	None	40.808151	-96.62516802	Lancaster County
82554	Fee-for-Service	1548251390	1548251390	1	1	KUMAR, DEVINDER S MD	2/8/2015	208VP0000X	NA	Other	026	PHYSICIANS	42788	05	Anesthesiology	0	In state provider	None	23861 MCBEAN PKWY	STE A-4	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
82558	Fee-for-Service	1699096784	1699096784	1	1	KIM, MICHAEL L MD	11/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101880	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
82580	Fee-for-Service	1679100770	1679100770	1	1	KHAN, ZARA	11/24/2023	207P00000X	NA	Other	026	PHYSICIANS	184895	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
82647	Fee-for-Service	1295153708	1295153708	1	1	KUIZIN, GRAHAM C MD	12/18/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	153626	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
82648	Fee-for-Service	1437277118	1437277118	1	1	KAZANEGRA, RADMILA MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92982	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	488 E VALLEY PARKWAY	#310	ESCONDIDO	CA	92025	3373	37	06073	33.12523814	-117.0769715	San Diego County
82652	Fee-for-Service	1881895761	1881895761	1	1	KIMURA, AKIKO C MD	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77709	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
82659	Fee-for-Service	1225136278	1225136278	1	1	KUNIN, JULIE D	2/29/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	211 W ROBINSON AVE	None	SAN DIEGO	CA	92103	4019	37	06073	32.74673898	-117.165548	San Diego County
82670	Fee-for-Service	1568072916	1568072916	1	1	KRAVETS, HALYNA	11/18/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1402 W COLONIAL PKWY	None	ROSEVILLE	CA	95661	5007	31	06061	38.7279723	-121.2418395	Placer County
82678	Fee-for-Service	1427125640	1427125640	1	1	KIM, JOHN J MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61681	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
82696	Fee-for-Service	1730279423	1730279423	1	2	KARUK TRIBE	2/27/2017	No Taxonomy Provided	NA	None	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	1515 S OREGON ST	None	YREKA	CA	96097	3425	47	06093	41.7176996	-122.642006	Siskiyou County
82707	Fee-for-Service	1134119894	1134119894	1	1	KHAN, ASHRAF A MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	64107	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
82740	Fee-for-Service	1952485120	1952485120	1	1	KARANAS, YVONNE L MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54575	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
82778	Fee-for-Service	1417642810	1417642810	1	1	KLOS, LASHAWN LMFT	7/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
82781	Fee-for-Service	1558425595	1558425595	1	1	KHOURY, CHRISTINE S DPM	12/23/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2299 POST SREET	SUITE 205	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
82785	Fee-for-Service	1700805223	1700805223	1	1	KELLEY, ROBIN K MD	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84975	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA STE 36	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
82796	Fee-for-Service	1174656755	1174656755	1	1	KELCHNER, MATTHEW O DC	5/27/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
82816	Fee-for-Service	1881037380	1881037380	1	1	KHODAGHOLIAN, ELMA B NP	3/5/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
82891	Fee-for-Service	1790968659	1790968659	1	1	KALANTARI, GITA J MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95847	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
82936	Fee-for-Service	1831278589	1831278589	1	1	KLAMATH PEDIATRIC CLINIC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	WARWICK, TRACEY M MD	2310 MT VIEW BLVD	None	KLAMATH FALLS	OR	97601	1134	00	None	42.25121145	-121.7845244	Klamath County
82941	Fee-for-Service	1205835394	1205835394	1	1	KEVIN FINLEY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1320 W MAIN ST	None	NEWARK	OH	43055	0000	00	None	40.04686705	-82.4504997	Licking County
82953	Fee-for-Service	1245365196	1245365196	1	1	KALEIDA HEALTH SYSTEM	2/15/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	219 BRYANT ST	None	BUFFALO	NY	14222	2006	00	None	42.909219	-78.87537	Erie County
82958	Fee-for-Service	1568072916	1568072916	1	1	KRAVETS, HALYNA	11/18/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1402 W COLONIAL PKWY	None	ROSEVILLE	CA	95661	5007	31	06061	38.7279723	-121.2418395	Placer County
82973	Fee-for-Service	1205899689	1205899689	1	1	KUZYK, DONALD I DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	2369 MICHAEL DR	None	NEWBURY PARK	CA	91320	3233	56	06111	34.18273526	-118.9285429	Ventura County
82976	Fee-for-Service	1851477368	1851477368	1	1	KARADI, CHANDU A MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77113	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
82986	Fee-for-Service	1730279423	1730279423	1	2	KARUK TRIBE	2/27/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1515 S OREGON ST	None	YREKA	CA	96097	3425	47	06093	41.7176996	-122.642006	Siskiyou County
82988	Fee-for-Service	1053430157	1053430157	1	1	KHRAMOV, ILIYA MD	1/13/2022	2085N0700X	NA	MRI Provider	026	PHYSICIANS	154143	None	None	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
82997	Fee-for-Service	1821264631	1821264631	1	1	KAPANEK, KIMBERLY J	3/29/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 WEST 6TH STREET	STE 111	LOS ANGELES	CA	90017	1823	19	06037	34.05416748	-118.2622848	Los Angeles County
82998	Fee-for-Service	1821402132	1821402132	1	1	KELLY, SONYA M PHD	12/14/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	STE 200	SANTA ROSA	CA	95403	0991	49	06097	38.47617	-122.7235455	Sonoma County
83003	Fee-for-Service	1194958587	1194958587	1	1	KIM, YOUNG MD	11/6/2023	207R00000X	NA	Other	026	PHYSICIANS	78274	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
83005	Fee-for-Service	1104936418	1104936418	1	1	KAUFFMAN, LEE J DC	12/31/1989	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3829 WATT AVE	None	SACRAMENTO	CA	95821	2646	34	06067	38.635353	-121.38327	Sacramento County
83015	Fee-for-Service	1710349022	1710349022	1	1	KASSARDJIAN, ARI MD	4/13/2020	207ZP0102X	NA	Other	026	PHYSICIANS	152650	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
83088	Fee-for-Service	1124154398	1124154398	1	1	KEER, HAROLD MD	4/30/1994	207RH0003X	NA	Oncology	026	PHYSICIANS	78924	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
83115	Fee-for-Service	1609514827	1609514827	1	1	KREIN, SARAH CCC-SLP	7/12/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
83143	Fee-for-Service	1003304759	1003304759	1	1	KAMEL, JOSEPH	6/25/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	19263	07	Dermatology	0	In state provider	None	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	30	06059	33.61321911	-117.8722084	Orange County
83183	Fee-for-Service	1194954396	1194954396	1	1	KAUFFMAN, JASON P DO	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12345	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
83190	Fee-for-Service	1306830781	1306830781	1	1	KHAN, ARSHAD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MT AUBURN PROFESSIONAL	330 MT. AUBURN STREET	None	CAMBRIDGE	MA	02238	0000	00	None	42.373899	-71.1342405	Middlesex County
83199	Fee-for-Service	1124010095	1124010095	1	1	KOONCE, WILLIAM C MD	12/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	58414	41	Internal Medicine	0	In state provider	None	219 NOGALES AVE	STE B	SANTA BARBARA	CA	93105	3848	42	06083	34.43171016	-119.7220176	Santa Barbara County
83201	Fee-for-Service	1821559162	1821559162	1	1	KELLOGG, LEVI A	6/16/2023	207L00000X	NA	Other	026	PHYSICIANS	184717	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
83208	Fee-for-Service	1245869361	1245869361	1	1	KANASE, RUTURAJ DO	10/18/2023	390200000X	NA	Other	026	PHYSICIANS	20749	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
83236	Fee-for-Service	1245365196	1245365196	1	1	KALEIDA HEALTH SYSTEM	2/15/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	219 BRYANT ST	None	BUFFALO	NY	14222	2006	00	None	42.909219	-78.87537	Erie County
83250	Fee-for-Service	1104203405	1104203405	1	1	KO, JEFFREY Z MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144966	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
83279	Fee-for-Service	1821182403	1821182403	1	1	KIRSCH, SCOTT D MD	7/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	23278	08	Family Practice	0	In state provider	None	12291 WASHINGTON BLVD	STE 500	WHITTIER	CA	90606	2551	19	06037	33.96734104	-118.0508773	Los Angeles County
83285	Fee-for-Service	1356322150	1356322150	1	1	KUPPERMAN, NATHAN MD	9/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58501	40	Pediatrics	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
83295	Fee-for-Service	1306906797	1306906797	1	1	KASTING, DAVID S MD	6/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	25762	78	Neoplastic Diseases/Oncology	0	In state provider	None	3212 LOMA VISTA RD	STE 260	VENTURA	CA	93003	3042	56	06111	34.2760182	-119.2530926	Ventura County
83304	Fee-for-Service	1710349022	1710349022	1	1	KASSARDJIAN, ARI MD	4/13/2020	207ZP0102X	NA	Other	026	PHYSICIANS	152650	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
83338	Fee-for-Service	1831769512	1831769512	1	1	KOGAN, ROSALIE VERED	2/24/2025	207R00000X	NA	Other	026	PHYSICIANS	192284	41	Internal Medicine	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
83347	Fee-for-Service	1467083238	1467083238	1	1	KNUDSEN, LUJUANA V CNM	5/27/2020	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1881 BUSINESS CENTER DR	SUITE 8A	SAN BERNARDINO	CA	92408	3448	36	06071	34.06846141	-117.2811029	San Bernardino County
83375	Fee-for-Service	1720057516	1720057516	1	1	KOZAR, VALERIA I MD	4/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89502	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
83390	Fee-for-Service	1780762864	1780762864	1	1	KAPOOR, SACHIN DO	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9139	01	General Practice	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
83409	Fee-for-Service	1942369699	1942369699	1	1	KOERNER, ALAN H MD	6/30/1993	207W00000X	NA	Ophthalmology	026	PHYSICIANS	9916	39	Preventive (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
83442	Fee-for-Service	1073751491	1073751491	1	1	KENT, SHARI L	10/21/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23795 WR HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5903	27	06053	36.57664711	-121.9143421	Monterey County
83454	Fee-for-Service	1548215684	1548215684	1	1	KLAEHN, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	570 W BROWN RD	None	MESA	AZ	85201	3227	00	None	33.434577	-111.8444355	Maricopa County
83455	Fee-for-Service	1447625090	1447625090	1	1	KAIROS MANAGEMENT ONE LLC	3/12/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1620 E CHAPMAN AVE	None	FULLERTON	CA	92831	4016	30	06059	33.87412251	-117.8990595	Orange County
83482	Fee-for-Service	1558565127	1558565127	1	1	KHARODAWALA, MURTAZA A	11/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105171	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	MD	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
83506	Fee-for-Service	1568100998	1568100998	1	1	KANE, JAMES M NP	8/1/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	782 MEDICAL CENTER DR E	STE 311	CLOVIS	CA	93611	6892	10	06019	36.84379626	-119.6609117	Fresno County
83511	Fee-for-Service	1013413707	1013413707	1	1	KIM, JOSEPH S MD	5/22/2023	207P00000X	NA	Other	026	PHYSICIANS	165949	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
83546	Fee-for-Service	1013062769	1013062769	1	6	KAISER FOUNDATION HOSPITALS	1/25/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MOBILE	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83554	Fee-for-Service	1619723996	1619723996	1	1	KNOX, JENNIFER LMFT	8/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5380 STEEG RD	None	TWENTYNINE PALMS	CA	92277	7863	36	06071	34.15698394	-115.9139103	San Bernardino County
83571	Fee-for-Service	1235255480	1235255480	1	1	KRAMP, DAVID M CRNA	5/16/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
83583	Fee-for-Service	1306906797	1306906797	1	1	KASTING, DAVID S MD	6/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	25762	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3212 LOMA VISTA RD	STE 260	VENTURA	CA	93003	3042	56	06111	34.2760182	-119.2530926	Ventura County
83585	Fee-for-Service	1871595223	1871595223	1	1	KARIN, ROM R MD	12/13/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	53047	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
83691	Fee-for-Service	1184890550	1184890550	1	1	KUSSIN, JODY R PHD	1/5/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11937	-	NOT APPLICABLE	0	In state provider	None	975 FLYNN ROAD	None	CAMARILLO	CA	93012	8704	56	06111	34.22667906	-119.0196947	Ventura County
83693	Fee-for-Service	1881990711	1881990711	1	1	KUMBHAT, NEHA P MD	5/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114060	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
83695	Fee-for-Service	1154042885	1154042885	1	1	KIM, CHRISTINE NP	8/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
83702	Fee-for-Service	1659342509	1659342509	1	1	KELLY DEAN GUBLER, D.O.	6/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	501 N GRAHAM ST	STE 580	PORTLAND	OR	97227	2003	00	None	45.54285348	-122.671035	Multnomah County
83714	Fee-for-Service	1235627217	1235627217	1	1	KUANG, DALEN C MD	9/30/2022	390200000X	NA	Other	026	PHYSICIANS	165962	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
83717	Fee-for-Service	1538487756	1538487756	1	1	KHATIB, NORA	10/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140794	18	Ophthalmology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
83735	Fee-for-Service	1184700692	1184700692	1	1	KIME, RYAN J MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85908	66	Emergency Medicine (Urgent Care)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
83738	Fee-for-Service	1043575186	1043575186	1	1	KIM, YEONSOO J MD	6/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123753	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
83749	Fee-for-Service	1306859194	1306859194	1	1	KEYSER, WILLIAM G MD	4/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32412	01	General Practice	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
83754	Fee-for-Service	1598783607	1598783607	1	1	KETTELLE, JOHN B MD	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	67553	02	General Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
83757	Fee-for-Service	1437461415	1437461415	1	1	KIMBERLY CONSTANCE BECKER DO	9/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
83776	Fee-for-Service	1205028834	1205028834	1	1	KIM, CHEOL CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1813 W LA HABRA BLVD	None	LA HABRA	CA	90631	5131	30	06059	33.9319113	-117.9659634	Orange County
83816	Fee-for-Service	1518595768	1518595768	1	1	KIM, KAILYN L MD	7/19/2023	207R00000X	NA	Other	026	PHYSICIANS	187181	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
83849	Fee-for-Service	1942652425	1942652425	1	1	KAHN, ZACHARY W LMFT	11/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
83870	Fee-for-Service	1306906797	1306906797	1	1	KASTING, DAVID S MD	6/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	25762	40	Pediatrics	0	In state provider	None	3212 LOMA VISTA RD	STE 260	VENTURA	CA	93003	3042	56	06111	34.2760182	-119.2530926	Ventura County
83878	Fee-for-Service	1639245319	1639245319	1	1	KIRPEKAR, RASHMI MD	10/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50216	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
83883	Fee-for-Service	1003032426	1003032426	1	1	KIM, DANNY H PT	9/23/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
83885	Fee-for-Service	1073645610	1073645610	1	1	KIM, KYUNG-HWA LMFT	6/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
83915	Fee-for-Service	1023272275	1023272275	1	1	KARNEZIS, ANASTASIOS T MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11185	04	Otology, Laryngology, Rhinology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
83936	Fee-for-Service	1801938113	1801938113	1	1	KELMAN, SIMONE M PT	4/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10515 BALBOA BLVD.	SUITE 140	GRANADA HILLS	CA	91344	6350	19	06037	34.261497	-118.502318	Los Angeles County
83956	Fee-for-Service	1558600551	1558600551	1	1	KAPADIA, ZAUREEN MD	8/7/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	140414	67	Endocrinology	0	In state provider	None	815 BAY AVE	None	CAPITOLA	CA	95010	2186	44	06087	36.98097987	-121.9554791	Santa Cruz County
83962	Fee-for-Service	1235455510	1235455510	1	1	KF RINALDI LLC	7/1/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16553 RINALDI STREET	None	GRANADA HILLS	CA	91344	3798	19	06037	34.27927048	-118.492803	Los Angeles County
83973	Fee-for-Service	1790225639	1790225639	1	1	KAMAT, LEENA MD PC	1/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	5401 NORRIS CANYON RD	SUITE 204	SAN RAMON	CA	94583	5406	07	06013	37.77752374	-121.9579277	Contra Costa County
83974	Fee-for-Service	1154740298	1154740298	1	1	KHORMAEE, SARIAH MD	7/23/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	159127	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84020	Fee-for-Service	1386613701	1386613701	1	1	KIRPALANI, MAYA M PT	4/16/2020	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7737 MEANY AVE	B5-7	BAKERSFIELD	CA	93308	5266	15	06029	35.39423549	-119.0882835	Kern County
84039	Fee-for-Service	1306859194	1306859194	1	1	KEYSER, WILLIAM G MD	4/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32412	66	Emergency Medicine (Urgent Care)	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
84080	Fee-for-Service	1932242716	1932242716	1	1	KU, WENDY PSYD	7/15/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
84087	Fee-for-Service	1508504689	1508504689	1	1	KARMA TMS PC	1/22/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	560 S PASEO DOROTEA	STE 4B	PALM SPRINGS	CA	92264	1434	33	06065	33.8146094	-116.5017737	Riverside County
84097	Fee-for-Service	1093721672	1093721672	1	1	KHAN, AMAN S MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60839	20	Orthopedic Surgery	0	In state provider	None	1800 SULLIVAN AVE	RM 307	DALY CITY	CA	94015	2223	41	06081	37.68077723	-122.4728941	San Mateo County
84123	Fee-for-Service	1942290564	1942290564	1	1	KING, JENNIFER K MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95364	83	Rheumatology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
84143	Fee-for-Service	1659710382	1659710382	1	1	KWAK, MICHAEL S MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133861	40	Pediatrics	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
84146	Fee-for-Service	1881613313	1881613313	1	1	KAMINSKY, LAWRENCE S MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	39829	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2100 WEBSTER ST	STE 318	SAN FRANCISCO	CA	94115	2377	38	06075	37.7904826	-122.4324477	San Francisco County
84191	Fee-for-Service	1932209624	1932209624	1	1	KOBAISS, HASSAN A	5/19/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
84210	Fee-for-Service	1689658122	1689658122	1	1	KEANE, JESSICA A MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88323	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
84223	Fee-for-Service	1700864881	1700864881	1	1	KHAN, RIZWAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4351 E LOHMAN, STE 301	None	LAS CRUCES	NM	88011	0000	00	None	32.32353423	-106.726982	Doña Ana County
84224	Fee-for-Service	1649674268	1649674268	1	1	KRISHNAMURTHY, AMRITA MD	4/7/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150944	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
84229	Fee-for-Service	1881751857	1881751857	1	1	KIM, DONG HOON MD	6/30/1987	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	42545	40	Pediatrics	0	In state provider	None	942 S NEW HAMPSHIRE AVE	None	LOS ANGELES	CA	90006	6008	19	06037	34.05438791	-118.2926318	Los Angeles County
84236	Fee-for-Service	1700964814	1700964814	1	1	KIBE, HARRISON MD	8/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130459	25	Physical Medicine and Rehabilitation	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
84263	Fee-for-Service	1528056777	1528056777	1	1	KIM, DAVID Y MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51561	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
84279	Fee-for-Service	1760508899	1760508899	1	1	KIDD, ELIZABETH A MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112524	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84285	Fee-for-Service	1477513703	1477513703	1	1	KIM, MICHAEL MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84227	41	Internal Medicine	0	In state provider	None	350 30TH STREET	SUITE 320	OAKLAND	CA	94609	3424	01	06001	37.81892183	-122.2640154	Alameda County
84308	Fee-for-Service	1316919442	1316919442	2	1	KELADA, YOUSSRY Y MD	6/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30726	08	Family Practice	0	In state provider	None	680 SUNRISE AVE	None	ROSEVILLE	CA	95661	0680	31	06061	38.7360182	-121.2720418	Placer County
84311	Fee-for-Service	1851559546	1851559546	1	1	KOJOGLANIAN, SAMUEL A MD	8/6/2008	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60872	06	Cardiovascular Disease (M.D. only)	0	In state provider	AMC	24868 APPLE ST	STE 103-104	SANTA CLARITA	CA	91321	5040	19	06037	34.37883973	-118.5423667	Los Angeles County
84352	Fee-for-Service	1639194822	1639194822	1	1	KHAN, JEFFREY A M.D.	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81319	10	Gastroenterology (M.D. only)	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
84404	Fee-for-Service	1720066970	1720066970	1	1	KELSO, JOHN MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	54197	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
84411	Fee-for-Service	1942290564	1942290564	1	1	KING, JENNIFER K MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95364	01	General Practice	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
84418	Fee-for-Service	1619353042	1619353042	1	7	KAWEAH DELTA HEALTH CARE INC	5/3/2018	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1110 S BEN MADDOX WAY	SUITE B	VISALIA	CA	93292	3643	54	06107	36.321048	-119.2761675	Tulare County
84429	Fee-for-Service	1457618076	1457618076	1	1	KROL, JOSHUA J DO	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13184	01	General Practice	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
84433	Fee-for-Service	1881613313	1881613313	1	1	KAMINSKY, LAWRENCE S MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	39829	07	Dermatology	0	In state provider	None	2100 WEBSTER ST	STE 318	SAN FRANCISCO	CA	94115	2377	38	06075	37.7904826	-122.4324477	San Francisco County
84460	Fee-for-Service	1053399980	1053399980	1	1	KHAN, ABDUL WAHEED MD	1/6/2009	207R00000X	NA	Other	026	PHYSICIANS	54203	41	Internal Medicine	0	In state provider	None	1144 NORMAN DR	STE 205	MANTECA	CA	95336	4962	39	06077	37.79425166	-121.1998524	San Joaquin County
84463	Fee-for-Service	1629240528	1629240528	1	1	KATO, DIANE S	5/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	164 MAPLE ST	SUITE 5	AUBURN	CA	95603	5012	31	06061	38.89704549	-121.077261	Placer County
84479	Fee-for-Service	1043674153	1043674153	1	1	KUMAR, AKASH MD	8/27/2020	207SG0201X	NA	Other	026	PHYSICIANS	150897	47	Miscellaneous	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
84512	Fee-for-Service	1649674268	1649674268	1	1	KRISHNAMURTHY, AMRITA MD	4/7/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150944	70	Clinic (mixed specialty)	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
84515	Fee-for-Service	1063592194	1063592194	1	1	KUO, JEFFREY V MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61814	None	None	0	In state provider	None	3969 4TH AVE	None	SAN DIEGO	CA	92103	3165	37	06073	32.74948151	-117.1615826	San Diego County
84522	Fee-for-Service	1730196304	1730196304	1	1	KROGSTAD, JUDI A MD	3/15/1996	171100000X	NA	Other	026	PHYSICIANS	72335	40	Pediatrics	0	In state provider	None	7011 N HOWARD ST	None	FRESNO	CA	93720	2955	10	06019	36.8382219	-119.783793	Fresno County
84527	Fee-for-Service	1881833853	1881833853	1	1	KADIVAR, KHADIJEH MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125422	30	Radiology	0	In state provider	None	7300 NORTH FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
84539	Fee-for-Service	1689295925	1689295925	1	1	KONDRAT, JASON DO	8/5/2024	207P00000X	NA	Other	026	PHYSICIANS	20804	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
84548	Fee-for-Service	1780012484	1780012484	1	1	KELLY, STEPHANIE L LMFT	6/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2258 CAMINO RAMON	None	SAN RAMON	CA	94583	1353	07	06013	37.776033	-121.970205	Contra Costa County
84567	Fee-for-Service	1760508899	1760508899	1	1	KIDD, ELIZABETH A MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112524	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84607	Fee-for-Service	1003863317	1003863317	1	1	KIM, PIUS J MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88747	41	Internal Medicine	0	In state provider	None	11525 BROOKSHIRE AVE	STE 301	DOWNEY	CA	90241	4982	19	06037	33.93544635	-118.1318321	Los Angeles County
84656	Fee-for-Service	1518980069	1518980069	1	1	KING, JULIE A MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78917	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
84689	Fee-for-Service	1174531933	1174531933	1	1	KALE BODILY	7/7/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
84692	Fee-for-Service	1720066970	1720066970	1	1	KELSO, JOHN MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	54197	03	Allergy	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
84712	Fee-for-Service	1023161676	1023161676	1	1	KARIMI, NEDA MD	11/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92760	18	Ophthalmology	0	In state provider	None	2601 E MAIN STREET	STE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
84717	Fee-for-Service	1659698447	1659698447	1	2	KWOK-OLEKSY, CHRISTINA DPM	2/21/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2929 SUMMIT STREET	STE 101	OAKLAND	CA	94609	3423	01	06001	37.81835392	-122.2648668	Alameda County
84723	Fee-for-Service	1437474780	1437474780	1	1	KARNANI, RAJAN H MD INC	5/1/1999	174400000X	NA	Other	026	PHYSICIANS	60870	13	Neurology (M.D. only)	0	In state provider	None	18419 HWY 18	SUITE 1	APPLE VALLEY	CA	92307	2229	36	06071	34.53946944	-117.2621779	San Bernardino County
84725	Fee-for-Service	1427233840	1427233840	1	1	KINGS VIEW CORPORATION	12/11/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1822 JENSEN AVENUE	STE 102, 103, 104	SANGER	CA	93657	2864	10	06019	36.70728951	-119.5635105	Fresno County
84734	Fee-for-Service	1124107818	1124107818	1	1	KIM, PETER S MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64504	40	Pediatrics	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
84740	Fee-for-Service	1083636450	1083636450	1	1	KHAWAJA, SHAZAH	10/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55816	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DRIVE	SUITE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
84745	Fee-for-Service	1003076399	1003076399	1	1	KWIATKOWSKI, KATHERINE A MD	1/3/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	174490	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
84750	Fee-for-Service	1891792693	1891792693	1	1	KIM, HYUNG L MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78041	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
84754	Fee-for-Service	1790946408	1790946408	1	1	KAKIMOTO, AMY C MD	8/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99824	08	Family Practice	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
84855	Fee-for-Service	1851488662	1851488662	1	2	KAYE, STEVEN M MD	12/12/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	29768	-	NOT APPLICABLE	0	In state provider	None	10529 SLATER AVE	STE 10505, 10507, 10537	FOUNTAIN VALLEY	CA	92708	7725	30	06059	33.70910384	-117.944985	Orange County
84865	Fee-for-Service	1295829083	1295829083	1	1	KLUG, RAYMOND A MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100007	20	Orthopedic Surgery	0	In state provider	None	1040 ELM AVE	SUITE #100	LONG BEACH	CA	90813	3264	19	06037	33.779799	-118.1879535	Los Angeles County
84869	Fee-for-Service	1477844108	1477844108	1	1	KHAN, MOHAMMED A MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142716	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	RM 1340	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
84892	Fee-for-Service	1679768204	1679768204	1	1	KARIMPOUR, FARSHAD MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110975	None	None	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
84914	Fee-for-Service	1588607691	1588607691	1	1	KHORSANDI, MEHDI	9/18/2017	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	52802	10	Gastroenterology (M.D. only)	0	In state provider	None	1510 S CENTRAL AVE	620	GLENDALE	CA	91204	2500	19	06037	34.12709764	-118.2577911	Los Angeles County
84951	Fee-for-Service	1861639114	1861639114	1	1	KONG, XIAO-TANG MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109357	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
84973	Fee-for-Service	1194704387	1194704387	1	1	KAJITANI, MICHIO MD	7/6/2017	208G00000X	NA	General Surgery	026	PHYSICIANS	89049	33	Thoracic Surgery	0	In state provider	None	401 E HIGHLAND AVE	STE 450A	SAN BERNARDINO	CA	92404	3836	36	06071	34.1358627	-117.2757778	San Bernardino County
84991	Fee-for-Service	1528080728	1528080728	1	1	KOBAYASHI, DAVID P MD	1/29/1994	207L00000X	NA	Other	026	PHYSICIANS	71286	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
84995	Fee-for-Service	1811924764	1811924764	1	1	KELLY, KEVIN M MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71711	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
84998	Fee-for-Service	1689743437	1689743437	2	1	KAYVANFAR, JOHN J MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	36821	20	Orthopedic Surgery	0	In state provider	None	18607 VENTURA BLVD	STE 101	TARZANA	CA	91356	4144	19	06037	34.16995274	-118.5388841	Los Angeles County
85016	Fee-for-Service	1063919595	1063919595	1	1	KHAN, SALMA M LCSW	8/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3655 ALAMO STREET	SUITE 202	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
85042	Fee-for-Service	1114505765	1114505765	1	1	KAISER FOUNDATION HEALTH PLA	10/19/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	772	5615 SCOTTS VALLEY DRIVE	FL 1, RM 14R06	SCOTTS VALLEY	CA	95066	0000	44	06087	37.06232425	-122.0064552	Santa Cruz County
85057	Fee-for-Service	1265895080	1265895080	1	1	KULAGY PHYSICAL THERAPY, PC	4/20/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6080 CENTER DR.	6TH FLOOR SUITE # 639	LOS ANGELES	CA	90045	9205	19	06037	33.97675505	-118.391083	Los Angeles County
85059	Fee-for-Service	1730617994	1730617994	1	1	KATIRAIE, MICHAEL DO	8/24/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16783	None	None	0	In state provider	None	9200 W PICO BLVD	None	LOS ANGELES	CA	90035	1319	19	06037	34.0552525	-118.3922955	Los Angeles County
85066	Fee-for-Service	1053301283	1053301283	1	1	KORNGUTH, LINDA MD	10/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105712	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
85080	Fee-for-Service	1467501098	1467501098	1	1	KUHN, KEVIN M MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97849	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L STREET	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
85096	Fee-for-Service	1396893905	1396893905	1	1	KAISER FOUNDATION HEALTH	1/30/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #441	710 LAWRENCE EXPY	RM 194	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
85102	Fee-for-Service	1851770044	1851770044	1	1	KHOUBIAN, JONATHAN J MD	11/1/2023	2080P0203X	NA	Other	026	PHYSICIANS	149291	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
85116	Fee-for-Service	1417921586	1417921586	1	1	KIM, SUSAN MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144819	83	Rheumatology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
85121	Fee-for-Service	1003076365	1003076365	1	1	KOENIG, SCOTT J MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124279	20	Orthopedic Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
85132	Fee-for-Service	1790041713	1790041713	1	1	KU, NAM K MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130087	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
85134	Fee-for-Service	1982806097	1982806097	1	1	KAMRAVA, MITCHELL R MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99555	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
85143	Fee-for-Service	1225463854	1225463854	1	1	KANG, LESA OD	8/18/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
85174	Fee-for-Service	1043396575	1043396575	1	1	KAPADIA, TRUPTI Y MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69377	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
85188	Fee-for-Service	1861421711	1861421711	1	1	KNITTLE, RUSSELL P MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72047	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
85207	Fee-for-Service	1588822696	1588822696	1	1	KIM, ALISON J MD	7/1/2013	207R00000X	NA	Other	026	PHYSICIANS	124615	30	Radiology	0	In state provider	None	1901 OUTLET CENTER DRIVE	SUITE 120	OXNARD	CA	93036	0664	56	06111	34.21965581	-119.1491337	Ventura County
85231	Fee-for-Service	1306911441	1306911441	1	1	KORETZ, ESTHER B LCSW	2/13/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16255 VENTURA BLVD	SUITE 806	ENCINO	CA	91436	2317	19	06037	34.15693902	-118.4876816	Los Angeles County
85272	Fee-for-Service	1114161692	1114161692	1	1	KEITH GATES MD	3/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 15TH AVE SE	None	PUYALLUP	WA	98372	3715	00	None	47.17745153	-122.2900155	Pierce County
85277	Fee-for-Service	1255302972	1255302972	1	1	KOBALTER, KRIS F MD	10/31/1992	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	69005	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1067 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3459	09	06017	38.91384447	-119.9985861	El Dorado County
85294	Fee-for-Service	1073517751	1073517751	1	1	KISHORE, KALLURI K MD	9/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53094	45	Nephrology (Renal-Kidney)	0	In state provider	None	1144 COFFEE RD	None	MODESTO	CA	95355	4205	50	06099	37.659627	-120.9756125	Stanislaus County
85296	Fee-for-Service	1922397082	1922397082	1	1	KANDIL, ABDULLAH O MD	10/18/2019	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	128449	25	Physical Medicine and Rehabilitation	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
85308	Fee-for-Service	1275093148	1275093148	1	1	KABEER, RANA A MD	7/28/2023	207P00000X	NA	Other	026	PHYSICIANS	183351	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
85330	Fee-for-Service	1518946722	1518946722	1	1	KAUL, NEERJA MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54899	None	None	0	In state provider	None	450 EAST ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
85337	Fee-for-Service	1982188587	1982188587	1	1	KAUR, KULDEEP	10/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
85348	Fee-for-Service	1386783942	1386783942	1	1	KUTNER, LISA J MD	3/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85706	36	Psychiatry	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
85379	Fee-for-Service	1104832013	1104832013	1	1	KAURA, MANJIT K PHD	1/4/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
85387	Fee-for-Service	1710140876	1710140876	1	1	KAPOOR, NAMRATA MD	6/13/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	135382	18	Ophthalmology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
85389	Fee-for-Service	1346548518	1346548518	1	1	KO, JOAN S MD	8/14/2019	208800000X	NA	Other	026	PHYSICIANS	161913	34	Urology and Urological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
85548	Fee-for-Service	1396825865	1396825865	1	1	KAISER, BENTE L N MD	12/30/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	103372	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1300 N VERMONT AVENUE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
85575	Fee-for-Service	1992521033	1992521033	1	1	KTRATSYAN, LEVON NP	12/13/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	19	06037	34.24862229	-118.2886742	Los Angeles County
85609	Fee-for-Service	1699889212	1699889212	1	1	KILAGHBIAN, TALINE A MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73274	None	None	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
85659	Fee-for-Service	1124106711	1124106711	1	1	KAMPMAN, KENNETH M MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40283	05	Anesthesiology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
85668	Fee-for-Service	1619255775	1619255775	1	1	KALEEL, MOHAMMED R MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141194	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
85669	Fee-for-Service	1073908935	1073908935	1	1	KHALILI, JOSHUA N MD	2/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144809	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
85675	Fee-for-Service	1295925253	1295925253	1	1	KHAN, TARIQ A MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112661	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
85699	Fee-for-Service	1386732246	1386732246	1	1	KLANG, ADAM R MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66296	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
85716	Fee-for-Service	1679624191	1679624191	1	1	KASKO, ANDRE M DO	7/23/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	6300	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6370 SPLIT ROCK AVE	None	TWENTYNINE PALMS	CA	92277	2550	36	06071	34.1377759	-116.0602401	San Bernardino County
85815	Fee-for-Service	1861540650	1861540650	1	1	KAISER FOUNDATION HEALTH	12/8/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY MOB 2	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
85828	Fee-for-Service	1477754612	1477754612	1	1	KHAJA, ALIUDDIN M MD	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92186	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
85866	Fee-for-Service	1043569775	1043569775	1	1	KEPHART, KATHERINE R LCSW	9/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
85885	Fee-for-Service	1467500066	1467500066	1	1	KAISER PERM PHCY #508	2/6/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12815 HEACOCK ST	None	MORENO VALLEY	CA	92553	2836	33	06065	33.934842	-117.2438195	Riverside County
85899	Fee-for-Service	1285657015	1285657015	1	1	KIM, BRIAN S MD	1/1/1998	207L00000X	NA	Other	026	PHYSICIANS	62989	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
85901	Fee-for-Service	1780732628	1780732628	1	1	KOONTZ, NANCY J NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6640 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65911992	-117.7737909	Orange County
85938	Fee-for-Service	1508038704	1508038704	1	1	KWAN, IRENE Y NP	4/11/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2433 CENTRAL AVENUE	SUITE A	ALAMEDA	CA	94501	4564	01	06001	37.76358675	-122.2413153	Alameda County
85944	Fee-for-Service	1376936062	1376936062	1	1	KIM, SHARON E MD	8/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121835	41	Internal Medicine	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
85959	Fee-for-Service	1154675114	1154675114	1	1	KADAMBI, ANIRUDH MD	8/13/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	143532	25	Physical Medicine and Rehabilitation	0	In state provider	None	8805 HAVEN AVE	SUITE 100	RANCHO CUCAMONGA	CA	91730	5149	36	06071	34.09424614	-117.5756838	San Bernardino County
85969	Fee-for-Service	1194856112	1194856112	1	1	KALRA, SUMITA K DO	2/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9428	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
85977	Fee-for-Service	1255576591	1255576591	1	1	KAUR, SUKHJINDER MD	5/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109086	41	Internal Medicine	0	In state provider	None	770 MASON STREET	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
85988	Fee-for-Service	1386732246	1386732246	1	1	KLANG, ADAM R MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66296	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
85991	Fee-for-Service	1205285590	1205285590	1	1	KAKAR, POOJA A MD	8/21/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162815	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
86006	Fee-for-Service	1811099559	1811099559	1	1	KOHLER, ALIYA K MD	1/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174925	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
86012	Fee-for-Service	1376954768	1376954768	1	2	KASHANI, HOUMAN M MD APC	6/21/2017	261QM2500X	NA	Other	026	PHYSICIANS	84361	01	General Practice	0	In state provider	None	2214 S HOOVER ST	None	LOS ANGELES	CA	90007	1848	19	06037	34.035687	-118.283982	Los Angeles County
86018	Fee-for-Service	1144250762	1144250762	1	1	KHAN, NAYYAR A MD	12/11/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46262	40	Pediatrics	0	In state provider	None	1621 GOLD ST	None	ALVISO	CA	95002	0000	43	06085	37.42478519	-121.9760557	Santa Clara County
86037	Fee-for-Service	1144378977	1144378977	1	1	KABIRI, MICHAEL MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70150	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
86039	Fee-for-Service	1316172935	1316172935	1	1	KUNA, KALYAN G MD	9/27/2023	207L00000X	NA	Other	026	PHYSICIANS	180562	None	None	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
86050	Fee-for-Service	1174568414	1174568414	1	1	KRAMAR, MARK H MD	3/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90863	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
86074	Fee-for-Service	1245388149	1245388149	1	1	KLOCK, DOROTHY M MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74516	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
86078	Fee-for-Service	1104079292	1104079292	1	1	KENY, AMEET V MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108253	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
86095	Fee-for-Service	1376506600	1376506600	1	1	KIANG, JACQUELINE C MD	7/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83189	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
86111	Fee-for-Service	1639597065	1639597065	1	1	KWONG, ALLEN B MD	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152892	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
86116	Fee-for-Service	1942241740	1942241740	1	1	KIAI, KIANUSCH MD	1/1/1998	207L00000X	NA	Other	026	PHYSICIANS	55126	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
86133	Fee-for-Service	1003835547	1003835547	1	1	KING, MELANIE E NP	5/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	16412	-	NOT APPLICABLE	0	In state provider	None	1310 M ST	None	FRESNO	CA	93721	1808	10	06019	36.73926478	-119.7905188	Fresno County
86139	Fee-for-Service	1861514531	1861514531	1	1	KHAN, IMRAN MD	2/6/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	94558	41	Internal Medicine	0	In state provider	None	201 HARTNELL AVE	None	REDDING	CA	96002	1843	45	06089	40.56739956	-122.3690135	Shasta County
86145	Fee-for-Service	1689085888	1689085888	1	1	KAZARYAN, ANNA MD	7/12/2019	207RR0500X	NA	Other	026	PHYSICIANS	148297	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
86160	Fee-for-Service	1972793537	1972793537	1	1	KETCHUM, ERIC S MD	9/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112728	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
86182	Fee-for-Service	1245732635	1245732635	1	1	KILFORD, CHANTEL M NP	2/16/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
86215	Fee-for-Service	1346285897	1346285897	1	1	KUNDA, ANAND S MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91132	22	Pathology (M.D. only)	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
86221	Fee-for-Service	1609495399	1609495399	1	1	KINGDON, JOANNA E MD	9/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186558	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
86236	Fee-for-Service	1730331059	1730331059	1	1	KOO, JENNIFER MD	3/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98095	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
86256	Fee-for-Service	1487283263	1487283263	1	1	KRUG, KATHRYN LMFT	1/12/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	110356	-	NOT APPLICABLE	0	In state provider	None	8 CRESTWOOD RD	None	BOULEVARD	CA	91905	9725	37	06073	32.7075769	-116.3623755	San Diego County
86280	Fee-for-Service	1073680096	1073680096	1	1	KAMATH, MURALI H	12/3/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60324	None	None	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
86319	Fee-for-Service	1275266942	1275266942	1	1	KIM, ERICK	12/9/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
86343	Fee-for-Service	1104242924	1104242924	1	1	KIM, CHARLES MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142099	18	Ophthalmology	0	In state provider	None	1425 W H STREET	None	OAKDALE	CA	95671	3591	50	06099	37.75771796	-120.8627767	Stanislaus County
86372	Fee-for-Service	1164088787	1164088787	1	1	KOTTLOWSKI, ANDREA L AU	8/15/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
86395	Fee-for-Service	1609333889	1609333889	1	1	KRIKORIAN, NATASHA PSYD	3/25/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
86409	Fee-for-Service	1851486302	1851486302	1	1	KANWAR, GURINDERJIT S	11/30/1993	208M00000X	NA	Other	026	PHYSICIANS	50548	41	Internal Medicine	0	In state provider	None	5404 LAUREL HILLS DR	# D	SACRAMENTO	CA	95841	3106	34	06067	38.661669	-121.338675	Sacramento County
86422	Fee-for-Service	1184070013	1184070013	1	1	KIM, ANDREW MD	9/27/2021	207L00000X	NA	Other	026	PHYSICIANS	173279	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
86427	Fee-for-Service	1861514531	1861514531	1	1	KHAN, IMRAN MD	2/6/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	94558	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	201 HARTNELL AVE	None	REDDING	CA	96002	1843	45	06089	40.56739956	-122.3690135	Shasta County
86429	Fee-for-Service	1730493081	1730493081	1	1	KHARRAZI, NEDA PHD	6/9/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94303	3341	43	06085	37.43304542	-122.1759654	Santa Clara County
86473	Fee-for-Service	1598966822	1598966822	1	1	KENT GUY MEREDITH	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5169 S COTTONWOOD ST	STE 52	MURRAY	UT	84107	6767	00	None	40.658895	-111.891447	Salt Lake County
86584	Fee-for-Service	1467415455	1467415455	1	1	KIM, KUNGSOO MD	4/30/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	47842	01	General Practice	0	In state provider	None	18102 PIONEER BLVD	STE 201	ARTESIA	CA	90701	4404	19	06037	33.86654413	-118.0821405	Los Angeles County
86586	Fee-for-Service	1568669802	1568669802	1	1	KOCHEVAR, RONALD J	10/18/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	444 GLENOAKS BLVD	None	GLENDALE	CA	91202	2917	19	06037	34.1598361	-118.2632528	Los Angeles County
86596	Fee-for-Service	1699402669	1699402669	1	1	KNOLL, BRIAN PSYD	10/2/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	147 BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
86628	Fee-for-Service	1851398606	1851398606	1	1	KARIGER, ROBERT K MD	7/31/1995	207L00000X	NA	Other	026	PHYSICIANS	70486	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
86632	Fee-for-Service	1063961241	1063961241	1	1	KAHEN AND KAHEN MD INC	2/6/2017	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9700 WOODMAN AVE	STE A 10	ARLETA	CA	91331	8040	19	06037	34.24604728	-118.4474624	Los Angeles County
86704	Fee-for-Service	1952411084	1952411084	1	1	KHAN, RADIA W MD	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94270	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
86708	Fee-for-Service	1871235085	1871235085	1	1	KAMRAN BROUKHIM, MD, PC	12/8/2022	163WG0000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	P, INC.	19228 VENTURA BLVD	D	TARZANA	CA	91356	3101	19	06037	34.17257653	-118.5520458	Los Angeles County
86719	Fee-for-Service	1609899145	1609899145	1	1	KIM, NANCY MD	7/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76034	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	5400 BALBOA BLVD	STE 202	ENCINO	CA	91316	1529	19	06037	34.169283	-118.501072	Los Angeles County
86739	Fee-for-Service	1366833915	1366833915	1	1	KHAN, RUMANA MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136176	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	SUITE 550	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
86791	Fee-for-Service	1306872783	1306872783	1	1	KAPTEIN, ELAINE M MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31866	45	Nephrology (Renal-Kidney)	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
86831	Fee-for-Service	1023300811	1023300811	1	1	KARNWAL, ABHISHEK MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122259	05	Anesthesiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
86887	Fee-for-Service	1134274897	1134274897	1	3	KAISER FOUND HOSP WLA	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
86903	Fee-for-Service	1861717829	1861717829	1	1	KUZMA, KRISTIN C MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118977	66	Emergency Medicine (Urgent Care)	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
86911	Fee-for-Service	1336230267	1336230267	1	1	KATZ, GLENN S MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35304	40	Pediatrics	0	In state provider	None	27800 MEDICAL CENTER RD	STE 204	MISSION VIEJO	CA	92691	6408	30	06059	33.55952733	-117.6645199	Orange County
86938	Fee-for-Service	1790282556	1790282556	1	1	KAUR, MEHER MD	3/3/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182730	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
86949	Fee-for-Service	1992238224	1992238224	1	1	KHANEKI, SINA MD	9/23/2021	207R00000X	NA	Other	026	PHYSICIANS	173944	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
86972	Fee-for-Service	1669601480	1669601480	1	1	KELSEY SISTI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS PL	None	SAINT LOUIS	MO	63110	1002	00	None	38.63728519	-90.26492064	St. Louis city
87008	Fee-for-Service	1720378763	1720378763	1	1	KALAC, MATKO MD	9/9/2022	207RX0202X	NA	Oncology	026	PHYSICIANS	181409	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
87050	Fee-for-Service	1740693142	1740693142	1	1	KATKAR, RUJUTA MD	7/24/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	176062	67	Endocrinology	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
87051	Fee-for-Service	1659555068	1659555068	1	1	KIM, KWANG T CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	SONGS ACUPUNCTURE	756 S KINGSLEY DR	None	LOS ANGELES	CA	90005	2440	19	06037	34.058142	-118.3030093	Los Angeles County
87053	Fee-for-Service	1548924194	1548924194	1	1	KIM, ASHLYNNE OD	8/16/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18370 BURBANK BLVD	207	TARZANA	CA	91356	2804	19	06037	34.17173059	-118.5331881	Los Angeles County
87062	Fee-for-Service	1922179829	1922179829	1	1	KW00N, JEREMIAH V MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73720	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
87068	Fee-for-Service	1023501228	1023501228	1	1	KAHLON, JASLEEN MD	9/12/2021	208M00000X	NA	Other	026	PHYSICIANS	174675	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87070	Fee-for-Service	1588762769	1588762769	1	1	KIM, SALLY I MD	4/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	57460	18	Ophthalmology	0	In state provider	None	5730 BEACH BLVD	STE 201	BUENA PARK	CA	90621	4305	30	06059	33.87709616	-117.9981771	Orange County
87092	Fee-for-Service	1790833531	1790833531	1	1	KAISER FOUNDATION HEALTH	11/1/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #341	395 HICKEY BLVD	FL 1	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
87153	Fee-for-Service	1639666563	1639666563	1	1	KAMAL, SUMATT MD	4/4/2023	207R00000X	NA	Other	026	PHYSICIANS	175586	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
87156	Fee-for-Service	1578503330	1578503330	1	1	KIM, JOON P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67595	05	Anesthesiology	0	In state provider	J P KIM MD INC	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
87169	Fee-for-Service	1548751357	1548751357	1	1	KIM, DIEGO A PT	12/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1045 W REDONDO BEACH BLV	130	GARDENA	CA	90247	4129	19	06037	33.89247044	-118.2931941	Los Angeles County
87205	Fee-for-Service	1861413296	1861413296	1	1	KAPLAN, LEE A MD	2/28/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	37152	07	Dermatology	0	In state provider	None	7301 GIRARD AVE	STE 301	LA JOLLA	CA	92037	5152	37	06073	32.83764565	-117.2715586	San Diego County
87225	Fee-for-Service	1952551228	1952551228	1	2	KEA, JON P MD	12/2/2016	207R00000X	NA	Other	026	PHYSICIANS	105566	41	Internal Medicine	0	In state provider	None	2121 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.0631281	-118.2731666	Los Angeles County
87274	Fee-for-Service	1932775079	1932775079	1	1	KAUR, AMANDEEP NP	1/10/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1255 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4801	48	06095	38.25815459	-122.0487714	Solano County
87306	Fee-for-Service	1467417444	1467417444	1	1	KAIBARA,TARO MD	5/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 N 3RD AVE	None	PHOENIX	AZ	85013	4434	00	None	33.4805218	-112.0782792	Maricopa County
87318	Fee-for-Service	1033361720	1033361720	1	1	KIM, CHUNG-LIM MD	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	45578	36	Psychiatry	0	In state provider	None	1900 E LA PALMA AVE	STE 101	ANAHEIM	CA	92805	1636	30	06059	33.84723552	-117.8908965	Orange County
87339	Fee-for-Service	1780079954	1780079954	1	1	KHANNA, ARJUN MD	6/20/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	185278	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87343	Fee-for-Service	1518982065	1518982065	1	1	KLEM, PETER S OD	7/3/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 PLEASANT GROVE BLVD	STE 100	ROSEVILLE	CA	95747	5886	31	06061	38.77233838	-121.3143437	Placer County
87372	Fee-for-Service	1841513249	1841513249	1	1	KEIZER, BRADLEY CRNA	12/27/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
87380	Fee-for-Service	1326213026	1326213026	1	1	KWOK, KYLE MD	6/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106019	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
87383	Fee-for-Service	1023155934	1023155934	1	1	KABOO, RANDHIR MD	10/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83963	05	Anesthesiology	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
87413	Fee-for-Service	1801493218	1801493218	1	1	KARIN HOMEHEALTH CARE INC	11/16/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	21049 DEVONSHIRE ST	SUITE 105A	CHATSWORTH	CA	91311	8282	19	06037	34.25727553	-118.592343	Los Angeles County
87451	Fee-for-Service	1164953543	1164953543	1	1	KANG, MICHAEL A MD	7/12/2021	207L00000X	NA	Other	026	PHYSICIANS	157583	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
87452	Fee-for-Service	1821686387	1821686387	1	1	KOLBOW, JENNIFER LMFT	5/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NSELING	765 N MAIN ST # 129	None	CORONA	CA	92878	1440	33	06065	33.8919027	-117.5637532	Riverside County
87462	Fee-for-Service	1780762542	1780762542	1	1	KUMAR, RENU MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40937	41	Internal Medicine	0	In state provider	None	1999 MOWRY AVE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
87468	Fee-for-Service	1225353592	1225353592	1	1	KAWANO, JORDAN C MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124884	41	Internal Medicine	0	In state provider	None	191 S BUENA VISTA ST	SUITE 400	BURBANK	CA	91505	4543	19	06037	34.15872557	-118.3283863	Los Angeles County
87475	Fee-for-Service	1699956359	1699956359	1	1	KORZEWSKI, MARGARET NP	8/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
87504	Fee-for-Service	1952572737	1952572737	1	1	KIANG, SHARON C MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121066	01	General Practice	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
87511	Fee-for-Service	1952551228	1952551228	1	2	KEA, JON P MD	12/2/2016	207R00000X	NA	Other	026	PHYSICIANS	105566	01	General Practice	0	In state provider	None	2121 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.0631281	-118.2731666	Los Angeles County
87532	Fee-for-Service	1376093054	1376093054	1	1	KALEMKERIS, CHRISTINA A NP	10/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87547	Fee-for-Service	1659373413	1659373413	1	1	KAPOOR, NARESH K MD	7/1/2013	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	175 N JACKSON AVE	STE 212	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
87562	Fee-for-Service	1346222494	1346222494	1	1	KING, DOUGLAS H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	KING, DOUGLAS H MD	501 N GRAHAM ST	STE 330	PORTLAND	OR	97227	2001	00	None	45.54285348	-122.671035	Multnomah County
87564	Fee-for-Service	1841556917	1841556917	1	1	KHAN, ALIYAH A MD	2/27/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	139906	01	General Practice	0	In state provider	None	3000 Q ST	3RD FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
87569	Fee-for-Service	1902291404	1902291404	1	1	KENDRICK-ADEY, ANASTASIA MD	4/1/2020	207P00000X	NA	Other	026	PHYSICIANS	167233	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
87604	Fee-for-Service	1740736610	1740736610	1	1	KHAN, MANAL F MD	8/23/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	168771	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
87626	Fee-for-Service	1679910558	1679910558	1	1	KURZ, JEFFREY S MD	2/24/2021	207P00000X	NA	Other	026	PHYSICIANS	132786	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
87662	Fee-for-Service	1427168772	1427168772	1	1	KAMINSKI, CHICHUAN Y MD	6/26/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53145	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
87692	Fee-for-Service	1083715114	1083715114	1	1	KURITSKY, LLOYD S DO	1/30/1990	207R00000X	NA	Other	026	PHYSICIANS	5956	41	Internal Medicine	0	In state provider	None	8881 FLETCHER PKWY	STE 360	LA MESA	CA	91942	6103	37	06073	32.78442148	-117.0073814	San Diego County
87701	Fee-for-Service	1023505419	1023505419	1	1	KABANI, SHELIZA MD	9/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	187866	89	Surgery-Traumatic	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
87708	Fee-for-Service	1184687592	1184687592	1	1	KAZANTSEV, GEORGE B MD	7/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83412	01	General Practice	0	In state provider	None	365 HAWTHORNE AVE	STE 101	OAKLAND	CA	94609	3115	01	06001	37.82079728	-122.2633226	Alameda County
87723	Fee-for-Service	1881769339	1881769339	1	1	KUROSE, KEITH E MD	10/29/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104125	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
87750	Fee-for-Service	1780762542	1780762542	1	1	KUMAR, RENU MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40937	01	General Practice	0	In state provider	None	1999 MOWRY AVE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
87754	Fee-for-Service	1225353592	1225353592	1	1	KAWANO, JORDAN C MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124884	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	191 S BUENA VISTA ST	SUITE 400	BURBANK	CA	91505	4543	19	06037	34.15872557	-118.3283863	Los Angeles County
87764	Fee-for-Service	1700144565	1700144565	1	1	KALOUYAN, MARLENE K MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115750	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
87770	Fee-for-Service	1619187952	1619187952	1	1	KNOX, JANETTE K MFT	7/18/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	42233	-	NOT APPLICABLE	0	In state provider	None	20350 VENTURA BLVD	STE 230	WOODLAND HILLS	CA	91364	2487	19	06037	34.16912779	-118.5759948	Los Angeles County
87786	Fee-for-Service	1588650626	1588650626	1	1	KINGSBURY, GRANT A MD INC	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64822	41	Internal Medicine	0	In state provider	INC	4060 FOURTH AVENUE	#500	SAN DIEGO	CA	92103	2138	37	06073	32.75053673	-117.1616539	San Diego County
87792	Fee-for-Service	1952572737	1952572737	1	1	KIANG, SHARON C MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121066	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
87801	Fee-for-Service	1669024121	1669024121	1	1	KALINGA CARE HOME	4/13/2021	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1230 VANCOUVER	None	LIVERMORE	CA	94550	6028	01	06001	37.66660146	-121.7799585	Alameda County
87836	Fee-for-Service	1659373413	1659373413	1	1	KAPOOR, NARESH K MD	11/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	35427	40	Pediatrics	0	In state provider	None	175 N JACKSON AVE	STE 212	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
87847	Fee-for-Service	1881629335	1881629335	1	1	KIM, ALEXANDER MD	11/29/2010	174400000X	NA	Other	026	PHYSICIANS	73116	09	Gynecology (D.O. only)	0	In state provider	None	9001 WILSHIRE BLVD	STE 203	BEVERLY HILLS	CA	90211	1838	19	06037	34.06708548	-118.3880025	Los Angeles County
87852	Fee-for-Service	1346222494	1346222494	1	1	KING, DOUGLAS H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	KING, DOUGLAS H MD	501 N GRAHAM ST	STE 330	PORTLAND	OR	97227	2001	00	None	45.54285348	-122.671035	Multnomah County
87858	Fee-for-Service	1134483506	1134483506	1	1	KAISER FOUNDATION HEALTH	7/6/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	FL 2	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
87921	Fee-for-Service	1447307764	1447307764	1	1	KAISER FND HLTH PLAN INC	6/20/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARMACY#428	3900 ALAMO ST	None	SIMI VALLEY	CA	93063	2111	56	06111	34.28628637	-118.7195497	Ventura County
87966	Fee-for-Service	1053979674	1053979674	1	1	KRUGER, STEPHEN DO	5/29/2024	261QU0200X	NA	Other	026	PHYSICIANS	22402	08	Family Practice	0	In state provider	None	447 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74338833	-121.432305	San Joaquin County
87969	Fee-for-Service	1114334398	1114334398	1	1	KALER, MANINDER S MD	10/15/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
87981	Fee-for-Service	1972536654	1972536654	1	1	KARMAKAR, KANKA MD	5/15/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54941	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
88001	Fee-for-Service	1194803916	1194803916	1	1	KAPLAN, ISSAC L MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	69176	30	Radiology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
88011	Fee-for-Service	1437170990	1437170990	1	1	KO, ANDREW C MD	5/30/1991	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	61260	None	None	0	In state provider	None	17822 BEACH BLVD	STE 301	HUNTINGTON BEACH	CA	92708	7197	30	06059	33.70331388	-117.9890471	Orange County
88041	Fee-for-Service	1750300364	1750300364	1	2	KATONA, PETER MD	9/30/1996	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	43505	41	Internal Medicine	0	In state provider	37-121 CHS, UCLA	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
88053	Fee-for-Service	1558920132	1558920132	1	1	KHAN, SHEHZEIN DO	1/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19777	None	None	0	In state provider	None	3201 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7374	34	06067	38.58561	-121.2838875	Sacramento County
88071	Fee-for-Service	1639246648	1639246648	1	1	KURZBARD, MARC A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29784	41	Internal Medicine	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
88076	Fee-for-Service	1588650626	1588650626	1	1	KINGSBURY, GRANT A MD INC	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64822	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	4060 FOURTH AVENUE	#500	SAN DIEGO	CA	92103	2138	37	06073	32.75053673	-117.1616539	San Diego County
88082	Fee-for-Service	1700015997	1700015997	1	1	KO ROBERSON, CELINE M PSYD	3/6/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
88086	Fee-for-Service	1023090115	1023090115	1	1	KALAUOKALANI, DONNA MD	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86774	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
88114	Fee-for-Service	1790776771	1790776771	2	1	KHAN, FARAZ MD	5/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176369	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
88136	Fee-for-Service	1881629335	1881629335	1	1	KIM, ALEXANDER MD	11/29/2010	174400000X	NA	Other	026	PHYSICIANS	73116	41	Internal Medicine	0	In state provider	None	9001 WILSHIRE BLVD	STE 203	BEVERLY HILLS	CA	90211	1838	19	06037	34.06708548	-118.3880025	Los Angeles County
88159	Fee-for-Service	1417236688	1417236688	3	1	KERRY EASTLAND ENTERPRISES I	10/1/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 N TUSTIN AVE	STE K	SANTA ANA	CA	92705	3605	30	06059	33.752241	-117.8342255	Orange County
88165	Fee-for-Service	1770736811	1770736811	1	1	KOZICZ, LINDSAY J	11/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21073	-	NOT APPLICABLE	0	In state provider	None	11101 S MAIN STREET	None	LOS ANGELES	CA	90061	1925	19	06037	33.93458787	-118.2739109	Los Angeles County
88166	Fee-for-Service	1063132223	1063132223	1	1	KRAVEC, MEGAN PT	5/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3184 COLLINS DR	None	MERCED	CA	95348	3132	24	06047	37.32178614	-120.4760525	Merced County
88285	Fee-for-Service	1790815256	1790815256	1	1	KIM, YOUNGSHIN T MFT	3/13/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41757	-	NOT APPLICABLE	0	In state provider	None	1835 CUNNINGHAM AVE	None	SAN JOSE	CA	95122	1712	43	06085	37.33159025	-121.8306882	Santa Clara County
88303	Fee-for-Service	1457587602	1457587602	1	2	KELLY M. SWADE D.O.	5/31/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20448	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
88305	Fee-for-Service	1740797331	1740797331	1	1	KAJI, EMILCE M DO	10/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18779	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
88319	Fee-for-Service	1487150041	1487150041	1	1	KHOURY, VICKY C MD	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	177625	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
88329	Fee-for-Service	1750300364	1750300364	1	2	KATONA, PETER MD	9/30/1996	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	43505	77	Infectious Disease	0	In state provider	37-121 CHS, UCLA	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
88423	Fee-for-Service	1881629335	1881629335	1	1	KIM, ALEXANDER MD	11/29/2010	174400000X	NA	Other	026	PHYSICIANS	73116	77	Infectious Disease	0	In state provider	None	9001 WILSHIRE BLVD	STE 203	BEVERLY HILLS	CA	90211	1838	19	06037	34.06708548	-118.3880025	Los Angeles County
88427	Fee-for-Service	1699548719	1699548719	1	1	KAPADIA MEDICAL CORPORATION	6/28/2024	163WP0000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	13542 2ND ST	None	YUCAIPA	CA	92399	0001	36	06071	34.007832	-117.0432455	San Bernardino County
88441	Fee-for-Service	1316229560	1316229560	1	1	KAUR, HARPREET PHD	5/7/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4231	30	06059	33.78029455	-117.864369	Orange County
88444	Fee-for-Service	1932266293	1932266293	1	1	KAISER FOUND HOSP PHCY	1/29/1976	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
88454	Fee-for-Service	1568479392	1568479392	1	1	KERAMATI, SHAHIN MD	8/24/2004	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	80033	None	None	0	In state provider	None	5959 SAGEBRUSH RD	None	LA JOLLA	CA	92037	7040	37	06073	32.82720649	-117.2427261	San Diego County
88461	Fee-for-Service	1932549565	1932549565	1	1	KELLY, INGRID OT	7/12/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
88509	Fee-for-Service	1639164676	1639164676	1	1	KLEIN, MICHAEL S MD	3/4/1993	208600000X	NA	General Surgery	026	PHYSICIANS	72711	02	General Surgery	0	In state provider	None	335 KATHERINE AVE	None	SALINAS	CA	93901	3176	27	06053	36.65981144	-121.6491192	Monterey County
88513	Fee-for-Service	1073848164	1073848164	1	1	KORNBLITH, AARON E MD	4/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113692	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
88532	Fee-for-Service	1417184805	1417184805	1	1	KIM, BRIAN S MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117246	None	None	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
88536	Fee-for-Service	1295775740	1295775740	1	1	KENSIC, ROBERT J MD	1/1/1979	207L00000X	NA	Other	026	PHYSICIANS	23839	05	Anesthesiology	0	In state provider	None	1100 MAR WEST ST	STE E	TIBURON	CA	94920	1861	21	06041	37.87730188	-122.4618619	Marin County
88550	Fee-for-Service	1740836493	1740836493	1	1	KONO, ALLISON K NP	2/12/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 N EUCLID ST	None	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
88568	Fee-for-Service	1710392840	1710392840	1	2	KOHAN, PEDRAM J MD	8/2/2022	207R00000X	NA	Other	026	PHYSICIANS	156402	None	None	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
88576	Fee-for-Service	1689791493	1689791493	1	1	KIM, JIN TAE MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73178	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
88586	Fee-for-Service	1710992516	1710992516	1	1	KACHER-COFF, JILL MD	7/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82012	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
88588	Fee-for-Service	1649664566	1649664566	1	1	KERKHOFF, ANDREW D MD	6/27/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	145809	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
88594	Fee-for-Service	1760952394	1760952394	1	1	KANTOR, PAUL F MD	1/28/2019	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	159186	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
88599	Fee-for-Service	1063915825	1063915825	1	1	KHOSA, JASKIRAN MD	7/1/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	174085	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
88626	Fee-for-Service	1952459778	1952459778	1	1	KOHL, DAVID A MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86165	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
88637	Fee-for-Service	1548700891	1548700891	1	1	KENDRA PENSKI LICENSED CLINI	2/10/2021	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ELLNESS CENTER	3737 MORAGA AVE	A203	SAN DIEGO	CA	92117	5491	37	06073	32.8086683	-117.2109991	San Diego County
88650	Fee-for-Service	1003842899	1003842899	1	1	KAISER, KEVIN G MD	8/26/1993	207L00000X	NA	Other	026	PHYSICIANS	55611	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
88674	Fee-for-Service	1104974096	1104974096	1	1	KADRI, NILOFER K MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66400	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
88688	Fee-for-Service	1033401849	1033401849	1	2	KESSELMAN, ANDREW J MD	5/31/2022	2085R0204X	NA	Other	026	PHYSICIANS	141867	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88714	Fee-for-Service	1417722737	1417722737	1	1	KAGANOVSKY, GREGORY	1/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4572 TELEPHONE RD	STE 903	VENTURA	CA	93003	5663	56	06111	34.25635267	-119.2348313	Ventura County
88715	Fee-for-Service	1699548719	1699548719	1	1	KAPADIA MEDICAL CORPORATION	6/28/2024	163WP0000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	13542 2ND ST	None	YUCAIPA	CA	92399	0001	36	06071	34.007832	-117.0432455	San Bernardino County
88723	Fee-for-Service	1407000748	1407000748	1	1	KANAGALA, VIKRAM S MD	4/1/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	152928	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
88724	Fee-for-Service	1912265752	1912265752	1	1	KANADA, KIMBERLY N MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127204	07	Dermatology	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	43	06085	37.36777579	-122.0276404	Santa Clara County
88732	Fee-for-Service	1427607167	1427607167	1	1	KOLT, STRAWBERRY F	1/30/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	23861 MCBEAN PKWY	STE E-16	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
88738	Fee-for-Service	1366578049	1366578049	1	1	KIM, TAE S MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81760	18	Ophthalmology	0	In state provider	None	11829 SOUTH ST	STE 102	CERRITOS	CA	90703	6828	19	06037	33.85850426	-118.0811251	Los Angeles County
88775	Fee-for-Service	1801880182	1801880182	1	1	KEALEY, GERALD P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	STATE UNIV OF IOWA	200 HAWKINS DR	None	IOWA CITY	IA	85542	1009	00	None	41.659929	-91.548099	Johnson County
88779	Fee-for-Service	1801092721	1801092721	1	1	KAU, RYAN L MD	3/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121769	04	Otology, Laryngology, Rhinology	0	In state provider	None	2950 RESEARCH PARK DRIVE	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
88791	Fee-for-Service	1245681253	1245681253	1	1	KAHOANO, BRIANA E MFT	3/30/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44664	-	NOT APPLICABLE	0	In state provider	None	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	44	06087	36.99276804	-122.0178271	Santa Cruz County
88798	Fee-for-Service	1093970493	1093970493	1	1	KUBALIK, MICHAEL ALAN MD	2/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102362	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
88813	Fee-for-Service	1831241140	1831241140	1	1	KIM, EDDIE S MD	3/31/1989	207R00000X	NA	Other	026	PHYSICIANS	67041	41	Internal Medicine	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
88821	Fee-for-Service	1588862478	1588862478	1	1	KASTURI, VELLORE G MD FACOG	8/23/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146393	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1418 E MAIN STREET	210	SANTA MARIA	CA	93454	4836	42	06083	34.95286855	-120.4137315	Santa Barbara County
88845	Fee-for-Service	1811044134	1811044134	1	1	KAISER PERMANENTE PHARM.	5/1/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#371	1900 E LAMBERT RD	None	BREA	CA	92821	4371	30	06059	33.92526172	-117.8762995	Orange County
88859	Fee-for-Service	1740549583	1740549583	1	1	KAKISH, JOVANA G MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139197	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
88864	Fee-for-Service	1164049904	1164049904	1	1	KI, HANNA CNP	6/4/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	720 ALAMITOS AVE	None	LONG BEACH	CA	90813	4726	19	06037	33.77576654	-118.1800352	Los Angeles County
88866	Fee-for-Service	1205859329	1205859329	1	1	KATZMAN, HAROLD J MD	9/6/2005	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	INC	4403 S VERMONT AVE	None	LOS ANGELES	CA	90037	2413	19	06037	34.00342736	-118.2915892	Los Angeles County
88885	Fee-for-Service	1356496772	1356496772	1	3	KAISER FOUNDATION HOSPITALS	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
88902	Fee-for-Service	1184330185	1184330185	1	1	KENT, MIRIAM LMFT	1/9/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 AVENUE I	204	REDONDO BEACH	CA	90277	5608	19	06037	33.81905278	-118.3864232	Los Angeles County
88908	Fee-for-Service	1679271191	1679271191	1	1	KEY, CYNTHIA	4/6/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
88919	Fee-for-Service	1376554956	1376554956	1	1	KIM, GEMMA MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55682	08	Family Practice	0	In state provider	None	555 TECHEVAH DR	3W105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
88925	Fee-for-Service	1013997303	1013997303	1	1	KHATTRI, SONAL MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105678	40	Pediatrics	0	In state provider	None	15611 POMERADO RD	SUITE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
88927	Fee-for-Service	1548700891	1548700891	1	1	KENDRA PENSKI LICENSED CLINI	2/10/2021	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ELLNESS CENTER	3737 MORAGA AVE	A203	SAN DIEGO	CA	92117	5491	37	06073	32.8086683	-117.2109991	San Diego County
88935	Fee-for-Service	1376588541	1376588541	1	1	KARP, MICHAEL LMFT	10/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12115 MESA VERDE DR	None	VALLEY CENTER	CA	92082	5063	37	06073	33.27547182	-117.0697178	San Diego County
88979	Fee-for-Service	1811915812	1811915812	1	1	KERI, JASON S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82017	36	Psychiatry	0	In state provider	None	3551 FRONT ST	None	SAN DIEGO	CA	92103	4815	37	06073	32.74252807	-117.1649294	San Diego County
88999	Fee-for-Service	1285195982	1285195982	1	1	KODUMUDI, GOPAL MD	8/1/2023	390200000X	NA	Other	026	PHYSICIANS	185374	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
89021	Fee-for-Service	1659482420	1659482420	1	1	KEGLEY, MARY A MD	11/20/2018	207R00000X	NA	Other	026	PHYSICIANS	87180	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
89035	Fee-for-Service	1528367174	1528367174	1	1	KHAN, HUMA N MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119519	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
89041	Fee-for-Service	1710234216	1710234216	1	1	KHAN, SONYA Y MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148306	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
89080	Fee-for-Service	1841332905	1841332905	1	1	KEYES, BRIAN O DO	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8833	05	Anesthesiology	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
89119	Fee-for-Service	1306877006	1306877006	1	1	KIM, STEVEN P DPM	5/13/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3883 AIRWAY DR	STE 165	SANTA ROSA	CA	95403	1675	49	06097	38.483226	-122.739705	Sonoma County
89140	Fee-for-Service	1912019993	1912019993	1	1	KHAW, PENTHEA S MD	7/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53807	40	Pediatrics	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
89146	Fee-for-Service	1508051566	1508051566	1	1	KOMMINENI, BHUPAL MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34651	41	Internal Medicine	0	In state provider	None	1330 SAN BERNARDINO RD	STE G	UPLAND	CA	91786	4974	36	06071	34.10294486	-117.6325059	San Bernardino County
89187	Fee-for-Service	1356496772	1356496772	1	1	KAISER FOUNDATION HOSPITALS	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
89196	Fee-for-Service	1841258209	1841258209	1	1	KEEFE, KRISTIN A MD	7/5/2018	207VH0002X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83013	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
89252	Fee-for-Service	1073554531	1073554531	1	1	KOLLEN, ROBERT MD	6/30/1989	207P00000X	NA	Other	026	PHYSICIANS	33600	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
89253	Fee-for-Service	1962412981	1962412981	1	1	KURIYAMA, STEVE	4/30/1989	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	46547	41	Internal Medicine	0	In state provider	None	122 ESCONDIDO AVE	STE 101	VISTA	CA	92084	6061	37	06073	33.19129432	-117.2369533	San Diego County
89350	Fee-for-Service	1144361593	1144361593	1	1	KUCHERINA,ANDREY	6/13/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	4922	00	None	40.700349	-73.9416015	Kings County
89369	Fee-for-Service	1073793329	1073793329	1	1	KHALETSKIY, ALEXANDER MD	1/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93171	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
89376	Fee-for-Service	1528119500	1528119500	1	1	KIM, DANNY D CA	5/30/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3340 W BALL RD	SUITE B	ANAHEIM	CA	92804	3729	30	06059	33.81726795	-118.0068541	Orange County
89383	Fee-for-Service	1275767311	1275767311	1	1	KELLOW, ZINA S MD	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107405	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
89391	Fee-for-Service	1659378966	1659378966	1	1	KWAN, YVONNE Y MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	79797	41	Internal Medicine	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
89394	Fee-for-Service	1609819663	1609819663	1	1	KURTZ, ROBERT I MD	3/26/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18897	36	Psychiatry	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93912	3195	27	06053	36.696987	-121.633164	Monterey County
89441	Fee-for-Service	1790779783	1790779783	1	1	KIM, FRANCINE M MD	9/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88853	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
89442	Fee-for-Service	1194924670	1194924670	1	1	KHAIRA, AJIT S MD INC	9/30/1989	302F00000X	NA	Other	026	PHYSICIANS	46411	41	Internal Medicine	0	In state provider	None	3120 TULARE ST	STE 102	FRESNO	CA	93721	1443	10	06019	36.74193828	-119.7786169	Fresno County
89485	Fee-for-Service	1396478137	1396478137	1	1	KIM, MIKAYLA PHD	10/4/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
89501	Fee-for-Service	1073718334	1073718334	1	1	KENNEDY, THERESA A R LCSW	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	60436	-	NOT APPLICABLE	0	In state provider	None	2425 ENBORG LANE	None	SAN JOSE	CA	95128	2648	43	06085	37.31105733	-121.937923	Santa Clara County
89504	Fee-for-Service	1861829392	1861829392	1	1	KAPOOR, KALVIN K DO	4/19/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	19241	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
89618	Fee-for-Service	1477634715	1477634715	1	1	KWAN, LEO WM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23356	05	Anesthesiology	0	In state provider	None	101 VALENCIA MESA DR	None	FULLERTON	CA	92835	0000	30	06059	33.89356031	-117.9271656	Orange County
89623	Fee-for-Service	1467501742	1467501742	1	1	KIM, YOUNG C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25863	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
89642	Fee-for-Service	1154684892	1154684892	1	1	KULKARNI, ANUBHI R MD	10/4/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	157394	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
89643	Fee-for-Service	1639330012	1639330012	1	1	KASWALA, DHARMESH H MD	6/18/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	137726	10	Gastroenterology (M.D. only)	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
89721	Fee-for-Service	1720147184	1720147184	1	1	KARL, LAURIE A MD	5/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70159	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
89726	Fee-for-Service	1609943588	1609943588	1	1	KRIEGER, LAUREN ERIC MD	11/1/1996	204D00000X	NA	Other	026	PHYSICIANS	78413	20	Orthopedic Surgery	0	In state provider	None	3300 WEBSTER ST	STE 1200	OAKLAND	CA	94609	3126	01	06001	37.82132826	-122.2621843	Alameda County
89731	Fee-for-Service	1861929499	1861929499	1	1	KAUR EXPRESS INC	9/13/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	9820 SIERRA AVE	SUITE D	FONTANA	CA	92335	6778	36	06071	34.07537559	-117.4357502	San Bernardino County
89759	Fee-for-Service	1568919033	1568919033	1	1	KWON, MEEAE YOON MD INC	10/11/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
89782	Fee-for-Service	1215266770	1215266770	1	1	KUBAT, ERIC P MD	2/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	107243	02	General Surgery	0	In state provider	None	1501 TROUSDALE DR	FLOOR 5	BURLINGTON	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
89796	Fee-for-Service	1770702698	1770702698	1	1	KAO, WAYNE W PSYD	9/22/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
89838	Fee-for-Service	1679677967	1679677967	1	1	KUTAS, ALEX MD	11/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	30388	67	Endocrinology	0	In state provider	None	3300 E SOUTH ST	STE 103	LONG BEACH	CA	90805	4582	19	06037	33.86018093	-118.1537163	Los Angeles County
89848	Fee-for-Service	1144848201	1144848201	1	1	KIRIBOON, JONATHAN	5/14/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 E WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
89850	Fee-for-Service	1811946205	1811946205	1	1	KOCHHAR, STEPHANIE C MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	71260	05	Anesthesiology	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
89871	Fee-for-Service	1649591884	1649591884	1	1	KREZANOSKI, PAUL J MD	12/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145967	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
89877	Fee-for-Service	1841515749	1841515749	1	1	KOLLENGODE, VIJAY S MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119220	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
89937	Fee-for-Service	1245302066	1245302066	1	1	KODALI, PRATIMA MD	8/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79521	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
90006	Fee-for-Service	1699791160	1699791160	1	1	KELLEY, NEIL R DPM INC	12/19/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SPECIALIST PODIATRY CTR	2504 HARRISON AVENUE	STE B	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
90013	Fee-for-Service	1447367420	1447367420	1	1	KEDAR CHINTAPALLI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
90034	Fee-for-Service	1255637997	1255637997	1	1	KURAN, RASHA A MD INC	5/29/2015	193400000X	NA	Other	026	PHYSICIANS	79950	77	Infectious Disease	0	In state provider	None	2828 H STREET	SUITE A	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
90043	Fee-for-Service	1437239605	1437239605	1	1	KIM, HOWARD L MD	9/19/2011	193400000X	NA	Other	026	PHYSICIANS	86646	13	Neurology (M.D. only)	0	In state provider	None	26060 ACERO	STE 204	MISSION VIEJO	CA	92691	2768	30	06059	33.61891985	-117.6760873	Orange County
90065	Fee-for-Service	1821044819	1821044819	2	1	KAW, MATTHEW K M	4/17/2012	207R00000X	NA	Other	026	PHYSICIANS	88602	41	Internal Medicine	0	In state provider	None	4355 PECK RD	None	EL MONTE	CA	91732	1905	19	06037	34.08355379	-118.018206	Los Angeles County
90068	Fee-for-Service	1083082507	1083082507	1	1	KITAJIMA, MIA NP	11/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
90115	Fee-for-Service	1316094634	1316094634	1	1	KAISER PERMANENTE PHCY	11/16/1977	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4904 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0980897	-118.2963555	Los Angeles County
90117	Fee-for-Service	1952620569	1952620569	1	1	KUMAR, SANDHYA B MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112612	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
90126	Fee-for-Service	1760778971	1760778971	1	1	KELLOGG, EVA R LMFT	4/14/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	91070	-	NOT APPLICABLE	0	In state provider	None	2323 HEARST AVE	None	BERKELEY	CA	94709	1319	01	06001	37.87476797	-122.2628697	Alameda County
90136	Fee-for-Service	1932115086	1932115086	1	1	KLEIN, ARTHUR MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9076	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
90159	Fee-for-Service	1922327626	1922327626	1	1	KATHRYN B. SNYDER	11/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2925 RYAN DR SE	None	SALEM	OR	97301	9687	00	None	44.920224	-123.001551	Marion County
90160	Fee-for-Service	1932293560	1932293560	1	1	KHOO, MAUREEN MD	10/6/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83835	None	None	0	In state provider	None	106 LA CASA VIA	STE 260	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
90178	Fee-for-Service	1184886749	1184886749	1	1	KHARRUBI, RANI M MD	7/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
90187	Fee-for-Service	1598849820	1598849820	1	1	KATO, GUY K OD	1/31/1987	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6309 GREENLEAF AVE	None	WHITTIER	CA	90601	3536	19	06037	33.984207	-118.037378	Los Angeles County
90226	Fee-for-Service	1245302066	1245302066	1	1	KODALI, PRATIMA MD	8/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79521	10	Gastroenterology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
90228	Fee-for-Service	1467961359	1467961359	1	1	KATCHIKIAN, HURIG MD	2/1/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165416	None	None	0	In state provider	None	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
90242	Fee-for-Service	1114160405	1114160405	1	1	KIM, SUSAN J MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113591	03	Allergy	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
90274	Fee-for-Service	1588653554	1588653554	1	1	KING, ANDREW T MD	5/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	81770	30	Radiology	0	In state provider	None	65 N MADISON AVE	STE MEZZ	PASADENA	CA	91101	2040	19	06037	34.14705803	-118.1384317	Los Angeles County
90281	Fee-for-Service	1871941021	1871941021	1	1	KIM, SIMON K MD	6/4/2020	390200000X	NA	Other	026	PHYSICIANS	153009	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
90291	Fee-for-Service	1477943199	1477943199	1	1	KIM, EILEEN H MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146059	None	None	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
90306	Fee-for-Service	1609902212	1609902212	1	1	KINGS CANYON UNIFIED SD	1/1/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	675 W MANNING AVE	None	REEDLEY	CA	93654	2427	10	06019	36.60418047	-119.454885	Fresno County
90313	Fee-for-Service	1467947176	1467947176	1	1	KIM, SANG HOON MD	7/27/2022	208M00000X	NA	Other	026	PHYSICIANS	179500	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
90314	Fee-for-Service	1669975470	1669975470	1	1	KLETZ, NED D MD	9/26/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177089	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
90344	Fee-for-Service	1265469977	1265469977	2	1	KIM, EUGENE J MD	3/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55113	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
90367	Fee-for-Service	1255419156	1255419156	1	1	KAJANI, NIZAR MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50395	22	Pathology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
90371	Fee-for-Service	1447324975	1447324975	1	1	KAO, AIMEE W MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79207	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90397	Fee-for-Service	1972651750	1972651750	1	1	KAISER FOUNDATION HOSPITALS	12/16/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y 321	4131 GEARY BLVD	STE 101	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
90423	Fee-for-Service	1932115086	1932115086	1	1	KLEIN, ARTHUR MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9076	01	General Practice	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
90444	Fee-for-Service	1881686707	1881686707	1	1	KYLASA, KRISHNA R MD	11/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88957	30	Radiology	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
90476	Fee-for-Service	1760621759	1760621759	1	1	KOLLMORGEN, ROBERT C MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	11856	20	Orthopedic Surgery	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
90479	Fee-for-Service	1336696970	1336696970	1	1	KHAN, ZAFFAR	7/31/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
90517	Fee-for-Service	1659567030	1659567030	1	1	KAIRYS, MARYANN PHD	6/14/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3625 E THOUSAND OAKS	STE 209	WESTLAKE VILLAGE	CA	91362	3566	56	06111	34.16480359	-118.8299997	Ventura County
90518	Fee-for-Service	1508925900	1508925900	1	1	KELLY-SAADE PEDIATRICS	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL CORPORATION	8337 TELEGRAPH RD	STE 119	PICO RIVERA	CA	90660	4941	19	06037	33.96454327	-118.1134473	Los Angeles County
90536	Fee-for-Service	1114553195	1114553195	1	1	KIM, YOUNG DO	12/8/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20267	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
90586	Fee-for-Service	1881642098	1881642098	1	1	KUHN, KEVIN M MD	12/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135744	20	Orthopedic Surgery	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
90602	Fee-for-Service	1982698452	1982698452	1	1	KEENE, RICHARD J MD	10/9/1981	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20760	30	Radiology	0	In state provider	None	3028 E 14TH ST	None	OAKLAND	CA	94601	2204	01	06001	37.7785506	-122.2276659	Alameda County
90645	Fee-for-Service	1962651679	1962651679	1	1	KRAKOWSKI, ANDREW C MD	6/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98058	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
90661	Fee-for-Service	1265664452	1265664452	1	1	KLEIN, ALLISON L MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108521	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
90664	Fee-for-Service	1053686204	1053686204	1	1	KUO, GARY R MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126766	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
90665	Fee-for-Service	1619464773	1619464773	1	1	KOH, SUNG WOO MD	6/28/2023	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	164034	None	None	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
90668	Fee-for-Service	1326150384	1326150384	1	1	KUTZSCHER, MARILYN M MD	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	49471	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	STE 423	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
90679	Fee-for-Service	1518124536	1518124536	1	1	KIM, GLORIA S MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74176	None	None	0	In state provider	None	1131 WILSHIRE BLVD	#100200	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
90701	Fee-for-Service	1154598449	1154598449	1	1	KAISER FOUNDATION HEALTH	6/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER P PHARMACY #554	1336 S BRIDGEGATE DR	None	DIAMOND BAR	CA	91765	3955	19	06037	33.99743665	-117.8357377	Los Angeles County
90746	Fee-for-Service	1750525671	1750525671	1	1	KIM, JOSEPH C MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93780	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90762	Fee-for-Service	1225250012	1225250012	1	1	KAHN, MELISSA E MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91058	22	Pathology (M.D. only)	0	In state provider	None	200 NORTH ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
90781	Fee-for-Service	1962677294	1962677294	1	1	KIM, STEVEN H MD	6/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116204	45	Nephrology (Renal-Kidney)	0	In state provider	None	97 SAN MARIN DRIVE	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
90869	Fee-for-Service	1144513755	1144513755	1	1	KRAUSS, DEREK J LMFT	3/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
90896	Fee-for-Service	1225485964	1225485964	1	1	KANNAN, KAVYA KANNAMMA MD	8/29/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	175955	None	None	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
90928	Fee-for-Service	1497026421	1497026421	1	1	KNAPP, SUZANNE M LCSW	6/6/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
90934	Fee-for-Service	1962651679	1962651679	1	1	KRAKOWSKI, ANDREW C MD	6/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98058	07	Dermatology	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
90939	Fee-for-Service	1023407871	1023407871	1	1	KASISCHKE, NICHOLAS R PT	9/24/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15095 AMARGOSA RD	SUITE 104	VICTORVILLE	CA	92394	1875	36	06071	34.52479785	-117.3303132	San Bernardino County
90970	Fee-for-Service	1487894879	1487894879	1	1	KATO, ANA V MD	8/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102664	40	Pediatrics	0	In state provider	None	1701 CESAR E CHAVEZ AV	STE 456 & 532	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
90973	Fee-for-Service	1851954044	1851954044	1	1	KATZ, AUSTEN D MD	8/2/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	192182	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90986	Fee-for-Service	1558924001	1558924001	1	1	KHAN, FARAZ A MD	3/15/2023	207P00000X	NA	Other	026	PHYSICIANS	184647	None	None	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
91032	Fee-for-Service	1104924760	1104924760	1	1	KATO, GREGORY K MD	11/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80703	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
91040	Fee-for-Service	1053608026	1053608026	1	1	KERRIDGE, WILLIAM D MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142446	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
91063	Fee-for-Service	1558451815	1558451815	1	1	KAM, SAM SHEUNG-TSAM MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65063	41	Internal Medicine	0	In state provider	INC	17170 COLIMA RD	STE E	HACIENDA HEIGHTS	CA	91745	6771	19	06037	33.9907128	-117.9325812	Los Angeles County
91067	Fee-for-Service	1962677294	1962677294	1	1	KIM, STEVEN H MD	6/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116204	41	Internal Medicine	0	In state provider	None	97 SAN MARIN DRIVE	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
91071	Fee-for-Service	1265745780	1265745780	1	1	KU, TINA K MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119947	18	Ophthalmology	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
91091	Fee-for-Service	1407303324	1407303324	1	1	KHAN, NAILA A DO	7/8/2020	207R00000X	NA	Other	026	PHYSICIANS	17030	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
91111	Fee-for-Service	1053750612	1053750612	1	1	KRISTA ARNET	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	320 ALPENGLOW LN	None	LIVINGSTON	MT	59047	8506	00	None	45.675135	-110.5268085	Park County
91130	Fee-for-Service	1588781678	1588781678	1	1	KHATTAR, FARID F	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
91193	Fee-for-Service	1699129775	1699129775	1	1	KELLY, MELISSA C DO	4/5/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18170	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
91227	Fee-for-Service	1245610674	1245610674	1	1	KARIM, ALIM MD	10/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188056	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
91240	Fee-for-Service	1851437321	1851437321	1	1	KAUSHAL, SUJATA MD	11/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
91290	Fee-for-Service	1891847018	1891847018	1	1	KAWASHIMA, REBEKAH MD	8/6/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69441	40	Pediatrics	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
91296	Fee-for-Service	1679797948	1679797948	1	1	KSHIRSAGAR, MALTI P MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
91299	Fee-for-Service	1487668513	1487668513	1	1	KENNEDY, RICHARD L MD	8/31/1989	208VP0014X	NA	Other	026	PHYSICIANS	62033	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
91311	Fee-for-Service	1407207608	1407207608	1	1	KAKANI, RAMSHARAN MD	10/23/2022	207R00000X	NA	Other	026	PHYSICIANS	176203	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
91323	Fee-for-Service	1730533803	1730533803	1	1	KASOWSKI, MAYA M MD	6/13/2019	207ZP0101X	NA	Other	026	PHYSICIANS	156576	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
91347	Fee-for-Service	1558451815	1558451815	1	1	KAM, SAM SHEUNG-TSAM MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65063	10	Gastroenterology (M.D. only)	0	In state provider	INC	17170 COLIMA RD	STE E	HACIENDA HEIGHTS	CA	91745	6771	19	06037	33.9907128	-117.9325812	Los Angeles County
91411	Fee-for-Service	1043823354	1043823354	1	1	KITANO, MARC LMFT	11/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
91433	Fee-for-Service	1750477279	1750477279	1	1	KHATCHTOURIAN, HENRIK MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55623	01	General Practice	0	In state provider	None	445 W BROADWAY	None	GLENDALE	CA	91204	1208	19	06037	34.14684551	-118.2633525	Los Angeles County
91435	Fee-for-Service	1760476386	1760476386	1	1	KLEYN, RONALD L MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42548	08	Family Practice	0	In state provider	None	3837 N CLARK ST	None	FRESNO	CA	93726	4806	10	06019	36.788049	-119.7852065	Fresno County
91442	Fee-for-Service	1427584044	1427584044	2	1	KMTV INC.	5/16/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	825 WASHINGTON BLVD	STE. C	MONTEBELLO	CA	90640	6179	19	06037	33.99425774	-118.1171946	Los Angeles County
91459	Fee-for-Service	1407281124	1407281124	1	1	KIM, JOSEPH MD	1/31/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	128332	None	None	0	In state provider	None	1805 N CALIFORNIA ST	201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
91507	Fee-for-Service	1699737676	1699737676	1	1	KENT, MELISSA S PA	1/6/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53433	-	NOT APPLICABLE	0	In state provider	None	2414 HOOVER AVE	SUITES A,B,C	NATIONAL CITY	CA	91950	8581	37	06073	32.66033086	-117.1043552	San Diego County
91540	Fee-for-Service	1487276853	1487276853	1	1	KOGAN, MARSEL NP	10/5/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27550 NEWHALL RANCH RD	STE 203	VALENCIA	CA	91355	6049	19	06037	34.43622185	-118.5636085	Los Angeles County
91604	Fee-for-Service	1619339298	1619339298	1	1	KUEI, ANDREW J	9/8/2022	2085R0204X	NA	Other	026	PHYSICIANS	176216	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
91617	Fee-for-Service	1619353042	1619353042	1	3	KAWEAH DELTA HEALTH CARE INC	11/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	833 SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.212967	-119.0961185	Tulare County
91649	Fee-for-Service	1780690636	1780690636	1	1	KIM, DUKE D	1/1/1979	163WP0200X	NA	Other	026	PHYSICIANS	24150	None	None	0	In state provider	MISSION PEDI MED CLN INC	26302 LA PAZ	STE 106	MISSION VIEJO	CA	92691	5327	30	06059	33.60034452	-117.671202	Orange County
91675	Fee-for-Service	1497251466	1497251466	1	1	KERR, DANA MD	7/26/2023	390200000X	NA	Other	026	PHYSICIANS	184484	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
91721	Fee-for-Service	1932137023	1932137023	1	1	KESHISHYAN, VARDUSH AU	7/21/2014	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 N MARYLAND AVE	#200	GLENDALE	CA	91206	4261	19	06037	34.149357	-118.2537315	Los Angeles County
91723	Fee-for-Service	1760476386	1760476386	1	1	KLEYN, RONALD L MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42548	01	General Practice	0	In state provider	None	3837 N CLARK ST	None	FRESNO	CA	93726	4806	10	06019	36.788049	-119.7852065	Fresno County
91730	Fee-for-Service	1508933821	1508933821	1	1	KASHANI, HALEH M PHD	7/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3429	21	06041	38.00702954	-122.5471567	Marin County
91818	Fee-for-Service	1174835730	1174835730	1	1	KHERSONSKY, ALEXA MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119157	05	Anesthesiology	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
91836	Fee-for-Service	1447324298	1447324298	1	1	KEENAN, RORY M CRNA	8/1/2002	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
91841	Fee-for-Service	1518963198	1518963198	1	1	KAZI, NADEEM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	GREATER AZ GASTRO ASSOC	1780 E. FLORENCE BLV.	STE 104	CASA GRANDE	AZ	85222	0000	00	None	32.881185	-111.7107135	Pinal County
91876	Fee-for-Service	1316130099	1316130099	1	1	KIM, IL YOUNG MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33707	41	Internal Medicine	0	In state provider	None	3919 BEVERLY BLVD	STE 100	LOS ANGELES	CA	90004	3432	19	06037	34.07634552	-118.294164	Los Angeles County
91887	Fee-for-Service	1932189024	1932189024	1	1	KNIGHT, PAUL M MD	4/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82794	30	Radiology	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
91888	Fee-for-Service	1104280833	1104280833	1	1	KENNEDY, ELENA MD	8/11/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	176243	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
91964	Fee-for-Service	1588219356	1588219356	1	1	KIM, JENNIFER OT	2/20/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
91971	Fee-for-Service	1013095777	1013095777	1	1	KHAN, AMER MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66762	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
91994	Fee-for-Service	1245675461	1245675461	1	1	KIM, UOO R MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153393	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
92025	Fee-for-Service	1801943121	1801943121	1	1	KAISER PERM PHCY #357	4/3/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 EUCLID ST	None	GARDEN GROVE	CA	92840	3304	30	06059	33.786882	-117.9410535	Orange County
92065	Fee-for-Service	1457314684	1457314684	1	1	KALANTAR-ZADEH, KAMYAR	2/1/1997	207RN0300X	NA	Nephrology	026	PHYSICIANS	61298	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
92107	Fee-for-Service	1760625412	1760625412	1	1	KVAM, KATHRYN A MD	6/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116421	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
92119	Fee-for-Service	1326500893	1326500893	1	1	KD JOHNSON & ASSOCIATES	9/12/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2140 PROFESSIONAL DR	SUITE 205	ROSEVILLE	CA	95661	3776	31	06061	38.74231476	-121.2482109	Placer County
92137	Fee-for-Service	1588628408	1588628408	1	1	KOO, CHULHWE	7/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45580	None	None	0	In state provider	None	3975 JACKSON ST	STE 305	RIVERSIDE	CA	92503	3950	33	06065	33.92729721	-117.4413503	Riverside County
92142	Fee-for-Service	1669422929	1669422929	1	1	KANEISHI, NELSON K MD	8/31/1995	207ZP0102X	NA	Other	026	PHYSICIANS	72461	22	Pathology (M.D. only)	0	In state provider	None	1600 THE ESPLANADE	STE A	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
92152	Fee-for-Service	1063979417	1063979417	1	1	KURE MEDICAL SOLUTIONS INC	7/2/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1050 SHAW AVE	STE 1053	CLOVIS	CA	93612	3940	10	06019	36.806391	-119.6957745	Fresno County
92219	Fee-for-Service	1639286404	1639286404	1	1	KIRAN, KANTHI MD	8/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82486	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
92245	Fee-for-Service	1578531885	1578531885	1	1	KAYGUSUZ, MURAT MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	52850	40	Pediatrics	0	In state provider	None	49111 HIGHWAY 111	None	COACHELLA	CA	92236	1432	33	06065	33.68950858	-116.1825133	Riverside County
92309	Fee-for-Service	1326196312	1326196312	1	1	KHAN, MANSURUR R MD	3/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72399	41	Internal Medicine	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91722	5108	19	06037	34.088004	-117.893475	Los Angeles County
92323	Fee-for-Service	1710253430	1710253430	1	1	KHAN, MUSTAFA K MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145306	25	Physical Medicine and Rehabilitation	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92353	Fee-for-Service	1457314684	1457314684	1	1	KALANTAR-ZADEH, KAMYAR	2/1/1997	207RN0300X	NA	Nephrology	026	PHYSICIANS	61298	45	Nephrology (Renal-Kidney)	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
92373	Fee-for-Service	1093773798	1093773798	1	1	KEBO, LARRY OD INC	9/7/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 JENSEN AVE	None	SANGER	CA	93657	2413	10	06019	36.7076405	-119.5578098	Fresno County
92385	Fee-for-Service	1437104858	1437104858	2	1	KOMIN, MICHAEL L MD	7/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	76214	08	Family Practice	0	In state provider	None	1150 E LERDO HWY	STE C	SHAFTER	CA	93263	9420	15	06029	35.49996992	-119.2613936	Kern County
92386	Fee-for-Service	1871569087	1871569087	1	1	KASCH, JANINE DO	6/1/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5832	08	Family Practice	0	In state provider	None	9855 ERMA RD	STE 108	SAN DIEGO	CA	92131	1007	37	06073	32.91965883	-117.1142366	San Diego County
92400	Fee-for-Service	1619027257	1619027257	1	1	KARAS, RANDA F MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53914	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
92406	Fee-for-Service	1891187381	1891187381	1	1	KHOUZAM, NADINE M MD	6/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118603	45	Nephrology (Renal-Kidney)	0	In state provider	None	4650 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92450	Fee-for-Service	1932977659	1932977659	1	1	KING, ALEXANDRA	1/23/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
92456	Fee-for-Service	1174635155	1174635155	1	1	KWAN, WALTER P MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73131	01	General Practice	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
92467	Fee-for-Service	1821148842	1821148842	1	1	KOBYLECKA, MONIKA LAC	10/17/2017	207LP2900X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92478	Fee-for-Service	1578674677	1578674677	1	1	KAKES, RICHARD MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	61859	05	Anesthesiology	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90095	0001	19	06037	34.05682871	-118.360716	Los Angeles County
92498	Fee-for-Service	1043236292	1043236292	1	1	KORDAS, KARIN C	6/29/2004	207R00000X	NA	Other	026	PHYSICIANS	78648	None	None	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
92557	Fee-for-Service	1982669552	1982669552	1	1	KIM, JOSHUA C DO	1/4/2008	207R00000X	NA	Other	026	PHYSICIANS	8224	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
92571	Fee-for-Service	1649706102	1649706102	1	1	KRAUSE, REED F MD	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	161102	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
92589	Fee-for-Service	1649539404	1649539404	1	1	KIM, ESTHER L MD	12/10/2020	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	127421	None	None	0	In state provider	None	1200 TUSTIN AVE	STE 140	SANTA ANA	CA	92705	3508	30	06059	33.75564579	-117.8342574	Orange County
92603	Fee-for-Service	1720377492	1720377492	1	1	KOHLIEBER, RENE N MD	1/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116238	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
92613	Fee-for-Service	1700423282	1700423282	1	1	KIAII, BOB MD	2/18/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	165340	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
92621	Fee-for-Service	1629021662	1629021662	1	1	KETHINENI, NEELIMA MD	4/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90570	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
92626	Fee-for-Service	1699846592	1699846592	1	1	KNOWLES, JENNIFER S MD	7/23/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55437	45	Nephrology (Renal-Kidney)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92660	Fee-for-Service	1811605850	1811605850	1	1	KANAE, MALIA K PT	12/30/2022	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
92668	Fee-for-Service	1194220392	1194220392	1	1	KWONG, AUSTIN A MD	6/21/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165774	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92708	Fee-for-Service	1821143983	1821143983	1	1	KRAMER, JOHN W DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	SIERRA CHIROPRACTIC	20049 HIGHWAY 108	# C	SONORA	CA	95370	8422	55	06109	37.98655712	-120.286685	Tuolumne County
92714	Fee-for-Service	1750674453	1750674453	1	1	KANTNER, JAMES P LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
92827	Fee-for-Service	1609011204	1609011204	1	1	KIM, EDWARD T MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136939	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
92891	Fee-for-Service	1912098534	1912098534	1	1	KENNEDY E JM	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31026	41	Internal Medicine	0	In state provider	None	901 PACIFIC ST	None	MONTEREY	CA	93940	4447	27	06053	36.59205474	-121.898679	Monterey County
92906	Fee-for-Service	1629021662	1629021662	1	1	KETHINENI, NEELIMA MD	4/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90570	77	Infectious Disease	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
92913	Fee-for-Service	1699846592	1699846592	1	1	KNOWLES, JENNIFER S MD	7/23/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55437	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92960	Fee-for-Service	1255771291	1255771291	1	1	KELKER, TARIQ A MD	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125913	02	General Surgery	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
92968	Fee-for-Service	1114212834	1114212834	1	1	KOROMZAY, DANIELA MFT	2/8/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1036 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1440	21	06041	37.95745195	-122.5499352	Marin County
92969	Fee-for-Service	1497819809	1497819809	1	1	KIM, CATHERINE A MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51524	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
92991	Fee-for-Service	1588770812	1588770812	1	1	KAYE, KENNETH L MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39831	22	Pathology (M.D. only)	0	In state provider	None	100 E VALLEY VIEW DR	None	FULLERTON	CA	92832	1321	30	06059	33.88118053	-117.9227565	Orange County
93066	Fee-for-Service	1407830888	1407830888	1	1	KIENZLE,MICHAEL G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
93184	Fee-for-Service	1467482133	1467482133	1	1	KONYALIAN, VIKEN R MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78310	02	General Surgery	0	In state provider	None	101 CITY DR S	B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
93198	Fee-for-Service	1619353042	1619353042	1	2	KAWEAH DELTA HEALTH CARE INC	11/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	119 N AKERS ST	None	VISALIA	CA	93291	5122	54	06107	36.330228	-119.3501025	Tulare County
93202	Fee-for-Service	1699846592	1699846592	1	1	KNOWLES, JENNIFER S MD	7/23/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55437	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
93244	Fee-for-Service	1700028735	1700028735	1	1	KAYYAL, SIMON Y MD	10/4/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161496	13	Neurology (M.D. only)	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
93258	Fee-for-Service	1316487168	1316487168	1	1	KLEIN, ANNE T LMFT	3/15/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	831 ALAMO DRIVE	SUITE 6C	VACAVILLE	CA	95688	5343	48	06095	38.34840279	-121.9987874	Solano County
93279	Fee-for-Service	1922028174	1922028174	1	1	KEI, JONATHAN MD	12/6/2007	207P00000X	NA	Other	026	PHYSICIANS	92379	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
93313	Fee-for-Service	1114121621	1114121621	1	1	KENNEMER, KENNE W JR LMFT	11/17/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24498	-	NOT APPLICABLE	0	In state provider	None	440 ARROWOOD DRIVE	None	SANTA ROSA	CA	95407	7503	49	06097	38.421684	-122.718069	Sonoma County
93347	Fee-for-Service	1659946812	1659946812	1	1	KAISER FOUNDATION HEALTH PLA	8/2/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	961	1650 LOS GAMOS DR	FL 2 RM 2600	SAN RAFAEL	CA	94903	0000	21	06041	38.02105246	-122.5420674	Marin County
93358	Fee-for-Service	1972979987	1972979987	1	1	KASSISSA-MOURAD, CHRISTINE	10/3/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	15097	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
93409	Fee-for-Service	1699736785	1699736785	1	1	KIRAN S GANGAHAR, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
93431	Fee-for-Service	1396788824	1396788824	1	1	KHAN, AFSAR A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST ELIZABETH HOSPITAL	2209 GENESEE ST	None	UTICA	NY	13501	5930	00	None	43.08264	-75.266046	Oneida County
93438	Fee-for-Service	1376554261	1376554261	1	1	KAKAZU, CLINTON Z MD	1/31/2011	207L00000X	NA	Other	026	PHYSICIANS	85510	05	Anesthesiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	91116	6790	19	06037	33.83760674	-118.3572569	Los Angeles County
93466	Fee-for-Service	1215940465	1215940465	1	1	KARIN HOEG	10/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
93468	Fee-for-Service	1184647950	1184647950	1	1	KING, LU-WEI MD	9/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50695	None	None	0	In state provider	None	801 E MOUNTAIN VIEW ST	STE C	BARSTOW	CA	92311	3052	36	06071	34.89324445	-117.0177579	San Bernardino County
93488	Fee-for-Service	1619353042	1619353042	1	2	KAWEAH DELTA HEALTH CARE INC	3/21/2022	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	119 N AKERS ST	None	VISALIA	CA	93291	5122	54	06107	36.330228	-119.3501025	Tulare County
93492	Fee-for-Service	1013433549	1013433549	1	1	KU, WEN-HAU	5/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16275 MONTEREY RD	STE C	MORGAN HILL	CA	95037	5466	43	06085	37.11612997	-121.6448825	Santa Clara County
93500	Fee-for-Service	1891075784	1891075784	1	1	KNIVETON, CONNIE S MD	1/6/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69016	None	None	0	In state provider	None	210 BALDWIN AVE	None	SAN MATEO	CA	94401	3915	41	06081	37.56682977	-122.3257349	San Mateo County
93523	Fee-for-Service	1134265218	1134265218	1	1	KWONG, SUSAN S OD	8/28/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12737 GLENOAKS BLVD	STE 3	SYLMAR	CA	91342	4724	19	06037	34.30181336	-118.4422626	Los Angeles County
93529	Fee-for-Service	1518166024	1518166024	1	1	KHURANA, ASHNA K MD	4/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94557	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
93580	Fee-for-Service	1790231009	1790231009	1	1	KAZARIAN, ANI OD	7/30/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17310 VENTURA BLVD	None	ENCINO	CA	91316	3904	19	06037	34.16093637	-118.5106255	Los Angeles County
93611	Fee-for-Service	1922139898	1922139898	1	1	KIM, EDWARD H MD	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79149	02	General Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
93702	Fee-for-Service	1548466030	1548466030	1	1	KINER, JASON L MD	3/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
93715	Fee-for-Service	1851093876	1851093876	1	1	KAUR, MANJOVAN PT	3/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
93751	Fee-for-Service	1750066726	1750066726	1	1	KHINDA, SUNEHA OD	10/12/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	521 E ELDER ST	STE 102	FALLBROOK	CA	92028	3082	37	06073	33.38015149	-117.246267	San Diego County
93756	Fee-for-Service	1962727602	1962727602	1	1	KLINE, ANNA LPCC	4/4/2022	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
93776	Fee-for-Service	1366883068	1366883068	1	1	KIRUPANANTHAN, NIROSHAN MD	3/3/2021	208M00000X	NA	Other	026	PHYSICIANS	170160	None	None	0	In state provider	None	3460 KATELLA AVE	None	LOS ALAMITOS	CA	90720	2334	30	06059	33.8029707	-118.073517	Orange County
93815	Fee-for-Service	1215001532	1215001532	1	1	KOPF, ERIC W MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	66297	41	Internal Medicine	0	In state provider	None	3260 BEARD RD	SUITE 5	NAPA	CA	94558	3423	28	06055	38.32237321	-122.2955875	Napa County
93844	Fee-for-Service	1730522871	1730522871	1	1	KETCHERSID, JEFFREY S MD	10/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136374	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93848	Fee-for-Service	1770169526	1770169526	1	1	KEENER, ASHLEY D CNP	2/2/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
93849	Fee-for-Service	1760531081	1760531081	1	1	KIM, HOON MD	11/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79317	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
93878	Fee-for-Service	1154946085	1154946085	1	1	KOTY, BRIANNA CRNA	9/28/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
93883	Fee-for-Service	1902228612	1902228612	1	1	KUWABARA, ANNE MD	10/11/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	157183	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
93920	Fee-for-Service	1538682810	1538682810	1	1	KUMARS TRANSPORT	4/3/2018	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1112 W FREMONT STREET	None	STOCKTON	CA	95203	2622	39	06077	37.95498697	-121.3071064	San Joaquin County
93950	Fee-for-Service	1457439291	1457439291	1	1	KUTE, KELLIE MARIE MD	7/31/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79996	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
93965	Fee-for-Service	1023081817	1023081817	1	1	KO, EDMUND Y	10/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116697	None	None	0	In state provider	None	11370 ANDERSON ST	STE 1100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
93988	Fee-for-Service	1548466030	1548466030	1	1	KINER, JASON L MD	3/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
93995	Fee-for-Service	1265412779	1265412779	1	1	KELLY, PETER R MD	4/24/2023	207R00000X	NA	Other	026	PHYSICIANS	29430	None	None	0	In state provider	None	230 PROSPECT PLACE	SUITE 340B	CORONADO	CA	92118	1991	37	06073	32.69468235	-117.1677128	San Diego County
94020	Fee-for-Service	1902428345	1902428345	1	1	KIM, ESTHER W OD	9/23/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
94023	Fee-for-Service	1558704924	1558704924	1	1	KRAUS, NICOLE J DO MD	5/30/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	14034	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
94047	Fee-for-Service	1689684078	1689684078	1	1	KAVURI, SUBBARAMAIAH MD	11/5/1996	207L00000X	NA	Other	026	PHYSICIANS	48719	05	Anesthesiology	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
94054	Fee-for-Service	1982969838	1982969838	1	1	KAWASAKI, BRIAN T MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126912	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
94066	Fee-for-Service	1447363726	1447363726	1	1	KARAPETYAN, ARMEN MD	3/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113172	41	Internal Medicine	0	In state provider	None	191 S BUENA VISTA ST	STE 150	BURBANK	CA	91505	4522	19	06037	34.15872557	-118.3283863	Los Angeles County
94097	Fee-for-Service	1811373897	1811373897	1	1	KAUR, KARANVIR NP	9/16/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
94102	Fee-for-Service	1134276454	1134276454	1	1	KAISER PERMANENTE PHCY	10/5/1977	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	152	1717 E DATE PL	None	SAN BERNARDINO	CA	92404	4428	36	06071	34.14094893	-117.2500411	San Bernardino County
94107	Fee-for-Service	1295787943	1295787943	1	1	KATZ, RICHARD L MD	5/31/1989	207L00000X	NA	Other	026	PHYSICIANS	65803	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
94123	Fee-for-Service	1023541539	1023541539	1	1	KAN, NATHAN DO	9/14/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19862	None	None	0	In state provider	None	19111 TOWN CENTER DR	None	APPLE VALLEY	CA	92308	8989	36	06071	34.46573149	-117.2467156	San Bernardino County
94126	Fee-for-Service	1629568043	1629568043	1	1	KIM, DANIEL DO	10/13/2021	207R00000X	NA	Other	026	PHYSICIANS	18905	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
94134	Fee-for-Service	1558456947	1558456947	1	1	KORNBERG, RICHARD L MD	1/1/1979	207N00000X	NA	Dermatology	026	PHYSICIANS	13900	07	Dermatology	0	In state provider	None	110 W PENNSYLVANIA AVE	None	SAN DIEGO	CA	92103	4016	37	06073	32.74515642	-117.1641388	San Diego County
94151	Fee-for-Service	1972779775	1972779775	1	1	KAUSHIK, NEERU MD	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	81329	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
94188	Fee-for-Service	1740728351	1740728351	1	1	KIGHTLINGER HARRIS, JERAD M	7/21/2023	208800000X	NA	Other	026	PHYSICIANS	181813	None	None	0	In state provider	D	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
94207	Fee-for-Service	1861446841	1861446841	1	2	KHALILI, MANOUTCHER MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	52178	None	None	0	In state provider	None	18318 SHERMAN WAY	None	RESEDA	CA	91335	4424	19	06037	34.2010535	-118.5324345	Los Angeles County
94225	Fee-for-Service	1013177633	1013177633	1	1	KHAJA, NIDAL DPM	4/9/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2075 PALOS VERDES DR N	None	LOMITA	CA	90717	3701	19	06037	33.77602431	-118.3163591	Los Angeles County
94247	Fee-for-Service	1124493861	1124493861	1	1	KELLY, RICK J LCSW	2/3/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2220 ST. GEORGE LN.	4	CHICO	CA	95926	2281	04	06007	39.7555	-121.8460989	Butte County
94257	Fee-for-Service	1497901938	1497901938	1	1	KAUR, ISHMINDER MD	8/21/2020	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169649	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
94289	Fee-for-Service	1356499248	1356499248	1	1	KURASHIGE-ENDO, LORIS T OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
94325	Fee-for-Service	1962051581	1962051581	1	1	KIM, RAYMOND J MD	9/12/2019	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
94357	Fee-for-Service	1447363726	1447363726	1	1	KARAPETYAN, ARMEN MD	3/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113172	01	General Practice	0	In state provider	None	191 S BUENA VISTA ST	STE 150	BURBANK	CA	91505	4522	19	06037	34.15872557	-118.3283863	Los Angeles County
94364	Fee-for-Service	1578636890	1578636890	1	1	KOMMINENI, SREEDHAR MD	5/30/2008	207L00000X	NA	Other	026	PHYSICIANS	89325	05	Anesthesiology	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
94402	Fee-for-Service	1083212716	1083212716	1	1	KINGS HEALTHCARE & WELLNESS	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	851 LESLIE LN	None	HANFORD	CA	93230	5643	16	06031	36.3150274	-119.6577478	Kings County
94422	Fee-for-Service	1033643887	1033643887	1	1	KIM, JONATHAN W MD	6/8/2021	207L00000X	NA	Other	026	PHYSICIANS	161701	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
94439	Fee-for-Service	1265076889	1265076889	1	1	KIM, HYUNJONG PT	11/8/2023	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
94475	Fee-for-Service	1528696812	1528696812	1	1	KAUR, PARNEET DPM	8/3/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3501 PALMER DR	STE 201	CAMERON PARK	CA	95682	8276	09	06017	38.66181999	-120.9663334	El Dorado County
94476	Fee-for-Service	1992982292	1992982292	1	1	KAW, HENRY M D INC	6/15/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	95068	08	Family Practice	0	In state provider	None	321 N POMONA AVE	STE B	FULLERTON	CA	92832	1927	30	06059	33.87321495	-117.9221357	Orange County
94579	Fee-for-Service	1720590417	1720590417	1	1	KING, HAYLIE OT	12/20/2018	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
94583	Fee-for-Service	1407141757	1407141757	1	1	KO, SAE H MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126003	02	General Surgery	0	In state provider	None	121 SOTOYOME ST	SUITE 203	SANTA ROSA	CA	95405	4822	49	06097	38.44224	-122.70195	Sonoma County
94591	Fee-for-Service	1487803946	1487803946	1	1	KINNE, ERICA L MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110179	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
94596	Fee-for-Service	1306849419	1306849419	1	1	KRUCZEK,KENNETH E DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2424 50TH STE 202	None	LUBBOCK	TX	79412	0000	00	None	33.54880351	-101.8697805	Lubbock County
94603	Fee-for-Service	1659724847	1659724847	1	1	KOTECKI, MAUREEN N CRNA	10/27/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
94614	Fee-for-Service	1750472338	1750472338	1	1	KORANSKY, MARK MD	6/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	63039	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
94637	Fee-for-Service	1487728960	1487728960	1	1	KASHANI, KAMELIA DO	12/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9505	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
94676	Fee-for-Service	1952320574	1952320574	1	1	KIM, DAVID S MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79690	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
94708	Fee-for-Service	1538107453	1538107453	1	1	KIMBERLY KOWALSKI	6/3/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2180 MAIN ST	None	WAILUKU	HI	96793	1625	00	None	20.88706871	-156.5045126	Maui County
94727	Fee-for-Service	1902224744	1902224744	1	1	KANDARIAN, BRANDON S MD	12/15/2020	207L00000X	NA	Other	026	PHYSICIANS	153595	None	None	0	In state provider	None	15466 LOS GATOS BLVD -29	STE 109	LOS GATOS	CA	95032	2542	43	06085	37.24461239	-121.9586642	Santa Clara County
94728	Fee-for-Service	1255904421	1255904421	1	1	KOHAGEN, MATTHEW J LMFT	6/1/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
94736	Fee-for-Service	1225195365	1225195365	1	2	KAUR, SUKHBIR MD	11/15/2010	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	53283	40	Pediatrics	0	In state provider	None	371 E BULLARD AVE	# 115	FRESNO	CA	93710	5217	10	06019	36.82286735	-119.7823563	Fresno County
94764	Fee-for-Service	1992982292	1992982292	1	1	KAW, HENRY M D INC	6/15/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	95068	01	General Practice	0	In state provider	None	321 N POMONA AVE	STE B	FULLERTON	CA	92832	1927	30	06059	33.87321495	-117.9221357	Orange County
94771	Fee-for-Service	1396901914	1396901914	1	1	KORILYN S ZACHRISON, M.D.	1/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	55 FRUIT ST	None	BOSTON	MA	02114	2621	00	None	42.363216	-71.0687745	Suffolk County
94773	Fee-for-Service	1477628014	1477628014	1	1	KIMURA, YUSUKE F MD	6/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102949	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
94784	Fee-for-Service	1164524088	1164524088	1	1	KUMAR, MANISHA S DO	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7919	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
94825	Fee-for-Service	1942401823	1942401823	1	1	KARP, TRACEY L CRNA	7/11/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
94834	Fee-for-Service	1013954825	1013954825	1	1	KATUKOTA, VIJAY C MD	2/25/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	38343	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1177 N PARK AVE	None	POMONA	CA	91768	3028	19	06037	34.06950662	-117.7549507	Los Angeles County
94836	Fee-for-Service	1386105484	1386105484	1	1	KAYANAN, JEWELANA M LMFT	1/25/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	20301 FLANAGAN ROAD	20331 & 20371	TRABUCO CANYON	CA	92679	0975	30	06059	33.66754509	-117.5843188	Orange County
94837	Fee-for-Service	1346659604	1346659604	1	1	KELLEY, COLLEEN A	6/4/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	15775 LAGUNA CANYON RD	STE 110	IRVINE	CA	92618	3192	30	06059	33.6663745	-117.760682	Orange County
94861	Fee-for-Service	1629459896	1629459896	1	1	KANDASAMY, ALITIA K MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162869	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
94875	Fee-for-Service	1518946649	1518946649	1	1	KUEHN, NICOLAUS J MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55874	None	None	0	In state provider	None	2820 N ONTARIO STREET	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
94903	Fee-for-Service	1134274897	1134274897	1	1	KAISER FOUND HOSP WLA	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
94920	Fee-for-Service	1265842967	1265842967	1	1	KOSKELO, MERRIT A MD	11/12/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139697	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
94950	Fee-for-Service	1821217159	1821217159	1	1	KARRI, SIRISHA MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153082	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
95004	Fee-for-Service	1851586234	1851586234	1	1	KRAUEL, THOMAS F OD APC	3/19/2008	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 THOMASON LN	None	ALTURAS	CA	96101	3150	25	06049	41.49499631	-120.5560718	Modoc County
95017	Fee-for-Service	1538524756	1538524756	1	1	KO, JINGYING Z CRNA	7/21/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
95039	Fee-for-Service	1376106344	1376106344	1	1	KOWALCZYK, MARK	5/15/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	180227	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
95074	Fee-for-Service	1164524088	1164524088	1	1	KUMAR, MANISHA S DO	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7919	83	Rheumatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
95088	Fee-for-Service	1003924697	1003924697	1	1	KWAK, SANG PHYSICAL THERAPY	9/19/2011	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	12665 GARDEN GROVE BLVD	STE 707	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
95106	Fee-for-Service	1538232731	1538232731	1	1	KREGER, JONATHAN B DPM	7/1/1990	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	172 WASHINGTON AVE	STE A	UKIAH	CA	95482	6319	23	06045	39.13417289	-123.2073629	Mendocino County
95124	Fee-for-Service	1225568256	1225568256	1	1	KHOSLA, MAYUR MD	12/3/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
95133	Fee-for-Service	1689201279	1689201279	1	1	KELLEY, ALEXANDRA GABRIELLE	4/21/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	20847	40	Pediatrics	0	In state provider	DO	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
95159	Fee-for-Service	1407184237	1407184237	1	1	KLATT, IVONNE M PSYD	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23688	-	NOT APPLICABLE	0	In state provider	None	1466 LINCOLN AVE	None	SAN RAFAEL	CA	94901	2021	21	06041	37.98004532	-122.5221262	Marin County
95165	Fee-for-Service	1447254404	1447254404	1	1	KILGORE, ERIC J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	0000	00	None	45.720117	-122.647986	Clark County
95184	Fee-for-Service	1093985368	1093985368	1	1	KWAN, ELIZABETH MD	11/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96475	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4383	01	06001	37.63347961	-122.0897735	Alameda County
95195	Fee-for-Service	1487776746	1487776746	1	1	KOHAN, KEVIN J DO	12/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10509	25	Physical Medicine and Rehabilitation	0	In state provider	None	819 AUTO CENTER DRIVE	None	PALMDALE	CA	93551	4599	19	06037	34.59142164	-118.14665	Los Angeles County
95239	Fee-for-Service	1821217159	1821217159	1	1	KARRI, SIRISHA MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153082	68	Hematology	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
95378	Fee-for-Service	1942931092	1942931092	1	1	KRENTZ, CHRISTINE MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	189167	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
95425	Fee-for-Service	1205924800	1205924800	1	1	KIM, SOO Y MD	6/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86091	10	Gastroenterology (M.D. only)	0	In state provider	None	6169 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82583257	-119.7831277	Fresno County
95430	Fee-for-Service	1306887831	1306887831	1	1	KINNISON, JOHN R MD	7/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82715	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
95438	Fee-for-Service	1790833622	1790833622	1	1	KONO, MINA MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71764	41	Internal Medicine	0	In state provider	None	2428 SANTA MONICA BLVD	STE 208	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
95445	Fee-for-Service	1225116833	1225116833	1	1	KONG, DANIEL L MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73962	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
95451	Fee-for-Service	1326119967	1326119967	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SANTA CLARA	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
95453	Fee-for-Service	1679746358	1679746358	1	1	KANE, ELAINA J	1/31/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
95542	Fee-for-Service	1295724524	1295724524	1	1	KHANNA, SANJEEV MD	2/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100041	30	Radiology	0	In state provider	None	16311 VENTURA BLVD	SUITE 120	ENCINO	CA	91436	2124	19	06037	34.15706864	-118.4885978	Los Angeles County
95545	Fee-for-Service	1700897048	1700897048	1	1	KALASSIAN, KENNETH G MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75584	05	Anesthesiology	0	In state provider	None	1950 E MOUNTAIN ST	None	PASADENA	CA	91104	4015	19	06037	34.16182344	-118.1100662	Los Angeles County
95581	Fee-for-Service	1851488662	1851488662	1	1	KAYE, STEVEN M MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	29768	01	General Practice	0	In state provider	None	7119 SEVILLE AVE	SUITE C	HUNTINGTON PARK	CA	90255	5944	19	06037	33.97493756	-118.2224857	Los Angeles County
95639	Fee-for-Service	1972687044	1972687044	1	1	KUMRA, VIVEK MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54579	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
95644	Fee-for-Service	1376708701	1376708701	1	1	KHAN, ANJUM H	8/10/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
95646	Fee-for-Service	1447235932	1447235932	1	1	KOH, YONG-KYOO MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	50260	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
95654	Fee-for-Service	1225064108	1225064108	1	1	KOMATINENI, NEELIMA	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92983	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
95658	Fee-for-Service	1598190654	1598190654	1	1	KANGWANA, KADZO F LCSW	12/9/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
95686	Fee-for-Service	1417993890	1417993890	1	1	KEREGHA, PATIENCE B MD	2/14/2007	174400000X	NA	Other	026	PHYSICIANS	51718	05	Anesthesiology	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
95735	Fee-for-Service	1790833622	1790833622	1	1	KONO, MINA MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71764	40	Pediatrics	0	In state provider	None	2428 SANTA MONICA BLVD	STE 208	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
95741	Fee-for-Service	1457640500	1457640500	1	1	KIM, THOMAS MD	12/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89521	3861	00	None	39.52483792	-119.7968314	Washoe County
95764	Fee-for-Service	1568048254	1568048254	1	1	KANDU TRANSPORT SERVICES LLC	7/5/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5665 AMNEST	None	SACRAMENTO	CA	95835	1928	34	06067	38.678445	-121.494231	Sacramento County
95766	Fee-for-Service	1629145453	1629145453	1	1	KRINGEL, JAMES C MD	5/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86561	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
95779	Fee-for-Service	1720109150	1720109150	1	1	KO, JAMES Y MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111595	05	Anesthesiology	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
95820	Fee-for-Service	1316054968	1316054968	1	1	KOEHLER, RICHARD P MD	12/2/2022	208600000X	NA	General Surgery	026	PHYSICIANS	55554	None	None	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
95829	Fee-for-Service	1700897048	1700897048	1	1	KALASSIAN, KENNETH G MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75584	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1950 E MOUNTAIN ST	None	PASADENA	CA	91104	4015	19	06037	34.16182344	-118.1100662	Los Angeles County
95868	Fee-for-Service	1851488662	1851488662	1	1	KAYE, STEVEN M MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	29768	08	Family Practice	0	In state provider	None	7119 SEVILLE AVE	SUITE C	HUNTINGTON PARK	CA	90255	5944	19	06037	33.97493756	-118.2224857	Los Angeles County
95903	Fee-for-Service	1639379258	1639379258	1	1	KUMARIA, TANYA MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94564	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
95911	Fee-for-Service	1669038154	1669038154	1	1	KAUFMAN, RACHEL S MD	8/30/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180619	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
95935	Fee-for-Service	1902067085	1902067085	1	1	KRISHNAMURTHY, PRAMOD B MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140626	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1010 NUT TREE	None	VACAVILLE	CA	95687	4172	48	06095	38.35458369	-121.9530637	Solano County
95958	Fee-for-Service	1154683530	1154683530	1	1	KAZANCHYAN, MOVSES MD	5/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
95963	Fee-for-Service	1225133473	1225133473	1	1	KIMBALL MEDICAL CTR	9/27/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 RIVER AVE	None	LAKEWOOD	NJ	08701	5237	00	None	40.07293601	-74.21756656	Ocean County
95979	Fee-for-Service	1356438113	1356438113	1	1	KALKSTEIN, STEPHEN W MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	25872	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
95989	Fee-for-Service	1487606265	1487606265	1	1	KIRSCH, CLAUDIA F MD	5/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75182	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
96043	Fee-for-Service	1306923883	1306923883	1	1	KAMALI, AZIZULAH MD	4/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40135	41	Internal Medicine	0	In state provider	KAMALI, AZIZ MD INC	4505 PRECISSI LN	# A	STOCKTON	CA	95207	6205	39	06077	37.98851034	-121.3149434	San Joaquin County
96067	Fee-for-Service	1720109150	1720109150	1	1	KO, JAMES Y MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111595	40	Pediatrics	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
96115	Fee-for-Service	1962583872	1962583872	1	1	KRISTENSEN, TORBEN B MD	10/1/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	76094	30	Radiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
96120	Fee-for-Service	1477589257	1477589257	1	1	KHAN, MOHAMMAD SHAHID A MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81486	41	Internal Medicine	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
96154	Fee-for-Service	1578162806	1578162806	1	1	KAILANY, JOAN E	7/21/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
96158	Fee-for-Service	1851488662	1851488662	1	1	KAYE, STEVEN M MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	29768	41	Internal Medicine	0	In state provider	None	7119 SEVILLE AVE	SUITE C	HUNTINGTON PARK	CA	90255	5944	19	06037	33.97493756	-118.2224857	Los Angeles County
96191	Fee-for-Service	1922137140	1922137140	1	1	KORY T ANDERSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
96192	Fee-for-Service	1447469424	1447469424	1	1	KATZ, SAMUEL MD	1/31/1992	207P00000X	NA	Other	026	PHYSICIANS	69003	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
96206	Fee-for-Service	1205834819	1205834819	1	1	KLEIN, WILLIAM P MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	14712	49	Unknown	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
96221	Fee-for-Service	1902067085	1902067085	1	1	KRISHNAMURTHY, PRAMOD B MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140626	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1010 NUT TREE	None	VACAVILLE	CA	95687	4172	48	06095	38.35458369	-121.9530637	Solano County
96248	Fee-for-Service	1275046336	1275046336	1	1	KLOTZ, JEANETTE L CRNA	4/2/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
96250	Fee-for-Service	1225133473	1225133473	1	1	KIMBALL MEDICAL CTR	9/27/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 RIVER AVE	None	LAKEWOOD	NJ	08701	5237	00	None	40.07293601	-74.21756656	Ocean County
96252	Fee-for-Service	1881728913	1881728913	1	1	KRELL, LAURA D LMFT	9/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
96279	Fee-for-Service	1043604465	1043604465	1	1	KANSAGRA, KARTIK P MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143946	30	Radiology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
96307	Fee-for-Service	1295342384	1295342384	1	1	KRAL, SARAH E LMFT	11/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
96331	Fee-for-Service	1306923883	1306923883	1	1	KAMALI, AZIZULAH MD	4/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40135	35	Pediatric Cardiology (M.D. only)	0	In state provider	KAMALI, AZIZ MD INC	4505 PRECISSI LN	# A	STOCKTON	CA	95207	6205	39	06077	37.98851034	-121.3149434	San Joaquin County
96335	Fee-for-Service	1609938539	1609938539	1	1	KOUTOULAS, KOSTA A OD	10/18/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	VISION AT MISSION	7380 MISSION ST	None	DALY CITY	CA	94014	2666	41	06081	37.69010909	-122.4659671	San Mateo County
96356	Fee-for-Service	1487638235	1487638235	1	1	KELLEY BURNETT DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 SW RAMSEY AVE	STE #204	GRANTS PASS	OR	97527	0000	00	None	42.41914017	-123.3463417	Josephine County
96366	Fee-for-Service	1356392781	1356392781	1	1	KANKIPATI, SHOBA MD	6/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80382	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 TAYLOR BLVD	STE 201	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
96379	Fee-for-Service	1700443090	1700443090	1	1	KOELLER, CHANDRA E	6/28/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1551 GRAND AVE	None	GROVER BEACH	CA	93433	2226	40	06079	35.12116313	-120.6122479	San Luis Obispo County
96409	Fee-for-Service	1336460310	1336460310	1	1	KRISTIN RENEE SCHROEDER D.O.	3/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 E UNIVERSITY AVE	None	DES MOINES	IA	50316	2302	00	None	41.60040747	-93.609657	Polk County
96411	Fee-for-Service	1083057525	1083057525	1	1	KELLY, ISAAC L MD	2/11/2022	208800000X	NA	Other	026	PHYSICIANS	134284	None	None	0	In state provider	None	210 W BONITA AVE	STE 100	POMONA	CA	91767	1865	19	06037	34.09639602	-117.750267	Los Angeles County
96433	Fee-for-Service	1356381966	1356381966	1	1	KHOURY, WISAM J MD	3/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79795	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1818 VERDUGO BLVD	STE 302	GLENDALE	CA	91208	1442	19	06037	34.20560177	-118.216054	Los Angeles County
96482	Fee-for-Service	1447469424	1447469424	1	1	KATZ, SAMUEL MD	1/31/1992	207P00000X	NA	Other	026	PHYSICIANS	69003	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
96493	Fee-for-Service	1205834819	1205834819	1	1	KLEIN, WILLIAM P MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	14712	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
96497	Fee-for-Service	1508933441	1508933441	1	1	KOH, HAN A MD	8/31/1993	207RH0000X	NA	Hematology	026	PHYSICIANS	72463	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
96502	Fee-for-Service	1184634875	1184634875	1	1	KOHLI, MEETA MD	3/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88105	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
96512	Fee-for-Service	1902067085	1902067085	1	1	KRISHNAMURTHY, PRAMOD B MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140626	41	Internal Medicine	0	In state provider	None	1010 NUT TREE	None	VACAVILLE	CA	95687	4172	48	06095	38.35458369	-121.9530637	Solano County
96579	Fee-for-Service	1871676379	1871676379	1	1	KIM, YONG-HOON	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NAM SAN DANG	957 BEACON AVE	None	LOS ANGELES	CA	90015	1107	19	06037	34.04993343	-118.2753166	Los Angeles County
96582	Fee-for-Service	1235227760	1235227760	1	1	KIM, YOUNG-RAE MD	3/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	52615	25	Physical Medicine and Rehabilitation	0	In state provider	None	3010 W ORANGE AVE	STE 407	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
96587	Fee-for-Service	1841756582	1841756582	1	1	KFI SPEECH THERAPY PROFESSON	3/1/2024	261QH0700X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ONAL CORPORATION	27184 ORTEGA HWY	103	SAN JUAN CAPISTRA	CA	92675	5705	30	06059	33.50327965	-117.6557278	Orange County
96591	Fee-for-Service	1326401043	1326401043	1	1	KAUR, AVNEET MD	9/13/2021	207R00000X	NA	Other	026	PHYSICIANS	174554	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
96607	Fee-for-Service	1386320331	1386320331	1	1	KUNG, JASMIN CRNA	8/16/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
96616	Fee-for-Service	1033437678	1033437678	1	1	KESHAVAMURTHY, RAVI MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128789	18	Ophthalmology	0	In state provider	None	4125 BANGS AVENUE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
96619	Fee-for-Service	1306923883	1306923883	1	1	KAMALI, AZIZULAH MD	4/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40135	38	Geriatrics	0	In state provider	KAMALI, AZIZ MD INC	4505 PRECISSI LN	# A	STOCKTON	CA	95207	6205	39	06077	37.98851034	-121.3149434	San Joaquin County
96623	Fee-for-Service	1518481795	1518481795	1	1	KENNEDY, TARA NP	1/5/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
96646	Fee-for-Service	1053336974	1053336974	2	1	KALPARI, KAMRAN MD	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75275	41	Internal Medicine	0	In state provider	None	8797 BEVERLY BOULEVARD	SUITE 315	WEST HOLLYWOOD	CA	90048	1862	19	06037	34.07720377	-118.3835422	Los Angeles County
96656	Fee-for-Service	1356392781	1356392781	1	1	KANKIPATI, SHOBA MD	6/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80382	68	Hematology	0	In state provider	None	400 TAYLOR BLVD	STE 201	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
96659	Fee-for-Service	1871944371	1871944371	1	1	KENNETH, MARGARET NP	8/15/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
96664	Fee-for-Service	1497259956	1497259956	1	1	KAISER FNDT HEALTH PLAN INC	7/13/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	501 J ST	1ST FL	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
96671	Fee-for-Service	1992821128	1992821128	1	1	KARBASSI, BAHAR OD	2/12/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	365 E HILLCREST DRIVE	None	THOUSAND OAKS	CA	91360	5802	56	06111	34.18122452	-118.8704974	Ventura County
96697	Fee-for-Service	1447577226	1447577226	1	1	KO, HANJO MD	4/27/2020	207L00000X	NA	Other	026	PHYSICIANS	128793	05	Anesthesiology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
96712	Fee-for-Service	1598824187	1598824187	1	1	KAY, ALEX P MD	8/31/1993	207RN0300X	NA	Nephrology	026	PHYSICIANS	53122	41	Internal Medicine	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
96720	Fee-for-Service	1356381966	1356381966	1	1	KHOURY, WISAM J MD	3/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79795	08	Family Practice	0	In state provider	None	1818 VERDUGO BLVD	STE 302	GLENDALE	CA	91208	1442	19	06037	34.20560177	-118.216054	Los Angeles County
96732	Fee-for-Service	1023069382	1023069382	1	1	KESWANI, VINEETA C MD	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90860	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	0000	19	06037	34.040502	-118.191954	Los Angeles County
96748	Fee-for-Service	1073585212	1073585212	1	1	KLEIN, BARRY D MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	41210	None	None	0	In state provider	None	215 W JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
96758	Fee-for-Service	1417231630	1417231630	1	1	KING'S PHARMACY AND COMPOUND	2/15/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ING CENTER	510 SUPERIOR AVE	SUITE 120	NEWPORT BEACH	CA	92663	3665	30	06059	33.63019271	-117.9294795	Orange County
96769	Fee-for-Service	1598728644	1598728644	1	1	KEVIN WYCOFF MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6401 FRANCE AVE S	None	MINNEAPOLIS	MN	55435	2104	00	None	44.88704016	-93.32668847	Hennepin County
96781	Fee-for-Service	1205834819	1205834819	1	1	KLEIN, WILLIAM P MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	14712	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
96791	Fee-for-Service	1447577945	1447577945	1	1	KEENER, ADRIENNE M MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120007	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	SUITE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
96792	Fee-for-Service	1750754511	1750754511	1	1	KIHIKA, JAMES	12/2/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14472 MEADOW BROOK LANE	None	CORONA	CA	92880	3918	33	06065	33.93925773	-117.6000199	Riverside County
96797	Fee-for-Service	1700807542	1700807542	1	1	KO, LILA K LCSW	6/21/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	515 E. FIRST STREET	SUITE D	TUSTIN	CA	92780	3335	30	06059	33.74583051	-117.8188245	Orange County
96805	Fee-for-Service	1669558185	1669558185	1	1	KAN, PATRICIA B MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47084	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
96837	Fee-for-Service	1730166158	1730166158	1	1	KOH, ANTHONY K MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81090	41	Internal Medicine	0	In state provider	None	2800 BENEDICT DRIVE	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
96839	Fee-for-Service	1659613974	1659613974	1	1	KOEGEL, ASHLEY K MD	7/31/2019	2080P0207X	NA	Hematology	026	PHYSICIANS	142443	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
96847	Fee-for-Service	1750608931	1750608931	1	1	KAMALI, POURANG MD INC	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90859	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	769 MEDICAL CENTER CT	STE 301	CHULA VISTA	CA	91911	6602	37	06073	32.619186	-117.0200925	San Diego County
96856	Fee-for-Service	1518933266	1518933266	2	1	KUNDI, ANITA DO	6/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	6725	08	Family Practice	0	In state provider	None	8221 ROCHESTER	STE 120	RANCHO CUCAMONGA	CA	91730	0721	36	06071	34.104249	-117.5430105	San Bernardino County
96859	Fee-for-Service	1659883114	1659883114	1	1	KWAN, ALAN CNP	9/26/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
96871	Fee-for-Service	1235227760	1235227760	1	1	KIM, YOUNG-RAE MD	3/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	52615	83	Rheumatology	0	In state provider	None	3010 W ORANGE AVE	STE 407	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
96893	Fee-for-Service	1114377355	1114377355	1	1	KAVENEY LUPO, KIEREN M DO	6/16/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
96901	Fee-for-Service	1376654293	1376654293	1	1	KARTOUMAH, ALMUTAZ B MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	1225 E HANCOCK RD	STE 203	BULLHEAD CITY	AZ	86442	5962	00	None	35.108307	-114.6055365	Mohave County
96930	Fee-for-Service	1427252048	1427252048	1	1	KRUGH, LYNDA A	12/14/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
96944	Fee-for-Service	1356392781	1356392781	1	1	KANKIPATI, SHOBA MD	6/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80382	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 TAYLOR BLVD	STE 201	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
96975	Fee-for-Service	1235592361	1235592361	1	1	KU, CRISTY MD	7/7/2021	390200000X	NA	Other	026	PHYSICIANS	171814	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
96979	Fee-for-Service	1346578911	1346578911	1	1	KAISER, SCOTT P MD	2/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110477	20	Orthopedic Surgery	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
96986	Fee-for-Service	1427072214	1427072214	1	1	KWAN, BENJAMIN C MD	10/29/1973	207W00000X	NA	Ophthalmology	026	PHYSICIANS	15172	18	Ophthalmology	0	In state provider	None	2665 WALNUT ST	None	HUNTINGTON PARK	CA	90255	5709	19	06037	33.97314742	-118.2230864	Los Angeles County
97001	Fee-for-Service	1598824187	1598824187	1	1	KAY, ALEX P MD	8/31/1993	207RN0300X	NA	Nephrology	026	PHYSICIANS	53122	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
97014	Fee-for-Service	1174562243	1174562243	1	1	KHAN, AHMEREEN MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55695	41	Internal Medicine	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
97069	Fee-for-Service	1659784593	1659784593	1	1	KHURANA, ANJIT MD	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143948	01	General Practice	0	In state provider	None	17073 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41987484	-117.2906045	San Bernardino County
97072	Fee-for-Service	1114144417	1114144417	1	1	KOCH, CHRISTOPHER T MD	10/2/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	122160	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
97081	Fee-for-Service	1750754511	1750754511	1	1	KIHIKA, JAMES	12/2/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14472 MEADOW BROOK LANE	None	CORONA	CA	92880	3918	33	06065	33.93925773	-117.6000199	Riverside County
97101	Fee-for-Service	1073539060	1073539060	1	1	KEDESHIAN, PAUL A MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79315	84	Surgery-Head and Neck	0	In state provider	None	1260 15TH ST	STE 1200	SANTA MONICA	CA	90404	1147	19	06037	34.02648965	-118.4867439	Los Angeles County
97110	Fee-for-Service	1083723803	1083723803	1	1	KEYSER, ERIC J MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	73867	None	None	0	In state provider	None	1940 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07889352	-117.7478982	Los Angeles County
97118	Fee-for-Service	1891874574	1891874574	1	1	KIM, JANE OD	2/5/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	BLUE SKY OPTOMETRY	720 E VALLEY BLVD	None	SAN GABRIEL	CA	91776	3547	19	06037	34.08007642	-118.0912958	Los Angeles County
97130	Fee-for-Service	1881824399	1881824399	1	1	KRETZMANN, BENJAMIN R MD	3/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116280	41	Internal Medicine	0	In state provider	None	8640 W 3RD STREET	SUITE 300	LOS ANGELES	CA	90048	3386	19	06037	34.07357646	-118.3813447	Los Angeles County
97143	Fee-for-Service	1437341401	1437341401	1	1	KIM, KUBINNE MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91526	07	Dermatology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
97159	Fee-for-Service	1023273604	1023273604	1	1	KULKARNI, VEDANT A MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98261	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
97178	Fee-for-Service	1558585653	1558585653	1	1	KLUS, MAUREEN B	6/3/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10992 SAN DIEGO MISSION	None	SAN DIEGO	CA	92108	2444	37	06073	32.78503881	-117.1020911	San Diego County
97193	Fee-for-Service	1922134493	1922134493	1	1	KLEIN, KARA B LCSW	3/10/2005	1041C0700X	NA	Mental Health Outpatient Services	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5225 WILSHIRE BLVD	STE 201	LOS ANGELES	CA	90036	4346	19	06037	34.06221752	-118.3436505	Los Angeles County
97199	Fee-for-Service	1104872993	1104872993	1	1	KIM, JOHN J MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
97237	Fee-for-Service	1437250834	1437250834	1	1	KAMBOJ, PREM K MD	12/8/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32580	None	None	0	In state provider	None	943 N GEM ST	None	TULARE	CA	93274	2127	54	06107	36.22119529	-119.3398764	Tulare County
97253	Fee-for-Service	1235420241	1235420241	1	1	KIM, IRENE A MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126132	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
97276	Fee-for-Service	1255548483	1255548483	1	2	KEDREN COMMUNITY HEALTH	3/1/2020	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	4211 SOUTH AVALON BLVD	None	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
97310	Fee-for-Service	1811237191	1811237191	1	1	KNOX, OMA C MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124295	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
97322	Fee-for-Service	1417157652	1417157652	1	1	KADAKIA, MITUL B MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130262	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	365 HAWTHORNE AVE	SUITE 201	OAKLAND	CA	94609	3114	01	06001	37.82079728	-122.2633226	Alameda County
97336	Fee-for-Service	1477220655	1477220655	1	1	KHAN, PANIZ MD	12/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
97366	Fee-for-Service	1952647711	1952647711	1	1	K'BURG, REGINA I PSYD	11/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8788 ELK GROVE BLVD	STE M	ELK GROVE	CA	95624	1768	34	06067	38.408382	-121.3770645	Sacramento County
97404	Fee-for-Service	1417278565	1417278565	1	1	KUO, ENID T MD	11/15/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	107937	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
97409	Fee-for-Service	1780047142	1780047142	1	1	KURTZ, KRISTEN MD	5/17/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151471	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
97414	Fee-for-Service	1194361634	1194361634	1	1	K DAVID FLORA DPM INC	2/15/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1086 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22388137	-119.3371979	Tulare County
97420	Fee-for-Service	1881824399	1881824399	1	1	KRETZMANN, BENJAMIN R MD	3/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116280	83	Rheumatology	0	In state provider	None	8640 W 3RD STREET	SUITE 300	LOS ANGELES	CA	90048	3386	19	06037	34.07357646	-118.3813447	Los Angeles County
97446	Fee-for-Service	1942321393	1942321393	1	1	KIM, JA-HONG MD	4/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99141	34	Urology and Urological Surgery	0	In state provider	None	10833 LA CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
97478	Fee-for-Service	1922134493	1922134493	1	1	KLEIN, KARA B LCSW	9/28/2004	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5225 WILSHIRE BLVD	STE 201	LOS ANGELES	CA	90036	4346	19	06037	34.06221752	-118.3436505	Los Angeles County
97502	Fee-for-Service	1033461603	1033461603	1	1	KEMPF, CHRISTOPHER F NP	6/17/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
97510	Fee-for-Service	1134786437	1134786437	2	1	KS HEALTHCARE	8/19/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	904 E PACIFIC COAST HWY	None	LONG BEACH	CA	90806	5626	19	06037	33.78984548	-118.181295	Los Angeles County
97537	Fee-for-Service	1235420241	1235420241	1	1	KIM, IRENE A MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126132	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
97561	Fee-for-Service	1043325939	1043325939	1	1	KINKEL, REVERE P MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89360	13	Neurology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
97589	Fee-for-Service	1922551407	1922551407	1	1	KAPAHALOU, LINDSEY LMFT	10/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
97596	Fee-for-Service	1851391833	1851391833	1	1	KATRAGADDA, RAGHU R MD	8/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78647	05	Anesthesiology	0	In state provider	None	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1730	01	06001	37.55887933	-121.9797796	Alameda County
97659	Fee-for-Service	1558612978	1558612978	1	1	KIM, BRIAN J MD	5/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122621	34	Urology and Urological Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
97760	Fee-for-Service	1831582220	1831582220	1	1	KMY PROSTHETIC & ORTHOTIC	6/25/2015	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7210 N MILBURN AVE	SUITE 105	FRESNO	CA	93722	2380	10	06019	36.84006828	-119.8789971	Fresno County
97785	Fee-for-Service	1760004139	1760004139	1	1	KELLER, MARIE	7/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
97786	Fee-for-Service	1720022619	1720022619	1	1	KLEINER, MICHELLE R NP	12/31/2018	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	277 RANCHEROS DR	STE 301	SAN MARCOS	CA	92069	2993	37	06073	33.13859391	-117.1604009	San Diego County
97793	Fee-for-Service	1689635906	1689635906	1	1	KIM, CHIN G MD INC	8/31/1981	174400000X	NA	Other	026	PHYSICIANS	34967	02	General Surgery	0	In state provider	None	3400 W BALL RD	STE 208	ANAHEIM	CA	92804	3735	30	06059	33.81724472	-118.0083216	Orange County
97802	Fee-for-Service	1629604533	1629604533	1	1	KAJANI, NATASHA K MD	10/13/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	180289	None	None	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
97819	Fee-for-Service	1477736650	1477736650	1	1	KANG, DAE-WOOK MD APC	9/18/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79486	41	Internal Medicine	0	In state provider	None	2000 W HEDDING ST	STE 10	SAN JOSE	CA	95128	1426	43	06085	37.33165619	-121.9348885	Santa Clara County
97833	Fee-for-Service	1962063743	1962063743	1	1	KUMAR, POOJA MD	10/7/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176594	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
97858	Fee-for-Service	1548903941	1548903941	1	1	K2 HEALTH CARE INC	7/12/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 NUT TREE RD	110	VACAVILLE	CA	95687	4166	48	06095	38.3564252	-121.9532031	Solano County
97929	Fee-for-Service	1275783607	1275783607	1	1	KWOK, JAY OD	9/22/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1031 W CHAPMAN AVE	STE 204	ORANGE	CA	92868	2872	30	06059	33.78791049	-117.8632755	Orange County
97934	Fee-for-Service	1952961815	1952961815	1	1	KASZUBSKI, MELISA S AU	12/30/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
98015	Fee-for-Service	1740692797	1740692797	1	1	KALKIN, PAUL A LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
98024	Fee-for-Service	1285849992	1285849992	1	1	KIM, OOK MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97565	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
98071	Fee-for-Service	1407305097	1407305097	1	1	KOZLOSKI, JUSTIN P OD	1/25/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	82227 US HIGHWAY 111	STE B2	INDIO	CA	92201	5668	33	06065	33.71471443	-116.2312195	Riverside County
98151	Fee-for-Service	1063988897	1063988897	1	1	KALAW, VALERIO T MD	3/5/2024	207R00000X	NA	Other	026	PHYSICIANS	175354	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
98153	Fee-for-Service	1962865451	1962865451	1	1	KIM, TAE YEON MD	10/30/2020	207L00000X	NA	Other	026	PHYSICIANS	167819	None	None	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
98166	Fee-for-Service	1568849065	1568849065	1	1	KHOO, TERESA MD	6/13/2018	390200000X	NA	Other	026	PHYSICIANS	148459	08	Family Practice	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
98179	Fee-for-Service	1619055100	1619055100	1	1	KEHOE, JOSHUA M MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75308	02	General Surgery	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
98196	Fee-for-Service	1366599680	1366599680	1	1	KAISER FND HLTH PLN INC	3/28/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMAN PHARM #551	1011 BALDWIN PARK BLVD	FL 1	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
98325	Fee-for-Service	1124149224	1124149224	1	1	KRAMER, SHELLEY C PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SHELLEY B KRAMER PHD	2181 S EL CAMINO REAL	STE 305	OCEANSIDE	CA	92054	6288	37	06073	33.18767693	-117.3284773	San Diego County
98360	Fee-for-Service	1588719579	1588719579	1	2	KAISER FOUNDATION HOSP	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17542 E 17TH STREET	STE 300	TUSTIN	CA	92780	1960	30	06059	33.75966953	-117.8261065	Orange County
98417	Fee-for-Service	1285701128	1285701128	1	1	KOON, SEAN E MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70370	01	General Practice	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
98432	Fee-for-Service	1376740605	1376740605	1	1	KIM, AMY H MD	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104808	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92359	2804	36	06071	34.049547	-117.264078	San Bernardino County
98493	Fee-for-Service	1396995163	1396995163	1	1	KELLY, TARA M NP	12/8/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
98533	Fee-for-Service	1518045277	1518045277	1	1	KHURANA, SANJEEV S MD	6/18/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85265	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
98554	Fee-for-Service	1518609007	1518609007	1	1	KIM, HEIDI NP	2/25/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16955 VANOWEN	None	VAN NUYS	CA	91406	4542	19	06037	34.19389751	-118.503342	Los Angeles County
98579	Fee-for-Service	1093702060	1093702060	2	1	KCI USA INC	8/29/2012	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	720 N VALLEY ST	STE K	ANAHEIM	CA	92801	3830	30	06059	33.842232	-117.956433	Orange County
98630	Fee-for-Service	1932562709	1932562709	1	1	KHAN, MAHMUDA MD	8/21/2019	207R00000X	NA	Other	026	PHYSICIANS	160741	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
98692	Fee-for-Service	1992762769	1992762769	1	1	KIM, JIM C	10/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	67383	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
98699	Fee-for-Service	1366676892	1366676892	1	1	KHAN, KAMRAN MD PC	12/21/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	5495 S RAINBOW BLVD	STE 102	LAS VEGAS	NV	89118	1872	00	None	36.08899879	-115.2429219	Clark County
98705	Fee-for-Service	1609133784	1609133784	1	1	KURTZMAN, MARC F MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145172	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
98746	Fee-for-Service	1316263759	1316263759	1	1	KRISHNAN, LAVANYA P MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130272	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
98757	Fee-for-Service	1871589754	1871589754	1	1	KURT J KLISE, MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	616 10TH ST	None	PERRY	IA	50220	2221	00	None	41.83405164	-94.0944011	Dallas County
98777	Fee-for-Service	1891894432	1891894432	1	1	KIRK WEBER	4/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	334 TOWN CENTER AVE	None	BIG SKY	MT	59716	1529	00	None	45.260424	-111.3007635	Gallatin County
98778	Fee-for-Service	1174696645	1174696645	1	1	KOKOTOVIC, ANNA M	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	42	06083	34.42310529	-119.7066629	Santa Barbara County
98784	Fee-for-Service	1255438727	1255438727	1	1	KIM, BILL H MD	3/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	42471	10	Gastroenterology (M.D. only)	0	In state provider	None	11480 BROOKSHIRE AVE	STE 200	DOWNEY	CA	90241	5021	19	06037	33.93622932	-118.1311752	Los Angeles County
98793	Fee-for-Service	1164918710	1164918710	1	1	KAGEDAN, DANIEL J MD	1/27/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
98812	Fee-for-Service	1730690728	1730690728	1	2	KNICKERBOCKER, SANDRA L LMFT	1/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2816 ADAMS AVE	None	SAN DIEGO	CA	92116	1401	37	06073	32.76289253	-117.1335427	San Diego County
98813	Fee-for-Service	1851719413	1851719413	1	1	KOO, JENNY MD	7/27/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	139737	40	Pediatrics	0	In state provider	None	3003 HEALTH CENTER DRIVE	None	SAN DIEGO	CA	92123	2700	37	06073	32.79785552	-117.1563475	San Diego County
98866	Fee-for-Service	1659633352	1659633352	1	1	KRAUS, EMILY A MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128576	01	General Practice	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
98894	Fee-for-Service	1336358829	1336358829	1	1	KOSHY, RUBEN G MD	2/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123754	05	Anesthesiology	0	In state provider	None	975 SOUTH FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
98933	Fee-for-Service	1790863298	1790863298	1	1	KIRMIZ, SAMIRA MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90572	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
98953	Fee-for-Service	1164817094	1164817094	1	1	KANG, JANICE H MD	7/6/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	154827	26	Psychiatry (child)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
98982	Fee-for-Service	1689683690	1689683690	1	1	KO, DAVID H MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69524	41	Internal Medicine	0	In state provider	None	477 N EL CAMINO REAL	None	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
99004	Fee-for-Service	1831126424	1831126424	1	1	KORENBERG, JULIE R MD	3/16/1998	174400000X	NA	Other	026	PHYSICIANS	40959	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
99018	Fee-for-Service	1780684761	1780684761	1	1	KARIPINENI, SHAKIRA B MD	8/8/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	33906	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1730	01	06001	37.55887933	-121.9797796	Alameda County
99027	Fee-for-Service	1841691284	1841691284	1	1	KAZARYANTS, KIMBERLY PHD	4/15/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
99056	Fee-for-Service	1255867743	1255867743	1	1	KIANOUSH, SINA MD	9/25/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	191537	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
99073	Fee-for-Service	1093232282	1093232282	1	1	KAISER FOUNDATION HEALTH	4/19/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	28150 KELLER RD	1ST FLR	MURRIETA	CA	92563	0000	33	06065	33.62913	-117.1684665	Riverside County
99096	Fee-for-Service	1114311248	1114311248	1	1	KOH, EILEEN H	4/15/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	162266	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
99103	Fee-for-Service	1750729588	1750729588	1	1	KAW, HONE S MD	9/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126514	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 204	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
99113	Fee-for-Service	1316387707	1316387707	1	1	KHALAF, NAILA MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132564	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
99130	Fee-for-Service	1316922370	1316922370	1	1	KNE, TANYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
99139	Fee-for-Service	1639245426	1639245426	1	1	KEYS, JENNIFER MD	11/27/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
99183	Fee-for-Service	1639415870	1639415870	1	1	KULLAR, JASNEET D MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125656	41	Internal Medicine	0	In state provider	None	7600 OLD DOMINION COURT	None	APTOS	CA	95003	3821	44	06087	36.97913818	-121.9099818	Santa Cruz County
99219	Fee-for-Service	1790863298	1790863298	1	1	KIRMIZ, SAMIRA MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90572	67	Endocrinology	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
99221	Fee-for-Service	1750498226	1750498226	1	1	KHARBANDA, SANDHYA MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53866	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
99252	Fee-for-Service	1376875518	1376875518	1	1	KRISHAN, RAJEEV M D A	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76632	10	Gastroenterology (M.D. only)	0	In state provider	PROFEFFIONAL CORP	9900 STOCKDALE HWY	STE 208	BAKERSFIELD	CA	93311	3634	15	06029	35.35412167	-119.1124089	Kern County
99273	Fee-for-Service	1124275516	1124275516	1	1	KIM, RENEE PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	433 N ALTADENA DR	STE 8	PASADNEA	CA	91107	2558	19	06037	34.153452	-118.098669	Los Angeles County
99282	Fee-for-Service	1316971278	1316971278	1	1	KEYES, MARY A MD	1/31/1988	207L00000X	NA	Other	026	PHYSICIANS	64754	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
99285	Fee-for-Service	1912229352	1912229352	1	1	KUTNER, KATE L LMFT	10/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5360 JACKSON DR	SUITE 218C	LA MESA	CA	91942	6002	37	06073	32.77680573	-117.0176327	San Diego County
99286	Fee-for-Service	1336201102	1336201102	1	1	KLASSEN, CHRISTOPHER L MD	9/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	155803	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
99296	Fee-for-Service	1144218108	1144218108	1	1	KIM, YOUNG W MD	11/28/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	133940	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
99299	Fee-for-Service	1740385418	1740385418	1	1	KURITZKES, RICHARD A	3/31/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	56970	41	Internal Medicine	0	In state provider	None	2625 W ALAMEDA AVE	STE 404	BURBANK	CA	91505	4817	19	06037	34.1577056	-118.329779	Los Angeles County
99315	Fee-for-Service	1356372924	1356372924	1	1	KOOROS, KOOROSH MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138035	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
99325	Fee-for-Service	1366520017	1366520017	1	1	KOCH, CRAIG S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	28577	40	Pediatrics	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
99332	Fee-for-Service	1548673684	1548673684	1	1	KIRKPATRICK, JENNIFER T MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
99340	Fee-for-Service	1912118159	1912118159	1	1	KATSUFUMI NISHIDA	11/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
99341	Fee-for-Service	1255867743	1255867743	1	1	KIANOUSH, SINA MD	9/25/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	191537	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
99359	Fee-for-Service	1568564417	1568564417	1	1	KOLENDRIANOS, ERNEST MD	12/19/1973	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32522	40	Pediatrics	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
99362	Fee-for-Service	1689277022	1689277022	1	1	KIRCHER, KELSEY CCC-SLP	3/11/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
99377	Fee-for-Service	1336792159	1336792159	1	1	KELLEGHAN, ANNEMARIE R PHD	10/13/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
99407	Fee-for-Service	1326033366	1326033366	1	1	KIM, JENNIFER MD	10/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152256	30	Radiology	0	In state provider	None	29101 HOSPITAL RD.	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
99428	Fee-for-Service	1730291386	1730291386	1	1	KNOTT, PHILIP D MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94493	84	Surgery-Head and Neck	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
99448	Fee-for-Service	1548624331	1548624331	1	1	KUO, DANIEL T DO	8/10/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18290	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
99461	Fee-for-Service	1093887333	1093887333	1	1	KOHLI, ROHIT MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145487	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 SUNSET BLVD W	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
99586	Fee-for-Service	1740385418	1740385418	1	1	KURITZKES, RICHARD A	3/31/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	56970	10	Gastroenterology (M.D. only)	0	In state provider	None	2625 W ALAMEDA AVE	STE 404	BURBANK	CA	91505	4817	19	06037	34.1577056	-118.329779	Los Angeles County
99605	Fee-for-Service	1356372924	1356372924	1	1	KOOROS, KOOROSH MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138035	10	Gastroenterology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
99610	Fee-for-Service	1770999088	1770999088	1	1	KWONG, STANLEY MD	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153653	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
99639	Fee-for-Service	1144662263	1144662263	1	1	KAISER FOUNDATION HEALTH	8/21/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	2300 CAMINO RAMON	FL 1	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
99642	Fee-for-Service	1295840841	1295840841	1	1	KASTRUP, JOHN J MD	4/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	1505 WIGWAM PARKWAY	STE 330	HENDERSON	NV	89074	8195	00	None	36.03397117	-115.0492369	Clark County
99654	Fee-for-Service	1730359480	1730359480	1	1	KATEL, SARAH F MD	4/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102621	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
99671	Fee-for-Service	1225195365	1225195365	1	1	KAUR, SUKHBIR MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53283	40	Pediatrics	0	In state provider	None	6311 N FRESNO ST	STE 101	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
99681	Fee-for-Service	1841346087	1841346087	1	1	KAMPERMAN, KATHRYN J NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99703	Fee-for-Service	1922367382	1922367382	1	1	KAHARI, KELLY A MD	1/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124260	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
99736	Fee-for-Service	1548624331	1548624331	1	1	KUO, DANIEL T DO	8/10/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18290	25	Physical Medicine and Rehabilitation	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
99763	Fee-for-Service	1952331530	1952331530	1	1	KELLOGG, JASON P MD	7/29/2008	2084P0805X	NA	Psychiatry	026	PHYSICIANS	66130	36	Psychiatry	0	In state provider	None	3151 AIRWAY AVE	STE T-3	COSTA MESA	CA	92626	4607	30	06059	33.67783408	-117.8720921	Orange County
99789	Fee-for-Service	1720007545	1720007545	1	1	KARAN, JOHN H MD	12/1/1997	2084N0400X	NA	Neurology	026	PHYSICIANS	51995	13	Neurology (M.D. only)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
99793	Fee-for-Service	1790312437	1790312437	1	1	KY, KEVIN DO	11/7/2023	207R00000X	NA	Other	026	PHYSICIANS	20931	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
99808	Fee-for-Service	1316326630	1316326630	1	1	KOSSYREVA, ELENA A MD	2/11/2022	207P00000X	NA	Other	026	PHYSICIANS	153153	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
99843	Fee-for-Service	1619611688	1619611688	1	1	KELLEY, BRITTANY CRNA	11/18/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
99864	Fee-for-Service	1881081172	1881081172	1	1	KASHIF, MOHAMMAD MD	8/1/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	151793	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
99879	Fee-for-Service	1043482557	1043482557	1	1	KWAN, CHRISTINE MD	4/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131421	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
99889	Fee-for-Service	1700013174	1700013174	1	1	KHETERPAL, MEENAL K MD	3/30/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	165 SAINT DOMINICS DR	SUITE 120	MANTECA	CA	95337	7802	39	06077	37.79882972	-121.2447835	San Joaquin County
99899	Fee-for-Service	1881784445	1881784445	1	1	KAREN FARST	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	SLOT 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
99907	Fee-for-Service	1457397556	1457397556	1	1	KERWIN, WALTER F MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75336	41	Internal Medicine	0	In state provider	None	8631 W 3RD ST	STE 1017E	LOS ANGELES	CA	90048	5913	19	06037	34.07361928	-118.3803143	Los Angeles County
99913	Fee-for-Service	1356464747	1356464747	1	1	KELLER, KRIS M	6/25/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
99917	Fee-for-Service	1891896569	1891896569	1	1	KUHSE, MARK B MD	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87209	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
99935	Fee-for-Service	1750547493	1750547493	1	1	KUMAR, RAJIV MD	11/27/2023	2085R0204X	NA	Other	026	PHYSICIANS	128422	None	None	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
99961	Fee-for-Service	1760944391	1760944391	1	1	KLAR, SOFIA DO	9/1/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21355	None	None	0	In state provider	None	7695 CARDINAL CT	STE 240	SAN DIEGO	CA	92123	3357	37	06073	32.79146985	-117.1578472	San Diego County
99976	Fee-for-Service	1295925113	1295925113	1	1	KJELDSEN, LEIGH F	4/18/2016	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2415 HIGH SCHOOL AVE	STE 300	CONCORD	CA	94520	1815	07	06013	37.98481374	-122.0347555	Contra Costa County
99988	Fee-for-Service	1134387111	1134387111	1	1	KIM, WOOJIN MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112072	10	Gastroenterology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90032	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
99990	Fee-for-Service	1568403210	1568403210	1	1	KRISHNAN, ARUN R MD	9/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54527	30	Radiology	0	In state provider	None	2801 K STREET	SUITE 502	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
100024	Fee-for-Service	1851658314	1851658314	1	1	KHAN, MEHWISH A MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138637	41	Internal Medicine	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
100039	Fee-for-Service	1740997097	1740997097	1	1	KDPKIV INC	8/9/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3810 GOVERNOR DR	None	SAN DIEGO	CA	92122	2028	37	06073	32.85458149	-117.2057946	San Diego County
100099	Fee-for-Service	1164577979	1164577979	1	2	KAISER FOUNDATION HOSP	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES-HOSPICE	74 N PASADENA AVE	6TH FLOOR	PASADENA	CA	91103	3600	19	06037	34.147269	-118.15236	Los Angeles County
100105	Fee-for-Service	1972524007	1972524007	1	1	KIVES, ANDREW A MD	1/31/1995	207P00000X	NA	Other	026	PHYSICIANS	22515	66	Emergency Medicine (Urgent Care)	0	In state provider	None	131 GLORIA DR	None	SAN RAFAEL	CA	94901	3620	21	06041	37.97022147	-122.5413548	Marin County
100119	Fee-for-Service	1255354908	1255354908	1	1	KENNEDY, WILLIAM A MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50202	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
100143	Fee-for-Service	1659791713	1659791713	1	1	KUROBE, AILEEN N MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139659	01	General Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
100157	Fee-for-Service	1568968253	1568968253	1	1	KHOO, JANICE S MD	10/24/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
100164	Fee-for-Service	1043482557	1043482557	1	1	KWAN, CHRISTINE MD	4/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131421	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
100172	Fee-for-Service	1114074432	1114074432	1	1	KAISER FOUNDATION HEALTH	8/27/1990	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
100180	Fee-for-Service	1174054043	1174054043	1	1	KONG, ERWIN MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	159563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
100190	Fee-for-Service	1457397556	1457397556	1	1	KERWIN, WALTER F MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75336	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8631 W 3RD ST	STE 1017E	LOS ANGELES	CA	90048	5913	19	06037	34.07361928	-118.3803143	Los Angeles County
100239	Fee-for-Service	1013060888	1013060888	1	1	KOZART, MICHAEL MD	10/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80689	36	Psychiatry	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
100240	Fee-for-Service	1346652583	1346652583	1	1	KHORAMI, SEAN S MD	10/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144435	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100263	Fee-for-Service	1295925113	1295925113	1	1	KJELDSEN, LEIGH F	4/18/2016	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2415 HIGH SCHOOL AVE	STE 300	CONCORD	CA	94520	1815	07	06013	37.98481374	-122.0347555	Contra Costa County
100277	Fee-for-Service	1730683913	1730683913	1	1	KUMAR, NISHA MD	9/5/2023	207LP3000X	NA	Other	026	PHYSICIANS	179471	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
100297	Fee-for-Service	1316080344	1316080344	1	1	KUO, TRACY F PHD	8/17/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
100342	Fee-for-Service	1235273376	1235273376	1	1	KARAHALIOS, SOTERIA E MD	1/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	34663	41	Internal Medicine	0	In state provider	None	5 LOWER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57544273	-121.8164209	Monterey County
100343	Fee-for-Service	1144346388	1144346388	1	1	KOONINGS, MELISSA C CRNA	6/13/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
100388	Fee-for-Service	1164577979	1164577979	1	2	KAISER FOUNDATION HOSP	8/30/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES-HOSPICE	74 N PASADENA AVE	6TH FLOOR	PASADENA	CA	91103	3600	19	06037	34.147269	-118.15236	Los Angeles County
100405	Fee-for-Service	1790190585	1790190585	2	1	KOCHIK, SARAH E OD	8/11/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
100406	Fee-for-Service	1386962082	1386962082	1	1	KUBIK, MELANIE J MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129187	22	Pathology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
100417	Fee-for-Service	1790005098	1790005098	1	1	KIM, CHOOWON MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143523	30	Radiology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
100431	Fee-for-Service	1700394913	1700394913	1	1	KLER, AVTAR S	1/29/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3924 RHAPSODY CT	None	ANTELOPE	CA	95843	4830	34	06067	38.714886	-121.3727085	Sacramento County
100467	Fee-for-Service	1396714937	1396714937	1	1	KRUEGER, MICHAEL L DO	6/21/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	6760	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7033 N FRESNO ST	STE 301	FRESNO	CA	93720	2979	10	06019	36.838044	-119.7813175	Fresno County
100485	Fee-for-Service	1679513550	1679513550	1	1	KIM, CHAN S MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71667	08	Family Practice	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
100502	Fee-for-Service	1255992251	1255992251	1	1	KOEK, ADRIANA MD	9/25/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	187230	13	Neurology (M.D. only)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
100504	Fee-for-Service	1982685046	1982685046	1	1	KULUS, KATHLEEN A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1406 6TH AVE N	None	SAINT CLOUD	MN	56303	1900	00	None	45.5746739	-94.17010435	Stearns County
100506	Fee-for-Service	1528478278	1528478278	1	1	KANG, JIEUN M LMFT	1/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
100511	Fee-for-Service	1184731127	1184731127	1	1	KADER, ANDREW K A MD	6/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116234	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
100514	Fee-for-Service	1134322985	1134322985	1	1	KAUSHAL, AMIT MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106142	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
100564	Fee-for-Service	1598363855	1598363855	1	1	KAUR, GAGANDEEP	8/22/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95014741	-	NOT APPLICABLE	0	In state provider	None	1018 21ST STREET	None	BAKERSFIELD	CA	93301	4709	15	06029	35.37813217	-119.0132767	Kern County
100582	Fee-for-Service	1902085657	1902085657	1	1	KUO, YU HUNG MD	6/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129803	14	Neurological Surgery	0	In state provider	None	2335 E KASHIAN LANE	301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
100586	Fee-for-Service	1871683474	1871683474	1	1	KESTLE, JOHN R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MEDICAL DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77069459	-111.8370155	Salt Lake County
100613	Fee-for-Service	1750467270	1750467270	1	1	KUTNER, SUSAN E MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41301	02	General Surgery	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
100614	Fee-for-Service	1215136098	1215136098	1	1	KIROLOS, HENRY N MD	2/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107771	40	Pediatrics	0	In state provider	None	200 MED PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
100632	Fee-for-Service	1912536921	1912536921	1	1	KHAN, RABIA	3/1/2024	208M00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
100647	Fee-for-Service	1962131946	1962131946	1	1	KAUFMAN, KELLY A PT	8/29/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
100656	Fee-for-Service	1376074880	1376074880	1	1	KUMAR, MANAV MD	6/16/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158976	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
100671	Fee-for-Service	1578595641	1578595641	1	1	KNC MEDICAL SUPPLY INC	3/17/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3931 W SLAUSON AVE	None	LOS ANGELES	CA	90043	2970	19	06037	33.9889785	-118.3431645	Los Angeles County
100672	Fee-for-Service	1053801696	1053801696	1	1	KIM, DANIEL H MD	11/19/2021	207P00000X	NA	Other	026	PHYSICIANS	174723	None	None	0	In state provider	None	101 VALENCIA MESA	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
100678	Fee-for-Service	1699912451	1699912451	1	1	KAHN, MARSHALL A MD	4/22/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	28041	01	General Practice	0	In state provider	None	8337 TELEGRAPH RD	STE 11	PICO RIVERA	CA	90660	4909	19	06037	33.96454327	-118.1134473	Los Angeles County
100700	Fee-for-Service	1427289107	1427289107	1	1	KENNY, KRISTEN L DO	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11415	08	Family Practice	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
100706	Fee-for-Service	1164691820	1164691820	1	1	KANG, TYLER Y MD	10/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81013	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
100710	Fee-for-Service	1124476270	1124476270	1	1	KHADER, WASEEM DO	11/21/2021	2083A0300X	NA	Adult Primary Care	026	PHYSICIANS	16567	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
100720	Fee-for-Service	1700394913	1700394913	1	1	KLER, AVTAR S	1/29/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3924 RHAPSODY CT	None	ANTELOPE	CA	95843	4830	34	06067	38.714886	-121.3727085	Sacramento County
100752	Fee-for-Service	1396714937	1396714937	1	1	KRUEGER, MICHAEL L DO	6/21/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	6760	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7033 N FRESNO ST	STE 301	FRESNO	CA	93720	2979	10	06019	36.838044	-119.7813175	Fresno County
100828	Fee-for-Service	1528133170	1528133170	1	1	KOLTZOVA-RANG, YULIA MD	12/1/2001	207R00000X	NA	Other	026	PHYSICIANS	70575	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
100842	Fee-for-Service	1538190988	1538190988	1	1	KATIBLOO, NADINE LMFT	9/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4010 BARRANCA PKWY	STE 252	IRVINE	CA	92604	1716	30	06059	33.68346716	-117.8075649	Orange County
100854	Fee-for-Service	1104859800	1104859800	1	1	KKN PHARMACY CORPORATION	6/3/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27881 LA PAZ RD	E	LAGUNA NIGUEL	CA	92677	3910	30	06059	33.55697558	-117.7096203	Orange County
100855	Fee-for-Service	1295172484	1295172484	1	1	KAUFMANN, SONIA C DO	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12758	01	General Practice	0	In state provider	None	10 CONGRESS ST	SUITE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
100859	Fee-for-Service	1235513102	1235513102	1	1	KUMAR, GAURAV MD	2/1/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151187	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	11911 CENTRAL AVE	None	CHINO	CA	91710	1906	36	06071	34.03704117	-117.6893971	San Bernardino County
100886	Fee-for-Service	1245387570	1245387570	1	1	KAISER FDN HLTH PLAN	8/9/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #167	2295 S VINEYARD AVE	FL 1	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
100899	Fee-for-Service	1215136098	1215136098	1	1	KIROLOS, HENRY N MD	2/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107771	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
100915	Fee-for-Service	1942593207	1942593207	1	1	KLIPFEL, LISA C LMFT	11/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2738 CAMINO CAPISTRANO	STE 3	SAN CLEMENTE	CA	92671	4854	30	06059	33.44259306	-117.6442416	Orange County
100944	Fee-for-Service	1093818403	1093818403	1	1	KAMMER, REBECCA L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5701 E SANTA ANA CANYON	STE H	ANAHEIM	CA	92807	3231	30	06059	33.8514537	-117.789653	Orange County
100982	Fee-for-Service	1922049501	1922049501	1	1	KOOCHEK, KAMRAN MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77834	30	Radiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
100988	Fee-for-Service	1760673073	1760673073	1	1	KHALILIFARD, FARINAZ LMFT	9/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
100999	Fee-for-Service	1235210683	1235210683	1	1	KATZ, DARYL E OD	2/3/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14400 BEAR VALLEY RD	STE 204	VICTORVILLE	CA	92392	5406	36	06071	34.473717	-117.347913	San Bernardino County
101033	Fee-for-Service	1629337449	1629337449	1	1	KAJLA, JATINDER S MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135215	None	None	0	In state provider	None	975 S FAIRMONT AVENUE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
101034	Fee-for-Service	1942212527	1942212527	1	1	KOONER, BANITA B DO	10/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7649	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
101039	Fee-for-Service	1396714937	1396714937	1	1	KRUEGER, MICHAEL L DO	6/21/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	6760	20	Orthopedic Surgery	0	In state provider	None	7033 N FRESNO ST	STE 301	FRESNO	CA	93720	2979	10	06019	36.838044	-119.7813175	Fresno County
101089	Fee-for-Service	1356583389	1356583389	1	1	KO, PHEBE S MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119617	05	Anesthesiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
101117	Fee-for-Service	1275519001	1275519001	1	1	KAISER, JAY A MD	8/2/1973	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	25290	30	Radiology	0	In state provider	None	3301 EL CAMINO REAL	STE 100	ATHERTON	CA	94027	3803	41	06081	37.46631066	-122.2076453	San Mateo County
101138	Fee-for-Service	1205018231	1205018231	1	1	KATZBERG, KELLY N MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94912	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
101140	Fee-for-Service	1649249244	1649249244	1	1	KAPLAN, MARSHAL B MD INC	1/1/1995	207L00000X	NA	Other	026	PHYSICIANS	38254	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
101147	Fee-for-Service	1164996880	1164996880	1	1	KAMDEN HOME HEALTH CARE INC	9/7/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2128 NILES ST	None	BAKERSFIELD	CA	93305	5008	15	06029	35.37658728	-118.9681215	Kern County
101149	Fee-for-Service	1972511012	1972511012	1	1	KITTRICK, BRUCE H MD	7/12/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	66403	41	Internal Medicine	0	In state provider	None	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
101165	Fee-for-Service	1205033040	1205033040	1	1	KHAN, OSSAM	8/9/2023	207R00000X	NA	Other	026	PHYSICIANS	178449	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
101177	Fee-for-Service	1063474583	1063474583	2	1	KAMDAR, BINA A MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	50638	41	Internal Medicine	0	In state provider	None	520 W FOOTHILL BLVD	None	AZUSA	CA	91702	2343	19	06037	34.13348555	-117.913005	Los Angeles County
101188	Fee-for-Service	1184914525	1184914525	1	1	KASAM, IQBAL I MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109426	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
101228	Fee-for-Service	1760446454	1760446454	1	1	KIM, KYUNG C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36758	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
101229	Fee-for-Service	1457380107	1457380107	1	1	KOZAK, RICHARD J MD	10/14/1993	207P00000X	NA	Other	026	PHYSICIANS	75758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	756 E ARROW HWY	None	POMONA	CA	91767	2247	19	06037	34.0899259	-117.7377883	Los Angeles County
101238	Fee-for-Service	1679585889	1679585889	1	1	KAPTEINA, ANNELESE C MD	12/31/1988	207L00000X	NA	Other	026	PHYSICIANS	51495	05	Anesthesiology	0	In state provider	None	5101 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.771997	-117.0059635	San Diego County
101240	Fee-for-Service	1811068679	1811068679	1	1	KAEGI, DAVID M MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60437	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
101258	Fee-for-Service	1306887757	1306887757	1	1	KUDRICK, NATHAN T MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86674	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
101291	Fee-for-Service	1821379900	1821379900	1	1	KRAMER, KURT AU	9/16/2022	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
101326	Fee-for-Service	1003989419	1003989419	1	1	KRAK, MICAHEL D MD	3/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	41229	40	Pediatrics	0	In state provider	None	2067 W VISTA WAY	STE 100	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
101345	Fee-for-Service	1124166129	1124166129	1	1	KOH, JANIS K MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89188	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
101394	Fee-for-Service	1881669190	1881669190	1	1	KERN, DONALD M LMFT	8/1/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23123 VENTURA BLVD	STE 211	WOODLAND HILLS	CA	91364	1104	19	06037	34.16339045	-118.629576	Los Angeles County
101427	Fee-for-Service	1245762970	1245762970	1	1	KUO, SHERWIN MD	6/5/2020	390200000X	NA	Other	026	PHYSICIANS	167223	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
101448	Fee-for-Service	1609095017	1609095017	1	1	KUO, CINDY Y DO	1/7/2008	207P00000X	NA	Other	026	PHYSICIANS	8907	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
101458	Fee-for-Service	1770288532	1770288532	1	1	KOBZEFF, KELSEY NP	7/5/2023	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	4685	55	06109	37.97749352	-120.3700335	Tuolumne County
101467	Fee-for-Service	1063474583	1063474583	2	1	KAMDAR, BINA A MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	50638	08	Family Practice	0	In state provider	None	520 W FOOTHILL BLVD	None	AZUSA	CA	91702	2343	19	06037	34.13348555	-117.913005	Los Angeles County
101469	Fee-for-Service	1295093490	1295093490	1	1	KAZEMI, SEPIDEH MD INC	10/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	94770	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16300 SAND CANYON AVE	STE 311	IRVINE	CA	92618	3703	30	06059	33.66115075	-117.7742405	Orange County
101483	Fee-for-Service	1003296096	1003296096	1	1	KAZEM, AHMAD N DC	8/9/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
101517	Fee-for-Service	1457380107	1457380107	1	1	KOZAK, RICHARD J MD	10/14/1993	207P00000X	NA	Other	026	PHYSICIANS	75758	01	General Practice	0	In state provider	None	756 E ARROW HWY	None	POMONA	CA	91767	2247	19	06037	34.0899259	-117.7377883	Los Angeles County
101526	Fee-for-Service	1811068679	1811068679	1	1	KAEGI, DAVID M MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60437	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3030 CHILDRENS WAY	STE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
101532	Fee-for-Service	1235455197	1235455197	1	1	KULE, ROBERT R MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118454	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	MC5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
101541	Fee-for-Service	1790778728	1790778728	1	1	KAHN, STEPHEN J MD	3/31/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62715	30	Radiology	0	In state provider	None	2600 PARK AVE	STE 203	CONCORD	CA	94520	1923	07	06013	37.98468938	-122.0340623	Contra Costa County
101542	Fee-for-Service	1619220738	1619220738	1	2	KIM-ALMEIDA, AHESUN LMFT	4/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
101587	Fee-for-Service	1467433938	1467433938	1	1	KARGOZARAN, HAMED MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85718	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
101626	Fee-for-Service	1821258849	1821258849	1	1	KRAD, NUHA MD	2/1/2024	2085B0100X	NA	MRI Provider	026	PHYSICIANS	129175	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
101706	Fee-for-Service	1518460328	1518460328	1	1	KASHEM, SAKEEN	5/10/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	166653	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
101743	Fee-for-Service	1720002058	1720002058	1	1	KUMAR, SARMISTHA DO	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8250	None	None	0	In state provider	None	2120 THIBODO RD	None	VISTA	CA	92081	7901	37	06073	33.16745345	-117.2180381	San Diego County
101807	Fee-for-Service	1275799124	1275799124	1	1	KIM, HAENA MD	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126331	04	Otology, Laryngology, Rhinology	0	In state provider	None	106 LA CASA VIA	STE 200	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
101814	Fee-for-Service	1811068679	1811068679	1	1	KAEGI, DAVID M MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60437	79	Neurology-Child	0	In state provider	None	3030 CHILDRENS WAY	STE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
101863	Fee-for-Service	1467741330	1467741330	1	1	KAMATH, SMITHA PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
101917	Fee-for-Service	1902450414	1902450414	1	1	KIDIWA, NADIA	11/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
101925	Fee-for-Service	1790145050	1790145050	1	1	KUZNETSKY, LYNNE F LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	SUITE LL3	ENCINO	CA	91436	4927	19	06037	34.15687678	-118.4876342	Los Angeles County
101937	Fee-for-Service	1013479997	1013479997	1	1	KIM, GRACE C	4/12/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178510	None	None	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
101979	Fee-for-Service	1588008767	1588008767	1	1	KASSAR, ALEXANDER G MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132911	None	None	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
102018	Fee-for-Service	1164139069	1164139069	1	1	KIMBLE, CHARRIN	3/20/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
102032	Fee-for-Service	1912120932	1912120932	1	1	KELLY, CHRISTINE C NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
102052	Fee-for-Service	1083931489	1083931489	1	1	KUNDER, CHRISTIAN A MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117953	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102072	Fee-for-Service	1518564145	1518564145	1	1	KAUR, MANPREET NP	4/19/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2322 BUTANO DRIVE	STE 205	SACRAMENTO	CA	95825	0629	34	06067	38.606373	-121.3814655	Sacramento County
102074	Fee-for-Service	1063582989	1063582989	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN JOSE	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
102115	Fee-for-Service	1679595169	1679595169	1	1	KELLIE, SUSAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
102144	Fee-for-Service	1801933288	1801933288	1	1	KOZLOFF, MATTHEW S MD	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55616	None	None	0	In state provider	None	380 E PASEO EL MIRADOR	None	PALM SPRINGS	CA	92262	4842	33	06065	33.83989835	-116.543696	Riverside County
102161	Fee-for-Service	1811359516	1811359516	1	1	KAUR, ROUMINDER DO	9/26/2022	207R00000X	NA	Other	026	PHYSICIANS	20243	None	None	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
102163	Fee-for-Service	1194073171	1194073171	1	1	KING, BRANDAN J	4/15/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2295 S VINEYARD AVENUE	None	ONTARIO	CA	91764	7925	36	06071	34.031889	-117.608112	San Bernardino County
102168	Fee-for-Service	1205959533	1205959533	1	1	KATZ, MITCHELL H MD	10/1/1998	207R00000X	NA	Other	026	PHYSICIANS	61707	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
102176	Fee-for-Service	1740587583	1740587583	1	1	KITAHARA, SUMIRE K MD	1/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102595	22	Pathology (M.D. only)	0	In state provider	None	200 NORTH ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
102191	Fee-for-Service	1881652063	1881652063	1	1	KOCH, BRIAN A MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73827	None	None	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
102254	Fee-for-Service	1962475624	1962475624	1	1	KIM, BO K MD	4/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70312	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
102292	Fee-for-Service	1417047283	1417047283	1	1	KEISER, LEROY W MD	12/4/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	28436	78	Neoplastic Diseases/Oncology	0	In state provider	None	3555 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.476944	-122.7281625	Sonoma County
102326	Fee-for-Service	1295842540	1295842540	1	1	KHAN, SEEMA M MD	2/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87129	36	Psychiatry	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
102349	Fee-for-Service	1699282285	1699282285	1	1	KERN COUNTY HOSPITAL AUTHORI	12/3/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	6001 TRUXTUN AVE STE 210	None	BAKERSFIELD	CA	93309	0662	15	06029	35.36262467	-119.0725572	Kern County
102386	Fee-for-Service	1730586918	1730586918	1	1	KLAMATH OPHTHALMOLOGY, PC	2/5/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	628 N 1ST ST	SUITE C	LAKEVIEW	OR	97630	1506	00	None	42.19019123	-120.3467593	Lake County
102398	Fee-for-Service	1104488089	1104488089	1	1	KIM, WON I CNP	8/26/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102435	Fee-for-Service	1689700981	1689700981	1	2	KULKARNI, VIVEKANAND MD	1/11/2008	207L00000X	NA	Other	026	PHYSICIANS	102014	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102459	Fee-for-Service	1194188771	1194188771	1	1	KRAMER, ANDREW W MD	6/24/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167873	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
102487	Fee-for-Service	1295362507	1295362507	1	1	KUMAR, ANJALI M MD	2/12/2024	208M00000X	NA	Other	026	PHYSICIANS	187229	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
102501	Fee-for-Service	1114311677	1114311677	1	1	KAUR, JASKARIN MD	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
102553	Fee-for-Service	1134214901	1134214901	1	1	KALLAS, HARRY J MD	5/17/1995	2080P0203X	NA	Other	026	PHYSICIANS	81209	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
102554	Fee-for-Service	1093799652	1093799652	2	1	KHOURDAJI, ABDALLAH MD	12/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	34143	07	Dermatology	0	In state provider	None	801 S HAM LANE	STE A	LODI	CA	95242	7502	39	06077	38.124495	-121.2882875	San Joaquin County
102556	Fee-for-Service	1154524320	1154524320	1	1	KUHLMAN, MARY LISA MD	7/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	57062	36	Psychiatry	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
102557	Fee-for-Service	1528590536	1528590536	1	1	KRUG, AARON MD	5/7/2020	208800000X	NA	Other	026	PHYSICIANS	158115	34	Urology and Urological Surgery	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
102563	Fee-for-Service	1881767895	1881767895	1	1	KO, JOUNGHWA NP	5/12/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
102577	Fee-for-Service	1417047283	1417047283	1	1	KEISER, LEROY W MD	12/4/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	28436	68	Hematology	0	In state provider	None	3555 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.476944	-122.7281625	Sonoma County
102581	Fee-for-Service	1689092405	1689092405	1	1	KHOONG, ELAINE C MD	5/23/2017	390200000X	NA	Other	026	PHYSICIANS	139951	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
102586	Fee-for-Service	1235756891	1235756891	1	1	KAUR, GUNEET LCSW	8/12/2021	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
102636	Fee-for-Service	1023596616	1023596616	1	1	KHAL, BRIAN PT	11/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6770 N WEST AVE	101A	FRESNO	CA	93711	1399	10	06019	36.83680641	-119.8262494	Fresno County
102656	Fee-for-Service	1649777988	1649777988	1	1	KIM, MARIE MD	6/30/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	164090	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
102670	Fee-for-Service	1255520565	1255520565	1	1	KANAN, RENEE J MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86411	01	General Practice	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
102673	Fee-for-Service	1730586918	1730586918	1	1	KLAMATH OPHTHALMOLOGY, PC	2/5/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	None	628 N 1ST ST	SUITE C	LAKEVIEW	OR	97630	1506	00	None	42.19019123	-120.3467593	Lake County
102700	Fee-for-Service	1649834227	1649834227	1	1	KANG, DI PHD	11/4/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2557 MOWRY AVE	STE 21	FREMONT	CA	94538	1603	01	06001	37.55561575	-121.9826617	Alameda County
102785	Fee-for-Service	1457595506	1457595506	1	1	KHEMANI, SONAL R MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94856	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
102809	Fee-for-Service	1326119967	1326119967	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SANTA CLARA	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
102816	Fee-for-Service	1295778215	1295778215	1	1	KHAN, MOHAMMAD N MD	5/14/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	183205	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
102831	Fee-for-Service	1710058532	1710058532	1	1	KAU, ERIC L MD	4/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89398	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
102843	Fee-for-Service	1134214901	1134214901	1	1	KALLAS, HARRY J MD	5/17/1995	2080P0203X	NA	Other	026	PHYSICIANS	81209	40	Pediatrics	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
102884	Fee-for-Service	1932487063	1932487063	1	1	KIM, MICHAEL P JR DO	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14134	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
102887	Fee-for-Service	1679648737	1679648737	1	1	KIYAN PAUL AO	2/5/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	595 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3811	36	06071	34.13598078	-117.2961958	San Bernardino County
102899	Fee-for-Service	1578806329	1578806329	1	1	KEYASHIAN, AIMEE M MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131773	41	Internal Medicine	0	In state provider	None	350 30TH ST	STE 320	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
102902	Fee-for-Service	1518166826	1518166826	1	1	KRAUSE, MATTHEW D PHD	6/25/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
102904	Fee-for-Service	1619048501	1619048501	1	1	KUGAYA, AKIRA MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92092	36	Psychiatry	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
102924	Fee-for-Service	1447391347	1447391347	1	1	KALANGIE, MAUDY V DO	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	11332	05	Anesthesiology	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92401	1217	36	06071	34.131303	-117.3225325	San Bernardino County
102967	Fee-for-Service	1881019149	1881019149	1	1	KAJITA, KRISTEN N OT	2/9/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	SUITE 120	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
102970	Fee-for-Service	1891828687	1891828687	1	1	KIM, ERIC MD	3/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106719	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
102992	Fee-for-Service	1770812935	1770812935	1	1	KEVORKIAN, TINA L OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
103010	Fee-for-Service	1912113309	1912113309	1	1	KORMAN, LOWELL R MD	10/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111655	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
103035	Fee-for-Service	1720008212	1720008212	1	1	KHASIMUDDIN, SYED A MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87340	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
103037	Fee-for-Service	1952733867	1952733867	1	1	KARAPETIAN, ROCHELLE PSYD	9/25/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4955 VAN NUYS BLVD	STE 301	SHERMAN OAKS	CA	91403	1815	19	06037	34.160805	-118.4487295	Los Angeles County
103039	Fee-for-Service	1457632432	1457632432	1	1	KRISHNAMOHAN, PRASHANTH MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135599	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103094	Fee-for-Service	1063582989	1063582989	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN JOSE	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
103125	Fee-for-Service	1669870119	1669870119	1	1	KWOK, VICTOR MD	1/23/2015	261Q00000X	NA	Other	026	PHYSICIANS	114875	38	Geriatrics	0	In state provider	None	1431 NORIEGA ST	None	SAN FRANCISCO	CA	94122	4431	38	06075	37.75408109	-122.4791868	San Francisco County
103133	Fee-for-Service	1609990290	1609990290	1	1	KEITH KEN ABE, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU ST	STE 999	HONOLULU	HI	96826	1077	00	None	21.30030321	-157.8342762	Honolulu County
103149	Fee-for-Service	1134291305	1134291305	1	1	KOTZIN, MELISSA H LMFT	10/30/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
103154	Fee-for-Service	1134562689	1134562689	1	1	KOSHY, SHINEY M MD	7/5/2018	2084N0402X	NA	Neurology	026	PHYSICIANS	132968	79	Neurology-Child	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
103163	Fee-for-Service	1649230871	1649230871	1	1	KRANTZ, WILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 STADIUM DR	None	MORGANTOWN	WV	26506	7911	00	None	39.65345878	-79.95562791	Monongalia County
103166	Fee-for-Service	1689694457	1689694457	1	1	KSK ENTERPRISES LLC	8/26/2013	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1901 E 4TH STREET	SUITE 200	SANTA ANA	CA	92705	3918	30	06059	33.74826845	-117.8397675	Orange County
103167	Fee-for-Service	1902240955	1902240955	1	1	KUTAY, ERIN D MD	4/21/2020	111NR0200X	NA	Other	026	PHYSICIANS	135591	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
103210	Fee-for-Service	1003929837	1003929837	1	1	KRISILOFF, MILTON MD	12/14/1977	208800000X	NA	Other	026	PHYSICIANS	20665	34	Urology and Urological Surgery	0	In state provider	None	2001 SANTA MONICA BLVD	# 1165W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
103212	Fee-for-Service	1952372328	1952372328	1	1	KYCEY, JOHN F	8/31/1992	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
103215	Fee-for-Service	1902433311	1902433311	1	1	KUTZSCHER, MICHAEL B MD	8/16/2024	207L00000X	NA	Other	026	PHYSICIANS	190838	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
103219	Fee-for-Service	1932324175	1932324175	1	1	KULASA, KRISTEN M MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96293	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
103233	Fee-for-Service	1497029144	1497029144	1	1	KEATING, MEGAN M NP	11/28/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
103260	Fee-for-Service	1407185267	1407185267	1	1	KRISTA S. BUCKINGHAM, NP	7/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
103271	Fee-for-Service	1629634084	1629634084	1	1	KOZLOWSKI, PAIGE DO	4/11/2024	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
103280	Fee-for-Service	1619353042	1619353042	1	1	KAWEAH DELTA HEALTH CARE INC	3/21/2022	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
103281	Fee-for-Service	1053585760	1053585760	1	1	KIM, SHARON B MD	7/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117129	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
103283	Fee-for-Service	1043371347	1043371347	1	1	KIM, ROSA J LAC	5/27/2014	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3407 W 6TH STREET	STE 608	LOS ANGELES	CA	90020	2504	19	06037	34.06363337	-118.295759	Los Angeles County
103374	Fee-for-Service	1437250859	1437250859	1	1	KAISERMAN, KEVIN B MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78831	67	Endocrinology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
103387	Fee-for-Service	1407184237	1407184237	1	2	KLATT, IVONNE M PSYD	7/25/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
103402	Fee-for-Service	1003115619	1003115619	1	1	KHAN, JAWAD MD	8/13/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	154905	20	Orthopedic Surgery	0	In state provider	None	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.714	-117.9333585	Orange County
103412	Fee-for-Service	1669870119	1669870119	1	1	KWOK, VICTOR MD	1/23/2015	261Q00000X	NA	Other	026	PHYSICIANS	114875	41	Internal Medicine	0	In state provider	None	1431 NORIEGA ST	None	SAN FRANCISCO	CA	94122	4431	38	06075	37.75408109	-122.4791868	San Francisco County
103415	Fee-for-Service	1902843790	1902843790	1	1	KIOUMEHR, FARHAD MD	12/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	42899	30	Radiology	0	In state provider	None	14915 BURBANK BLVD	None	SHERMAN OAKS	CA	91411	3610	19	06037	34.17213345	-118.4582475	Los Angeles County
103419	Fee-for-Service	1598714511	1598714511	1	1	KRAMER, KRISTINA MD	6/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79481	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	130 LA CASA VIA	STE 2-208	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
103430	Fee-for-Service	1669812947	1669812947	1	1	KANG, JOSEPH B DO	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13792	41	Internal Medicine	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
103431	Fee-for-Service	1285781591	1285781591	1	1	KAISER FOUNDATION HLTH	4/13/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TWO NORTH PHARMACY #637	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
103441	Fee-for-Service	1477907020	1477907020	1	1	KHOSHNEVIS, MATIN MD	1/28/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	150500	None	None	0	In state provider	None	5773 GREENBACK LANE	None	SACRAMENTO	CA	95841	2013	34	06067	38.682576	-121.3271415	Sacramento County
103442	Fee-for-Service	1811251929	1811251929	1	1	KUMAR, SUMIT MD	4/11/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	133698	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
103445	Fee-for-Service	1912935388	1912935388	1	1	KANG, EUNI K MD	9/12/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79226	40	Pediatrics	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
103450	Fee-for-Service	1538511837	1538511837	1	1	KENNEDY, MALLORY A OD	2/27/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7379 INDIANA AVENUE	None	RIVERSIDE	CA	92504	4547	33	06065	33.93662943	-117.4019057	Riverside County
103473	Fee-for-Service	1801956842	1801956842	1	1	KAWAMOTO, HENRY K JR MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	21863	24	Plastic Surgery	0	In state provider	INC	1301 20TH ST	STE 460	SANTA MONICA	CA	90404	2088	19	06037	34.02976782	-118.4812493	Los Angeles County
103482	Fee-for-Service	1962776245	1962776245	1	1	KEYASHIAN, BRIAN J MD	1/28/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	147947	02	General Surgery	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
103496	Fee-for-Service	1003929837	1003929837	1	1	KRISILOFF, MILTON MD	12/14/1977	208800000X	NA	Other	026	PHYSICIANS	20665	01	General Practice	0	In state provider	None	2001 SANTA MONICA BLVD	# 1165W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
103515	Fee-for-Service	1164942223	1164942223	1	1	KATZEN, SETH M DO	3/29/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	9333 GENESSE AVE	STE 350	SAN DIEGO	CA	92121	2103	37	06073	32.875668	-117.2139225	San Diego County
103542	Fee-for-Service	1376688374	1376688374	1	1	KOPPERS, JACQUELINE K	3/24/2008	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5341 ALHAMA DR	STE 5	WOODLAND HILLS	CA	92367	2127	19	06037	34.16629608	-118.5930782	Los Angeles County
103550	Fee-for-Service	1104177450	1104177450	1	1	KLENOW, MEGAN M MD	4/15/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	114017	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
103564	Fee-for-Service	1619353042	1619353042	1	1	KAWEAH DELTA HEALTH CARE INC	11/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
103588	Fee-for-Service	1659538866	1659538866	1	1	KNUTSON, THOMAS J MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115428	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
103607	Fee-for-Service	1609242023	1609242023	1	1	KIRIAKO, LEILA S LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
103664	Fee-for-Service	1437250859	1437250859	1	1	KAISERMAN, KEVIN B MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78831	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
103673	Fee-for-Service	1366519241	1366519241	1	1	KIVULS, JURIS MD	4/29/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	54681	24	Plastic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
103705	Fee-for-Service	1598714511	1598714511	1	1	KRAMER, KRISTINA MD	6/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79481	66	Emergency Medicine (Urgent Care)	0	In state provider	None	130 LA CASA VIA	STE 2-208	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
103710	Fee-for-Service	1962196022	1962196022	1	1	KREST HOLDINGS, LLC	1/16/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	109 E CENTRAL AVENUE	None	MADERA	CA	93638	3109	20	06039	36.96738581	-120.0655542	Madera County
103712	Fee-for-Service	1205842978	1205842978	1	1	KC IMAGING LLC	8/19/2015	2085B0100X	NA	MRI Provider	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2970 HILLTOP MALL RD	STE 103	RICHMOND	CA	94806	1948	07	06013	37.97819764	-122.329244	Contra Costa County
103726	Fee-for-Service	1275734410	1275734410	1	1	KHONSARI, FRED MD INC	4/6/2010	208800000X	NA	Other	026	PHYSICIANS	31098	34	Urology and Urological Surgery	0	In state provider	None	1140 W LA VETA	# 605	ORANGE	CA	92868	4219	30	06059	33.7802984	-117.8651669	Orange County
103730	Fee-for-Service	1700950532	1700950532	1	2	KAISER FOUNDATION HOSPITALS	2/9/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR BAYVIEW	NORTH BLDG RM # 1112	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
103775	Fee-for-Service	1508966201	1508966201	1	1	KOSS, MICHAEL N MD INC	10/5/2007	207ZP0102X	NA	Other	026	PHYSICIANS	40559	47	Miscellaneous	0	In state provider	None	2222 OCEAN VIEW AVE	STE 212	LOS ANGELES	CA	90057	2774	19	06037	34.06282775	-118.2749065	Los Angeles County
103792	Fee-for-Service	1427652130	1427652130	1	1	KOKO, ADEBOLA A NP	3/27/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
103817	Fee-for-Service	1942666060	1942666060	1	1	KERN RADIOLOGY MEDICAL GROUP	2/19/2016	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4500 MORNING DR	SUITE 202	BAKERSFIELD	CA	93306	7277	15	06029	35.39343836	-118.9166214	Kern County
103840	Fee-for-Service	1699703959	1699703959	1	1	KELLY, JOHN P MD	4/22/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	68410	None	None	0	In state provider	None	11160 WARNER AVE	STE 311	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
103855	Fee-for-Service	1619353042	1619353042	1	1	KAWEAH DELTA HEALTH CARE INC	6/25/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
103856	Fee-for-Service	1700957875	1700957875	1	1	KALOYANOVA, ELENA K LMFT	7/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1330 LINCOLN AVE.	SUITE 106 B	SAN RAFAEL	CA	94701	2141	21	06041	37.97629089	-122.5226851	Marin County
103898	Fee-for-Service	1093210999	1093210999	1	1	KULAS, NICHOLAS DO	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	19388	None	None	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
103926	Fee-for-Service	1861453904	1861453904	1	1	KHAN, ARSHAD MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72493	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
103945	Fee-for-Service	1629623186	1629623186	1	1	KANG PHYSICAL THERAPY INC.	1/13/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25301 CABOT RD	STE 111	LAGUNA HILLS	CA	92653	5511	30	06059	33.59420834	-117.6752724	Orange County
103946	Fee-for-Service	1013065986	1013065986	1	1	KAISER FOUND HEALTH PLAN	9/16/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY-C	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
103959	Fee-for-Service	1427029792	1427029792	1	1	KUHL, SARAH J MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67243	77	Infectious Disease	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
103986	Fee-for-Service	1841446010	1841446010	1	1	KAHLON, HARNEK S MD	9/25/2014	2084P0800X	NA	Psychiatry	026	PHYSICIANS	121508	36	Psychiatry	0	In state provider	None	8001 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2329	34	06067	38.4669	-121.417101	Sacramento County
104003	Fee-for-Service	1619432598	1619432598	1	1	KAISER FOUNDATION HOSPITALS	10/4/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	27200 IRIS AVE	None	MORENO VALLEY	CA	92555	4803	33	06065	33.8955513	-117.189743	Riverside County
104010	Fee-for-Service	1053548644	1053548644	1	1	KHEMLANI, SUNIEL S MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121065	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104016	Fee-for-Service	1700950532	1700950532	1	2	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR BAYVIEW	NORTH BLDG RM # 1112	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
104065	Fee-for-Service	1508966201	1508966201	1	1	KOSS, MICHAEL N MD INC	10/5/2007	207ZP0102X	NA	Other	026	PHYSICIANS	40559	22	Pathology (M.D. only)	0	In state provider	None	2222 OCEAN VIEW AVE	STE 212	LOS ANGELES	CA	90057	2774	19	06037	34.06282775	-118.2749065	Los Angeles County
104085	Fee-for-Service	1417681644	1417681644	1	1	KIM, YUN HEE LAC	9/5/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	329 E. PICO BIVD	None	LOS ANGELES	CA	90015	2509	19	06037	34.03492958	-118.2578549	Los Angeles County
104109	Fee-for-Service	1457685687	1457685687	1	1	KAI, ALTHEA LMFT	9/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	825 COLLEGE AVE	STE 3	SANTA ROSA	CA	95404	4108	49	06097	38.445705	-122.712534	Sonoma County
104144	Fee-for-Service	1619353042	1619353042	1	1	KAWEAH DELTA HEALTH CARE INC	11/15/2016	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
104145	Fee-for-Service	1275654857	1275654857	1	1	KIM, PAUL OD	8/15/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	621 S WESTERN AVE	214	LOS ANGELES	CA	90005	3039	19	06037	34.06282163	-118.309122	Los Angeles County
104177	Fee-for-Service	1437137197	1437137197	1	1	KIRGAN, DANIEL M MD	8/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	1707 W CHARLESTON BLVD	STE 120	LAS VEGAS	NV	89102	2352	00	None	36.15879353	-115.1643015	Clark County
104193	Fee-for-Service	1619691656	1619691656	1	1	KRAMER, ABIGAIL O PHD	1/12/2023	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
104196	Fee-for-Service	1518594910	1518594910	1	1	KROL, CAITLIN T	7/9/2024	207L00000X	NA	Other	026	PHYSICIANS	187053	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
104248	Fee-for-Service	1427029792	1427029792	1	1	KUHL, SARAH J MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67243	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
104275	Fee-for-Service	1942284278	1942284278	1	1	KEYS, MICHELE M DO	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14742	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
104313	Fee-for-Service	1083138994	1083138994	1	1	KAMOTHO, ZIPPORAH W	8/22/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11972 GADWALL DR	None	JURUPA VALLEY	CA	91752	2941	33	06065	33.9792245	-117.543096	Riverside County
104320	Fee-for-Service	1336101500	1336101500	1	1	KWAN, CHUK W MD INC	2/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	32238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	929 CLAY ST	STE 600	SAN FRANCISCO	CA	94108	1571	38	06075	37.79398652	-122.4083496	San Francisco County
104341	Fee-for-Service	1891565412	1891565412	1	1	KESHISHYAN, LILIT NP	12/13/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	19	06037	34.24862229	-118.2886742	Los Angeles County
104354	Fee-for-Service	1598814030	1598814030	1	1	KAICER, EL KHANSA LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
104433	Fee-for-Service	1619353042	1619353042	1	1	KAWEAH DELTA HEALTH CARE INC	6/20/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
104465	Fee-for-Service	1477887842	1477887842	1	1	KULKARNI, MALABIKA MD INC	12/10/2010	207L00000X	NA	Other	026	PHYSICIANS	79003	05	Anesthesiology	0	In state provider	None	869 NORTH CHERRY STREET	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
104471	Fee-for-Service	1366976326	1366976326	1	1	KAHEN, NEGAR MD	9/14/2022	208M00000X	NA	Other	026	PHYSICIANS	161357	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
104499	Fee-for-Service	1619461696	1619461696	1	1	KUSUMO, FAIZ MD	9/13/2024	111NR0200X	NA	Other	026	PHYSICIANS	186906	30	Radiology	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
104520	Fee-for-Service	1376693325	1376693325	1	1	KRISHNAN, SENDHIL K MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130341	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	801 N TUSTIN AVE	SUITE 706	SANTA ANA	CA	92705	3611	30	06059	33.752286	-117.8341735	Orange County
104522	Fee-for-Service	1083110811	1083110811	1	1	KLOOSTER, BRITTANY L MD	9/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164875	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
104569	Fee-for-Service	1700957602	1700957602	1	1	KOZMAN, MAHER S MD	4/1/1995	2084P0804X	NA	Psychiatry	026	PHYSICIANS	46450	26	Psychiatry (child)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104580	Fee-for-Service	1033295548	1033295548	1	1	KHAN, YASMIN F MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70089	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
104600	Fee-for-Service	1083138994	1083138994	1	1	KAMOTHO, ZIPPORAH W	8/22/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11972 GADWALL DR	None	JURUPA VALLEY	CA	91752	2941	33	06065	33.9792245	-117.543096	Riverside County
104613	Fee-for-Service	1275173643	1275173643	1	1	KANIA, MARISSA LCSW	1/21/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1620 E ROSEVILLE PKWY	110	ROSEVILLE	CA	95661	3995	31	06061	38.74929858	-121.2417037	Placer County
104615	Fee-for-Service	1386668002	1386668002	1	1	KIM, JEANNIE MD	1/2/2007	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	72965	01	General Practice	0	In state provider	None	5550 UNIVERSITY AVE	STE 200	SAN DIEGO	CA	92105	2307	37	06073	32.74809744	-117.0773303	San Diego County
104657	Fee-for-Service	1770355752	1770355752	1	1	KOSCHEL, DEANNA NP	9/24/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
104674	Fee-for-Service	1396275103	1396275103	1	1	KAYSERIAN, EDWARD MD	9/10/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
104676	Fee-for-Service	1477902419	1477902419	1	1	KIM, DANIEL MD	6/4/2020	390200000X	NA	Other	026	PHYSICIANS	152545	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
104716	Fee-for-Service	1275616005	1275616005	1	1	KAZEM,IMRAN MD	6/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5656 S POWER RD	None	GILBERT	AZ	85295	8487	00	None	33.31386	-111.6877185	Maricopa County
104737	Fee-for-Service	1962874107	1962874107	1	1	KORC, PAUL J MD INC	10/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105862	10	Gastroenterology (M.D. only)	0	In state provider	None	1 HOAG DR, CANCER CENTER	BLDG 41, 3RD FLOOR	NEWPORT BEACH	CA	92663	0000	30	06059	33.62421676	-117.9309656	Orange County
104754	Fee-for-Service	1396716114	1396716114	1	1	KAIME, ELAINE M MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60114	68	Hematology	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
104773	Fee-for-Service	1225448616	1225448616	1	1	KHALIL, ADAM M MD	6/6/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	182862	14	Neurological Surgery	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
104784	Fee-for-Service	1184987927	1184987927	1	1	KHAN, YUSRA MD	8/18/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	168367	40	Pediatrics	0	In state provider	None	416 W FOOTHILL BLVD	None	RIALTO	CA	92376	4953	36	06071	34.10677653	-117.3773835	San Bernardino County
104789	Fee-for-Service	1841860129	1841860129	1	1	KAUR, HARPREET CRNA	10/12/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1100 MAGELLAN DR.	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
104798	Fee-for-Service	1366520124	1366520124	1	1	KAPOOR, SHALIN MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61763	40	Pediatrics	0	In state provider	None	2450 EAST ST	None	CONCORD	CA	94520	0000	07	06013	37.9830627	-122.0342408	Contra Costa County
104804	Fee-for-Service	1134104037	1134104037	1	1	KEDLAYA, DIVAKARA MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55622	25	Physical Medicine and Rehabilitation	0	In state provider	None	11370 ANDERSON ST	STE 2400	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
104814	Fee-for-Service	1487738399	1487738399	2	1	KHACHTRIAN, MARINA MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	69378	01	General Practice	0	In state provider	None	12643 SHERMAN WAY	UNIT I	NORTH HOLLYWOOD	CA	91605	5272	19	06037	34.20123149	-118.408464	Los Angeles County
104828	Fee-for-Service	1285627224	1285627224	1	1	KIM, FRANK H MD	2/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87046	34	Urology and Urological Surgery	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
104831	Fee-for-Service	1598143380	1598143380	1	1	KONKOLY, ANDREA MD	2/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156935	08	Family Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
104833	Fee-for-Service	1912195413	1912195413	1	1	KIM, JAMES S MD	5/23/2011	207L00000X	NA	Other	026	PHYSICIANS	105753	05	Anesthesiology	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
104859	Fee-for-Service	1760419386	1760419386	1	1	KWONG, DONNA MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72182	41	Internal Medicine	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
104862	Fee-for-Service	1669891222	1669891222	1	1	KOMI E. VOVER-DASSU MD	7/6/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
104963	Fee-for-Service	1063462448	1063462448	1	1	KLINE, KATRINA G MD	6/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92494	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
104968	Fee-for-Service	1780250563	1780250563	1	1	KUBIREDDI, SRAVANTHI MD	10/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	500 UNIVERSITY AVE.	SUITE # 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
105003	Fee-for-Service	1568753911	1568753911	1	1	KLARICH, MARY KATE CNP	4/1/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
105037	Fee-for-Service	1396716114	1396716114	1	1	KAIME, ELAINE M MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60114	78	Neoplastic Diseases/Oncology	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
105069	Fee-for-Service	1831295286	1831295286	1	1	KRIVY, JULIE B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10313 GEORGIA AVE	STE 306	SILVER SPRING	MD	20902	5006	00	None	39.02484636	-77.04579357	Montgomery County
105078	Fee-for-Service	1831245505	1831245505	1	1	KENDRICK, JESSICA B MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
105081	Fee-for-Service	1699089508	1699089508	1	1	KHAWAR, TALHA MD	8/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114544	83	Rheumatology	0	In state provider	None	153 B PIONEER LANE	None	BISHOP	CA	93514	2517	14	06027	37.3624356	-118.4073711	Inyo County
105099	Fee-for-Service	1134679756	1134679756	1	1	KEPHART, GERALD L PT	2/19/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
105122	Fee-for-Service	1730507872	1730507872	1	1	KATZ, YISRAEL MD	12/28/2018	208M00000X	NA	Other	026	PHYSICIANS	158910	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
105146	Fee-for-Service	1972759843	1972759843	1	1	KONZEVIK, CLARA LMFT	10/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13101 WASHINGTON BLVD	226	CULVER CITY	CA	90230	0000	19	06037	33.99397583	-118.440813	Los Angeles County
105165	Fee-for-Service	1275597528	1275597528	1	1	KIRCHNER, CHRISTL E NP	9/10/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
105170	Fee-for-Service	1396304457	1396304457	1	1	KO, YOON Y MD	9/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20130	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
105186	Fee-for-Service	1366439358	1366439358	2	1	KCI USA INC	12/5/2011	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3951 PERFORMANCE DR	STE H	SACRAMENTO	CA	95838	3264	34	06067	38.639979	-121.464099	Sacramento County
105199	Fee-for-Service	1295769651	1295769651	1	1	KIM, DANIEL I MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54577	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
105203	Fee-for-Service	1962676361	1962676361	2	1	KASLE, DOUGLAS T PHD	7/26/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	303 POTRERO ST	BLDG 29 UNIT 307	SANTA CRUZ	CA	95060	2741	44	06087	36.98079126	-122.030791	Santa Cruz County
105207	Fee-for-Service	1063404127	1063404127	1	1	KELLY A. BENNETT, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3601 4TH STREET	None	LUBBOCK	TX	79430	0002	00	None	33.58953	-101.891907	Lubbock County
105209	Fee-for-Service	1871672527	1871672527	1	1	KIM, JOSEPH J MD	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87973	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
105219	Fee-for-Service	1275788440	1275788440	1	1	KAMGAR, MOHAMMAD MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101658	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90045	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
105220	Fee-for-Service	1407142342	1407142342	1	1	KUNG, MATTHEW MD	4/7/2023	208600000X	NA	General Surgery	026	PHYSICIANS	184022	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
105262	Fee-for-Service	1558526004	1558526004	1	1	KOO, WINSON F MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116206	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
105282	Fee-for-Service	1548329295	1548329295	1	1	KUPFERBERG, DAVID H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64547	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
105309	Fee-for-Service	1316042534	1316042534	1	1	KHORASHADI, AFAGH MD	3/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62101	40	Pediatrics	0	In state provider	A MEDICAL CORPORATION	22 ODYSSEY	STE 230	IRVINE	CA	92618	7700	30	06059	33.66719598	-117.7642461	Orange County
105311	Fee-for-Service	1891842118	1891842118	1	1	KAISER FOUNDATION HEHALTH	2/1/1989	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	022	1550 TOWN CENTER DR	None	MONTEBELLO	CA	90640	2159	19	06037	34.03650569	-118.0887188	Los Angeles County
105360	Fee-for-Service	1831302090	1831302090	1	1	KERGER, CHRISTOPHER E	1/13/1994	174400000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3855 PRINCETON DR	None	SANTA ROSA	CA	95405	7061	49	06097	38.443581	-122.675679	Sonoma County
105431	Fee-for-Service	1629281233	1629281233	1	1	KORMI, TOURAJ MD	7/5/2024	208200000X	NA	General Surgery	026	PHYSICIANS	48807	24	Plastic Surgery	0	In state provider	None	2999 REGENT ST	SUITE 425	BERKELEY	CA	94705	2119	01	06001	37.85592021	-122.2566436	Alameda County
105437	Fee-for-Service	1225147424	1225147424	1	1	KEZIRIAN, ROBERT H MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44040	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
105438	Fee-for-Service	1518151752	1518151752	1	1	KIRSCHBAUM, STEPHEN F MD	12/5/2007	207ZP0102X	NA	Other	026	PHYSICIANS	87075	22	Pathology (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
105533	Fee-for-Service	1205288628	1205288628	1	1	KRISTEN COX	10/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CTY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
105551	Fee-for-Service	1750907721	1750907721	1	1	KEEPERS OF HOPE	9/11/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	SUITE 217	NORTH HOLLYWOOD	CA	91602	1875	19	06037	34.15389329	-118.3679999	Los Angeles County
105570	Fee-for-Service	1548329295	1548329295	1	1	KUPFERBERG, DAVID H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64547	70	Clinic (mixed specialty)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
105589	Fee-for-Service	1922038736	1922038736	1	1	KHURANA. RAMESH K MD	4/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53635	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
105593	Fee-for-Service	1083061253	1083061253	1	1	KIELY, KATE E MD	10/2/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	186890	None	None	0	In state provider	None	1247 E ALLUVIAL AVE	SUITE 101	FRESNO	CA	93720	2686	10	06019	36.84470048	-119.7606195	Fresno County
105601	Fee-for-Service	1477651149	1477651149	1	1	KILLPACK, STEVEN P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64433	41	Internal Medicine	0	In state provider	None	1 SHRADER ST	STE 550	SAN FRANCISCO	CA	94117	1034	38	06075	37.77467326	-122.4529451	San Francisco County
105604	Fee-for-Service	1700884905	1700884905	1	1	KOWELL, ARTHUR P MD	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	29779	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
105648	Fee-for-Service	1770858573	1770858573	1	1	KING, JUSTIN B MD INC	6/11/2012	193400000X	NA	Other	026	PHYSICIANS	89447	02	General Surgery	0	In state provider	None	6655 ALVARADO ROAD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
105679	Fee-for-Service	1487991576	1487991576	1	1	KARANDEEP SINGH, MD PC	9/24/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	L GROUP	921 W 7TH ST	None	OXNARD	CA	93030	6755	56	06111	34.19516476	-119.1890959	Ventura County
105698	Fee-for-Service	1558492249	1558492249	1	1	KLAMON, JULIE A LMFT	4/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28310 ROADSIDE DRIVE	249	AGOURA HILLS	CA	91301	4923	19	06037	34.14271418	-118.7432847	Los Angeles County
105707	Fee-for-Service	1790196442	1790196442	1	1	KINGSLEY SHAFFER, CHELLIE	6/20/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
105722	Fee-for-Service	1225147424	1225147424	1	1	KEZIRIAN, ROBERT H MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44040	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
105735	Fee-for-Service	1659766871	1659766871	1	1	KANG, ERIC	3/21/2018	390200000X	NA	Other	026	PHYSICIANS	144667	None	None	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
105744	Fee-for-Service	1093249864	1093249864	1	1	KETCHUM, MYLES J MD	9/24/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157188	08	Family Practice	0	In state provider	None	2480 SONOMA STREET	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
105762	Fee-for-Service	1134138571	1134138571	1	1	KASS, MARTIN B MD	1/1/1979	207L00000X	NA	Other	026	PHYSICIANS	31906	05	Anesthesiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
105779	Fee-for-Service	1538270038	1538270038	1	1	KAZMI, HASHIM R MD	12/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51606	45	Nephrology (Renal-Kidney)	0	In state provider	None	1524 27TH ST	STE 401	BAKERSFIELD	CA	93301	2056	15	06029	35.38387747	-119.0197575	Kern County
105786	Fee-for-Service	1154854750	1154854750	1	1	KENNING, BRITTANY N MD	9/20/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169904	08	Family Practice	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
105831	Fee-for-Service	1205927902	1205927902	1	1	KHAN, SALMA H MD	12/1/2003	2085N0904X	NA	Other	026	PHYSICIANS	64711	None	None	0	In state provider	None	2957 LOMA VISTA RD	None	VENTURA	CA	93003	2915	56	06111	34.27555639	-119.2565838	Ventura County
105834	Fee-for-Service	1720500028	1720500028	1	1	KARAPETYAN, HERMINE	11/17/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	26504 BOUQUET CANYON	None	SANTA CLARITA	CA	91350	2353	19	06037	34.42742329	-118.5368396	Los Angeles County
105840	Fee-for-Service	1750907721	1750907721	1	1	KEEPERS OF HOPE	9/11/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	SUITE 217	NORTH HOLLYWOOD	CA	91602	1875	19	06037	34.15389329	-118.3679999	Los Angeles County
105845	Fee-for-Service	1306281225	1306281225	1	1	KOESTER, NAOMI L MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146898	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
105853	Fee-for-Service	1013396118	1013396118	1	1	KELADA, JOHN PAUL Y MD	11/1/2017	390200000X	NA	Other	026	PHYSICIANS	145789	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
105868	Fee-for-Service	1588870802	1588870802	1	1	KOLLISCH, NANCY R MD INC	7/31/1981	174400000X	NA	Other	026	PHYSICIANS	44466	77	Infectious Disease	0	In state provider	None	8008 FROST ST	STE 200	SAN DIEGO	CA	92123	4207	37	06073	32.80027859	-117.1524832	San Diego County
105879	Fee-for-Service	1063079929	1063079929	1	1	KEY MEDICAL SUPPLY LLC	5/4/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4312 WOODMAN AVE	200	SHERMAN OAKS	CA	91423	5546	19	06037	34.148637	-118.4312035	Los Angeles County
105884	Fee-for-Service	1275898702	1275898702	1	1	KHAYALI, OMER R MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123936	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
105907	Fee-for-Service	1558509547	1558509547	1	1	KAVANAUGH, MARY E LMFT	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
105928	Fee-for-Service	1083634323	1083634323	1	1	KIM, GRACE S MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76484	67	Endocrinology	0	In state provider	None	1800 SULLIVAN AVE	RM 408	DALY CITY	CA	94015	2224	41	06081	37.68077723	-122.4728941	San Mateo County
105931	Fee-for-Service	1750456349	1750456349	1	1	KINGSLEY, ANTHONY M MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10301 GARVEY AVE	STE 100	EL MONTE	CA	91733	2180	19	06037	34.06275647	-118.0463355	Los Angeles County
105939	Fee-for-Service	1720278245	1720278245	1	1	KIM, RICKY B MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91390	30	Radiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
105946	Fee-for-Service	1356346449	1356346449	1	1	KELLAM, MARK E MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
105952	Fee-for-Service	1194761809	1194761809	1	1	KAN, YUET WAI KAN MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	25087	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
105954	Fee-for-Service	1184031650	1184031650	1	1	KAUS, ALLISON LMFT	7/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
105988	Fee-for-Service	1265462980	1265462980	2	1	KAPLAN, RICHARD T MD	7/22/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	76971	None	None	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
106010	Fee-for-Service	1205034394	1205034394	1	1	KURBANYAN, KRISTINA MD	5/11/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	111429	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
106039	Fee-for-Service	1811949860	1811949860	1	1	KUPFER, MICHAEL MD	6/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	41450	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
106040	Fee-for-Service	1679133789	1679133789	1	1	KANETA, KELLI A MD	7/14/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176966	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
106089	Fee-for-Service	1144310756	1144310756	1	1	KOURETAS, PETER C MD	1/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86464	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
106113	Fee-for-Service	1679621478	1679621478	1	1	KAISER FOUNDATION HEALTH PLA	5/29/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	014	4950 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5821	19	06037	34.09812092	-118.2980246	Los Angeles County
106121	Fee-for-Service	1790838878	1790838878	1	1	KAPLAN, SUSAN K	12/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
106127	Fee-for-Service	1801002704	1801002704	1	1	KING, MARIA A CNM	5/27/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1881 BUSINESS CENTER DR	SUITE 8A	SAN BERNARDINO	CA	92408	3448	36	06071	34.06846141	-117.2811029	San Bernardino County
106135	Fee-for-Service	1790313583	1790313583	1	1	KRAUS-KOZIOL, CAROLYN MD	7/17/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	185641	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
106155	Fee-for-Service	1194718064	1194718064	1	1	KILPATRICK, ROBERT A MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
106192	Fee-for-Service	1912961426	1912961426	1	1	KNOEPFLER, ANCA E MD	11/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	60289	41	Internal Medicine	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
106217	Fee-for-Service	1750456349	1750456349	1	1	KINGSLEY, ANTHONY M MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	38	Geriatrics	0	In state provider	None	10301 GARVEY AVE	STE 100	EL MONTE	CA	91733	2180	19	06037	34.06275647	-118.0463355	Los Angeles County
106243	Fee-for-Service	1386898658	1386898658	1	1	KRATER, MARY K	9/8/2009	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVENUE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
106245	Fee-for-Service	1720245095	1720245095	1	1	KUNKEL, BETZABEL A MD	10/31/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	107540	-	NOT APPLICABLE	0	In state provider	None	215 W BEAMER STREET	None	WOODLAND	CA	95695	2510	57	06113	38.68483629	-121.7937301	Yolo County
106318	Fee-for-Service	1265052914	1265052914	1	1	KHALEK, IMRAN MD	12/8/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
106335	Fee-for-Service	1538167804	1538167804	1	1	KELMINSON, STEPHEN MD	2/15/2022	2085R0204X	NA	Other	026	PHYSICIANS	166000	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
106425	Fee-for-Service	1023291945	1023291945	1	1	KHANNA, RAMAN R MD	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107768	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
106432	Fee-for-Service	1437237005	1437237005	1	1	KIM, RAN MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75587	None	None	0	In state provider	None	2700 GRANT ST	STE 306	CONCORD	CA	94520	2281	07	06013	37.98417931	-122.0361585	Contra Costa County
106452	Fee-for-Service	1184087983	1184087983	1	1	KRYPEL, ROSIE Q MD	9/1/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	173940	None	None	0	In state provider	None	350 DEL NORTE AVENUE	None	YUBA CITY	CA	95991	4123	51	06101	39.14502655	-121.615685	Sutter County
106458	Fee-for-Service	1922395516	1922395516	1	1	KIEU, MONICA CHAU Q DO	9/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
106523	Fee-for-Service	1033316013	1033316013	1	1	KANG, MARK J MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94963	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	SUITE # 1000	LOS ANGELES	CA	90033	4528	19	06037	34.06269295	-118.2030006	Los Angeles County
106532	Fee-for-Service	1972507580	1972507580	1	1	KADLEC REGIONAL MEDICAL	2/9/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
106557	Fee-for-Service	1467770982	1467770982	1	1	KUMAR, NARAIN K MD	10/12/2020	207R00000X	NA	Other	026	PHYSICIANS	164496	41	Internal Medicine	0	In state provider	None	800 SOUTH MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
106570	Fee-for-Service	1932331972	1932331972	1	1	KRANE, RITA MD	5/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116028	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
106649	Fee-for-Service	1538450010	1538450010	1	1	KOCHKINE, SERGEY	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
106659	Fee-for-Service	1891059630	1891059630	1	1	KOSKI, GABE LMFT	2/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
106675	Fee-for-Service	1508423567	1508423567	1	1	KWON, KEE JIN NP	12/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
106727	Fee-for-Service	1598957490	1598957490	1	1	KADAKIA, ANKITA S MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126366	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
106770	Fee-for-Service	1255861787	1255861787	1	1	KNOWLTON, LISA M MD	11/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
106784	Fee-for-Service	1467079616	1467079616	1	1	KULDANEK, MICHAEL E CCC-SLP	7/16/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
106808	Fee-for-Service	1538725221	1538725221	1	1	KHALIFIA, LAURA H LCSW	2/26/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
106818	Fee-for-Service	1356704779	1356704779	1	1	KHAN, SHAH Z MD	3/23/2020	207R00000X	NA	Other	026	PHYSICIANS	168036	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
106821	Fee-for-Service	1972507580	1972507580	1	1	KADLEC REGIONAL MEDICAL	2/9/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
106824	Fee-for-Service	1053411967	1053411967	1	1	KIM, ALEXIS H MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81813	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
106857	Fee-for-Service	1407957509	1407957509	1	1	KENNEDY, FRANK R MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	57613	89	Surgery-Traumatic	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
106865	Fee-for-Service	1700087392	1700087392	1	1	KLEIN, JASON D DO	1/12/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	4855 BLUE DIAMOND RD	None	LAS VEGAS	NV	89139	7602	00	None	36.03258913	-115.2074608	Clark County
106879	Fee-for-Service	1417513524	1417513524	1	1	KRAFFT, MICHAEL R MD	10/19/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	181767	None	None	0	In state provider	None	14971 HOLT AVENUE	None	TUSTIN	CA	92780	3406	30	06059	33.74650424	-117.8141329	Orange County
106928	Fee-for-Service	1487732509	1487732509	1	1	KWON, SOON H OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	731 N EUCLID ST	None	ANAHEIM	CA	92801	4116	30	06059	33.842385	-117.9416385	Orange County
106929	Fee-for-Service	1225556723	1225556723	1	1	KLEMPNER, HANNAH	7/28/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
106938	Fee-for-Service	1942479852	1942479852	1	1	KC BUGG, PHD, APC	8/6/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	446 S MARENGO AVE	STE A	PASADENA	CA	91101	3113	19	06037	34.138512	-118.1458425	Los Angeles County
106952	Fee-for-Service	1053488908	1053488908	1	1	KALINA, SHARON L MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50417	24	Plastic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
106966	Fee-for-Service	1679109979	1679109979	1	1	KDPKI INC	3/11/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3664 GOVERNOR DR	None	SAN DIEGO	CA	92122	2418	37	06073	32.85305493	-117.2085494	San Diego County
106968	Fee-for-Service	1003427469	1003427469	1	1	KWONG, TIFFANY C OD	5/7/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11028 LOWER AZUSA	SUITE B	EL MONTE	CA	91731	5406	19	06037	34.09193387	-118.0251713	Los Angeles County
106972	Fee-for-Service	1710902150	1710902150	1	1	KUMAR, ASHA R MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	29494	40	Pediatrics	0	In state provider	None	820 W SERVICE AVE	None	WEST COVINA	CA	91790	3716	19	06037	34.06348712	-117.9309405	Los Angeles County
107010	Fee-for-Service	1750464707	1750464707	1	1	KOLODNY, MICKEY M MD	10/3/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47101	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17742 BEACH BLVD	STE 325	HUNTINGTON BEACH	CA	92647	6852	30	06059	33.704487	-117.989061	Orange County
107015	Fee-for-Service	1598957490	1598957490	1	1	KADAKIA, ANKITA S MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126366	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
107020	Fee-for-Service	1780664565	1780664565	1	1	KAUFMANN, VICTORIA A MD	12/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65667	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
107035	Fee-for-Service	1770631566	1770631566	1	1	KAISER FOUND HLTH PLN IN	4/2/2001	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #132	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
107095	Fee-for-Service	1396271797	1396271797	1	1	KANJI, JOSHUA A MD	2/11/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	171274	None	None	0	In state provider	None	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
107108	Fee-for-Service	1356704779	1356704779	1	1	KHAN, SHAH Z MD	3/23/2020	207R00000X	NA	Other	026	PHYSICIANS	168036	41	Internal Medicine	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
107142	Fee-for-Service	1043745466	1043745466	1	1	KUYUMCU, GOKHAN	10/2/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	189914	30	Radiology	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
107190	Fee-for-Service	1013449149	1013449149	1	1	KIM, MATTHEW MD	3/9/2021	208M00000X	NA	Other	026	PHYSICIANS	166804	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
107199	Fee-for-Service	1144675497	1144675497	1	1	KHAN, RANIA MD	8/14/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160010	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
107221	Fee-for-Service	1134334550	1134334550	1	1	KURKJIAN, AZAD PMD	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	99007	36	Psychiatry	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
107233	Fee-for-Service	1447663919	1447663919	1	1	KANDAVEL, PRASHANTHI MD	6/18/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167506	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
107235	Fee-for-Service	1386157816	1386157816	1	1	KIM, ANDREW T PT	4/4/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
107241	Fee-for-Service	1053488908	1053488908	1	1	KALINA, SHARON L MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50417	46	Hand Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
107295	Fee-for-Service	1467771410	1467771410	1	1	KAO, CHIASUI MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136479	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107298	Fee-for-Service	1750464707	1750464707	1	1	KOLODNY, MICKEY M MD	10/3/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47101	08	Family Practice	0	In state provider	None	17742 BEACH BLVD	STE 325	HUNTINGTON BEACH	CA	92647	6852	30	06059	33.704487	-117.989061	Orange County
107339	Fee-for-Service	1902879752	1902879752	1	1	KURIAN DAMIAN	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 MALCOLM X BLVD	None	NEW YORK	NY	10037	1802	00	None	40.81447535	-73.94040027	New York County
107418	Fee-for-Service	1629396684	1629396684	1	1	KARCH, CHRISTOPH O J MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129008	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
107430	Fee-for-Service	1043745466	1043745466	1	1	KUYUMCU, GOKHAN	10/2/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	189914	70	Clinic (mixed specialty)	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
107451	Fee-for-Service	1538201520	1538201520	1	1	KNOWLES, JOSHUA W MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87974	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107496	Fee-for-Service	1043356637	1043356637	1	1	KIA AFSHAR	10/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
107500	Fee-for-Service	1902973878	1902973878	1	1	KAUFER, ERIC S MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71390	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
107513	Fee-for-Service	1154504900	1154504900	1	1	KHAN, HASHIM A MD	5/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110977	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
107547	Fee-for-Service	1295383719	1295383719	1	1	KEEHNER, MEGHANN J AU	7/5/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
107553	Fee-for-Service	1689319030	1689319030	1	1	KIM, MIN KYEONG AU	1/31/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	321 MIDDLEFIELD ROAD	SUITE 165,260	MENLO PARK	CA	94025	3500	41	06081	37.45657153	-122.168099	San Mateo County
107564	Fee-for-Service	1588686042	1588686042	1	1	KADAKIA, HEMAL H MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	89218	41	Internal Medicine	0	In state provider	None	1300 NORTH VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
107572	Fee-for-Service	1518279710	1518279710	1	1	KURAMOTO, ALAN T MD	6/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120680	30	Radiology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
107600	Fee-for-Service	1417048307	1417048307	1	1	KHAN, ZEENAT A MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55416	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
107610	Fee-for-Service	1043739345	1043739345	1	1	KATIRAI, ANDREW MD	2/20/2024	207L00000X	NA	Other	026	PHYSICIANS	189087	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
107627	Fee-for-Service	1144541665	1144541665	1	1	KIM, PAUL S MD	4/6/2018	207LP2900X	NA	Other	026	PHYSICIANS	135423	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
107628	Fee-for-Service	1558942953	1558942953	1	1	KHAN, MUZZAMAL NP	1/11/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
107636	Fee-for-Service	1245573419	1245573419	1	1	KHARARJIAN, ARMEN	8/14/2020	207ZP0101X	NA	Other	026	PHYSICIANS	155020	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
107651	Fee-for-Service	1144265463	1144265463	1	1	KAHN, DANIEL A MD	6/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87014	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
107682	Fee-for-Service	1134217813	1134217813	1	1	KOTHARY, HEMMAL S MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76603	01	General Practice	0	In state provider	None	9500 STOCKDALE HWY	SUITE 200	BAKERSFIELD	CA	93311	3621	15	06029	35.35452448	-119.1074625	Kern County
107683	Fee-for-Service	1245834217	1245834217	1	1	KAPLAN HOSPICE, INC	5/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 138	NORTH HOLLYWOOD	CA	91601	2249	19	06037	34.1721655	-118.3608315	Los Angeles County
107687	Fee-for-Service	1235794181	1235794181	1	1	KARIM, MUNTARIN DO	11/6/2024	207RR0500X	NA	Other	026	PHYSICIANS	19630	83	Rheumatology	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
107688	Fee-for-Service	1962817668	1962817668	1	1	KHUC, KIM T MD	8/9/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155751	15	Obstetrics (D.O. only)	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
107702	Fee-for-Service	1568606564	1568606564	1	2	KOCHAV, MARGALIT MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121440	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
107705	Fee-for-Service	1174810782	1174810782	1	1	KATHERYN C STAMBUOUGH	8/30/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
107709	Fee-for-Service	1669631248	1669631248	1	1	KUMAR, RAMDAS N MD	10/4/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	115199	None	None	0	In state provider	None	16907 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7407	19	06037	34.25754015	-118.5004161	Los Angeles County
107713	Fee-for-Service	1598226789	1598226789	1	1	KLEINMAN, JOHN MD	8/2/2023	207L00000X	NA	Other	026	PHYSICIANS	182526	None	None	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
107724	Fee-for-Service	1588616536	1588616536	1	1	KHOURY, MICHAEL G DO	10/21/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	10334	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	1	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
107726	Fee-for-Service	1386173698	1386173698	1	2	KOO, SUSAN T MD	7/11/2020	207LA0401X	NA	Other	026	PHYSICIANS	87500	None	None	0	In state provider	None	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
107738	Fee-for-Service	1538201520	1538201520	1	1	KNOWLES, JOSHUA W MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87974	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107739	Fee-for-Service	1033564869	1033564869	1	1	KUMAR, MANISH MD	9/1/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166967	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
107753	Fee-for-Service	1467008367	1467008367	1	1	KENNEY, ASHLEY S PT	2/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50-225 CESAR CHAVEZ ST.	SUITE 103	COACHELLA	CA	92253	7243	33	06065	33.67309459	-116.181558	Riverside County
107798	Fee-for-Service	1023679537	1023679537	1	1	KHATUN, MST NURJAHAN MD	11/4/2022	207R00000X	NA	Other	026	PHYSICIANS	177424	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
107820	Fee-for-Service	1891724753	1891724753	1	1	KUSONRUKSA, TERMSAK MD	12/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	40625	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	4910 VAN NUYS BLVD	STE 201	SHERMAN OAKS	CA	91403	1715	19	06037	34.15979697	-118.4486826	Los Angeles County
107859	Fee-for-Service	1407086853	1407086853	1	1	KRISHNAN, KARTIK R MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130827	41	Internal Medicine	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
107887	Fee-for-Service	1790863579	1790863579	1	1	KRON, MICHAEL J MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74089	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
107894	Fee-for-Service	1821299298	1821299298	1	1	KORULA, JACOB MD APMC	7/31/1984	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	39567	10	Gastroenterology (M.D. only)	0	In state provider	None	622 W DUARTE RD	STE 302	ARCADIA	CA	91007	9278	19	06037	34.12645266	-118.0521552	Los Angeles County
107896	Fee-for-Service	1821485103	1821485103	1	1	KIBROM, SARA G MD	7/7/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154750	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
107907	Fee-for-Service	1912055724	1912055724	1	1	KAISER FOUNDATION HLTH	1/13/1995	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN MORSE AVE #1	2025 MORSE AVE	FL 1	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
107972	Fee-for-Service	1245834217	1245834217	1	1	KAPLAN HOSPICE, INC	5/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 138	NORTH HOLLYWOOD	CA	91601	2249	19	06037	34.1721655	-118.3608315	Los Angeles County
107974	Fee-for-Service	1962817668	1962817668	1	1	KHUC, KIM T MD	8/9/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155751	09	Gynecology (D.O. only)	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
107978	Fee-for-Service	1144232778	1144232778	1	1	KEARSE, WILFRED S MD JR	8/9/1996	208800000X	NA	Other	026	PHYSICIANS	83318	34	Urology and Urological Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
108020	Fee-for-Service	1598813321	1598813321	1	1	KAISER FOUNDATION HEALTH	6/18/1979	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #201	3955 BONITA RD	None	BONITA	CA	91902	1230	37	06073	32.65714827	-117.042186	San Diego County
108024	Fee-for-Service	1720050529	1720050529	1	1	KANG, YOUNG M MD INC	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86475	34	Urology and Urological Surgery	0	In state provider	None	5725 W LAS POSITAS BLVD	STE 250	PLEASANTON	CA	94588	4168	01	06001	37.688107	-121.8861427	Alameda County
108028	Fee-for-Service	1033564869	1033564869	1	1	KUMAR, MANISH MD	9/1/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166967	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
108031	Fee-for-Service	1154689271	1154689271	1	1	KEN S INAMASU MD	2/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	770 KAPIOLANI BLVD	STE 705	HONOLULU	HI	96813	5241	00	None	21.30051254	-157.8538506	Honolulu County
108047	Fee-for-Service	1417005315	1417005315	1	1	KHAN, RABIA J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49640	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 RESERVOIR DR	STE 314	SAN DIEGO	CA	92120	5150	37	06073	32.77628471	-117.0563688	San Diego County
108077	Fee-for-Service	1821013889	1821013889	1	1	KWA, ANDREW T MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93963	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
108095	Fee-for-Service	1780352443	1780352443	1	1	KESHISHIAN, LALA PT	3/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 101	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
108108	Fee-for-Service	1891724753	1891724753	1	1	KUSONRUKSA, TERMSAK MD	12/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	40625	04	Otology, Laryngology, Rhinology	0	In state provider	None	4910 VAN NUYS BLVD	STE 201	SHERMAN OAKS	CA	91403	1715	19	06037	34.15979697	-118.4486826	Los Angeles County
108114	Fee-for-Service	1942451489	1942451489	1	1	KURODA, RONALD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
108115	Fee-for-Service	1649258377	1649258377	1	1	KWEE, INGRID L MD	3/31/1991	2084N0400X	NA	Neurology	026	PHYSICIANS	40295	13	Neurology (M.D. only)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
108141	Fee-for-Service	1861430902	1861430902	1	1	KWOK, WEI W MD	4/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90368	05	Anesthesiology	0	In state provider	None	1301 N ROSE DRIVE	None	PLACENTIA	CA	92870	0000	30	06059	33.8868003	-117.8420447	Orange County
108147	Fee-for-Service	1174972012	1174972012	1	1	KRIGER, DIEGO I MD	4/24/2019	207R00000X	NA	Other	026	PHYSICIANS	157102	41	Internal Medicine	0	In state provider	None	3816 WOODRUFF AVE	STE 412	LONG BEACH	CA	90808	2146	19	06037	33.828102	-118.1165525	Los Angeles County
108180	Fee-for-Service	1821299298	1821299298	1	1	KORULA, JACOB MD APMC	7/31/1984	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	39567	41	Internal Medicine	0	In state provider	None	622 W DUARTE RD	STE 302	ARCADIA	CA	91007	9278	19	06037	34.12645266	-118.0521552	Los Angeles County
108188	Fee-for-Service	1033746797	1033746797	1	1	KOSCHE, CORY MD	10/3/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	185729	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
108203	Fee-for-Service	1144205881	1144205881	1	1	KUPELIAN, PATRICK A MD	5/11/2010	2085R0001X	NA	Other	026	PHYSICIANS	54049	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
108210	Fee-for-Service	1104169796	1104169796	1	1	KIM, LISA L MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136127	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
108212	Fee-for-Service	1285120725	1285120725	1	1	KETINENI, SUJITHA S MD	12/20/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
108258	Fee-for-Service	1306057989	1306057989	1	3	KRONLAND, RENE C MD	11/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85096	01	General Practice	0	In state provider	None	396 DORSEY DR	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22714445	-121.035285	Nevada County
108259	Fee-for-Service	1467958769	1467958769	1	1	KIM, ELISSA E MD	10/1/2021	207R00000X	NA	Other	026	PHYSICIANS	164489	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
108272	Fee-for-Service	1902307358	1902307358	1	1	KAISER FOUNDATION HEALTH	7/2/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN CORP 299541, CA	1721 TECHNOLOGY DRIVE	1ST FLOOR	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
108276	Fee-for-Service	1588670707	1588670707	1	1	KAO, JERRY MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77744	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
108294	Fee-for-Service	1366601833	1366601833	1	1	KREMEN, THOMAS J MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101807	20	Orthopedic Surgery	0	In state provider	None	2400 SOUTH FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
108334	Fee-for-Service	1417005315	1417005315	1	1	KHAN, RABIA J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49640	41	Internal Medicine	0	In state provider	None	5555 RESERVOIR DR	STE 314	SAN DIEGO	CA	92120	5150	37	06073	32.77628471	-117.0563688	San Diego County
108358	Fee-for-Service	1740211093	1740211093	1	1	KHADEMI, SARA MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83826	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
108365	Fee-for-Service	1679878631	1679878631	1	1	KRAUS, DENISE C LPCC	9/29/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
108396	Fee-for-Service	1558523217	1558523217	1	1	KIM, JI HYUN MD	10/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111884	78	Neoplastic Diseases/Oncology	0	In state provider	None	44105 15TH ST WEST	STE 409	LANCASTER	CA	93534	4000	19	06037	34.684218	-118.1568465	Los Angeles County
108399	Fee-for-Service	1588971758	1588971758	1	1	KRUTUL, ALLISON T PHD	12/3/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
108428	Fee-for-Service	1811970361	1811970361	1	1	KING, NICHOLAS A MD	9/29/2004	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	85437	20	Orthopedic Surgery	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
108483	Fee-for-Service	1720347263	1720347263	1	1	KUROSE, BRIAN D MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123047	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
108493	Fee-for-Service	1144205881	1144205881	1	1	KUPELIAN, PATRICK A MD	5/11/2010	2085R0001X	NA	Other	026	PHYSICIANS	54049	30	Radiology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
108498	Fee-for-Service	1124029756	1124029756	1	1	KRISTIN LB PETERSON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	347 SMITH AVE N	STE 302	SAINT PAUL	MN	55102	3355	00	None	44.94164123	-93.10866966	Ramsey County
108544	Fee-for-Service	1396760138	1396760138	1	2	KAISER, CRAIG DO	2/24/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	8306	-	NOT APPLICABLE	0	In state provider	None	7885 ANNANDALE AVENUE	None	DESERT HOT SPRING	CA	92240	1419	33	06065	33.99048848	-116.5242885	Riverside County
108580	Fee-for-Service	1386122448	1386122448	1	1	KANG, MOSE NP	8/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2110 N SANTA FE AVE	None	COMPTON	CA	90222	2822	19	06037	33.91171674	-118.2166547	Los Angeles County
108656	Fee-for-Service	1821480757	1821480757	1	1	KAMATH, SONIA MD	9/9/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	138831	07	Dermatology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
108681	Fee-for-Service	1558523217	1558523217	1	1	KIM, JI HYUN MD	10/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111884	30	Radiology	0	In state provider	None	44105 15TH ST WEST	STE 409	LANCASTER	CA	93534	4000	19	06037	34.684218	-118.1568465	Los Angeles County
108699	Fee-for-Service	1013371467	1013371467	1	1	KAUR, NAVNEET MD	10/11/2021	207R00000X	NA	Other	026	PHYSICIANS	160593	None	None	0	In state provider	None	1805 N CALIFORNIA ST	201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
108713	Fee-for-Service	1811970361	1811970361	1	1	KING, NICHOLAS A MD	9/29/2004	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	85437	41	Internal Medicine	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
108741	Fee-for-Service	1932728284	1932728284	1	1	KHAN, AKHIL M MD	10/27/2023	207R00000X	NA	Other	026	PHYSICIANS	187623	None	None	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
108794	Fee-for-Service	1033601844	1033601844	1	1	KASANAGOTTU, KOUSHIK MD	5/14/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	186556	41	Internal Medicine	0	In state provider	None	1850 N RIVERSIDE AVE	None	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
108796	Fee-for-Service	1588972889	1588972889	1	1	KUNSMAN, GLENN R DO	1/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVENUE A	None	YUMA	AZ	91066	0969	00	None	32.683167	-114.633459	Yuma County
108800	Fee-for-Service	1528386687	1528386687	1	1	KHAN, ZIAD U MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112115	68	Hematology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
108831	Fee-for-Service	1760649651	1760649651	1	1	KAUSAR, HUMA DO	6/15/2020	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
108850	Fee-for-Service	1871591073	1871591073	1	1	KAIN, TATIANA MD	1/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51531	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
108857	Fee-for-Service	1720053291	1720053291	1	1	KATSANIS, EMMANUEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
108858	Fee-for-Service	1306829478	1306829478	1	1	KAIN, ZEEV MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51580	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
108865	Fee-for-Service	1760992705	1760992705	1	1	KWON, MICHELLE E LMFT	3/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
108869	Fee-for-Service	1689723876	1689723876	1	1	KHAN, YAQOOT DO	2/25/2021	207RR0500X	NA	Other	026	PHYSICIANS	18542	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
108877	Fee-for-Service	1013439884	1013439884	1	1	KADOSH, EITAN LMFT	12/3/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 S FAIRFAX AVE	STE 214	LOS ANGELES	CA	90036	3198	19	06037	34.06725156	-118.3614386	Los Angeles County
108885	Fee-for-Service	1851462816	1851462816	1	1	KHO, JOAN MD	12/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87017	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
108920	Fee-for-Service	1033348651	1033348651	1	1	KIM, DEBORAH S MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120941	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
108925	Fee-for-Service	1972567246	1972567246	1	1	KEBEBEW, ELECTRON MD	5/9/1997	208600000X	NA	General Surgery	026	PHYSICIANS	62307	02	General Surgery	0	In state provider	None	45 CASTRO ST	STE 423	SAN FRANCISCO	CA	94114	1027	38	06075	37.76829732	-122.4357056	San Francisco County
108931	Fee-for-Service	1326400516	1326400516	1	1	KANTER, JOHN H MD	6/8/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	184442	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
108949	Fee-for-Service	1710563283	1710563283	1	1	KITSON, TEALE MD	9/9/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
108951	Fee-for-Service	1992827950	1992827950	1	1	KOTECHA, MONA K MD	9/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95000	05	Anesthesiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
108954	Fee-for-Service	1437128584	1437128584	1	1	KLUNK, CAITLIN M	6/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
108955	Fee-for-Service	1720170780	1720170780	1	1	KAYMEN, AMELIA MD	9/30/2003	207N00000X	NA	Dermatology	026	PHYSICIANS	53235	41	Internal Medicine	0	In state provider	None	3801 SACRAMENTO ST	FL 2	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
108974	Fee-for-Service	1508243270	1508243270	1	1	KOTHARI, PERIN A DO	8/20/2020	207L00000X	NA	Other	026	PHYSICIANS	17071	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
108983	Fee-for-Service	1073908125	1073908125	1	1	KANG, JENNIFER H MD	10/11/2021	2084A2900X	NA	Neurology	026	PHYSICIANS	172453	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
109004	Fee-for-Service	1952647711	1952647711	1	2	K'BURG, REGINA I PSYD	6/26/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
109021	Fee-for-Service	1619291127	1619291127	1	1	KELLOGG, ANN E DO	12/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2865 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
109038	Fee-for-Service	1740679216	1740679216	1	1	KEMP, DELASHAWN Y	12/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
109084	Fee-for-Service	1699847442	1699847442	1	1	KIM, YOON H DO	8/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9046	05	Anesthesiology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
109089	Fee-for-Service	1740357607	1740357607	1	1	KIENLE, BERTA E MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78395	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
109091	Fee-for-Service	1528386687	1528386687	1	1	KHAN, ZIAD U MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112115	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
109092	Fee-for-Service	1801959648	1801959648	1	1	KAIRIS, LISA A MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71709	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	245 TERRACINA BLVD	STE 104A	REDLANDS	CA	92373	4879	36	06071	34.03858912	-117.2066515	San Bernardino County
109130	Fee-for-Service	1568677573	1568677573	1	1	KIM, JAMES D MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98699	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
109150	Fee-for-Service	1598721425	1598721425	1	1	KINJO, SAKURA MD	7/23/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74007	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
109202	Fee-for-Service	1447323092	1447323092	1	1	KRISHNAN, SAVITHA MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71453	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
109211	Fee-for-Service	1962031617	1962031617	1	1	KHIEU, TINA OD	7/19/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
109229	Fee-for-Service	1831275502	1831275502	1	1	KELSEY, JAMES W OD INC	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SOUTH BAY FAMILY VISION	13416 HAWTHORNE BLVD	STE B	HAWTHORNE	CA	90250	5820	19	06037	33.91056338	-118.3524209	Los Angeles County
109267	Fee-for-Service	1336382837	1336382837	1	1	KOPSHEVER, JOSEPH	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	None	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109286	Fee-for-Service	1053337212	1053337212	1	1	KAVALIN, STEPHEN RN	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2699 LEE RD	STE 510	WINTER PARK	FL	32789	1742	00	None	28.60587447	-81.3846375	Orange County
109312	Fee-for-Service	1184896656	1184896656	1	1	KNUEPPEL, RYAN C MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105175	41	Internal Medicine	0	In state provider	None	710 LAWERENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
109317	Fee-for-Service	1710273073	1710273073	1	1	KIUREGHIAN, EMEEN A DO	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13989	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 SOUTH GRAND AVENUE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
109326	Fee-for-Service	1245539758	1245539758	1	1	KIM, JISUN LAC	3/20/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1825 HAMNER AVE	SUITE R	NORCO	CA	92860	2974	33	06065	33.90874263	-117.5612272	Riverside County
109359	Fee-for-Service	1629032271	1629032271	1	1	KANZLER, MATTHEW H MD	12/1/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	57056	07	Dermatology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
109364	Fee-for-Service	1750727244	1750727244	1	1	KEES, JING	10/28/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
109372	Fee-for-Service	1689674665	1689674665	1	1	KILARU, PRASAD G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60104	None	None	0	In state provider	None	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1730	01	06001	37.55887933	-121.9797796	Alameda County
109376	Fee-for-Service	1932596459	1932596459	1	1	KAIROS HOME CARE LLC	11/21/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4510 PERALTA BLVD	SUITE 7	FREMONT	CA	94536	5755	01	06001	37.5513906	-122.0111834	Alameda County
109379	Fee-for-Service	1528386687	1528386687	1	1	KHAN, ZIAD U MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112115	41	Internal Medicine	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
109399	Fee-for-Service	1912785346	1912785346	1	1	KURATA, KOURTNEY M PT	10/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	423 IMPERIAL HWY	None	FULLERTON	CA	92835	1146	30	06059	33.91749052	-117.925452	Orange County
109452	Fee-for-Service	1942683073	1942683073	2	1	KW, INC.	9/2/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2426 W 8TH ST	#103	LOS ANGELES	CA	90057	3840	19	06037	34.05650917	-118.2815796	Los Angeles County
109457	Fee-for-Service	1982290532	1982290532	1	1	KATALYST MD	1/14/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	8929 UNIVERSITY CENTER L	STE 201	SAN DIEGO	CA	92122	1008	37	06073	32.87036657	-117.2263573	San Diego County
109501	Fee-for-Service	1811692908	1811692908	1	1	KAVIANY, MERSEDEH M LMFT	10/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1010 N CENTRAL AVE	SUITE 310	GLENDALE	CA	91202	2937	19	06037	34.16012317	-118.2571026	Los Angeles County
109510	Fee-for-Service	1154376481	1154376481	1	1	KRAFT, ADAM MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
109530	Fee-for-Service	1104886142	1104886142	1	1	KUMAR, PARMOD	6/30/1989	207R00000X	NA	Other	026	PHYSICIANS	46046	None	None	0	In state provider	None	858 N CHERRY ST	STE B	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
109583	Fee-for-Service	1144495201	1144495201	1	1	KAHEN, PEDRAM	6/14/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1201 W WASHINGTON BLVD	None	LOS ANGELES	CA	90066	5801	19	06037	34.03940497	-118.2830671	Los Angeles County
109668	Fee-for-Service	1780624130	1780624130	1	1	KAUR, GAGANDEEP MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90394	None	None	0	In state provider	None	1427 MAGNOLIA AVE	None	CHICO	CA	95926	3226	04	06007	39.74063543	-121.8499003	Butte County
109698	Fee-for-Service	1437444247	1437444247	1	1	KIM, GINA J MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130067	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD.	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
109715	Fee-for-Service	1811382898	1811382898	1	1	KIM, ASHLEY MD	6/25/2019	390200000X	NA	Other	026	PHYSICIANS	159564	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
109721	Fee-for-Service	1154304640	1154304640	1	1	KON, DARISSA S MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71165	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
109723	Fee-for-Service	1891764775	1891764775	1	1	KONG, LI S MD	1/7/2010	2086S0129X	NA	General Surgery	026	PHYSICIANS	99886	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
109742	Fee-for-Service	1033268941	1033268941	1	1	KIM, JAMES J MD	3/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49011	13	Neurology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
109763	Fee-for-Service	1033317565	1033317565	1	1	KIM, YONG SIK MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112454	41	Internal Medicine	0	In state provider	None	16671 YORBA LINDA BLVD	STE 100	YORBA LINDA	CA	92886	2025	30	06059	33.8884134	-117.8435449	Orange County
109766	Fee-for-Service	1942463260	1942463260	1	1	KRAVITZ, JENA A PHD	1/4/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
109786	Fee-for-Service	1144757030	1144757030	1	1	KARAPETIANS, ANTHONY MD	11/20/2019	390200000X	NA	Other	026	PHYSICIANS	164315	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
109788	Fee-for-Service	1417909086	1417909086	1	1	KEITH ATKINS	4/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	620 SKYLINE DR	None	JACKSON	TN	38301	3923	00	None	35.63721	-88.831359	Madison County
109819	Fee-for-Service	1679621536	1679621536	1	1	KUNCIK, THOMAS M MD	2/28/1985	207R00000X	NA	Other	026	PHYSICIANS	51318	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
109824	Fee-for-Service	1023449543	1023449543	1	1	KACZOR, KATHARIN H PT	1/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
109859	Fee-for-Service	1932283215	1932283215	1	1	KAMAL E SHAMASH MD INC	2/28/1984	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PRIMARY HEALTHCARE ASSOC	901 CAMPUS DR	STE 112	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
109865	Fee-for-Service	1013964956	1013964956	1	1	KELLEY, DENISE M	3/17/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	569 SEARLS AVE	None	NEVADA CITY	CA	95959	3003	29	06057	39.25239536	-121.023735	Nevada County
109888	Fee-for-Service	1669577169	1669577169	1	1	KRAUS, CHRISTINE D PHD	8/7/2020	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
109889	Fee-for-Service	1912495656	1912495656	1	1	KAY, ROBERT	10/4/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	164748	20	Orthopedic Surgery	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
109893	Fee-for-Service	1427239771	1427239771	1	1	KEMPTON AND KEMPTON PHYSICAL	5/22/2012	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	2	Out of state provider	THERAPY	8495 S POWER RD	STE 103	QUEEN CREEK	AZ	85142	6068	00	None	33.264774	-111.685599	Maricopa County
109912	Fee-for-Service	1043473507	1043473507	1	1	KISTLER, BRIAN J MD	1/22/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	170907	None	None	0	In state provider	None	862 MEINECKE AVE	STE 100	SAN LUIS OBISPO	CA	93405	3701	40	06079	35.29243951	-120.668652	San Luis Obispo County
109918	Fee-for-Service	1568848042	1568848042	1	1	KERMANI, REZA MD INC	10/19/2015	2086S0127X	NA	General Surgery	026	PHYSICIANS	111955	02	General Surgery	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
109933	Fee-for-Service	1821293382	1821293382	1	1	KUMAR, PRASHANTH V MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102091	41	Internal Medicine	0	In state provider	None	12675 HESPERIA RD	None	VICTORVILLE	CA	92395	5878	36	06071	34.48143043	-117.2906246	San Bernardino County
109955	Fee-for-Service	1013326701	1013326701	1	1	KHAN, SARAH N LCSW	4/30/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
109972	Fee-for-Service	1689163990	1689163990	1	1	KEMEI, JOASH K NP	11/29/2023	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2354 PACHECO DR	None	MERCED	CA	95340	5636	24	06047	37.32700371	-120.4397992	Merced County
109984	Fee-for-Service	1437444247	1437444247	1	1	KIM, GINA J MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130067	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD.	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
109989	Fee-for-Service	1316573322	1316573322	1	1	KRCAL, CRAIG	9/25/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
110009	Fee-for-Service	1942238209	1942238209	1	1	KNAPP, WENDI A MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63852	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
110010	Fee-for-Service	1891764775	1891764775	1	1	KONG, LI S MD	1/7/2010	2086S0129X	NA	General Surgery	026	PHYSICIANS	99886	02	General Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
110030	Fee-for-Service	1033268941	1033268941	1	1	KIM, JAMES J MD	3/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49011	79	Neurology-Child	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
110047	Fee-for-Service	1790956043	1790956043	1	1	KANEGAE, THOMAS H MD INC	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25710	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	STE 804	LOS ANGELES	CA	90017	4808	19	06037	34.05362775	-118.2661889	Los Angeles County
110051	Fee-for-Service	1386968824	1386968824	1	1	KATIME, EDWARD E MD	1/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119474	01	General Practice	0	In state provider	None	1020 29TH STREET	STE 580	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
110054	Fee-for-Service	1184723231	1184723231	1	1	KIM, BERNARD S MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108352	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 407	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
110060	Fee-for-Service	1831455302	1831455302	1	1	KUEI, JEFFREY J MD	7/14/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145790	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
110075	Fee-for-Service	1477059400	1477059400	1	1	KIM, THERESA J MD	6/30/2021	207P00000X	NA	Other	026	PHYSICIANS	165480	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
110143	Fee-for-Service	1881653285	1881653285	1	1	KUMAR, PRATIBHA MD	4/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	40351	08	Family Practice	0	In state provider	None	43839 N 15TH ST WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
110146	Fee-for-Service	1306257910	1306257910	1	1	KUMAR, DEEPAK MD	7/10/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	130068	-	NOT APPLICABLE	0	In state provider	None	130 PROSPECTOR CT	None	FOLSOM	CA	95630	5119	34	06067	38.682225	-121.194279	Sacramento County
110147	Fee-for-Service	1720009673	1720009673	1	1	KOCOT, ELZBIETA B MD	10/31/1989	207R00000X	NA	Other	026	PHYSICIANS	48334	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
110148	Fee-for-Service	1508061227	1508061227	1	1	KUMAR, ASEEM MD	7/10/2023	207L00000X	NA	Other	026	PHYSICIANS	143218	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
110182	Fee-for-Service	1902856917	1902856917	1	1	KHERAJ, NAUSHADALI MD	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38084	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	201 S ALVARADO ST	STE 811	LOS ANGELES	CA	90057	2391	19	06037	34.06417777	-118.2719543	Los Angeles County
110209	Fee-for-Service	1003442971	1003442971	1	1	KEMPTON, EDWARD A MD	6/6/2023	207P00000X	NA	Other	026	PHYSICIANS	184394	None	None	0	In state provider	None	1800 SPRING RIDGE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
110213	Fee-for-Service	1962727669	1962727669	1	1	KINNEY, AUSTIN C MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118757	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
110216	Fee-for-Service	1952394694	1952394694	1	1	KEWALRAMANI, ASHOK C DO	5/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
110221	Fee-for-Service	1821293382	1821293382	1	1	KUMAR, PRASHANTH V MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102091	45	Nephrology (Renal-Kidney)	0	In state provider	None	12675 HESPERIA RD	None	VICTORVILLE	CA	92395	5878	36	06071	34.48143043	-117.2906246	San Bernardino County
110241	Fee-for-Service	1396879359	1396879359	1	1	KRANTZ, CARL D LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
110282	Fee-for-Service	1376213983	1376213983	1	1	KUMAR, ROHIT P PT	10/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1845 BUSINESS CENTER DR	SUITE 127	SAN BERNARDINO	CA	92408	3434	36	06071	34.06865027	-117.2832038	San Bernardino County
110304	Fee-for-Service	1700145661	1700145661	1	1	KOUL, ABHINAV MD	10/28/2019	207R00000X	NA	Other	026	PHYSICIANS	147676	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
110331	Fee-for-Service	1780154237	1780154237	1	1	KEINAN, AYELET PT	7/3/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
110343	Fee-for-Service	1518399013	1518399013	1	1	KHANAL, NABIN MD	1/8/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	192363	None	None	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
110344	Fee-for-Service	1184723231	1184723231	1	1	KIM, BERNARD S MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108352	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 407	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
110385	Fee-for-Service	1881972636	1881972636	1	1	KANSKA, KATARZYNA PSYD	5/23/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
110467	Fee-for-Service	1407460017	1407460017	1	1	KOMMU, SNEHA CCC-SLP	2/7/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B2	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
110485	Fee-for-Service	1689880593	1689880593	1	1	KANG, SOO WOONG MD INC	10/1/2002	207R00000X	NA	Other	026	PHYSICIANS	66630	41	Internal Medicine	0	In state provider	None	11832 ROSECRANS AVE	STE 127	NORWALK	CA	90650	4107	19	06037	33.90211977	-118.0813129	Los Angeles County
110552	Fee-for-Service	1336203496	1336203496	1	1	KELLY, THOMAS F MD	5/31/1989	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60630	01	General Practice	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
110553	Fee-for-Service	1952331530	1952331530	1	2	KELLOGG, JASON P MD	9/19/2019	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	66130	-	NOT APPLICABLE	0	In state provider	None	170 WILKERSON AVE	A&B	PERRIS	CA	92570	2220	33	06065	33.78602543	-117.220127	Riverside County
110570	Fee-for-Service	1396036976	1396036976	1	1	KAY, BRIAN DO	1/23/2018	207ZP0102X	NA	Other	026	PHYSICIANS	12868	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
110640	Fee-for-Service	1396893723	1396893723	1	1	KPADUWA, JULIUS C MD AMC	12/1/2001	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	11017 VALLEY MALL	None	EL MONTE	CA	91731	2617	19	06037	34.07470785	-118.0346252	Los Angeles County
110693	Fee-for-Service	1811915424	1811915424	1	1	KURACINA, DEBRA MD	1/1/1982	261QU0200X	NA	Other	026	PHYSICIANS	39902	66	Emergency Medicine (Urgent Care)	0	In state provider	None	625 PINE KNOT AVE	None	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24129855	-116.911417	San Bernardino County
110695	Fee-for-Service	1619923125	1619923125	1	1	KAJI, AMY H MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72045	66	Emergency Medicine (Urgent Care)	0	In state provider	None	21840 NORMANDIE AVE	# 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
110736	Fee-for-Service	1629334362	1629334362	1	1	KAISER FOUNDATION HEALTH	6/22/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	3430 E LA PALMA AVE	BLDG 2 FL 1	ANAHEIM	CA	92806	2020	30	06059	33.852105	-117.8444835	Orange County
110749	Fee-for-Service	1184022519	1184022519	1	1	KASHANI, SAMAN MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133253	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
110750	Fee-for-Service	1255349023	1255349023	1	1	KIANG, MICHELLE MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53558	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
110754	Fee-for-Service	1659704963	1659704963	1	1	KHAYZNIKOV, MAKSIM Y MD	7/28/2020	207R00000X	NA	Other	026	PHYSICIANS	145405	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
110755	Fee-for-Service	1720037633	1720037633	1	1	KURZ, BENEDIKT W MD	6/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81945	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
110758	Fee-for-Service	1225189418	1225189418	1	1	KOWNACKI, JOHN J MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	84672	18	Ophthalmology	0	In state provider	None	800 S FAIRMOUNT AVE	STE 312	PASADENA	CA	91105	3153	19	06037	34.13193177	-118.1517805	Los Angeles County
110808	Fee-for-Service	1982642450	1982642450	1	1	KRALIK, MICHAEL R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1331 N 7TH ST	STE 375	PHOENIX	AZ	85006	2707	00	None	33.463404	-112.0643505	Maricopa County
110812	Fee-for-Service	1487682308	1487682308	1	1	KIRKLAND, JAMES L MD	2/3/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
110821	Fee-for-Service	1295047058	1295047058	1	1	KIM, MI LA NP	11/20/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
110832	Fee-for-Service	1336103324	1336103324	1	1	KUCKER, JOSHUA S MD	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98059	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
110842	Fee-for-Service	1508913823	1508913823	1	1	KAISER FOUND HEALTH PLAN	9/16/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY-B	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
110857	Fee-for-Service	1396036976	1396036976	1	1	KAY, BRIAN DO	1/23/2018	207ZP0102X	NA	Other	026	PHYSICIANS	12868	22	Pathology (M.D. only)	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
110891	Fee-for-Service	1902685449	1902685449	1	1	KELLEY, NICHOLAS C PT	10/19/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23100 EUCALYPTUS AVE	SUITE C	MORENO VALLEY	CA	92553	5439	33	06065	33.93157977	-117.2598359	Riverside County
110925	Fee-for-Service	1801678735	1801678735	1	1	KYRIAZIS, ATHANASIA D CCC-SL	12/7/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
110942	Fee-for-Service	1942339395	1942339395	1	1	KAUFMAN, AARON H MD	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86551	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
110980	Fee-for-Service	1811915424	1811915424	1	1	KURACINA, DEBRA MD	1/1/1982	261QU0200X	NA	Other	026	PHYSICIANS	39902	01	General Practice	0	In state provider	None	625 PINE KNOT AVE	None	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24129855	-116.911417	San Bernardino County
110983	Fee-for-Service	1508965666	1508965666	1	1	KEYVANI, MADJID MD	9/30/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	104690	13	Neurology (M.D. only)	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
110987	Fee-for-Service	1518327535	1518327535	1	1	KALINJIAN, RAFFI M DO	1/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15544	01	General Practice	0	In state provider	None	13193 CENTRAL AVE	STE 100	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
111030	Fee-for-Service	1669638094	1669638094	1	1	KAUR, GURVINDER MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114294	41	Internal Medicine	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
111040	Fee-for-Service	1386320653	1386320653	1	1	KUNG, ALISON PT	6/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12424 WILSHIRE BLVD	101	LOS ANGELES	CA	90025	0000	19	06037	34.04150435	-118.4706154	Los Angeles County
111048	Fee-for-Service	1790202992	1790202992	1	1	KOVACS, BARTHOLOMEW J LMFT	2/2/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	123896	-	NOT APPLICABLE	0	In state provider	None	73RD N SECOND AVE	STE B	CHULA VISTA	CA	91910	1124	37	06073	32.65546795	-117.0821968	San Diego County
111055	Fee-for-Service	1669660684	1669660684	1	1	KIM, JOHN J MD	1/23/2008	207R00000X	NA	Other	026	PHYSICIANS	98654	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111075	Fee-for-Service	1164711461	1164711461	1	1	KADISH, JEREMY M DO	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14003	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
111076	Fee-for-Service	1912393489	1912393489	1	1	KAUFMAN, BRUCE E DO	8/4/2020	208M00000X	NA	Other	026	PHYSICIANS	18205	70	Clinic (mixed specialty)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
111093	Fee-for-Service	1538236484	1538236484	1	1	KOCH, ANNE M MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82487	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111114	Fee-for-Service	1942296520	1942296520	1	1	KUKOYI, OLADIPO A MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100559	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
111135	Fee-for-Service	1295707784	1295707784	1	1	KENNEDY, ROBERT G MD	6/21/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161212	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111151	Fee-for-Service	1558526525	1558526525	1	1	KHITRI, MONICA R MD	12/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101722	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
111269	Fee-for-Service	1205323219	1205323219	1	1	KHANJYAN, MICHAEL MD	8/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164122	30	Radiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
111274	Fee-for-Service	1487615886	1487615886	1	1	KING, ANDREW J	6/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86102	45	Nephrology (Renal-Kidney)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
111277	Fee-for-Service	1417377730	1417377730	1	1	KIL, DANIEL H MD	3/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150802	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
111291	Fee-for-Service	1124638465	1124638465	1	1	KAWWA, EYAD J PT	10/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
111303	Fee-for-Service	1487150421	1487150421	1	1	KYLE, ANDREW R MD	11/19/2021	207R00000X	NA	Other	026	PHYSICIANS	164093	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
111324	Fee-for-Service	1326494097	1326494097	1	1	KANTER, MARYN MD MPH	10/27/2023	207L00000X	NA	Other	026	PHYSICIANS	188562	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
111332	Fee-for-Service	1245338623	1245338623	1	1	KERNSTINE, KEMP H MD	3/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87155	02	General Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
111362	Fee-for-Service	1730279423	1730279423	1	1	KARUK TRIBE	9/1/2002	207Q00000X	NA	Adult Primary Care	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	1519 S OREGON ST	None	YREKA	CA	96097	3425	47	06093	41.71676111	-122.6424895	Siskiyou County
111384	Fee-for-Service	1265941686	1265941686	1	1	KODAD, DEVONEY LCSW	2/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
111396	Fee-for-Service	1720159635	1720159635	1	1	KELLY, MATTHEW P MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90569	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111420	Fee-for-Service	1790422442	1790422442	1	1	KAICHIAN, ALBERTA	4/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
111431	Fee-for-Service	1790875276	1790875276	1	1	KIWAN, ELIAS N MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54469	None	None	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
111473	Fee-for-Service	1386910321	1386910321	1	1	KEVIN M JENKINS DO AMC	8/16/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	944 W FOOTHILL BLVD	B	UPLAND	CA	91786	3757	36	06071	34.10675864	-117.6642959	San Bernardino County
111480	Fee-for-Service	1063087674	1063087674	1	1	KADENCE HEALTHCARE, INC	6/24/2021	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4740 NORTHGATE BL	120	SACRAMENTO	CA	95834	1151	34	06067	38.654262	-121.4770455	Sacramento County
111482	Fee-for-Service	1134234818	1134234818	1	1	KIM, STEVEN S MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
111563	Fee-for-Service	1265428254	1265428254	1	1	KIMBALL, BRIAN MD	6/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	STE 115	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
111564	Fee-for-Service	1720785074	1720785074	1	1	KONO, BRENNAN M PT	10/17/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8700 WARNER	SUITE 140	FOUNTAIN VALLEY	CA	92708	3207	30	06059	33.71568247	-117.977193	Orange County
111575	Fee-for-Service	1033693205	1033693205	1	1	KURTENBACH, ANN M PT	2/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
111588	Fee-for-Service	1134803380	1134803380	1	1	KERICH, CAROLINE CHERONO	7/12/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12316 CHILDRESS ST	None	BAKERSFIELD	CA	93312	5445	15	06029	35.41099131	-119.139194	Kern County
111592	Fee-for-Service	1447338199	1447338199	1	1	KAUR, GURINDER O MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72754	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
111610	Fee-for-Service	1578525499	1578525499	1	1	KUNAM, SYAM P MD	3/31/1989	2084P0800X	NA	Psychiatry	026	PHYSICIANS	46695	36	Psychiatry	0	In state provider	None	245 S HIGHLAND SPRINGS A	None	BANNING	CA	92220	5202	33	06065	33.92852086	-116.9468346	Riverside County
111618	Fee-for-Service	1962514091	1962514091	1	1	KELLER, SUSAN L CRNA	11/8/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
111647	Fee-for-Service	1730279423	1730279423	1	1	KARUK TRIBE	5/1/2006	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1519 S OREGON ST	None	YREKA	CA	96097	3425	47	06093	41.71676111	-122.6424895	Siskiyou County
111653	Fee-for-Service	1033264262	1033264262	1	1	KAPLAN, HARVEY S MD	2/28/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	13448	40	Pediatrics	0	In state provider	SAN MATEO CO GEN HSP	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
111657	Fee-for-Service	1467492538	1467492538	1	1	KAYSER, ANDREW S MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92572	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111673	Fee-for-Service	1225059520	1225059520	1	1	KATZNELSON, STEVEN MD	6/30/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	66893	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
111693	Fee-for-Service	1154533990	1154533990	1	1	KITTUR, JAYA A MD	10/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112971	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
111743	Fee-for-Service	1578868626	1578868626	1	1	KLESCZEWSKI, MICHELLE M NP	10/19/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
111766	Fee-for-Service	1134234818	1134234818	1	1	KIM, STEVEN S MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67555	08	Family Practice	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
111774	Fee-for-Service	1922373455	1922373455	1	1	KARIMIAN, ALI R MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120547	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
111787	Fee-for-Service	1770743312	1770743312	1	1	KECK, SARA A MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104085	41	Internal Medicine	0	In state provider	None	101 ROWLAND WAY	STE 320	NOVATO	CA	94949	6119	21	06041	38.09755172	-122.5591766	Marin County
111790	Fee-for-Service	1003898537	1003898537	1	1	KANG, DANNY OT	11/10/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9828 GARDEN GROVE BLVD	STE 110	GARDEN GROVE	CA	92844	1655	30	06059	33.77397547	-117.960813	Orange County
111799	Fee-for-Service	1639240526	1639240526	1	1	KAO, CHIU FA MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71213	83	Rheumatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111843	Fee-for-Service	1497948350	1497948350	1	1	KING, JONATHAN C MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112833	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
111847	Fee-for-Service	1316995830	1316995830	1	1	KESSLER, MICHAEL MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	34771	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
111877	Fee-for-Service	1134803380	1134803380	1	1	KERICH, CAROLINE CHERONO	7/12/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12316 CHILDRESS ST	None	BAKERSFIELD	CA	93312	5445	15	06029	35.41099131	-119.139194	Kern County
111893	Fee-for-Service	1417905209	1417905209	1	1	KRIPKE, CLARISSA C MD	4/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64158	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	# 805	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111928	Fee-for-Service	1427715341	1427715341	1	1	KENTFIELD ESTATES RANCH RCFE	1/12/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3800 SILVER SPUR WAY	None	SACRAMENTO	CA	95841	4411	34	06067	38.645361	-121.3760025	Sacramento County
111938	Fee-for-Service	1730279423	1730279423	1	1	KARUK TRIBE	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1519 S OREGON ST	None	YREKA	CA	96097	3425	47	06093	41.71676111	-122.6424895	Siskiyou County
112072	Fee-for-Service	1144397159	1144397159	1	1	KRISHNAN, DEVAPRAKASH	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45476	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
112074	Fee-for-Service	1770743312	1770743312	1	1	KECK, SARA A MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104085	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 ROWLAND WAY	STE 320	NOVATO	CA	94949	6119	21	06041	38.09755172	-122.5591766	Marin County
112097	Fee-for-Service	1558324947	1558324947	1	1	KILEY, ANTUAN MD	9/16/2005	174400000X	NA	Other	026	PHYSICIANS	74952	41	Internal Medicine	0	In state provider	W TEMPLE MEDICAL CLINIC	2815 W SUNSET BLVD	STE 108	LOS ANGELES	CA	90026	2168	19	06037	34.08207311	-118.2720834	Los Angeles County
112109	Fee-for-Service	1144380569	1144380569	1	1	KURUVILLA, PRAMITA E MD	10/15/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94117	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
112112	Fee-for-Service	1922649227	1922649227	1	1	KHANG DO ANESTHESIA INC.	10/22/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
112152	Fee-for-Service	1992105530	1992105530	1	1	KEANE, ELIZABETH LCSW	9/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
112177	Fee-for-Service	1194772046	1194772046	1	1	KIMBERLY WITKOP, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9575 ETHAN WADE WAY SE	None	SNOQUALMIE	WA	98065	9577	00	None	47.51467305	-121.8256635	King County
112185	Fee-for-Service	1760473797	1760473797	1	1	KATZMAN, BARRY MD INC	8/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	34834	18	Ophthalmology	0	In state provider	None	6244 EL CAJON BLVD	STE 22	SAN DIEGO	CA	92115	3918	37	06073	32.76342577	-117.0636924	San Diego County
112223	Fee-for-Service	1154766822	1154766822	1	1	KATOR MULK, TAIBA DO	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13856	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
112225	Fee-for-Service	1730279423	1730279423	1	1	KARUK TRIBE	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1519 S OREGON ST	None	YREKA	CA	96097	3425	47	06093	41.71676111	-122.6424895	Siskiyou County
112231	Fee-for-Service	1396785531	1396785531	1	1	KIM, EDWARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	1309	00	None	43.61455048	-116.256231	Ada County
112307	Fee-for-Service	1407831530	1407831530	1	1	KELLY, BERNADETTE A MD	3/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55070	08	Family Practice	0	In state provider	None	800 DELBON AVE	None	TURLOCK	CA	95382	2005	50	06099	37.51047152	-120.839499	Stanislaus County
112349	Fee-for-Service	1629026174	1629026174	1	1	KASHANI-SABET, MOHAMMED	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	75803	07	Dermatology	0	In state provider	None	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
112350	Fee-for-Service	1730142993	1730142993	1	1	KUMAR, VINOD MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	49366	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	525 34TH ST	None	BAKERSFIELD	CA	93301	2206	15	06029	35.39046247	-119.0083995	Kern County
112359	Fee-for-Service	1144397159	1144397159	1	1	KRISHNAN, DEVAPRAKASH	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45476	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
112379	Fee-for-Service	1699705624	1699705624	1	1	KAYA, KATHLEEN M MD	12/31/1985	207L00000X	NA	Other	026	PHYSICIANS	48705	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
112380	Fee-for-Service	1710082789	1710082789	1	1	KAUFER, DAVID I MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	80107	41	Internal Medicine	0	In state provider	None	2934 INGELOW STREET	None	SAN DIEGO	CA	92106	2311	37	06073	32.72652029	-117.2268796	San Diego County
112405	Fee-for-Service	1861727950	1861727950	1	1	KOSS, CATHERINE A S MD	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115493	41	Internal Medicine	0	In state provider	None	995 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75729541	-122.4066641	San Francisco County
112414	Fee-for-Service	1003070012	1003070012	1	1	KANTAMUNENI, UMA D MD	4/26/2010	207R00000X	NA	Other	026	PHYSICIANS	103695	41	Internal Medicine	0	In state provider	None	2333 MOWRY AVE	STE 300	FREMONT	CA	94538	1602	01	06001	37.55614438	-121.9822469	Alameda County
112417	Fee-for-Service	1992996326	1992996326	1	1	KHANNA, GAURAV MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112859	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
112437	Fee-for-Service	1952366460	1952366460	1	1	KING SOLOMON MGMT HEALTHCARE	11/3/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1400 W GLENOAKS BLVD	None	GLENDALE	CA	91201	1911	19	06037	34.16722426	-118.28454	Los Angeles County
112438	Fee-for-Service	1205375052	1205375052	1	1	KUTHAN, JEFFRY CRNA	2/11/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
112449	Fee-for-Service	1073743621	1073743621	1	1	KIM, MARK SUNG-KYOUNG MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120844	41	Internal Medicine	0	In state provider	None	11539 HAWTHORNE BLVD	6TH FLOOR	HAWTHORNE	CA	90250	2381	19	06037	33.929352	-118.352747	Los Angeles County
112469	Fee-for-Service	1083760698	1083760698	1	1	KELLEY MOULDS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 EXEMPLA CIR	None	LAFAYETTE	CO	80026	3370	00	None	39.97232464	-105.086171	Boulder County
112473	Fee-for-Service	1255439345	1255439345	1	1	KNOX, STEPHEN MARTIN MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	45 CASTRO ST	STE 325	SAN FRANCISCO	CA	94114	1028	38	06075	37.76829732	-122.4357056	San Francisco County
112495	Fee-for-Service	1972109551	1972109551	1	1	KENNETH GRIER MD INC	3/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	18564 US HIGHWAY 18	STE 101-102	APPLE VALLEY	CA	92307	2312	36	06071	34.53926652	-117.2592564	San Bernardino County
112534	Fee-for-Service	1194953190	1194953190	1	1	KIANI, ABRAHAM MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99386	05	Anesthesiology	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
112537	Fee-for-Service	1326039678	1326039678	1	1	KHAN, FAUZIA MD	11/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	50190	41	Internal Medicine	0	In state provider	None	135 LAS TUNAS DR	None	ARCADIA	CA	91007	8513	19	06037	34.10777602	-118.0358402	Los Angeles County
112545	Fee-for-Service	1124191085	1124191085	1	1	KLINE, RICHARD A MD	7/31/1992	208600000X	NA	General Surgery	026	PHYSICIANS	69004	89	Surgery-Traumatic	0	In state provider	None	725 E SANTA CLARA ST	STE 303	SAN JOSE	CA	95112	1938	43	06085	37.34328626	-121.8756374	Santa Clara County
112553	Fee-for-Service	1730168931	1730168931	1	3	KINGS EYE CTR MED GP INC	12/28/2015	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1395 W LACEY BLVD	None	HANFORD	CA	93230	5904	16	06031	36.32798439	-119.6660001	Kings County
112576	Fee-for-Service	1942536727	1942536727	1	1	KORNBLITH, LUCY Z MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114019	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
112579	Fee-for-Service	1730752395	1730752395	1	1	KENDRICK-OGUNLANA, RITA A PS	3/7/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	YD	15434 W SAGE ST	None	VICTORVILLE	CA	92395	3965	36	06071	34.51210263	-117.3272335	San Bernardino County
112586	Fee-for-Service	1326237801	1326237801	1	1	KOSHY, ANITA A MD	8/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75254	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
112588	Fee-for-Service	1346415072	1346415072	1	1	KIM, KYUNGROK MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	77040	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
112612	Fee-for-Service	1629180310	1629180310	1	1	KHETRAPAL, RABIN MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56137	41	Internal Medicine	0	In state provider	None	734 MOWRY AVE	None	FREMONT	CA	94536	4115	01	06001	37.56635225	-121.9749284	Alameda County
112624	Fee-for-Service	1043578024	1043578024	1	1	KLICK, COLE P MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141307	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
112636	Fee-for-Service	1578539409	1578539409	1	1	KIM, MARTHA B MD	4/6/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62897	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	153 PIONEER LANE	STE B	BISHOP	CA	93514	2517	14	06027	37.3624356	-118.4073711	Inyo County
112677	Fee-for-Service	1730512021	1730512021	1	1	KOCHAR, PUNEET S MD	4/25/2023	2085N0700X	NA	MRI Provider	026	PHYSICIANS	181446	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
112693	Fee-for-Service	1861727950	1861727950	1	1	KOSS, CATHERINE A S MD	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115493	77	Infectious Disease	0	In state provider	None	995 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75729541	-122.4066641	San Francisco County
112704	Fee-for-Service	1285674267	1285674267	1	1	KENDELL, SCOTT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 HILAND AVE	None	BURLEY	ID	83318	2682	00	None	42.53489313	-113.7833899	Cassia County
112720	Fee-for-Service	1912049917	1912049917	1	1	KARAKALIDI, KETINO CA	12/1/1999	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	KETINO KARAKALIDI ACUPUN	5250 SANTA MONICA BLVD	STE 312	LOS ANGELES	CA	90029	1255	19	06037	34.09077051	-118.3046976	Los Angeles County
112725	Fee-for-Service	1528354024	1528354024	1	1	KORITALA, THOYAJA MD	5/23/2023	208M00000X	NA	Other	026	PHYSICIANS	172457	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
112736	Fee-for-Service	1760778971	1760778971	1	2	KELLOGG, EVA R LMFT	6/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
112775	Fee-for-Service	1205360591	1205360591	1	1	KANGWA, MUKUKA MD	10/19/2021	2080P0204X	NA	Other	026	PHYSICIANS	169546	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
112830	Fee-for-Service	1124191085	1124191085	1	1	KLINE, RICHARD A MD	7/31/1992	208600000X	NA	General Surgery	026	PHYSICIANS	69004	02	General Surgery	0	In state provider	None	725 E SANTA CLARA ST	STE 303	SAN JOSE	CA	95112	1938	43	06085	37.34328626	-121.8756374	Santa Clara County
112840	Fee-for-Service	1659632362	1659632362	1	1	KANTHARIA, TINA H MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126911	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
112841	Fee-for-Service	1699807065	1699807065	1	1	KILLEEN, KELLY L MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92060	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
112890	Fee-for-Service	1629205190	1629205190	1	1	KIM, PAUL J MD	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93398	78	Neoplastic Diseases/Oncology	0	In state provider	None	2895 EDINGER AVE	None	TUSTIN	CA	92780	7257	30	06059	33.70859781	-117.8080464	Orange County
112939	Fee-for-Service	1780724435	1780724435	1	1	KIM, MARY MD	3/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119219	25	Physical Medicine and Rehabilitation	0	In state provider	None	11406 LOMA LINDA DRIVE	SUITE 300	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
112965	Fee-for-Service	1164515755	1164515755	1	1	KAPLAN, JOEL A MD	12/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87234	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
112998	Fee-for-Service	1386660629	1386660629	1	1	KIDO,DANIEL K MD	8/24/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	12502	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
113091	Fee-for-Service	1952328452	1952328452	1	1	KREGENOW, ROBERT MD	5/2/2024	2080P0204X	NA	Other	026	PHYSICIANS	74616	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
113095	Fee-for-Service	1639578487	1639578487	1	1	KIM, MONA G NP	5/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
113101	Fee-for-Service	1730140278	1730140278	1	1	KLINE, LAWRENCE E DO	1/1/1982	207RC0200X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
113119	Fee-for-Service	1003090267	1003090267	1	1	KIRMAN, CHRISTIAN N MD	12/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115197	24	Plastic Surgery	0	In state provider	None	106 LA CASA VIA	SUITE 200	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
113125	Fee-for-Service	1134206071	1134206071	1	1	KAMIMURA, MARI MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50512	None	None	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
113153	Fee-for-Service	1447664248	1447664248	1	1	KWOK, KAMMY PHD	9/10/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
113155	Fee-for-Service	1942564398	1942564398	1	1	KUBBARA, AAHD F MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
113168	Fee-for-Service	1346311255	1346311255	1	1	KESCHNER, DAVID B MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60653	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
113215	Fee-for-Service	1780727875	1780727875	1	1	KANG, ANNE C OD	5/30/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1615 E PLAZA BLVD	STE 101	NATIONAL CITY	CA	91950	3771	37	06073	32.67670551	-117.0885584	San Diego County
113228	Fee-for-Service	1508946716	1508946716	1	1	KORNHAUSER, ELLIOTT MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	35261	01	General Practice	0	In state provider	None	2629 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78784949	-117.8254935	Orange County
113250	Fee-for-Service	1821678616	1821678616	1	1	KANKOTIA, SHYAM MD	9/3/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
113262	Fee-for-Service	1548356942	1548356942	1	1	KOPF, CHRISTIANA S MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65520	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1201 ALHAMBRA BLVD	STE 320	SACRAMENTO	CA	95816	5242	34	06067	38.570076	-121.4657145	Sacramento County
113311	Fee-for-Service	1992807143	1992807143	1	1	KOHUT, JOHN J MD	2/21/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	17739	None	None	0	In state provider	None	1800 MEDICAL CENTER DR	STE 300	SAN BERNARDINO	CA	92411	1241	36	06071	34.131816	-117.322587	San Bernardino County
113314	Fee-for-Service	1558527010	1558527010	1	1	KAPADIA, DHAVAL M MD	4/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119616	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
113347	Fee-for-Service	1265821854	1265821854	2	1	KELLY, SARAH CNM	4/17/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1418 EAST MAIN ST	STE 210	SANTA MARIA	CA	93454	4833	42	06083	34.95286855	-120.4137315	Santa Barbara County
113367	Fee-for-Service	1699737932	1699737932	1	1	KATZ, ALBERT R MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51433	40	Pediatrics	0	In state provider	None	18411 CLARK ST	STE 201	TARZANA	CA	91356	3532	19	06037	34.16981538	-118.5337442	Los Angeles County
113408	Fee-for-Service	1104203249	1104203249	1	1	KUPFER, JEFFRY K CRNA	11/1/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
113410	Fee-for-Service	1316130842	1316130842	1	1	KENNEDY, SARAH P MD	1/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93541	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
113422	Fee-for-Service	1215228846	1215228846	1	1	KIM, JANE Y MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14277	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
113438	Fee-for-Service	1356393573	1356393573	1	1	KONG, VICTOR H MD	4/2/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68276	08	Family Practice	0	In state provider	None	605 W 6TH ST	None	SAN PEDRO	CA	90731	2523	19	06037	33.73875028	-118.2904334	Los Angeles County
113441	Fee-for-Service	1902493364	1902493364	1	1	KHAN KK, MUHAMMAD PT	1/8/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
113455	Fee-for-Service	1346311255	1346311255	1	1	KESCHNER, DAVID B MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60653	84	Surgery-Head and Neck	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
113463	Fee-for-Service	1477134054	1477134054	1	1	KINGHORN, CHRISTOPHER	8/16/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
113538	Fee-for-Service	1093264368	1093264368	1	1	KERN MEDICAL SURGERY CENTER	4/2/2019	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	9300 STOCKDALE HWY	SUITE 200	BAKERSFIELD	CA	93311	3611	15	06029	35.3545315	-119.1053925	Kern County
113543	Fee-for-Service	1932249885	1932249885	1	1	KHAN, FARRUKH S MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	42644	13	Neurology (M.D. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
113553	Fee-for-Service	1528229507	1528229507	1	1	KENNEDY VANESSA A MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116919	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	SUITE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
113555	Fee-for-Service	1386726032	1386726032	1	1	KARUK TRIBE	2/17/1998	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	325 ASIP ROAD	None	ORLEANS	CA	95556	0249	12	06023	41.30078777	-123.5477461	Humboldt County
113570	Fee-for-Service	1013099043	1013099043	1	1	KALIN, WHITNEY L MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118688	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
113599	Fee-for-Service	1750744520	1750744520	1	1	KIM, JIN S LMFT	1/28/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD.	STE 450	LOS ANGELES	CA	90010	3501	19	06037	34.06177566	-118.320844	Los Angeles County
113608	Fee-for-Service	1740418441	1740418441	1	1	KHALEDY, MAHMOOD MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108715	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
113627	Fee-for-Service	1427167634	1427167634	1	1	KRATZER, JAMES H MD	11/27/1985	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33867	08	Family Practice	0	In state provider	None	3428 E HUNTINGTON BLVD	None	FRESNO	CA	93702	3222	10	06019	36.73925467	-119.7668019	Fresno County
113723	Fee-for-Service	1356393573	1356393573	1	1	KONG, VICTOR H MD	4/2/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68276	40	Pediatrics	0	In state provider	None	605 W 6TH ST	None	SAN PEDRO	CA	90731	2523	19	06037	33.73875028	-118.2904334	Los Angeles County
113727	Fee-for-Service	1245325059	1245325059	1	1	KLAMATH CTY FIRE DIST#1	2/1/1999	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	None	143 N BROAD ST	None	KLAMATH FALLS	OR	97601	5958	00	None	42.2291013	-121.7756846	Klamath County
113734	Fee-for-Service	1841367851	1841367851	1	1	KUROHARA, MARGARET L MD	9/30/1990	207RA0201X	NA	Other	026	PHYSICIANS	43503	03	Allergy	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
113744	Fee-for-Service	1477785681	1477785681	1	1	KRONER, CHRISTOPHER A MD	4/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113859	08	Family Practice	0	In state provider	None	1499 W 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
113763	Fee-for-Service	1053605162	1053605162	1	1	KINCEY, JORDANA M MD	11/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115529	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
113837	Fee-for-Service	1740946623	1740946623	1	1	KAUR, HARJINDER LCSW	10/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
113843	Fee-for-Service	1386726032	1386726032	1	1	KARUK TRIBE	9/1/2002	207Q00000X	NA	Adult Primary Care	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	325 ASIP ROAD	None	ORLEANS	CA	95556	0249	12	06023	41.30078777	-123.5477461	Humboldt County
113865	Fee-for-Service	1992076715	1992076715	1	1	KAILEH, LYTH H MD	8/23/2019	207R00000X	NA	Other	026	PHYSICIANS	115330	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
113916	Fee-for-Service	1427167634	1427167634	1	1	KRATZER, JAMES H MD	11/27/1985	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33867	40	Pediatrics	0	In state provider	None	3428 E HUNTINGTON BLVD	None	FRESNO	CA	93702	3222	10	06019	36.73925467	-119.7668019	Fresno County
113919	Fee-for-Service	1225052749	1225052749	1	1	KEARL, GREGORY S MD INC	12/10/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79227	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
113920	Fee-for-Service	1093178659	1093178659	1	1	KOKOY MONDRAGON, CHANTHEL M	6/16/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	161672	None	None	0	In state provider	MD	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
113942	Fee-for-Service	1497839468	1497839468	1	1	KLEKMAN, RICHARD M MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58494	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
113959	Fee-for-Service	1063589182	1063589182	1	1	KOLAKOSKI, RYAN E PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1195 VALENCIA ST	None	SAN FRANCISCO	CA	94110	3026	38	06075	37.75384242	-122.4207982	San Francisco County
113967	Fee-for-Service	1114996956	1114996956	1	1	KARLA PARKES	3/13/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	909 2ND ST	None	LANGDON	ND	58249	2407	00	None	48.761928	-98.36666453	Cavalier County
113988	Fee-for-Service	1679560973	1679560973	1	1	KODAMA, CURTIS K DO	1/25/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	6143	08	Family Practice	0	In state provider	MOORPARK COMPREHENSIVE	6559 PRINCETON AVE	None	MOORPARK	CA	93021	1437	56	06111	34.28554666	-118.8746646	Ventura County
114004	Fee-for-Service	1306257910	1306257910	1	2	KUMAR, DEEPAK MD	7/19/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	130068	36	Psychiatry	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
114013	Fee-for-Service	1497833214	1497833214	1	1	KOPPEROINEN,AIRI H MD	8/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76126	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
114040	Fee-for-Service	1669669099	1669669099	1	1	KIM, TAE-WU E MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96772	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
114050	Fee-for-Service	1427687706	1427687706	1	1	KRAMER, ERIK MD	2/16/2024	207P00000X	NA	Other	026	PHYSICIANS	190174	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
114089	Fee-for-Service	1285070565	1285070565	1	1	KWON, ESTHER DPM	9/28/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3A36	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
114093	Fee-for-Service	1093796294	1093796294	1	1	KOSE, ROBERT E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1661 HOLLAND RD	STE 200	MAUMEE	OH	43537	4207	00	None	41.58935532	-83.6771859	Lucas County
114106	Fee-for-Service	1891731899	1891731899	1	1	KOTE, SUMANGALA K MD	7/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45756	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
114118	Fee-for-Service	1619330677	1619330677	1	1	KETCH, COURTNEY	2/13/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168350	15	Obstetrics (D.O. only)	0	In state provider	None	765 MEDICAL CENTER CT	SUITE 203	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
114133	Fee-for-Service	1386726032	1386726032	1	1	KARUK TRIBE	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	325 ASIP ROAD	None	ORLEANS	CA	95556	0249	12	06023	41.30078777	-123.5477461	Humboldt County
114136	Fee-for-Service	1790199958	1790199958	1	1	KHAN, RIDWAN A MD	2/27/2020	207R00000X	NA	Other	026	PHYSICIANS	142045	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
114154	Fee-for-Service	1922162460	1922162460	1	1	KISER, TERRI A	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
114199	Fee-for-Service	1528079795	1528079795	1	1	KIRKLAND, THEO MD	1/1/1982	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	39331	77	Infectious Disease	0	In state provider	None	225 DICKINSON ST	# H207	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
114204	Fee-for-Service	1922197227	1922197227	1	1	KUM, HEASOOK NP	4/25/2023	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8635 FIRESTONE BLVD	STE 100	DOWNEY	CA	90241	5242	19	06037	33.93691837	-118.1265474	Los Angeles County
114242	Fee-for-Service	1134185606	1134185606	1	1	KIM, EDWARD MD	1/1/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40557	01	General Practice	0	In state provider	#29	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
114245	Fee-for-Service	1467956433	1467956433	1	1	KELLER, JOHN H MD	6/29/2022	207P00000X	NA	Other	026	PHYSICIANS	164091	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
114252	Fee-for-Service	1881709889	1881709889	1	1	KELLY, NOLAND D. MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5169 COTTONWOOD ST	STE 410	MURRAY	UT	84107	6769	00	None	40.658895	-111.891447	Salt Lake County
114258	Fee-for-Service	1932357340	1932357340	1	1	KIM, HYESUN MD INC	11/3/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	100945	40	Pediatrics	0	In state provider	None	62 CORPORATE PARK	STE 125	IRVINE	CA	92606	3132	30	06059	33.69197468	-117.8247858	Orange County
114266	Fee-for-Service	1063555035	1063555035	1	1	KESLER, LORI S	7/15/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 REDWOOD WAY	STE 165	PETALUMA	CA	94954	1136	49	06097	38.27488269	-122.6665863	Sonoma County
114276	Fee-for-Service	1548415979	1548415979	1	1	KONSTANTIN, JOHN K MD	1/23/2014	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	102896	None	None	0	In state provider	None	2584 MACARUTHER BLVD	None	OAKLAND	CA	94602	2928	01	06001	37.79916578	-122.2113278	Alameda County
114282	Fee-for-Service	1487393971	1487393971	1	1	KELLY COLE LICENSED CLINICAL	8/9/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SOCIAL WORKER INC	655 F ST STE A	None	ARCATA	CA	95521	6366	12	06023	40.8666166	-124.0855684	Humboldt County
114337	Fee-for-Service	1780825604	1780825604	1	1	KAHWAJI, CHADI I MD	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97690	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
114351	Fee-for-Service	1336137165	1336137165	1	1	KERNS, SCOTT R MD	7/22/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	143278	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
114379	Fee-for-Service	1780845396	1780845396	1	1	KAUFFMAN, CASSANDRA M PSYD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
114394	Fee-for-Service	1891731899	1891731899	1	1	KOTE, SUMANGALA K MD	7/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45756	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
114407	Fee-for-Service	1619330677	1619330677	1	1	KETCH, COURTNEY	2/13/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168350	09	Gynecology (D.O. only)	0	In state provider	None	765 MEDICAL CENTER CT	SUITE 203	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
114419	Fee-for-Service	1386726032	1386726032	1	1	KARUK TRIBE	12/20/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	325 ASIP ROAD	None	ORLEANS	CA	95556	0249	12	06023	41.30078777	-123.5477461	Humboldt County
114426	Fee-for-Service	1275574527	1275574527	1	1	KUEBRICH, CHRISTOPHER T MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54665	08	Family Practice	0	In state provider	None	7300 NORTH FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
114441	Fee-for-Service	1932392875	1932392875	1	1	KIM, YOUN C MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92142	22	Pathology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
114442	Fee-for-Service	1336213271	1336213271	1	1	KASRAEIAN, ALI MD	9/13/2021	208800000X	NA	Other	026	PHYSICIANS	170704	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
114472	Fee-for-Service	1477747160	1477747160	1	1	KIRPALANI, DHIRUJ R MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88324	25	Physical Medicine and Rehabilitation	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
114477	Fee-for-Service	1437344538	1437344538	1	1	KUVHENGUHWA, AMOS W MD	11/14/2007	208600000X	NA	General Surgery	026	PHYSICIANS	59257	89	Surgery-Traumatic	0	In state provider	SO CAL ENDO MED GRP INC	3838 SHERMAN DR	STE 6	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
114503	Fee-for-Service	1558469965	1558469965	1	1	KUMAR, NANDAN P MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52968	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
114518	Fee-for-Service	1457868960	1457868960	1	1	KAUR, MANINDER P MD	7/20/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	163314	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114530	Fee-for-Service	1336587351	1336587351	1	1	KUZMACK, EDWARD M DO	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13577	None	None	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
114537	Fee-for-Service	1669553533	1669553533	1	1	KOHLI, ANJALI MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69082	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
114540	Fee-for-Service	1548318322	1548318322	1	1	KARUKONDA, SREE R MD	2/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64903	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
114593	Fee-for-Service	1316300643	1316300643	1	1	KRAMER, ADAM MD	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	168369	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
114654	Fee-for-Service	1659339687	1659339687	1	1	KUMAR, PIYUSH PHIL MD INC	4/28/2009	174400000X	NA	Other	026	PHYSICIANS	44592	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 GARDEN VIEW ST	STE 102	ENCINITAS	CA	92024	2478	37	06073	33.05922419	-117.260629	San Diego County
114661	Fee-for-Service	1164110219	1164110219	1	1	KRISHNAN, SOWMYA NP	7/5/2023	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1325 E. COOLEY DR	SUITE 101	COLTON	CA	92324	3947	36	06071	34.05468148	-117.306261	San Bernardino County
114688	Fee-for-Service	1235315540	1235315540	1	1	KAPITANSKI, NINA MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109664	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
114692	Fee-for-Service	1710371281	1710371281	1	1	KAPUR, ANITA D MD	3/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143745	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
114701	Fee-for-Service	1922418797	1922418797	1	1	KUO, FRANK MD	6/3/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	142728	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114706	Fee-for-Service	1639136575	1639136575	1	1	KIM, HANNAH MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66402	40	Pediatrics	0	In state provider	MGA OFFICE	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
114720	Fee-for-Service	1386830214	1386830214	1	1	KINGSBURG JOINT UNION	1/17/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1310 STROUD AVE	None	KINGSBURG	CA	93631	1000	10	06019	36.52510316	-119.5527806	Fresno County
114759	Fee-for-Service	1356337034	1356337034	1	1	KARIM, AQM R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5901 W INDIAN SCHOOL RD,	SUITE 1	PHOENIX	AZ	85033	0000	00	None	33.494724	-112.186827	Maricopa County
114766	Fee-for-Service	1437344538	1437344538	1	1	KUVHENGUHWA, AMOS W MD	11/14/2007	208600000X	NA	General Surgery	026	PHYSICIANS	59257	01	General Practice	0	In state provider	SO CAL ENDO MED GRP INC	3838 SHERMAN DR	STE 6	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
114774	Fee-for-Service	1225343106	1225343106	1	1	KIM, SUN E	2/20/2014	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	903 S CRENSHAW BLVD	STE 105	LOS ANGELES	CA	90019	1964	19	06037	34.05617593	-118.3221956	Los Angeles County
114789	Fee-for-Service	1508275181	1508275181	1	1	KAPOOR, ROHAN MD	1/31/2019	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	157883	39	Preventive (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
114797	Fee-for-Service	1619025558	1619025558	1	1	KAPLAN, DENNIS A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36421	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
114831	Fee-for-Service	1841566221	1841566221	1	1	KARNEZIS, ANTHONY N MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121240	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
114855	Fee-for-Service	1548229008	1548229008	1	1	KIM ANTHONY S MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86555	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
114869	Fee-for-Service	1497734404	1497734404	1	1	KASSIS, MICHAEL D	5/18/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1350 BURTON DRIVE	STE 260	VACAVILLE	CA	95687	3545	48	06095	38.36416107	-121.9552032	Solano County
114897	Fee-for-Service	1619968443	1619968443	1	1	KNIGHT, SUE J MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54750	41	Internal Medicine	0	In state provider	None	200 PORTER DR	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
114904	Fee-for-Service	1639839772	1639839772	1	1	KINGSLEY, PAIGE E	1/12/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
114907	Fee-for-Service	1487738456	1487738456	1	1	KILLION, SUSAN L MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84791	02	General Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
114913	Fee-for-Service	1275759425	1275759425	1	1	KWAK, KEVIN D MD	5/13/2004	207R00000X	NA	Other	026	PHYSICIANS	68495	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
114942	Fee-for-Service	1881784486	1881784486	1	1	KATZ, BRADLEY J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	65 N. MEDICAL DRIVE	None	SALT LAKE CITY	UT	84132	0001	00	None	40.7730872	-111.8376934	Salt Lake County
114945	Fee-for-Service	1578925764	1578925764	1	1	KIM, PETER S MD	9/13/2019	207P00000X	NA	Other	026	PHYSICIANS	159131	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
114946	Fee-for-Service	1659339687	1659339687	1	1	KUMAR, PIYUSH PHIL MD INC	4/28/2009	174400000X	NA	Other	026	PHYSICIANS	44592	41	Internal Medicine	0	In state provider	None	700 GARDEN VIEW ST	STE 102	ENCINITAS	CA	92024	2478	37	06073	33.05922419	-117.260629	San Diego County
114971	Fee-for-Service	1346400991	1346400991	1	1	KELLY, MEREDITH A MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131255	36	Psychiatry	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
114991	Fee-for-Service	1275665515	1275665515	1	1	KANI, HOSSEIN MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45925	01	General Practice	0	In state provider	None	1629 W 17TH STREET	#A	SANTA ANA	CA	92706	3335	30	06059	33.7601103	-117.890505	Orange County
115039	Fee-for-Service	1457557100	1457557100	1	1	KHAMSI, BABAK R MD	7/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119808	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
115054	Fee-for-Service	1437344538	1437344538	1	1	KUVHENGUHWA, AMOS W MD	11/14/2007	208600000X	NA	General Surgery	026	PHYSICIANS	59257	02	General Surgery	0	In state provider	SO CAL ENDO MED GRP INC	3838 SHERMAN DR	STE 6	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
115063	Fee-for-Service	1255315206	1255315206	1	1	KUMAR, ARVIND MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73624	41	Internal Medicine	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
115065	Fee-for-Service	1174642557	1174642557	1	1	KALAMA, JONATHAN D AU	8/17/2021	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	623 W DUARTE ROAD	8	ARCADIA	CA	91007	7349	19	06037	34.12648672	-118.0522757	Los Angeles County
115075	Fee-for-Service	1962850263	1962850263	1	1	KIM, MIN K	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	184748	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
115081	Fee-for-Service	1659698447	1659698447	1	1	KWOK-OLEKSY, CHRISTINA DPM	7/15/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	223 PLAZA PROFESSIONAL	None	EL CERRITO	CA	94530	0000	07	06013	37.89831601	-122.3001181	Contra Costa County
115087	Fee-for-Service	1093926818	1093926818	1	1	KOTA, PRIYAMVADA MD	11/18/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	113393	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
115108	Fee-for-Service	1003547373	1003547373	1	1	KEVIN STEPHANOFF, M.D., INC.	8/24/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5000	19	06037	33.8102385	-118.3441185	Los Angeles County
115124	Fee-for-Service	1760682819	1760682819	1	1	KULKARNI, SUJIT S MD	1/12/2011	208600000X	NA	General Surgery	026	PHYSICIANS	113106	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	2ND FLR	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
115143	Fee-for-Service	1922731777	1922731777	1	1	KARANU, LAURYN JANE W	7/7/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	700 GIBSON DR	APT 1121	ROSEVILLE	CA	95678	5860	31	06061	38.7807392	-121.2810033	Placer County
115145	Fee-for-Service	1023276144	1023276144	1	1	KAIPUST, NICOLE M MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116543	41	Internal Medicine	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
115200	Fee-for-Service	1275759425	1275759425	1	1	KWAK, KEVIN D MD	5/13/2004	207R00000X	NA	Other	026	PHYSICIANS	68495	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
115220	Fee-for-Service	1447784590	1447784590	1	1	KIM, MARIA N MD	12/12/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160291	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
115228	Fee-for-Service	1659339687	1659339687	1	1	KUMAR, PIYUSH PHIL MD INC	4/28/2009	174400000X	NA	Other	026	PHYSICIANS	44592	10	Gastroenterology (M.D. only)	0	In state provider	None	700 GARDEN VIEW ST	STE 102	ENCINITAS	CA	92024	2478	37	06073	33.05922419	-117.260629	San Diego County
115230	Fee-for-Service	1386199446	1386199446	1	1	KHURRAM ABBASS MD INC	5/10/2019	207RR0500X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	200 JOSE FIGUERES AVE	STE 480	SAN JOSE	CA	95116	1590	43	06085	37.36122014	-121.8505998	Santa Clara County
115245	Fee-for-Service	1316984800	1316984800	1	1	KARUPAIAH, SUDHA MD	6/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85414	41	Internal Medicine	0	In state provider	None	65 N 14TH ST	None	SAN JOSE	CA	95112	6207	43	06085	37.34351079	-121.8779494	Santa Clara County
115246	Fee-for-Service	1457454449	1457454449	1	1	KACHEL, RICHARD G MD	3/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87289	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
115250	Fee-for-Service	1194873984	1194873984	1	1	KAISER FOUNDATION HLTH	2/22/1995	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
115280	Fee-for-Service	1275665515	1275665515	1	1	KANI, HOSSEIN MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45925	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1629 W 17TH STREET	#A	SANTA ANA	CA	92706	3335	30	06059	33.7601103	-117.890505	Orange County
115313	Fee-for-Service	1992017784	1992017784	1	1	KAUR, HARRUP MD INC	1/10/2011	207W00000X	NA	Ophthalmology	026	PHYSICIANS	97285	18	Ophthalmology	0	In state provider	None	555 KNOWLES DR	STE 117	LOS GATOS	CA	95032	1542	43	06085	37.26166873	-121.9661521	Santa Clara County
115417	Fee-for-Service	1306906151	1306906151	1	1	KAMINSKI, ARTHUR D MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82482	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
115430	Fee-for-Service	1922731777	1922731777	1	1	KARANU, LAURYN JANE W	7/7/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	700 GIBSON DR	APT 1121	ROSEVILLE	CA	95678	5860	31	06061	38.7807392	-121.2810033	Placer County
115442	Fee-for-Service	1013169671	1013169671	1	1	KANAPARTHY, SRI SMITHA MD	10/10/2020	207LP3000X	NA	Other	026	PHYSICIANS	168037	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
115450	Fee-for-Service	1033519095	1033519095	1	1	KANWAR, SANDEEP MD	7/5/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152760	15	Obstetrics (D.O. only)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
115467	Fee-for-Service	1376035675	1376035675	1	1	KHAN, SOHEB MD	1/17/2022	207R00000X	NA	Other	026	PHYSICIANS	174729	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
115479	Fee-for-Service	1003937947	1003937947	1	1	KOO, SANDRA J MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121655	34	Urology and Urological Surgery	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
115487	Fee-for-Service	1124499413	1124499413	1	1	KATNIK, LORI L NP	1/23/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
115488	Fee-for-Service	1366510661	1366510661	1	1	KAHN, CHRISTOPHER A MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84298	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
115489	Fee-for-Service	1275759425	1275759425	1	1	KWAK, KEVIN D MD	5/13/2004	207R00000X	NA	Other	026	PHYSICIANS	68495	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
115503	Fee-for-Service	1750637658	1750637658	1	1	KINGSLAND, CONNIE M MFT	2/16/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1619 E CHAPMAN AVE	None	FULLERTON	CA	92831	4015	30	06059	33.87417451	-117.899001	Orange County
115517	Fee-for-Service	1356958466	1356958466	1	1	KIM, MINJUNG CRNA	2/15/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
115519	Fee-for-Service	1396003612	1396003612	1	1	KHANDPUR, RITIKA MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116996	07	Dermatology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
115532	Fee-for-Service	1457454449	1457454449	1	1	KACHEL, RICHARD G MD	3/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87289	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
115559	Fee-for-Service	1225090848	1225090848	1	1	KANUBHAI A PATEL MD	4/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1441 REDBUD BLVD	STE 101	MCKINNEY	TX	75069	3233	00	None	33.21189102	-96.63467395	Collin County
115569	Fee-for-Service	1538744404	1538744404	1	1	KING, AMBER E LCSW	3/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
115579	Fee-for-Service	1598814436	1598814436	1	1	KIM, SUNG S OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SUNRISE OPTOMETRY	1028 ROSECRANS AVE	None	FULLERTON	CA	92833	1948	30	06059	33.89341515	-117.9453673	Orange County
115691	Fee-for-Service	1245659523	1245659523	1	1	KLEIN, GERALDINE T MD	8/1/2020	208800000X	NA	Other	026	PHYSICIANS	168710	34	Urology and Urological Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
115741	Fee-for-Service	1538519459	1538519459	1	1	KAHL, JENNIFER	6/21/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	748 EUREKA CANYON ROAD	None	WATSONVILLE	CA	95076	0121	44	06087	37.01900162	-121.817666	Santa Cruz County
115753	Fee-for-Service	1770133001	1770133001	1	1	KAISER FOUNDATION HEALTH PLA	9/9/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	059R	9449 IMPERIAL HWY	BLDG C STE 122	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
115781	Fee-for-Service	1265703102	1265703102	1	1	KARDASHIAN, ARA A MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123325	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
115787	Fee-for-Service	1073691689	1073691689	1	1	KIM, DAE H DC	7/13/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3828 W. COMMONWEALTH AVE	None	FULLERTON	CA	92833	2851	30	06059	33.86998148	-117.978156	Orange County
115830	Fee-for-Service	1235692179	1235692179	1	1	KHUC, EMILY T DPM	9/30/2022	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
115857	Fee-for-Service	1619220738	1619220738	1	1	KIM-ALMEIDA, AHESUN LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
115862	Fee-for-Service	1679684781	1679684781	1	1	KLATZKO,MARTIN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDREN HEALTH CARE	2525 CHICAGO AVE #5	None	MINNEAPOLIS	MN	55404	0000	00	None	44.95666589	-93.26255996	Hennepin County
115897	Fee-for-Service	1871670737	1871670737	1	1	KOSCOVE, ERIC M MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47501	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 S SUSANA RD	None	COMPTON	CA	90221	5418	19	06037	33.87386619	-118.2070981	Los Angeles County
115929	Fee-for-Service	1639277130	1639277130	1	1	KO, YOUNG J MD	3/26/2009	207R00000X	NA	Other	026	PHYSICIANS	39814	41	Internal Medicine	0	In state provider	None	44215 15TH ST W	STE 303	LANCASTER	CA	93534	5505	19	06037	34.68666415	-118.1568572	Los Angeles County
115959	Fee-for-Service	1962916031	1962916031	1	1	KHOURY, LORIES LMFT	9/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 E CARRILLO ST	304	SANTA BARBARA	CA	93101	2121	42	06083	34.42430069	-119.6989389	Santa Barbara County
115967	Fee-for-Service	1558740951	1558740951	1	1	KOTHARI, PRANAY D MD	6/30/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144301	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
115981	Fee-for-Service	1306917349	1306917349	1	1	KUJUBU, DEAN A MD	5/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50795	45	Nephrology (Renal-Kidney)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
115996	Fee-for-Service	1093914202	1093914202	1	1	KENT, JOCELYNE G	5/3/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
116008	Fee-for-Service	1073547626	1073547626	1	1	KIM, NANCY K MD	3/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75513	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3663 W 6TH ST	STE 307	LOS ANGELES	CA	90020	3050	19	06037	34.06360557	-118.30199	Los Angeles County
116018	Fee-for-Service	1528276078	1528276078	1	1	KOUMJIAN, MICHAEL P MD APC	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37886	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
116021	Fee-for-Service	1457317919	1457317919	1	1	KRUER, JAMES MD	2/20/2024	207R00000X	NA	Other	026	PHYSICIANS	192464	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
116028	Fee-for-Service	1538519459	1538519459	1	1	KAHL, JENNIFER	6/21/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	748 EUREKA CANYON ROAD	None	WATSONVILLE	CA	95076	0121	44	06087	37.01900162	-121.817666	Santa Cruz County
116045	Fee-for-Service	1316331291	1316331291	1	1	KAUR, ROMA MD	3/31/2020	390200000X	NA	Other	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
116051	Fee-for-Service	1588168546	1588168546	1	1	KIZZEE, OLIVIA P MD	7/19/2021	208M00000X	NA	Other	026	PHYSICIANS	173608	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
116075	Fee-for-Service	1265703102	1265703102	1	1	KARDASHIAN, ARA A MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123325	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MED PLAZA	365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
116090	Fee-for-Service	1336467240	1336467240	1	1	KISSELL, NICOLAS L MD	6/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134966	67	Endocrinology	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	7759	27	06053	36.65911769	-121.6448024	Monterey County
116093	Fee-for-Service	1205866944	1205866944	1	1	KAO, JENNIFER H-W OD	9/15/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 LUNDY AVE	STE 120	SAN JOSE	CA	95131	1860	43	06085	37.38788073	-121.8866632	Santa Clara County
116142	Fee-for-Service	1780741652	1780741652	1	1	KUSHIDA, CLETE A MD	12/18/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50560	None	None	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
116175	Fee-for-Service	1215008461	1215008461	1	1	KAISER FOUNDATION HOSPITAL	8/1/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	BAYVIEW NORTH BLDG RM#1	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
116183	Fee-for-Service	1174678130	1174678130	1	1	KRUG, THOMAS J CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
116220	Fee-for-Service	1639277130	1639277130	1	1	KO, YOUNG J MD	3/26/2009	207R00000X	NA	Other	026	PHYSICIANS	39814	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	44215 15TH ST W	STE 303	LANCASTER	CA	93534	5505	19	06037	34.68666415	-118.1568572	Los Angeles County
116243	Fee-for-Service	1942447032	1942447032	1	1	KEVIN MODESTE	4/10/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
116266	Fee-for-Service	1952936346	1952936346	1	1	KAUR, RAVINDER NP	5/2/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	39	06077	38.02415455	-121.2934722	San Joaquin County
116305	Fee-for-Service	1528276078	1528276078	1	1	KOUMJIAN, MICHAEL P MD APC	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37886	33	Thoracic Surgery	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
116311	Fee-for-Service	1588712558	1588712558	1	1	KIM, SUNGHYE	4/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77748	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
116316	Fee-for-Service	1720195381	1720195381	1	1	KAPPAGODA, SHANTHI MD	11/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105647	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2799	41	06081	37.48093988	-122.2531826	San Mateo County
116325	Fee-for-Service	1689680696	1689680696	1	1	KOSHAK, MICHAEL M MD	11/6/1981	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36588	08	Family Practice	0	In state provider	None	5625 MELROSE AVE	None	LOS ANGELES	CA	90038	3909	19	06037	34.08351648	-118.323117	Los Angeles County
116338	Fee-for-Service	1720153034	1720153034	1	1	KHATTAK, MUHAMMAD N MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52193	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
116346	Fee-for-Service	1700956174	1700956174	1	1	KALAN, ARNOLD J MD INC	9/20/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	28905	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1127 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
116364	Fee-for-Service	1154843571	1154843571	1	1	KOOSHK JALALI, GHAZAL MD	10/28/2020	207R00000X	NA	Other	026	PHYSICIANS	170339	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
116370	Fee-for-Service	1538241161	1538241161	1	1	KING, JEFFREY K MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83190	01	General Practice	0	In state provider	None	133 W SANTA CLARA ST	None	VENTURA	CA	93001	2543	56	06111	34.27954148	-119.302884	Ventura County
116381	Fee-for-Service	1962039537	1962039537	1	1	KINDA, KATHLEEN M NP	4/16/2021	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
116413	Fee-for-Service	1386931244	1386931244	1	1	KANG, EUGENE J MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134855	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
116431	Fee-for-Service	1982184701	1982184701	1	1	KESLER, ANGELA R PT	8/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22038 OLD 44 DR	None	PALO CEDRO	CA	96073	8707	45	06089	40.56384214	-122.2377098	Shasta County
116460	Fee-for-Service	1518039353	1518039353	1	1	KOBORI, JOYCE MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	51544	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	# A200	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
116501	Fee-for-Service	1518157098	1518157098	1	1	KIM, SUNG YEAN LAC	6/9/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	46923 WARM SPRINGS BLVD	#103	FREMONT	CA	94539	7914	01	06001	37.48806956	-121.9285892	Alameda County
116528	Fee-for-Service	1376954768	1376954768	1	1	KASHANI, HOUMAN M MD APC	2/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84361	01	General Practice	0	In state provider	None	747 WAREHOUSE STREET	5TH FLOOR	LOS ANGELES	CA	90021	1106	19	06037	34.03450435	-118.2393996	Los Angeles County
116539	Fee-for-Service	1194156893	1194156893	1	1	KAMEL, KURT MD INC	10/23/2014	193400000X	NA	Other	026	PHYSICIANS	120938	05	Anesthesiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
116565	Fee-for-Service	1730185620	1730185620	1	1	KNUTZON, RANDY K MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	46090	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
116571	Fee-for-Service	1073011524	1073011524	1	1	KERRIGAN, TRILBY B LCSW	12/16/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
116632	Fee-for-Service	1851059943	1851059943	1	1	KIM, SOO MIN CRNA	1/27/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
116635	Fee-for-Service	1871817536	1871817536	1	1	KERK, KARIN D MD	1/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108988	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
116653	Fee-for-Service	1215068515	1215068515	1	1	KENSHALO, JAMES W LCSW	6/27/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11066	-	NOT APPLICABLE	0	In state provider	None	623 GREAT JONES STREET	None	FAIRFIELD	CA	94533	6005	48	06095	38.24881448	-122.0485767	Solano County
116654	Fee-for-Service	1992276679	1992276679	1	1	KNISELY, JENNIFER CNP	2/3/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
116666	Fee-for-Service	1497805378	1497805378	1	1	KUMAR, PARVESH MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86852	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
116674	Fee-for-Service	1639582406	1639582406	1	1	KNIGHT, KRISTEN	1/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
116675	Fee-for-Service	1801955521	1801955521	1	1	KENNEDY, KAREN R CRNA	4/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
116703	Fee-for-Service	1598091878	1598091878	1	1	KREMMEL, LINDSEY M PHD	1/30/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
116721	Fee-for-Service	1710659438	1710659438	1	1	KATHURIA, ANJANA	2/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
116736	Fee-for-Service	1114963543	1114963543	1	1	KALMANSON, DAVID J MD	2/15/1989	207P00000X	NA	Other	026	PHYSICIANS	35026	None	None	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
116738	Fee-for-Service	1578641288	1578641288	1	1	KHINE, STEVEN MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92253	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
116793	Fee-for-Service	1922005586	1922005586	1	1	KREGER, JENNIFER B MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77877	08	Family Practice	0	In state provider	None	480 MAIN STREET	None	MENDOCINO	CA	95460	0000	23	06045	39.30508226	-123.7986577	Mendocino County
116794	Fee-for-Service	1568759454	1568759454	1	1	KIM, DANIEL S MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136712	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
116814	Fee-for-Service	1396989489	1396989489	1	1	KARAMLOO, SARA DPM	8/4/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
116827	Fee-for-Service	1558720516	1558720516	1	1	KHAN, AYAZ O DO INC	2/6/2017	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	800 S HAM LN	None	LODI	CA	95242	3543	39	06077	38.124153	-121.2882315	San Joaquin County
116884	Fee-for-Service	1083933535	1083933535	1	1	KENNEDY, GANNON D MD	8/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117899	20	Orthopedic Surgery	0	In state provider	None	4870 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552184	-121.448493	Sacramento County
116886	Fee-for-Service	1306041355	1306041355	1	1	KOPELNIK, ALEXANDER MD	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90257	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
116893	Fee-for-Service	1205877917	1205877917	1	1	KALAYJIAN, LAURA A MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61593	13	Neurology (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	STE 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
116900	Fee-for-Service	1194758219	1194758219	1	1	KRESHAK, ALLYSON A MD	7/1/2008	207P00000X	NA	Other	026	PHYSICIANS	102811	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	8676	37	06073	32.7537975	-117.1658298	San Diego County
116906	Fee-for-Service	1336552405	1336552405	1	1	KATZ, DANIEL H MD	4/12/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	170867	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116924	Fee-for-Service	1497989636	1497989636	1	1	KWOK, JENNIFER A DO	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11416	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
116925	Fee-for-Service	1346654597	1346654597	1	1	KHESBAK, ZIYAD MD	1/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139524	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13100 STUDEBAKER ROAD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
116954	Fee-for-Service	1497805378	1497805378	1	1	KUMAR, PARVESH MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86852	30	Radiology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
116955	Fee-for-Service	1194707604	1194707604	1	1	KINOSHITA, KEITH D MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75100	02	General Surgery	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
116959	Fee-for-Service	1831106673	1831106673	1	1	KASSELS, BARRY P MD	10/15/2009	207L00000X	NA	Other	026	PHYSICIANS	78198	None	None	0	In state provider	None	817 COFFEE RD	STE C3	MODESTO	CA	95355	4241	50	06099	37.655235	-120.975616	Stanislaus County
116973	Fee-for-Service	1366901530	1366901530	1	1	KHORRAM, NASEEM M MD	11/15/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	177157	41	Internal Medicine	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
117019	Fee-for-Service	1902845209	1902845209	1	1	KASHYAP, ROHIT MD	5/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53146	45	Nephrology (Renal-Kidney)	0	In state provider	None	77 CADILLAC DR	STE 130	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
117060	Fee-for-Service	1003880261	1003880261	1	1	KARLIN, JAMSHYD D MD	1/1/1979	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33163	18	Ophthalmology	0	In state provider	None	7301 MEDICAL CENTER DR	STE 410	WEST HILLS	CA	91307	1994	19	06037	34.20285756	-118.6294575	Los Angeles County
117092	Fee-for-Service	1013408848	1013408848	1	1	KAUR, RAMANDEEP MD	10/28/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174248	None	None	0	In state provider	None	4770 W HERNDON AVE	SUITE 108	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
117118	Fee-for-Service	1003294968	1003294968	1	1	KUMAR, KRIS DO	10/23/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	19879	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
117123	Fee-for-Service	1801925367	1801925367	1	1	KYAW, RICHARD S MD	2/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	44805	None	None	0	In state provider	None	12560 PALM DR	STE B	DESERT HOT SPRING	CA	92240	4559	33	06065	33.957261	-116.501291	Riverside County
117125	Fee-for-Service	1093758393	1093758393	1	1	KANG, IKSOO, MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70734	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
117215	Fee-for-Service	1497989636	1497989636	1	1	KWOK, JENNIFER A DO	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11416	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
117229	Fee-for-Service	1326732355	1326732355	1	1	KIM, ROBYN NP	8/29/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1410 MOONEY BLVD	None	VISALIA	CA	93277	4440	54	06107	36.318231	-119.313621	Tulare County
117233	Fee-for-Service	1164579496	1164579496	1	1	KAISER FOUNDATION HEALTH PLA	1/27/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMAN PHAR#571	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
117241	Fee-for-Service	1992287437	1992287437	1	1	KAUR, NAVNEET CNP	5/27/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	384 E OLIVE AVE	STE 2	TURLOCK	CA	95380	4051	50	06099	37.49658844	-120.8452043	Stanislaus County
117249	Fee-for-Service	1497069058	1497069058	1	1	KALBERER, RYAN J	7/10/2013	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	6229 W 87TH STREET	None	LOS ANGELES	CA	90045	3901	19	06037	33.95860798	-118.3941238	Los Angeles County
117303	Fee-for-Service	1003813015	1003813015	1	1	KUMAR, NEIL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KIDNEY & HYPERTENSN CTR	2410 NW EDENBOWER BLVD,	STE 176	ROSEBURGH	OR	97470	0000	00	None	43.23590229	-123.3672271	Douglas County
117308	Fee-for-Service	1902845209	1902845209	1	1	KASHYAP, ROHIT MD	5/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53146	41	Internal Medicine	0	In state provider	None	77 CADILLAC DR	STE 130	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
117319	Fee-for-Service	1710207543	1710207543	1	1	KNAPP, WILLIAM K DO	1/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11948	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PARKWAY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
117349	Fee-for-Service	1568564284	1568564284	1	1	KISSINGER, WENDY A DO	7/8/2022	207P00000X	NA	Other	026	PHYSICIANS	12617	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
117391	Fee-for-Service	1790042042	1790042042	1	1	KALEEL, MICHAEL H MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123111	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
117399	Fee-for-Service	1457767444	1457767444	1	1	KRISTORAF HOME HEALTH INC	9/6/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	416 E COLORADO ST	SUITE C	GLENDALE	CA	91205	5100	19	06037	34.14259896	-118.2505986	Los Angeles County
117403	Fee-for-Service	1043398795	1043398795	1	1	KING, EARL F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24424	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
117436	Fee-for-Service	1205028651	1205028651	1	1	KIM, SARAH M L MD	1/31/2011	207RR0500X	NA	Other	026	PHYSICIANS	98391	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
117445	Fee-for-Service	1376662098	1376662098	1	1	KHANBOLOOKI, PARHAM MD	5/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94560	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
117488	Fee-for-Service	1740721430	1740721430	1	1	KIM, JUNHEE CPO	3/27/2024	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1335 VALENCIA DR	M	FULLERTON	CA	92833	4046	30	06059	33.866554	-117.9493816	Orange County
117492	Fee-for-Service	1902968175	1902968175	1	1	KASS, RONALD A MD INC	8/10/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 E MARCH LN	STE C300	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
117505	Fee-for-Service	1346454220	1346454220	1	1	KARAYIL, DILJIT B MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112183	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
117510	Fee-for-Service	1841607801	1841607801	1	1	KAWEAH DELTA HEALTH CARE	11/18/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	355 MONTE VISTA DRIVE	STE A	DINUBA	CA	93618	9229	54	06107	36.544158	-119.404117	Tulare County
117555	Fee-for-Service	1104873249	1104873249	1	1	KATTAN, DAVID MD APMC	11/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	69002	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4313 W PICO BLVD	None	LOS ANGELES	CA	90019	3134	19	06037	34.04801926	-118.3284895	Los Angeles County
117627	Fee-for-Service	1174507040	1174507040	1	1	KUBBEH, ABDALLAH V MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	39353	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1180 N INDIAN CANYON DR	STE E319	PALM SPRINGS	CA	92262	4809	33	06065	33.839505	-116.5455735	Riverside County
117630	Fee-for-Service	1649508318	1649508318	1	1	KANNADITHARAYIL, DEEPA MD	11/12/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	143758	13	Neurology (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
117631	Fee-for-Service	1386681336	1386681336	1	1	KIM, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST ALPHONSUS REG MED	323 E RIVERSIDE DR	None	EAGLE	ID	83616	6864	00	None	43.68954632	-116.3500565	Ada County
117670	Fee-for-Service	1184760423	1184760423	1	1	KALISH, LORETA MD	4/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92290	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
117727	Fee-for-Service	1508557877	1508557877	1	1	KINGS TMS THERAPY CLINIC	9/27/2024	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7454 MELROSE AVE	None	LOS ANGELES	CA	90046	7524	19	06037	34.08359863	-118.3524061	Los Angeles County
117753	Fee-for-Service	1093151995	1093151995	1	1	KLINE, AHNIKA S MD	7/13/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	135100	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
117768	Fee-for-Service	1154011062	1154011062	1	1	KIJAK, PATRICIA ANNE	6/14/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	78 WESTGATE CIRCLE	None	SANTA ROSA	CA	95401	5830	49	06097	38.435481	-122.757561	Sonoma County
117770	Fee-for-Service	1598991788	1598991788	1	1	KHAZANIE, AMITA R MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106656	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
117781	Fee-for-Service	1902968175	1902968175	1	1	KASS, RONALD A MD INC	8/10/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1801 E MARCH LN	STE C300	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
117797	Fee-for-Service	1396027181	1396027181	1	1	KAISER FOUNDATION HOSPITAL	8/6/2014	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	FONTANA	2295 S VINEYARD AVE	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
117801	Fee-for-Service	1841607801	1841607801	1	1	KAWEAH DELTA HEALTH CARE	2/1/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	355 MONTE VISTA DRIVE	STE A	DINUBA	CA	93618	9229	54	06107	36.544158	-119.404117	Tulare County
117802	Fee-for-Service	1295813012	1295813012	1	1	KELLEY, DIANE M MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43839	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
117804	Fee-for-Service	1447338025	1447338025	1	1	KIM, ANABEL Y MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90398	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
117831	Fee-for-Service	1730180852	1730180852	1	1	KOCH, GREGORY E PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4081 STEPHENS ST	None	SAN DIEGO	CA	92103	1242	37	06073	32.75147306	-117.1785382	San Diego County
117836	Fee-for-Service	1811923568	1811923568	1	1	KLUG, DONALD E MD	2/1/1999	207RN0300X	NA	Nephrology	026	PHYSICIANS	26922	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
117837	Fee-for-Service	1164404729	1164404729	1	1	KWON, TONY S MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71801	41	Internal Medicine	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
117843	Fee-for-Service	1104873249	1104873249	1	1	KATTAN, DAVID MD APMC	11/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	69002	41	Internal Medicine	0	In state provider	None	4313 W PICO BLVD	None	LOS ANGELES	CA	90019	3134	19	06037	34.04801926	-118.3284895	Los Angeles County
117846	Fee-for-Service	1255932786	1255932786	1	2	KABAFUSION, LLC	12/6/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5860 W. LAS POSITAS BLVD	SUITE 19	PLEASANTON	CA	94588	8557	01	06001	37.68403854	-121.8970072	Alameda County
117847	Fee-for-Service	1821199068	1821199068	1	1	KIM, SHIN Y MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	590 EUREKA AVE	None	RENO	NV	89512	3425	00	None	39.53407902	-119.8048858	Washoe County
117848	Fee-for-Service	1992970206	1992970206	1	1	KIM, HYUNG J MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97288	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
117852	Fee-for-Service	1124510045	1124510045	1	1	KRZYWON, LUCYNA MD	9/4/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	167335	02	General Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
117876	Fee-for-Service	1497169221	1497169221	1	1	KAZI, AASIF A MD	1/1/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	175180	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
117887	Fee-for-Service	1386710952	1386710952	1	1	KVARDA, KIM	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
117894	Fee-for-Service	1831484112	1831484112	1	1	KHOLEIF, CLARK T MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126235	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117901	Fee-for-Service	1083885164	1083885164	1	1	KASE, MICHAEL E MD	3/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106492	13	Neurology (M.D. only)	0	In state provider	None	1700 MOUNT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
117916	Fee-for-Service	1336305341	1336305341	1	1	KILIAN, BENJAMIN T DO	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
117958	Fee-for-Service	1306057989	1306057989	1	4	KRONLAND, RENE C MD	11/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85096	01	General Practice	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
118011	Fee-for-Service	1386649556	1386649556	1	1	KAMATH, RAM K MD	12/31/1990	207R00000X	NA	Other	026	PHYSICIANS	46329	41	Internal Medicine	0	In state provider	None	18564 HWY 18	#103-104	APPLE VALLEY	CA	92307	0000	36	06071	34.53926652	-117.2592564	San Bernardino County
118017	Fee-for-Service	1508557877	1508557877	1	1	KINGS TMS THERAPY CLINIC	3/26/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	7454 MELROSE AVE	None	LOS ANGELES	CA	90046	7524	19	06037	34.08359863	-118.3524061	Los Angeles County
118048	Fee-for-Service	1992192033	1992192033	1	1	KIM, CHRISTINE M MD	6/16/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	145587	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118058	Fee-for-Service	1154011062	1154011062	1	1	KIJAK, PATRICIA ANNE	6/14/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	78 WESTGATE CIRCLE	None	SANTA ROSA	CA	95401	5830	49	06097	38.435481	-122.757561	Sonoma County
118088	Fee-for-Service	1841607801	1841607801	1	1	KAWEAH DELTA HEALTH CARE	11/18/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	355 MONTE VISTA DRIVE	STE A	DINUBA	CA	93618	9229	54	06107	36.544158	-119.404117	Tulare County
118102	Fee-for-Service	1093862328	1093862328	1	1	KAISER, PERMANENTE #352	12/10/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1188 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.850314	-117.9416115	Orange County
118124	Fee-for-Service	1912944166	1912944166	1	1	KIM, SARA S MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70222	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
118125	Fee-for-Service	1811923568	1811923568	1	1	KLUG, DONALD E MD	2/1/1999	207RN0300X	NA	Nephrology	026	PHYSICIANS	26922	45	Nephrology (Renal-Kidney)	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
118127	Fee-for-Service	1497747943	1497747943	1	1	KAO, SAMUEL D MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	74093	20	Orthopedic Surgery	0	In state provider	None	450 SUTTER ST	RM 1533	SAN FRANCISCO	CA	94108	4004	38	06075	37.78934929	-122.4077786	San Francisco County
118159	Fee-for-Service	1932120797	1932120797	1	1	KHAN, ABDUL A MD	9/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	44120	41	Internal Medicine	0	In state provider	None	275 VICTORIA ST	STE 1E	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
118191	Fee-for-Service	1083885164	1083885164	1	1	KASE, MICHAEL E MD	3/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106492	36	Psychiatry	0	In state provider	None	1700 MOUNT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
118256	Fee-for-Service	1669491635	1669491635	1	1	KASSEL, STEVEN C MFT	9/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23560 LYONS AVE	204	NEWHALL	CA	91321	2521	19	06037	34.37936213	-118.5462451	Los Angeles County
118272	Fee-for-Service	1982680914	1982680914	1	1	KIM,ANDREW J MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62488	05	Anesthesiology	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
118284	Fee-for-Service	1184727687	1184727687	1	1	KHALILI,MANDANA MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65182	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
118301	Fee-for-Service	1386649556	1386649556	1	1	KAMATH, RAM K MD	12/31/1990	207R00000X	NA	Other	026	PHYSICIANS	46329	08	Family Practice	0	In state provider	None	18564 HWY 18	#103-104	APPLE VALLEY	CA	92307	0000	36	06071	34.53926652	-117.2592564	San Bernardino County
118336	Fee-for-Service	1669452025	1669452025	1	1	KONCHAK, PETER S DO	8/2/2023	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21313	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
118338	Fee-for-Service	1699112227	1699112227	1	1	KLEIMAN, ZACHARY I MD	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156462	05	Anesthesiology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
118351	Fee-for-Service	1447279948	1447279948	1	1	KHIN, KHINE K MD	1/1/2000	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	67196	08	Family Practice	0	In state provider	None	500 S ANAHEIM HILLS RD	STE 230	ANAHEIM	CA	92807	4760	30	06059	33.8427954	-117.7772895	Orange County
118370	Fee-for-Service	1477723203	1477723203	1	1	KHOJAYAN, VIGEN MD	10/13/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101697	08	Family Practice	0	In state provider	None	435 ARDEN AVE	STE 360	GLENDALE	CA	91203	1145	19	06037	34.15848148	-118.2628845	Los Angeles County
118376	Fee-for-Service	1841607801	1841607801	1	1	KAWEAH DELTA HEALTH CARE	2/20/2018	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	355 MONTE VISTA DRIVE	STE A	DINUBA	CA	93618	9229	54	06107	36.544158	-119.404117	Tulare County
118412	Fee-for-Service	1073651261	1073651261	1	1	KATZEN, JOHN T MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85745	24	Plastic Surgery	0	In state provider	None	120 S SPALDING DR	STE 340	BEVERLY HILLS	CA	90212	1841	19	06037	34.06625419	-118.4088854	Los Angeles County
118417	Fee-for-Service	1811923568	1811923568	1	1	KLUG, DONALD E MD	2/1/1999	207RN0300X	NA	Nephrology	026	PHYSICIANS	26922	41	Internal Medicine	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
118419	Fee-for-Service	1497747943	1497747943	1	1	KAO, SAMUEL D MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	74093	24	Plastic Surgery	0	In state provider	None	450 SUTTER ST	RM 1533	SAN FRANCISCO	CA	94108	4004	38	06075	37.78934929	-122.4077786	San Francisco County
118438	Fee-for-Service	1235612623	1235612623	1	1	KESSLER, ADAM PT	9/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
118456	Fee-for-Service	1497877500	1497877500	1	1	KRIJANOVSKI, YELENA L MD	3/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106347	68	Hematology	0	In state provider	None	2720 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
118468	Fee-for-Service	1013271147	1013271147	1	1	KANNO, SAMER S H MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137914	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
118470	Fee-for-Service	1346328945	1346328945	1	1	KANTER, RICHARD A MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	47444	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
118525	Fee-for-Service	1376763094	1376763094	1	1	KEVIN REE DO	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1680 DIAGONAL RD	None	WORTHINGTON	MN	56187	1008	00	None	43.63245526	-95.61545829	Nobles County
118534	Fee-for-Service	1114123171	1114123171	1	1	KIM, STACEY A MD	12/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115491	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	STE TSB-290	LOS ANGELES	CA	90048	1824	19	06037	34.07671715	-118.3799413	Los Angeles County
118547	Fee-for-Service	1689784308	1689784308	1	1	KYAW, NAING T MD	6/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97469	45	Nephrology (Renal-Kidney)	0	In state provider	None	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	37	06073	33.18081595	-117.3156434	San Diego County
118568	Fee-for-Service	1689748352	1689748352	1	1	KORTMEYER, DAVID E DC	12/1/1993	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	67555 E PALM CANYON DR	STE C108	CATHEDRAL CITY	CA	92234	5404	33	06065	33.78899689	-116.4834161	Riverside County
118571	Fee-for-Service	1184727687	1184727687	1	1	KHALILI,MANDANA MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65182	10	Gastroenterology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
118600	Fee-for-Service	1659351930	1659351930	1	1	KHOO, MARK K	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67768	41	Internal Medicine	0	In state provider	None	25800 CARLOS BEE BLVD	None	HAYWARD	CA	94542	3000	01	06001	37.657395	-122.0576265	Alameda County
118621	Fee-for-Service	1861855157	1861855157	1	1	KANG, HYUNWOO P MD	2/10/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	150380	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
118625	Fee-for-Service	1568744654	1568744654	1	1	KRASSNER, ALEXANDER D DO	4/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11745	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
118629	Fee-for-Service	1730322538	1730322538	1	1	KNAPP AND ZITTEL, A MEDICAL	10/6/2009	207PE0005X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	2770 EUREKA	100	REDDING	CA	96001	0252	45	06089	40.58592093	-122.4116893	Shasta County
118646	Fee-for-Service	1679078117	1679078117	1	1	KOVALSKIY, ALEKSANDR MD	11/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173918	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
118654	Fee-for-Service	1770902363	1770902363	1	1	KHINE, HTET MD	3/15/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
118741	Fee-for-Service	1497877500	1497877500	1	1	KRIJANOVSKI, YELENA L MD	3/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106347	78	Neoplastic Diseases/Oncology	0	In state provider	None	2720 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
118808	Fee-for-Service	1447413216	1447413216	1	1	KUDELKO, KRISTINA T MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102773	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118821	Fee-for-Service	1245256544	1245256544	1	1	KAPRE, SHEELA S MD	10/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	36052	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
118825	Fee-for-Service	1851437131	1851437131	1	1	KAPLAN, MICHAEL J MD	5/29/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52414	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
118835	Fee-for-Service	1689784308	1689784308	1	1	KYAW, NAING T MD	6/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97469	41	Internal Medicine	0	In state provider	None	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	37	06073	33.18081595	-117.3156434	San Diego County
118852	Fee-for-Service	1164982351	1164982351	1	1	KOHRMAN, HANNAH M MD	6/13/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177494	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
118862	Fee-for-Service	1306916390	1306916390	1	1	KADDIS, HODA F MD	6/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46408	40	Pediatrics	0	In state provider	None	6725 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4803	19	06037	33.9780186	-118.222576	Los Angeles County
118878	Fee-for-Service	1861811408	1861811408	1	1	KODALI, SINDHURA MD	4/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139845	40	Pediatrics	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94409	4364	41	06081	37.53039072	-122.2987772	San Mateo County
118944	Fee-for-Service	1740682194	1740682194	1	1	KHESSALI, HAMIDREZA MD	6/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138191	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
118982	Fee-for-Service	1508973249	1508973249	1	1	KLAUSNER, JEFFREY D MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81840	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
118985	Fee-for-Service	1154434306	1154434306	1	1	KEAGLE, JENNIFER N MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64773	24	Plastic Surgery	0	In state provider	None	2400 SOUTH FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
119018	Fee-for-Service	1942395140	1942395140	1	1	KAGEN, ALEXANDER MFT	11/19/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3430 BALMORAL DR	SUITE 8	SACRAMENTO	CA	95821	6326	34	06067	38.611251	-121.384035	Sacramento County
119028	Fee-for-Service	1740205236	1740205236	1	1	KULISCHAK, JOHN FRANK	10/31/1991	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	# 945	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
119052	Fee-for-Service	1932251394	1932251394	1	1	KASIRAMAN, ANATHANARAYAN	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64355	30	Radiology	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
119059	Fee-for-Service	1114576774	1114576774	1	1	KOTCHEVAR, MILES G CNP	11/4/2019	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119067	Fee-for-Service	1376906784	1376906784	1	1	KHURDAJIAN, HAKOP OD	10/16/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
119125	Fee-for-Service	1518047729	1518047729	1	1	KOBAYASHI, MARK MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43597	24	Plastic Surgery	0	In state provider	None	10833 LE CONTE AVE	BLDG 64	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
119137	Fee-for-Service	1932789161	1932789161	1	1	KATE KUTNER THERAPY AN INDIV	10/17/2022	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	IDUAL & FAMILY COUNSELIN	5360 JACKSON DR	SUITE 218C	LA MESA	CA	91942	6002	37	06073	32.77680573	-117.0176327	San Diego County
119145	Fee-for-Service	1134154263	1134154263	1	1	KEIDEL, MARK T MD	9/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76937	08	Family Practice	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
119156	Fee-for-Service	1760541353	1760541353	1	1	KIM, MARIBELLE R MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7893	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
119159	Fee-for-Service	1033124854	1033124854	1	1	KRISHAN, RAJEEV MD	12/1/2010	174400000X	NA	Other	026	PHYSICIANS	76632	10	Gastroenterology (M.D. only)	0	In state provider	None	9900 STOCKDALE HWY	STE 208	BAKERSFIELD	CA	93311	3634	15	06029	35.35412167	-119.1124089	Kern County
119178	Fee-for-Service	1356599146	1356599146	1	1	KINSLEY, JANE L LMFT	9/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 MAIN ST	SUITE 1	HALF MOON BAY	CA	94019	1924	41	06081	37.46082146	-122.429628	San Mateo County
119189	Fee-for-Service	1871098111	1871098111	1	1	KNAPP, AUSTEN N MD	6/9/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	177155	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119195	Fee-for-Service	1689629057	1689629057	1	1	KEDAN, ILAN MD	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93684	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
119199	Fee-for-Service	1902356405	1902356405	1	1	KNAPP, JESSICA L NP	11/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119211	Fee-for-Service	1134135379	1134135379	1	1	KAMBUROWSKI,MARIA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
119214	Fee-for-Service	1407810625	1407810625	1	1	KIM, DAVID D MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55594	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	147 W SIERRA MADRE BLVD	None	SIERRA MADRE	CA	91024	2492	19	06037	34.16191714	-118.0557211	Los Angeles County
119270	Fee-for-Service	1508973249	1508973249	1	1	KLAUSNER, JEFFREY D MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81840	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
119274	Fee-for-Service	1154434306	1154434306	1	1	KEAGLE, JENNIFER N MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64773	02	General Surgery	0	In state provider	None	2400 SOUTH FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
119308	Fee-for-Service	1073786661	1073786661	1	1	KHALESSI, ARASH A MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95850	14	Neurological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
119344	Fee-for-Service	1942941315	1942941315	1	1	KRZECZOWSKI, RACHEL DO	7/30/2024	208600000X	NA	General Surgery	026	PHYSICIANS	22901	02	General Surgery	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
119384	Fee-for-Service	1245888403	1245888403	1	1	KINDRED HOSPICE INC	3/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12297 OSBORNE ST	None	PACOIMA	CA	91331	2001	19	06037	34.26552624	-118.4017763	Los Angeles County
119417	Fee-for-Service	1992122196	1992122196	1	1	KUO, ALEXANDER MD	5/7/2020	390200000X	NA	Other	026	PHYSICIANS	140026	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
119430	Fee-for-Service	1275960551	1275960551	1	1	KELLY, BRITTANY A LCSW	4/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
119447	Fee-for-Service	1164924809	1164924809	1	1	KING, LILY M LMFT	3/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
119453	Fee-for-Service	1609803824	1609803824	1	1	KOELLE, JONATHAN S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79002	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
119470	Fee-for-Service	1548355712	1548355712	1	1	KAKUTANI, CARLA L MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	70090	08	Family Practice	0	In state provider	None	111 E GRANT AVE	None	WINTERS	CA	95694	1761	57	06113	38.52669504	-121.9662404	Yolo County
119492	Fee-for-Service	1235373564	1235373564	1	1	KUMAR, SHIVESH S MD	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	6900 N DURANGO DR	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
119506	Fee-for-Service	1750489332	1750489332	1	1	KALPANA RAVIKUMAR MD INC	1/29/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	44215 15TH STREET WEST	SUITE 114	LANCASTER	CA	93534	5503	19	06037	34.68666415	-118.1568572	Los Angeles County
119512	Fee-for-Service	1093178444	1093178444	1	1	KHALAF, ALEXANDER M MD	6/22/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	150459	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119526	Fee-for-Service	1699776302	1699776302	1	1	KHANNA, CHAND MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	35189	41	Internal Medicine	0	In state provider	None	23928 LYONS AVE	STE 203	NEWHALL	CA	91321	2454	19	06037	34.37895689	-118.5532505	Los Angeles County
119555	Fee-for-Service	1063835817	1063835817	1	1	KIRAKOSIAN, ARMAN DPM INC	7/20/2015	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	883 SNEATH LANE	SUITE 160	SAN BRUNO	CA	94066	2409	41	06081	37.63591781	-122.4231037	San Mateo County
119556	Fee-for-Service	1447681473	1447681473	1	1	KOHLBERGER, BRITTANY PHD	6/25/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2050 PEABODY RD	SUITE 300	VACAVILLE	CA	95687	6695	48	06095	38.333556	-121.9704855	Solano County
119559	Fee-for-Service	1700556438	1700556438	1	1	KALBAKJI, NATALY OD	10/27/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 N EUCLID AVENUE	SUITE A	UPLAND	CA	91786	6031	36	06071	34.097508	-117.6509735	San Bernardino County
119630	Fee-for-Service	1225441371	1225441371	1	1	KEELEY, BRIEZE R MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149385	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119634	Fee-for-Service	1609107077	1609107077	1	1	KHAN, RUKSAANA MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110575	41	Internal Medicine	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0302	34	06067	38.669562	-121.31379	Sacramento County
119643	Fee-for-Service	1316125909	1316125909	1	1	KASHANI, SEYEDAMIR MD	12/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111882	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3297	33	06065	33.912117	-117.195849	Riverside County
119652	Fee-for-Service	1336281013	1336281013	1	1	KIM, ALEXANDER T OD	9/4/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	WILSHIRE OPTOMETRY INC	3873 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	3202	19	06037	34.0617135	-118.31121	Los Angeles County
119655	Fee-for-Service	1528080967	1528080967	2	1	KENNEDY, KATHLEEN A MD	8/22/2022	207RH0000X	NA	Hematology	026	PHYSICIANS	82547	41	Internal Medicine	0	In state provider	None	1325 CHURCH ST	301	SANTA MARIA	CA	93454	5909	42	06083	34.95209265	-120.4147348	Santa Barbara County
119667	Fee-for-Service	1245888403	1245888403	1	1	KINDRED HOSPICE INC	3/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12297 OSBORNE ST	None	PACOIMA	CA	91331	2001	19	06037	34.26552624	-118.4017763	Los Angeles County
119682	Fee-for-Service	1356817126	1356817126	1	1	KELSEY K ANDERSON	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
119700	Fee-for-Service	1326562208	1326562208	1	1	KAWANA, KAELA PT	2/5/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18700 BEACH BLVD	SUITE 120 SUITE 110	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
119729	Fee-for-Service	1427122746	1427122746	1	1	KHADYE, ASAWARI S MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87016	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
119743	Fee-for-Service	1609803824	1609803824	1	1	KOELLE, JONATHAN S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79002	36	Psychiatry	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
119744	Fee-for-Service	1184305245	1184305245	1	1	KARIMIANPOUR, YASAMAN	2/6/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
119758	Fee-for-Service	1639257132	1639257132	1	1	KRAWIEC, MARK MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78833	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
119759	Fee-for-Service	1962576264	1962576264	1	1	KIM, PHILLIP MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60325	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
119782	Fee-for-Service	1629134846	1629134846	1	1	KAUR, SHIVINDER B MD	3/16/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	49175	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	512 WESTLINE DR	STE 103	ALAMEDA	CA	94501	5870	01	06001	37.76543497	-122.2715354	Alameda County
119839	Fee-for-Service	1437167715	1437167715	1	1	KO, GEMMA T H MD	12/5/1995	207R00000X	NA	Other	026	PHYSICIANS	70866	41	Internal Medicine	0	In state provider	None	433 N 4TH ST	STE 219	MONTEBELLO	CA	90640	4309	19	06037	34.01561115	-118.1019888	Los Angeles County
119846	Fee-for-Service	1811476658	1811476658	1	1	KHAKSHOOR, DAVID DPM	1/16/2022	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2080 CENTURY PARK E	STE 1207	LOS ANGELES	CA	90067	2015	19	06037	34.05887194	-118.4122914	Los Angeles County
119891	Fee-for-Service	1699152819	1699152819	1	1	KIM PAGLINGAYEN, JIN SEON M	7/6/2018	390200000X	NA	Other	026	PHYSICIANS	147192	08	Family Practice	0	In state provider	D	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
119950	Fee-for-Service	1164928172	1164928172	1	1	KONECNY, CHRISTINA M MD	9/26/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164121	None	None	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
120013	Fee-for-Service	1558389296	1558389296	1	1	KRIS C ANDERSON MD	5/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
120045	Fee-for-Service	1205833563	1205833563	1	2	KIM, KENNETH T MD	3/24/2021	207K00000X	NA	Other	026	PHYSICIANS	61259	None	None	0	In state provider	None	2600 REDONDO AVE	SUITE 400	LONG BEACH	CA	90806	2329	19	06037	33.806097	-118.151378	Los Angeles County
120092	Fee-for-Service	1043526882	1043526882	1	1	KRISHNAN, S. MD INC	2/15/2011	261QP2300X	NA	Other	026	PHYSICIANS	54481	41	Internal Medicine	0	In state provider	None	1031 E LATHAM AVENUE	STE 3	HEMET	CA	92543	4425	33	06065	33.7493735	-116.961021	Riverside County
120100	Fee-for-Service	1649458977	1649458977	1	1	KAMAL, SAMER M MD	11/2/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	121370	None	None	0	In state provider	None	5016 CHESEBRO RD	STE 200	AGOURA HILLS	CA	91301	2277	19	06037	34.14134802	-118.7392827	Los Angeles County
120110	Fee-for-Service	1205958139	1205958139	1	1	KUMAR, NEEL R MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
120116	Fee-for-Service	1366001364	1366001364	1	1	KRAL, STEFANIE H LMFT	11/7/2023	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
120126	Fee-for-Service	1740349851	1740349851	1	1	KASHANI, ATAOLAH MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41464	01	General Practice	0	In state provider	RESEDA MEDICAL CLINIC	18355 SHERMAN WAY	None	RESEDA	CA	91335	4436	19	06037	34.20121151	-118.533726	Los Angeles County
120131	Fee-for-Service	1699828988	1699828988	2	1	KATZ, ELI MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	52482	-	NOT APPLICABLE	0	In state provider	None	222 WEST VALERIO STREET	REAR BUILDING	SANTA BARBARA	CA	93101	2930	42	06083	34.42532284	-119.7137898	Santa Barbara County
120142	Fee-for-Service	1205060977	1205060977	1	1	KOSHGERIAN, PAUL MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137233	01	General Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
120217	Fee-for-Service	1891181095	1891181095	1	1	KNIGHT, DARREN MD	7/8/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	147400	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
120220	Fee-for-Service	1023372059	1023372059	1	1	KHANGURA, NINA K MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138779	41	Internal Medicine	0	In state provider	None	8220 WYMARK DR	SUITE 200	ELK GROVE	CA	95823	5413	34	06067	38.406888	-121.4100495	Sacramento County
120233	Fee-for-Service	1740284108	1740284108	1	1	KONUGRES, GEORGE S DO	8/1/2002	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	4832	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3150 BRISTOL ST	STE 150	COSTA MESA	CA	92626	7300	30	06059	33.68601312	-117.8854624	Orange County
120264	Fee-for-Service	1114568698	1114568698	1	1	KAISER FOUNDATION HEALTH PLA	2/11/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	045	7007 ROMAINE ST	None	LOS ANGELES	CA	90038	2328	19	06037	34.0889433	-118.3418281	Los Angeles County
120273	Fee-for-Service	1578641361	1578641361	1	1	KOTLER, STEPHEN W MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45514	18	Ophthalmology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
120292	Fee-for-Service	1386062347	1386062347	1	1	KOO, MATTHEW S MD	7/22/2020	207ZH0000X	NA	Other	026	PHYSICIANS	142047	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120313	Fee-for-Service	1063420701	1063420701	1	1	KIARASH, MIRKIA L MD	2/21/2008	208600000X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	5052 S JONES BLVD	SUITE 135	LAS VEGAS	NV	89118	0556	00	None	36.09684	-115.2250345	Clark County
120355	Fee-for-Service	1497713945	1497713945	1	1	KEANE, GERALD P MD	10/31/1992	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	50793	25	Physical Medicine and Rehabilitation	0	In state provider	None	919 SIR FRANCIS DRAKE BL	STE B	KENTFIELD	CA	94904	1535	21	06041	37.95432123	-122.5459031	Marin County
120370	Fee-for-Service	1689839888	1689839888	1	1	KAISER FOUNDATION HEALTH	9/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #673	1 QUALITY DR	SPECIALTY CARE BLDG, 1ST	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
120379	Fee-for-Service	1699327585	1699327585	1	1	KENNEY, NICOLE L	6/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
120421	Fee-for-Service	1144666272	1144666272	1	1	KIM, JENNIFER S MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131917	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
120463	Fee-for-Service	1255474342	1255474342	1	1	KERNER, JOHN A MD	1/1/1982	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	28373	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
120484	Fee-for-Service	1700296316	1700296316	1	1	KING, ERIN M LPCC	12/20/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
120503	Fee-for-Service	1598774101	1598774101	1	1	KRENZ, ELIZABETH I MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99889	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
120505	Fee-for-Service	1659829380	1659829380	1	1	KANG, JONATHAN MD DO	9/24/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14957	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
120516	Fee-for-Service	1497814065	1497814065	1	1	KURZ, CAROL R MD	10/31/1986	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55779	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
120599	Fee-for-Service	1467650473	1467650473	1	1	KOH, STEVEN S H MD	1/13/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	103468	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
120636	Fee-for-Service	1902613268	1902613268	1	1	KARNAZES, SANDRA LCSW	12/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
120665	Fee-for-Service	1750097515	1750097515	1	1	KELSEY PIETRO INC	7/3/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2599 E 28TH ST	STE 206	SIGNAL HILL	CA	90755	2139	19	06037	33.80808345	-118.160964	Los Angeles County
120671	Fee-for-Service	1588003602	1588003602	1	1	KAREEM, WAASIL MD	4/27/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	148360	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
120685	Fee-for-Service	1962722884	1962722884	1	1	KAPPAZ, LISA LCSW	7/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
120695	Fee-for-Service	1215902333	1215902333	1	1	KEDANSKY, MICHAEL D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
120707	Fee-for-Service	1386987758	1386987758	1	1	KATSUURA, YOSHIHIRO MD	3/19/2024	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	147737	None	None	0	In state provider	None	165 ROWLAND WAY	208	NOVATO	CA	94945	5038	21	06041	38.09824386	-122.559872	Marin County
120743	Fee-for-Service	1447253232	1447253232	1	1	KEVIN R KRAFFT M.D	12/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6140 W CURTISIAN AVE	STE 400	BOISE	ID	83704	8907	00	None	43.61461148	-116.2563345	Ada County
120750	Fee-for-Service	1962589804	1962589804	1	1	KARLEN, KRIS M MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60715	18	Ophthalmology	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
120801	Fee-for-Service	1447256623	1447256623	1	1	KERR, KAROL H MD	4/30/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
120831	Fee-for-Service	1336237254	1336237254	1	1	KAPLAN, NANCY L DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2702 LOW CT	None	FAIRFIELD	CA	94534	9727	48	06095	38.23678474	-122.0847463	Solano County
120879	Fee-for-Service	1942705363	1942705363	1	1	KHAMVONGSA, ERICA L LMFT	7/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
120882	Fee-for-Service	1073192860	1073192860	1	1	KIM, MYUNGHOON MD	7/15/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
120948	Fee-for-Service	1972542645	1972542645	1	1	KANE, RICHARD A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	355 RIDGE AVE	None	EVANSTON	IL	60202	3328	00	None	42.02450175	-87.68519074	Cook County
120955	Fee-for-Service	1033586169	1033586169	1	1	KAGHAZWALA, MUSTAFA S MD	10/16/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18421	36	Psychiatry	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
120965	Fee-for-Service	1588003602	1588003602	1	1	KAREEM, WAASIL MD	4/27/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	148360	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
120976	Fee-for-Service	1982696969	1982696969	1	1	KANJANAPONE, VALLOP MD	3/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	33464	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	702 WAKE AVE	None	EL CENTRO	CA	92243	7502	13	06025	32.77066047	-115.560144	Imperial County
120992	Fee-for-Service	1720215114	1720215114	1	1	KRISHNAN, RAJ KUMAR	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
121002	Fee-for-Service	1295920320	1295920320	1	1	KRISHNA, VIVEK R MD	7/11/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	158833	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
121017	Fee-for-Service	1760561005	1760561005	1	1	KLAREN, MICHELLE C PT	3/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8901 ACTIVITY	200	SAN DIEGO	CA	92126	4432	37	06073	32.8960193	-117.1345934	San Diego County
121021	Fee-for-Service	1508166273	1508166273	1	1	KHAN, FARHAT N MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114102	08	Family Practice	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
121027	Fee-for-Service	1265465579	1265465579	1	1	KORETZ RONALD LM	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	23109	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA STE 36	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
121092	Fee-for-Service	1699918110	1699918110	1	1	KONG, MAX X MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142646	22	Pathology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
121100	Fee-for-Service	1154357713	1154357713	1	1	KURY, KRISTINA M MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54666	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
121116	Fee-for-Service	1295485761	1295485761	1	1	KAPLAN, ALEXANDER B MD	3/18/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
121133	Fee-for-Service	1003824673	1003824673	1	1	KHALEELI, HOSAYN MD INC	4/29/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62789	41	Internal Medicine	0	In state provider	None	4201 TORRANCE BLVD	STE 250	TORRANCE	CA	90503	4535	19	06037	33.8375955	-118.358748	Los Angeles County
121135	Fee-for-Service	1629541602	1629541602	1	1	KOTHARI, NEHA PT	3/8/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1252 BROADWAY	SUITE B	PLACERVILLE	CA	95667	5806	09	06017	38.73128098	-120.7852781	El Dorado County
121211	Fee-for-Service	1366881039	1366881039	1	1	KELLEHER, SHANNON R LCSW	11/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	256 CAJON ST	SUITE E	REDLANDS	CA	92373	5278	36	06071	34.05204454	-117.1802319	San Bernardino County
121215	Fee-for-Service	1972730752	1972730752	1	1	KIM, AIMEE MD	10/23/2023	2086S0120X	NA	General Surgery	026	PHYSICIANS	191497	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
121216	Fee-for-Service	1043397789	1043397789	1	1	KERSCHMANN, KAREN L LCSW	2/26/2008	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5440 MOREHOUSE DR	STE 3800 BOX 20	SAN DIEGO	CA	92121	1798	37	06073	32.89370849	-117.2010904	San Diego County
121221	Fee-for-Service	1942203526	1942203526	1	1	KHIEU, WILLIAM U MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	79719	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	102 SAN MIGUEL AVE	None	SALINAS	CA	93901	3057	27	06053	36.65895947	-121.6556795	Monterey County
121230	Fee-for-Service	1023274420	1023274420	1	1	KIM, STEVEN T DO	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10448	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
121245	Fee-for-Service	1053324079	1053324079	1	1	KOPER, ALEX MD	1/1/1982	208800000X	NA	Other	026	PHYSICIANS	32523	34	Urology and Urological Surgery	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
121297	Fee-for-Service	1932111770	1932111770	1	1	KOSOLCHAROEN, BUNCHONG MD	5/1/2001	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39985	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5196 HILL RD EAST	SUITE 203	LAKEPORT	CA	95453	6362	17	06033	39.10527946	-122.9080599	Lake County
121314	Fee-for-Service	1295732568	1295732568	1	1	KORULA, JACOB MD APMC	10/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39567	41	Internal Medicine	0	In state provider	None	622 W DUARTE RD	STE 304	ARCADIA	CA	91007	9280	19	06037	34.12645266	-118.0521552	Los Angeles County
121320	Fee-for-Service	1265465579	1265465579	1	1	KORETZ RONALD LM	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	23109	11	Aviation (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA STE 36	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
121344	Fee-for-Service	1346272994	1346272994	1	1	KOUZ, RAFID J MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52317	68	Hematology	0	In state provider	None	1300 N VERMONT AVE	STE 606	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
121349	Fee-for-Service	1619935079	1619935079	1	2	KUSUMOTO, WALTER T MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	60788	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1645 ESPLANADE	STE 3	CHICO	CA	95926	3367	04	06007	39.74374167	-121.8502328	Butte County
121357	Fee-for-Service	1275265696	1275265696	1	1	KIM, HEE CNP	8/23/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4829 CLAIREMONT DR	None	SAN DIEGO	CA	92117	2706	37	06073	32.83175462	-117.2052088	San Diego County
121358	Fee-for-Service	1730760513	1730760513	1	1	KAO, TIFFANY MD	3/27/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
121363	Fee-for-Service	1922460625	1922460625	1	1	KARMARKAR, MEGHANA MD	8/29/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	155081	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
121372	Fee-for-Service	1265428916	1265428916	1	1	KANG, DENO D MD INC	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60288	None	None	0	In state provider	None	18102 PIONEER BLVD	STE 204	ARTESIA	CA	90701	4407	19	06037	33.86654413	-118.0821405	Los Angeles County
121388	Fee-for-Service	1154357713	1154357713	1	1	KURY, KRISTINA M MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54666	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
121415	Fee-for-Service	1316108509	1316108509	1	1	KANG, HYUNSEOK MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156305	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
121428	Fee-for-Service	1164622742	1164622742	1	1	KIM, JUDITH M MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83503	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
121501	Fee-for-Service	1376744599	1376744599	1	1	KELLER, NOAH E MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117557	None	None	0	In state provider	None	5301 F ST	STE 313	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
121502	Fee-for-Service	1306923248	1306923248	1	1	KHAGHANI, OROD MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69872	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
121515	Fee-for-Service	1912098286	1912098286	1	1	KOHN, DONALD B MD	12/1/1995	2080P0207X	NA	Hematology	026	PHYSICIANS	60297	02	General Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
121527	Fee-for-Service	1124196894	1124196894	1	1	KIRKLAND, SHARI L PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
121565	Fee-for-Service	1679708234	1679708234	1	1	KHANAL, KRISHNA P MD	9/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121654	01	General Practice	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
121576	Fee-for-Service	1427652825	1427652825	1	1	KRITIKOS, LISA V NP	2/25/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
121584	Fee-for-Service	1932111770	1932111770	1	1	KOSOLCHAROEN, BUNCHONG MD	5/1/2001	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39985	41	Internal Medicine	0	In state provider	None	5196 HILL RD EAST	SUITE 203	LAKEPORT	CA	95453	6362	17	06033	39.10527946	-122.9080599	Lake County
121585	Fee-for-Service	1043472533	1043472533	1	1	KAMALVAND, EHSAN	5/20/2008	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1635 E LINCOLN AVE	None	ORANGE	CA	92865	1929	30	06059	33.83499747	-117.8370225	Orange County
121605	Fee-for-Service	1942297361	1942297361	1	1	KANAMORI, DAVID E MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69648	41	Internal Medicine	0	In state provider	None	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
121610	Fee-for-Service	1750466405	1750466405	1	1	KLEE, KARIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13611 E COLFAX AVE	None	AURORA	CO	80045	5701	00	None	39.74039327	-104.8302052	Adams County
121611	Fee-for-Service	1295732568	1295732568	1	1	KORULA, JACOB MD APMC	10/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39567	10	Gastroenterology (M.D. only)	0	In state provider	None	622 W DUARTE RD	STE 304	ARCADIA	CA	91007	9280	19	06037	34.12645266	-118.0521552	Los Angeles County
121629	Fee-for-Service	1346272994	1346272994	1	1	KOUZ, RAFID J MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52317	78	Neoplastic Diseases/Oncology	0	In state provider	None	1300 N VERMONT AVE	STE 606	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
121630	Fee-for-Service	1285647487	1285647487	1	1	KACHRU, RITA	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	77959	None	None	0	In state provider	None	200 MED PLAZA	#365	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
121642	Fee-for-Service	1740392810	1740392810	1	1	KIDNEY DISEASE MED GRP I	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1505 WILSON TER	STE 155	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
121665	Fee-for-Service	1821294307	1821294307	1	1	KOLSI, MICHELLE S MD	4/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93068	40	Pediatrics	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
121694	Fee-for-Service	1841364841	1841364841	1	1	KO, EDWARD K MD	6/21/2011	207R00000X	NA	Other	026	PHYSICIANS	61149	41	Internal Medicine	0	In state provider	None	818 JACKSON ST	STE 101	SAN FRANCISCO	CA	94133	4870	38	06075	37.79580797	-122.4086365	San Francisco County
121704	Fee-for-Service	1760001572	1760001572	1	1	KIM, YO SUP MD	4/24/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121707	Fee-for-Service	1770685539	1770685539	1	1	KURT K RHYNHART M.D	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MEDICAL CENTER DR	None	LEBANON	NH	03756	1000	00	None	43.677621	-72.272745	Grafton County
121724	Fee-for-Service	1790897452	1790897452	1	1	KEVIN L GARDNER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	WASATCH PEAK FAMILY PRAC	1492 W ANTELOPE	None	LAYTON	UT	84041	1222	00	None	41.08925052	-111.99375	Davis County
121729	Fee-for-Service	1730684333	1730684333	1	1	KUO, CHRISTINE E MD	7/22/2022	207L00000X	NA	Other	026	PHYSICIANS	166060	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
121737	Fee-for-Service	1598183642	1598183642	1	1	KRAMER, KATELIN P MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143200	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
121755	Fee-for-Service	1558812958	1558812958	1	1	KARKI, PUJA CRNA	8/28/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
121773	Fee-for-Service	1932575388	1932575388	1	1	KO, JANET Y OD	9/6/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1598 WASHINGTON AVE	None	SAN LEANDRO	CA	94577	4465	01	06001	37.72227514	-122.1546132	Alameda County
121778	Fee-for-Service	1043997174	1043997174	1	1	KEVORY HOLDING COMPANY, INC	10/11/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5426 AVENIDA FIESTA	None	LA JOLLA	CA	92037	7202	37	06073	32.81883788	-117.2323504	San Diego County
121789	Fee-for-Service	1669631065	1669631065	1	1	KELLY, JEFFREY A PSYD	1/29/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1080 MASON MALL	6C	CRESCENT CITY	CA	95531	4334	08	06015	41.75270062	-124.1949584	Del Norte County
121806	Fee-for-Service	1265930481	1265930481	1	1	KATZ, STACEY LPCC	10/1/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
121809	Fee-for-Service	1679797575	1679797575	1	1	KINGS VIEW	10/2/2015	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	559 E BARDSLEY AVENUE	None	TULARE	CA	93274	5400	54	06107	36.1965538	-119.3415894	Tulare County
121810	Fee-for-Service	1699041426	1699041426	1	1	KESHISHIAN, DERIK MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135560	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2940	10	06019	36.84133078	-119.7824983	Fresno County
121814	Fee-for-Service	1821164690	1821164690	1	1	KELLMAN, LISA DO	6/1/1987	207P00000X	NA	Other	026	PHYSICIANS	5062	None	None	0	In state provider	None	16453 COLORADO AVE	None	PARAMOUNT	CA	90723	5011	19	06037	33.8848803	-118.1614216	Los Angeles County
121826	Fee-for-Service	1346970639	1346970639	1	1	KATER, LAURA LMFT	3/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
121861	Fee-for-Service	1376625327	1376625327	1	1	KLEIN, JULIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5301 E GRANT RD	None	TUCSON	AZ	85712	2805	00	None	32.252391	-110.8790055	Pima County
121874	Fee-for-Service	1003831793	1003831793	1	1	KRUUSMAGI, ELLEN B MD	2/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61813	08	Family Practice	0	In state provider	None	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	49	06097	38.440494	-122.74353	Sonoma County
121894	Fee-for-Service	1033110945	1033110945	1	1	KUSINIS, KEITH T MD	3/16/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	59736	08	Family Practice	0	In state provider	None	2035 BONITA AVE	None	LA VERNE	CA	91750	4442	19	06037	34.10181432	-117.7708168	Los Angeles County
121918	Fee-for-Service	1346272994	1346272994	1	1	KOUZ, RAFID J MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52317	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	STE 606	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
121936	Fee-for-Service	1538600952	1538600952	1	1	KIM, JACKSON P MD	8/4/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	158667	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121948	Fee-for-Service	1841206554	1841206554	1	1	KIM, ANGELA W MD	7/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75519	18	Ophthalmology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
121989	Fee-for-Service	1750813721	1750813721	1	1	KEP, JENNIFER DPM	10/4/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
121995	Fee-for-Service	1912149071	1912149071	1	1	KIMMERLING, REUVEN E MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121567	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
122002	Fee-for-Service	1568445476	1568445476	1	1	KIM, KEE D MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	52119	14	Neurological Surgery	0	In state provider	None	4860 Y ST	STE 100	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
122023	Fee-for-Service	1275920514	1275920514	1	1	KEEL, JESSICA MD	3/4/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162001	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
122093	Fee-for-Service	1891789350	1891789350	1	1	KADAR, ANDREW G MD INC	5/26/1977	207L00000X	NA	Other	026	PHYSICIANS	28333	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
122110	Fee-for-Service	1285711358	1285711358	1	1	KIMBERLY IRELAND, ARNP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6342 LITTLEROCK RD SW	None	TUMWATER	WA	98512	0000	00	None	46.99136462	-122.9242008	Thurston County
122117	Fee-for-Service	1972999464	1972999464	1	1	KINGSTON, SARA E MD	7/7/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172065	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
122152	Fee-for-Service	1245734789	1245734789	1	1	KHADARIAN, KEVORK A MD	4/30/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	164332	10	Gastroenterology (M.D. only)	0	In state provider	None	19950 RINALDI ST	300	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
122182	Fee-for-Service	1295391357	1295391357	1	1	KELLY M MANN	6/4/2020	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 CAROLINE ST	None	PORT ANGELES	WA	98362	3909	00	None	48.11505263	-123.4151177	Clallam County
122185	Fee-for-Service	1669675294	1669675294	1	1	KULLAR, RAVJEET K MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96939	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
122331	Fee-for-Service	1841587474	1841587474	1	1	KHANNA, NIMISHA D MD	7/29/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160478	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
122349	Fee-for-Service	1144392952	1144392952	1	1	KU, BERNICE M MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	57620	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
122355	Fee-for-Service	1649980939	1649980939	1	1	KAUR, SARABJIT NP	3/21/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	33	06065	33.52069117	-117.1653103	Riverside County
122356	Fee-for-Service	1780468389	1780468389	1	1	KIRSTEN ANGELIYAN MARRIAGE A	9/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ND FAMILY THERAPY, PROFE	4103 BERNARDO DR	None	SAN LUIS OBISPO	CA	93401	6250	40	06079	35.25231399	-120.633643	San Luis Obispo County
122394	Fee-for-Service	1871759084	1871759084	1	1	KANSAL, LEENA R MD	7/13/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	99271	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
122431	Fee-for-Service	1720665409	1720665409	1	1	KOWALSKI, MAREK M MD	3/14/2024	208M00000X	NA	Other	026	PHYSICIANS	186720	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
122497	Fee-for-Service	1174982912	1174982912	1	1	KUENNING, DOUGLAS C	5/1/2017	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4460 BLACK AVE	SUITE F	PLEASANTON	CA	94566	3169	01	06001	37.67215839	-121.8770704	Alameda County
122529	Fee-for-Service	1801126388	1801126388	1	1	KNIGHT, CHRISTINE LCSW	2/4/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10 DECLARATION DR	STE B	CHICO	CA	95973	4931	04	06007	39.7706355	-121.8743732	Butte County
122580	Fee-for-Service	1023166832	1023166832	1	1	KETSELA, GIZATCHEW MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81611	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
122605	Fee-for-Service	1134682610	1134682610	1	1	KHOSRAVI, CHAYANNE MD	6/11/2024	207R00000X	NA	Other	026	PHYSICIANS	180382	41	Internal Medicine	0	In state provider	None	400 PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
122622	Fee-for-Service	1316056146	1316056146	1	1	KUO, ALICE A MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63708	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
122631	Fee-for-Service	1699111690	1699111690	1	1	KENNEDY, ASHLEIGH J MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143750	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
122655	Fee-for-Service	1083879746	1083879746	1	1	KALANI, AMENEH DONYA MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132886	02	General Surgery	0	In state provider	None	202 W WILLOW AVE	SUITE 402	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
122659	Fee-for-Service	1801258843	1801258843	1	1	KARL SUN, M.D. INC.	1/10/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5555 RESERVOIR DRIVE	SUITE 112	SAN DIEGO	CA	92120	5195	37	06073	32.77628471	-117.0563688	San Diego County
122672	Fee-for-Service	1730237710	1730237710	1	1	KELLY, ADRIENNE M MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69080	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
122675	Fee-for-Service	1063554566	1063554566	1	1	KADOYAN, ARA D MD	12/3/1986	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42544	36	Psychiatry	0	In state provider	None	1560 E CHEVY CHASE DR	STE 340	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
122677	Fee-for-Service	1144837444	1144837444	1	1	KUN, VALERIE T CCC-A	4/3/2024	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	18725 GALE AVE	STE 209	CITY OF INDUSTRY	CA	91748	1358	19	06037	33.99452087	-117.8945676	Los Angeles County
122686	Fee-for-Service	1528008430	1528008430	1	1	KAHN, LISA PHD	9/1/1997	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16633 VENTURA BLVD	STE 1212	ENCINO	CA	91436	1869	19	06037	34.15803404	-118.4955475	Los Angeles County
122701	Fee-for-Service	1134582844	1134582844	1	1	KMD, LP	6/14/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2017 WEST AVENUE K-13	None	LANCASTER	CA	93536	5369	19	06037	34.6750593	-118.1664077	Los Angeles County
122712	Fee-for-Service	1679649743	1679649743	1	1	KHALIFE, MOHAMMED W MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	31097	05	Anesthesiology	0	In state provider	None	792 W TOWN AND COUNTRY R	None	ORANGE	CA	92868	4710	30	06059	33.77649954	-117.860409	Orange County
122736	Fee-for-Service	1598813644	1598813644	1	1	KHAWAR, OSMAN S MD	2/28/2008	207R00000X	NA	Other	026	PHYSICIANS	92165	45	Nephrology (Renal-Kidney)	0	In state provider	None	631 E GRAND AVENUE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12468152	-117.073451	San Diego County
122763	Fee-for-Service	1043393986	1043393986	1	1	KUMAR, RAJAPURAM R MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	36528	41	Internal Medicine	0	In state provider	None	780 W OLIVE AVE	STE 103	MERCED	CA	95348	2437	24	06047	37.31916174	-120.4814268	Merced County
122805	Fee-for-Service	1417998410	1417998410	1	1	KADIN, JAMES A MD	2/28/1985	207P00000X	NA	Other	026	PHYSICIANS	24975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	307 E CLARA ST	None	PORT HUENEME	CA	93041	2733	56	06111	34.1516463	-119.1967688	Ventura County
122807	Fee-for-Service	1245716190	1245716190	1	1	KISKIN, JOHN PT	12/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27450 YNEZ RD	SUITE 120	TEMECULA	CA	92591	4671	33	06065	33.50684549	-117.1502048	Riverside County
122828	Fee-for-Service	1750620522	1750620522	1	1	KNIGHT, JERRY LCSW	1/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
122875	Fee-for-Service	1801392428	1801392428	1	1	KAN, MARIE DENISE B MD	9/10/2021	207R00000X	NA	Other	026	PHYSICIANS	174547	None	None	0	In state provider	None	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	41	06081	37.5239043	-122.2667778	San Mateo County
122883	Fee-for-Service	1588663769	1588663769	1	5	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	126 S FLORAL ST	None	VISALIA	CA	93291	6259	54	06107	36.329472	-119.295558	Tulare County
122909	Fee-for-Service	1316056146	1316056146	1	1	KUO, ALICE A MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63708	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
122915	Fee-for-Service	1104818277	1104818277	1	1	KROEKER, BYRON L PT	9/27/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	701 CENTRAL VALLEY HWY	STE B & C	SHAFTER	CA	93263	2076	15	06029	35.50107282	-119.272308	Kern County
122980	Fee-for-Service	1639372170	1639372170	1	1	KESTER, LAURA M MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145145	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
122981	Fee-for-Service	1952454365	1952454365	1	1	KACHE, SARASWATI MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63936	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
123022	Fee-for-Service	1598813644	1598813644	1	1	KHAWAR, OSMAN S MD	2/28/2008	207R00000X	NA	Other	026	PHYSICIANS	92165	41	Internal Medicine	0	In state provider	None	631 E GRAND AVENUE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12468152	-117.073451	San Diego County
123050	Fee-for-Service	1043393986	1043393986	1	1	KUMAR, RAJAPURAM R MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	36528	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	780 W OLIVE AVE	STE 103	MERCED	CA	95348	2437	24	06047	37.31916174	-120.4814268	Merced County
123069	Fee-for-Service	1780039396	1780039396	1	1	KAZEMINI, NEDA LMFT	7/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
123071	Fee-for-Service	1669644563	1669644563	1	1	KALYAN, RANJANI MD	12/1/2010	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	113875	77	Infectious Disease	0	In state provider	None	5 MEDICAL PLAZA DR	STE 190	ROSEVILLE	CA	95661	2867	31	06061	38.76604411	-121.2466761	Placer County
123078	Fee-for-Service	1316106685	1316106685	1	1	KATCHERIAN, CHRISTOPHER G MD	12/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108987	46	Hand Surgery	0	In state provider	None	4902 IRVINE CENTER DR	SUITE 107	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
123088	Fee-for-Service	1003019936	1003019936	1	1	KWOK, JOSEPH C DO	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10770	25	Physical Medicine and Rehabilitation	0	In state provider	None	851 TRAEGER AVE	None	SAN BRUNO	CA	94066	3022	41	06081	37.62776422	-122.4223323	San Mateo County
123090	Fee-for-Service	1982639993	1982639993	1	1	KASEM, MARY N MD	11/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72302	None	None	0	In state provider	None	23838 VALENCIA BLVD	STE 200	VALENCIA	CA	91355	5319	19	06037	34.41337791	-118.5520369	Los Angeles County
123123	Fee-for-Service	1225333719	1225333719	1	1	KAISER FOUNDATION HEALTH	2/17/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #886	888 S HILL RD	FLR 1	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
123236	Fee-for-Service	1235688532	1235688532	1	1	KHARAZI, PAYAM PSYD	9/3/2021	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
123251	Fee-for-Service	1174609556	1174609556	1	1	KIMBALL, MATTHEW M MD	9/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135585	14	Neurological Surgery	0	In state provider	None	2 MEDICAL PLAZA DRIVE	STE 205	ROSEVILLE	CA	95661	3044	31	06061	38.76507948	-121.2477476	Placer County
123302	Fee-for-Service	1972671196	1972671196	1	1	KAISER, CAMERON D MD	3/18/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	91013	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
123303	Fee-for-Service	1568411429	1568411429	1	1	KMUCHA, STEVEN T MD	10/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65391	04	Otology, Laryngology, Rhinology	0	In state provider	None	108 LYNCH CREEK WAY	SUITE 7	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
123308	Fee-for-Service	1881652998	1881652998	1	1	KARNES, WILLIAM E MD	1/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57458	01	General Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
123309	Fee-for-Service	1497916852	1497916852	1	1	KONG, MARSHALL M MD	1/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145521	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
123341	Fee-for-Service	1962780049	1962780049	1	1	KREGER, EMILY M MD	3/20/2020	2086S0102X	NA	General Surgery	026	PHYSICIANS	133093	02	General Surgery	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
123360	Fee-for-Service	1295934826	1295934826	1	1	KIMIA, TANIA MD	3/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70419	03	Allergy	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
123366	Fee-for-Service	1316106685	1316106685	1	1	KATCHERIAN, CHRISTOPHER G MD	12/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108987	02	General Surgery	0	In state provider	None	4902 IRVINE CENTER DR	SUITE 107	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
123380	Fee-for-Service	1154862357	1154862357	1	1	KURZ, TROY L MD	8/27/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157190	36	Psychiatry	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
123433	Fee-for-Service	1366514044	1366514044	1	1	KHANNA, SANDEEP K MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	48969	18	Ophthalmology	0	In state provider	None	433 N 4TH ST	STE 214	MONTEBELLO	CA	90640	4309	19	06037	34.01561115	-118.1019888	Los Angeles County
123484	Fee-for-Service	1124000831	1124000831	1	1	KRAUEL, THOMAS F OD	3/19/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 THOMASON LN	None	ALTURAS	CA	96101	3150	25	06049	41.49499631	-120.5560718	Modoc County
123505	Fee-for-Service	1568570109	1568570109	1	1	KLEYNBERG MEDICAL CLINIC	8/5/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	6221 WILSHIRE BLVD	STE 504	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
123518	Fee-for-Service	1770542920	1770542920	1	1	KAUPKE, CHARLES MD	2/8/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	38574	45	Nephrology (Renal-Kidney)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
123527	Fee-for-Service	1568717957	1568717957	1	1	KELLEY NICOLE HAGEDOM MD	7/8/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVENUE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
123528	Fee-for-Service	1801425244	1801425244	1	1	KRYSHTAFOVYCH, SOLOMIYA MD	11/17/2023	207P00000X	NA	Other	026	PHYSICIANS	189420	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
123536	Fee-for-Service	1861716805	1861716805	1	1	KOON, SHIRLEY S DO	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14866	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	STE 220	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
123548	Fee-for-Service	1093977696	1093977696	1	1	KAKU, SHAWN K MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109964	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
123560	Fee-for-Service	1760821375	1760821375	1	1	KIM, HAN MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148354	18	Ophthalmology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
123566	Fee-for-Service	1194922351	1194922351	1	1	KITTUR, DARSHANA A MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106227	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
123568	Fee-for-Service	1255390464	1255390464	1	1	KIARASH MICHEL, M.D.	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81612	34	Urology and Urological Surgery	0	In state provider	A MEDICAL CORPORATION	8631 W 3RD ST	STE 715E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
123585	Fee-for-Service	1841524824	1841524824	1	1	KHAN, MAHBUBA MD	9/15/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	109032	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123593	Fee-for-Service	1407210461	1407210461	1	1	KIM, YOON-JIN	5/20/2024	2085R0204X	NA	Other	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
123598	Fee-for-Service	1881652998	1881652998	1	1	KARNES, WILLIAM E MD	1/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57458	10	Gastroenterology (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
123615	Fee-for-Service	1922238443	1922238443	1	1	KELSO, ANNETTE L LMFT	5/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	673 S AUBURN ST	STE B	GRASS VALLEY	CA	95945	7576	29	06057	39.2060146	-121.0613316	Nevada County
123692	Fee-for-Service	1861610859	1861610859	1	1	KOREAN HEALTH EDUCATION	10/20/1999	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	KHEIR ADHC-GRAMERCY PL	3030 W 8TH ST	STE 100	LOS ANGELES	CA	90005	1812	19	06037	34.0577165	-118.2925674	Los Angeles County
123699	Fee-for-Service	1922623552	1922623552	1	1	KAMIN CONSULTING, INC.	6/15/2023	174H00000X	NA	Other	102	DIABETES PREVENTION PROGRAM SUPPLIER	-	-	NOT APPLICABLE	0	In state provider	None	1111 BROADWAY	FLOOR 3	OAKLAND	CA	94607	4139	01	06001	37.80259998	-122.272282	Alameda County
123708	Fee-for-Service	1023128428	1023128428	1	1	KUO, WILLIAM T MD	9/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91133	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
123711	Fee-for-Service	1255316303	1255316303	2	1	KING, DANA M MD	7/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
123715	Fee-for-Service	1225072150	1225072150	1	1	KIM, JUDY M CRNA	1/22/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 N STATE ST	# 14-901	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
123722	Fee-for-Service	1447414180	1447414180	1	1	KAO, WEI-HSIN OD	12/3/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9428 VALLEY BLVD	STE 201	ROSEMEAD	CA	91770	1513	19	06037	34.0811223	-118.0635319	Los Angeles County
123733	Fee-for-Service	1679734362	1679734362	1	1	KHATER, NAZIH M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127635	34	Urology and Urological Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2050	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
123743	Fee-for-Service	1528281607	1528281607	1	1	KREMSKY, STANTON S MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47581	None	None	0	In state provider	P O BOX 660	1125 E 17TH ST	STE W125	SANTA ANA	CA	92701	2213	30	06059	33.76004145	-117.854838	Orange County
123803	Fee-for-Service	1770542920	1770542920	1	1	KAUPKE, CHARLES MD	2/8/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	38574	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
123843	Fee-for-Service	1003971102	1003971102	1	1	KOLAKOWSKI, STEPHEN MD	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146610	02	General Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
123848	Fee-for-Service	1487679858	1487679858	1	1	KIM, DOOJIN MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76453	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA STE B-	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
123850	Fee-for-Service	1255390464	1255390464	1	1	KIARASH MICHEL, M.D.	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81612	78	Neoplastic Diseases/Oncology	0	In state provider	A MEDICAL CORPORATION	8631 W 3RD ST	STE 715E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
123876	Fee-for-Service	1508808114	1508808114	2	1	KHAYAM-BASHI, SHIEVA C MD	3/1/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80687	08	Family Practice	0	In state provider	None	302 SILVER AVENUE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
123883	Fee-for-Service	1053742635	1053742635	1	1	KAMRANY, ELINA K LMFT	7/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23591 EL TORO ROAD	SUITE 207	LAKE FOREST	CA	92630	4774	30	06059	33.62150109	-117.699484	Orange County
123892	Fee-for-Service	1821076852	1821076852	1	1	KAMINSKY, ILYA RPT INC	8/1/2000	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6222 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90048	5193	19	06037	34.06325771	-118.3641574	Los Angeles County
123896	Fee-for-Service	1780004325	1780004325	1	1	KERN, KYLE C MD	11/16/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	139767	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
123914	Fee-for-Service	1992136683	1992136683	1	1	KOUHKAN, MEHRNAZ DPM	6/26/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9640 VENICE BLVD	None	CULVER CITY	CA	90232	2626	19	06037	34.02441972	-118.3967126	Los Angeles County
123937	Fee-for-Service	1104131184	1104131184	1	1	KASHIF, FARHEEN MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118066	41	Internal Medicine	0	In state provider	None	450 EAST ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
123974	Fee-for-Service	1114905007	1114905007	1	1	KROL, CHRISTOPHER M MD	6/20/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171861	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
123975	Fee-for-Service	1942299086	1942299086	1	1	K JOE REID, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5757 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4641	00	None	33.609672	-112.182786	Maricopa County
123977	Fee-for-Service	1710165006	1710165006	1	1	KARST, JEFFREY G MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89847	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
123999	Fee-for-Service	1003211343	1003211343	1	1	KOZAREV, OLIVIA LCSW	12/18/2017	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1252 BROADWAY	SUITE I	EL CAJON	CA	92021	4904	37	06073	32.80773453	-116.9381385	San Diego County
124056	Fee-for-Service	1831501840	1831501840	1	1	KYUNG, SUNGWON R MD	7/15/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	142183	78	Neoplastic Diseases/Oncology	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
124070	Fee-for-Service	1841549979	1841549979	1	1	KLIM, KARIE L LMFT	7/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	182 FARMERS LANE	204	SANTA ROSA	CA	95405	4761	49	06097	38.450979	-122.687253	Sonoma County
124077	Fee-for-Service	1972796332	1972796332	1	1	KUMAR, VISHAL MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105807	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
124096	Fee-for-Service	1417452913	1417452913	1	1	KAUR, GURMEHR MD	11/7/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176406	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
124101	Fee-for-Service	1629463682	1629463682	1	1	KROLOFF, MAXWELL J MD	3/29/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	143959	None	None	0	In state provider	None	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
124146	Fee-for-Service	1285830299	1285830299	1	1	KRAUSS, WILLIAM C MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102743	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
124154	Fee-for-Service	1881854941	1881854941	1	1	KHO, LINNA MD	9/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101703	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
124226	Fee-for-Service	1831615806	1831615806	1	1	KANG, RACHEL	10/2/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
124241	Fee-for-Service	1588600993	1588600993	1	1	KUO, KANE E MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84582	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
124269	Fee-for-Service	1659407534	1659407534	1	1	KAPPEL, PETER J MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88426	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
124303	Fee-for-Service	1760428445	1760428445	1	1	KATANI, MONIR MD	8/31/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54098	40	Pediatrics	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
124306	Fee-for-Service	1568623049	1568623049	1	2	KIM, JOSEPH MD	1/11/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	117128	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
124318	Fee-for-Service	1407932320	1407932320	1	1	KORNU, CHRISTINE W MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77521	40	Pediatrics	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
124319	Fee-for-Service	1912447665	1912447665	1	1	KEEVER, MARCELLA E	6/30/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	6006	34	06067	38.56554	-121.4664615	Sacramento County
124343	Fee-for-Service	1831501840	1831501840	1	1	KYUNG, SUNGWON R MD	7/15/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	142183	68	Hematology	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
124356	Fee-for-Service	1821625112	1821625112	1	1	KYINN, MABEL S MD	8/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179756	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
124376	Fee-for-Service	1558438382	1558438382	1	1	KHAIRULLAH, FIRHANA Z DO	12/26/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9087	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
124377	Fee-for-Service	1437478245	1437478245	1	1	KHAN, ROOZEHRA A DO	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
124396	Fee-for-Service	1700865417	1700865417	1	1	KILLMEIER, ALEXA P MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78045	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
124403	Fee-for-Service	1528621901	1528621901	1	1	KHEZRI, NICOLE	10/25/2024	390200000X	NA	Other	026	PHYSICIANS	188564	45	Nephrology (Renal-Kidney)	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
124440	Fee-for-Service	1588935118	1588935118	1	1	KINSEY, GENEVIEVE N MD	5/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119674	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
124452	Fee-for-Service	1912085721	1912085721	1	1	KIEKHAEFER, MICHAEL L MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69993	13	Neurology (M.D. only)	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
124470	Fee-for-Service	1124092549	1124092549	1	1	KHAN, RAHIL MD	3/18/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62362	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
124528	Fee-for-Service	1417913872	1417913872	1	1	KLEINMEN, ROBERT MICHAEL	1/31/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70487	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
124566	Fee-for-Service	1477641090	1477641090	2	1	KITT, DONALD C MD	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50585	13	Neurology (M.D. only)	0	In state provider	None	2250 HAYES ST	STE 504	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
124665	Fee-for-Service	1437478245	1437478245	1	1	KHAN, ROOZEHRA A DO	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11158	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
124680	Fee-for-Service	1023459211	1023459211	1	1	KOLOSKY, MATTHEW DO	1/8/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	15989	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITE 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
124704	Fee-for-Service	1467913061	1467913061	1	1	KULAR, RAJDEEP S MD	8/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179548	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
124719	Fee-for-Service	1659830040	1659830040	1	1	KRALIK, NATHANIEL C DO	7/15/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19606	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
124728	Fee-for-Service	1679621528	1679621528	1	1	KINNEY, LAURAINE J MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	23280	38	Geriatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
124738	Fee-for-Service	1912085721	1912085721	1	1	KIEKHAEFER, MICHAEL L MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69993	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
124746	Fee-for-Service	1285924290	1285924290	1	1	KANE, ARI J M MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141646	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
124756	Fee-for-Service	1396721569	1396721569	1	1	KUTSEN, MICHAEL C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6501 PRESTON RD	None	PLANO	TX	75024	2610	00	None	33.06156917	-96.79637224	Collin County
124764	Fee-for-Service	1518012301	1518012301	1	1	KAISER FOUNDATION	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL-DOWNEY	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
124803	Fee-for-Service	1548336589	1548336589	1	1	KING, FRANCES A LCSW	6/25/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3114 WILLOW AVE	STE 102	FRESNO	CA	93612	4750	10	06019	36.79547557	-119.7274817	Fresno
124817	Fee-for-Service	1821143777	1821143777	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
124830	Fee-for-Service	1932791456	1932791456	1	1	KESHISHYAN, DENIS NP	11/13/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
124860	Fee-for-Service	1801961511	1801961511	1	1	KAISER FOUNDATION HOSPITAL	8/28/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL SAN FRANCISCO	4131 GEARY BLVD	4TH FLOOR	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
124879	Fee-for-Service	1669033411	1669033411	1	1	KIM, BOBAE MD	9/19/2023	208M00000X	NA	Other	026	PHYSICIANS	181097	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
124886	Fee-for-Service	1649390147	1649390147	1	1	KANG, LISA M OD	9/7/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 W 6TH STREET	SUITE 101	CORONA	CA	92882	6508	33	06065	33.87811444	-117.5920508	Riverside County
124898	Fee-for-Service	1679265979	1679265979	1	1	KAUR, KAWALPREET	8/28/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
124900	Fee-for-Service	1245527340	1245527340	1	1	KIM, SANG Y DPM	5/5/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5451 LA PALMA AVE	SUITE 26	LA PALMA	CA	90623	1705	30	06059	33.84643146	-118.038843	Orange County
124923	Fee-for-Service	1962081463	1962081463	1	1	KIM, EUNA DO	10/13/2024	207R00000X	NA	Other	026	PHYSICIANS	20933	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
124924	Fee-for-Service	1699017061	1699017061	1	1	KAPLAN, RACHEL D DO	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14146	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
124953	Fee-for-Service	1043461007	1043461007	1	1	KENNEDY, MARY P LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
124989	Fee-for-Service	1003870007	1003870007	1	1	KANG, SANG-MO MD	5/1/1999	208600000X	NA	General Surgery	026	PHYSICIANS	78412	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
125013	Fee-for-Service	1073571741	1073571741	1	1	KOSTER, NANCY K MD	2/5/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	167408	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
125022	Fee-for-Service	1225066962	1225066962	1	1	KOHLI, GURMANDER S MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51411	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
125058	Fee-for-Service	1689297798	1689297798	1	1	KARUN GOGNA MD INC	7/15/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
125069	Fee-for-Service	1912959073	1912959073	1	1	KALOKOH , ISMAIL M	5/23/2023	207R00000X	NA	Other	026	PHYSICIANS	184616	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
125098	Fee-for-Service	1083702807	1083702807	1	1	KRANTZ, JODY SUE MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62688	67	Endocrinology	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
125149	Fee-for-Service	1801961511	1801961511	1	1	KAISER FOUNDATION HOSPITAL	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL SAN FRANCISCO	4131 GEARY BLVD	4TH FLOOR	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
125207	Fee-for-Service	1598259434	1598259434	1	1	KUIVENHOVEN, MATTHEW C DO	9/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19802	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
125215	Fee-for-Service	1932206224	1932206224	1	1	KAPOOR, SHALINI MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52055	18	Ophthalmology	0	In state provider	None	850 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4729	19	06037	34.05097684	-118.1379979	Los Angeles County
125219	Fee-for-Service	1962494575	1962494575	1	1	KORTE, CINDY MD	2/28/1992	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	73650	None	None	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
125254	Fee-for-Service	1174056220	1174056220	1	1	KWAN, EVAN MD	8/19/2021	207L00000X	NA	Other	026	PHYSICIANS	158417	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
125263	Fee-for-Service	1255328282	1255328282	2	2	KCI USA, INC	10/1/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	1380 GREG ST	SUITE 238	SPARKS	NV	89431	6072	00	None	39.52341171	-119.7606089	Washoe County
125272	Fee-for-Service	1346405842	1346405842	1	1	KOCHUVELI, BELLA MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111012	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN STREET	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
125294	Fee-for-Service	1407973902	1407973902	1	1	KWAN, JANE C MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78814	07	Dermatology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
125366	Fee-for-Service	1689863631	1689863631	1	1	KASSABIAN, SIRVART MD	6/6/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	170372	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
125385	Fee-for-Service	1083702807	1083702807	1	1	KRANTZ, JODY SUE MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62688	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
125407	Fee-for-Service	1588996078	1588996078	1	1	KITAZONO, RACHEL PHD	11/17/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
125438	Fee-for-Service	1013091099	1013091099	1	1	KUNKEL, JOHN F MD	8/12/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83756	22	Pathology (M.D. only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
125445	Fee-for-Service	1851430896	1851430896	1	1	KELLER, KIMBERLIE M DO	6/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11627	08	Family Practice	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
125481	Fee-for-Service	1013361815	1013361815	1	1	KHAN, SHAHFAR MD	7/7/2022	2080P0204X	NA	Other	026	PHYSICIANS	179228	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
125483	Fee-for-Service	1962442129	1962442129	1	1	KING, JENNIFER J MD	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76318	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
125521	Fee-for-Service	1871963454	1871963454	1	1	KLEIN, MARCUS PSYD	3/3/2022	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
125556	Fee-for-Service	1932219219	1932219219	1	1	KEAYS, SANDRA L LMFT	5/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16152 BEACH BLVD	STE 170	HUNTINGTON BEACH	CA	91762	0000	30	06059	33.72889962	-117.9891397	Orange County
125581	Fee-for-Service	1356070502	1356070502	1	1	KOSKINEN, KAREN L LCSW	10/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
125612	Fee-for-Service	1639244262	1639244262	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	WALNUT CREEK	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
125682	Fee-for-Service	1093990764	1093990764	1	1	KIM, ELLIOT H J LAC	6/7/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	8253 SIERRA AVE	SUITE 205	FONTANA	CA	92335	3577	36	06071	34.10379	-117.4357525	San Bernardino County
125726	Fee-for-Service	1740904259	1740904259	1	1	KARUKU, RACHEL W	6/23/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	36895 CENTAURUS PL	None	MURRIETA	CA	92563	2796	33	06065	33.58315676	-117.135013	Riverside County
125758	Fee-for-Service	1669423877	1669423877	1	1	KYLATHU, RANJIT MD	2/26/2025	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
125794	Fee-for-Service	1568856474	1568856474	1	1	KELSON, KYLE R MD	2/28/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159572	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
125808	Fee-for-Service	1194716225	1194716225	1	1	KHERA, KANWARJIT S MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141297	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
125812	Fee-for-Service	1457478414	1457478414	1	1	KING, KERRI C PHD	8/7/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5602	35	06069	36.83504962	-121.3858245	San Benito County
125843	Fee-for-Service	1548291156	1548291156	2	1	KHALID, YASMEEN MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62895	41	Internal Medicine	0	In state provider	None	1260 E ALMOND AVE	None	MADERA	CA	93637	6500	20	06039	36.9453747	-120.0454403	Madera County
125869	Fee-for-Service	1710749429	1710749429	1	1	KARIUKI, PAUL MBURU	4/24/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2831 MORNING STAR DRIVE	None	CORONA	CA	92881	8634	33	06065	33.83861362	-117.5444824	Riverside County
125873	Fee-for-Service	1013001379	1013001379	2	1	KIM, KYU H MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51510	40	Pediatrics	0	In state provider	None	15243 VANOWEN ST	STE 300	VAN NUYS	CA	91405	3605	19	06037	34.19394848	-118.4654115	Los Angeles County
125900	Fee-for-Service	1508808924	1508808924	1	1	KAVEGGIA, LASZLO P MD	4/10/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65446	None	None	0	In state provider	None	16300 SAND CANYON AVE	STE 102	IRVINE	CA	92618	3704	30	06059	33.66115075	-117.7742405	Orange County
125932	Fee-for-Service	1689656340	1689656340	1	1	KHACHATOURIANS, ARMOND	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77564	01	General Practice	0	In state provider	None	1505 WILSON TER	None	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
125980	Fee-for-Service	1013192426	1013192426	1	1	KIM, SHARON MD	1/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100045	79	Neurology-Child	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3876	30	06059	33.78077578	-117.8673468	Orange County
125990	Fee-for-Service	1952315186	1952315186	1	1	KWASMAN, MICHAEL A MD FACC	5/17/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60171	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
126015	Fee-for-Service	1740904259	1740904259	1	1	KARUKU, RACHEL W	6/23/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	36895 CENTAURUS PL	None	MURRIETA	CA	92563	2796	33	06065	33.58315676	-117.135013	Riverside County
126029	Fee-for-Service	1013910827	1013910827	1	1	KANTER, LEWIS J MD	2/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	34328	03	Allergy	0	In state provider	None	2412 N PONDEROSA DR	STE 111	CAMARILLO	CA	93010	2379	56	06111	34.24223352	-119.0227101	Ventura County
126031	Fee-for-Service	1740353614	1740353614	1	1	KOHEN-DINIAK, CAROLE G DO	1/24/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	15780	40	Pediatrics	0	In state provider	None	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
126063	Fee-for-Service	1134280530	1134280530	1	1	KENNY, KAREN M PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
126071	Fee-for-Service	1538474093	1538474093	1	1	KAPADIA, ASHMEETA P MD	9/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122545	01	General Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
126090	Fee-for-Service	1649605403	1649605403	1	1	KAISER FOUNDATION HOSPITAL	8/25/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN LEANDRO	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
126112	Fee-for-Service	1750776621	1750776621	1	1	KIM, STEPHANIE S MD	2/16/2018	208600000X	NA	General Surgery	026	PHYSICIANS	145746	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
126123	Fee-for-Service	1457693699	1457693699	1	1	KUMAR, ANDRE D MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131887	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126133	Fee-for-Service	1548291156	1548291156	2	1	KHALID, YASMEEN MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62895	83	Rheumatology	0	In state provider	None	1260 E ALMOND AVE	None	MADERA	CA	93637	6500	20	06039	36.9453747	-120.0454403	Madera County
126153	Fee-for-Service	1861514861	1861514861	1	1	KWOK, CLARK T MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109666	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
126158	Fee-for-Service	1710749429	1710749429	1	1	KARIUKI, PAUL MBURU	4/24/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2831 MORNING STAR DRIVE	None	CORONA	CA	92881	8634	33	06065	33.83861362	-117.5444824	Riverside County
126205	Fee-for-Service	1063070779	1063070779	1	1	KLAMATH FALLS CHRISTIAN COUN	12/3/2020	261QM0801X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	1	Border provider	SELING	1741 AUSTIN STREET	None	KLAMATH FALLS	OR	97603	4621	00	None	42.213348	-121.750454	Klamath County
126218	Fee-for-Service	1689656340	1689656340	1	1	KHACHATOURIANS, ARMOND	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77564	02	General Surgery	0	In state provider	None	1505 WILSON TER	None	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
126236	Fee-for-Service	1952329625	1952329625	1	1	KING, ELAINE Y MD	9/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75012	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
126238	Fee-for-Service	1962471920	1962471920	1	1	KROLIKOWSKI, JEANETTE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9312	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	ROOM # 506	SAN FRANCISCO	CA	94110	4418	38	06075	37.74746923	-122.4202583	San Francisco County
126252	Fee-for-Service	1588636922	1588636922	1	1	KARLSBERG, RONALD P MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37753	41	Internal Medicine	0	In state provider	None	414 N CAMDEN DR	STE 800	BEVERLY HILLS	CA	90210	4524	19	06037	34.06880486	-118.4042308	Los Angeles County
126293	Fee-for-Service	1487075735	1487075735	1	1	KASUKURTHI, PALLAVI MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129742	41	Internal Medicine	0	In state provider	None	11525 BROOKSHIRE AVE	400	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
126312	Fee-for-Service	1558044693	1558044693	1	1	KEYES, KARA A	8/8/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
126336	Fee-for-Service	1083794259	1083794259	1	1	KICIMAN, NAFIZ M MD	5/7/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49326	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
126338	Fee-for-Service	1841387966	1841387966	1	1	KAN, J H MD	8/20/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
126339	Fee-for-Service	1013414515	1013414515	1	1	KWON, CHRISTINE MD	1/3/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174551	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
126357	Fee-for-Service	1538474093	1538474093	1	1	KAPADIA, ASHMEETA P MD	9/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122545	08	Family Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
126374	Fee-for-Service	1811073323	1811073323	1	1	KUPPAHALLY, SUMAN S MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72494	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
126379	Fee-for-Service	1649605403	1649605403	1	1	KAISER FOUNDATION HOSPITAL	8/25/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN LEANDRO	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
126382	Fee-for-Service	1972776763	1972776763	1	1	KISSNER, LAUREN J MD	6/4/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	109864	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
126498	Fee-for-Service	1467713834	1467713834	1	1	KURKJIAN, A PAUL MD	8/22/2013	2084P0800X	NA	Psychiatry	026	PHYSICIANS	99007	36	Psychiatry	0	In state provider	A MEDICAL CORPORATION	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
126522	Fee-for-Service	1003398686	1003398686	1	1	KIM, KATRINA H PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
126531	Fee-for-Service	1306999404	1306999404	1	1	KLEE, MARIANNE P PHD	1/4/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
126540	Fee-for-Service	1588636922	1588636922	1	1	KARLSBERG, RONALD P MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37753	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	414 N CAMDEN DR	STE 800	BEVERLY HILLS	CA	90210	4524	19	06037	34.06880486	-118.4042308	Los Angeles County
126553	Fee-for-Service	1619129426	1619129426	1	1	KALIOUNDJI, SAM J MD	11/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105168	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
126574	Fee-for-Service	1679517239	1679517239	1	1	KOHATSU, KAREN E MD INC	12/17/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70665	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11939 RANCHO BERNARDO RD	#110	SAN DIEGO	CA	92128	2074	37	06073	33.02279756	-117.0732316	San Diego County
126591	Fee-for-Service	1902845373	1902845373	2	1	KOLAVALA, JANARDHANA R MD	10/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	38782	41	Internal Medicine	0	In state provider	None	18523 CORWIN ROAD	SUITE E	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
126601	Fee-for-Service	1588663769	1588663769	1	15	KAWEAH DELTA HEALTH CARE	3/15/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	2342 WEST SUNNYSIDE AVE	None	VISALIA	CA	93277	7287	54	06107	36.30375	-119.317014	Tulare County
126605	Fee-for-Service	1508940644	1508940644	1	1	KOUPAIE, JAFAR MD	1/29/2021	207NS0135X	NA	Dermatology	026	PHYSICIANS	51581	None	None	0	In state provider	None	101 PARK PL	SUITE 200	SAN RAMON	CA	94583	1761	07	06013	37.7730841	-121.9883297	Contra Costa County
126609	Fee-for-Service	1508253634	1508253634	1	1	KERRIGAN, CHRISTOPHER P MD	11/19/2019	207R00000X	NA	Other	026	PHYSICIANS	165043	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
126630	Fee-for-Service	1083794259	1083794259	1	1	KICIMAN, NAFIZ M MD	5/7/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49326	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
126642	Fee-for-Service	1487857595	1487857595	1	1	KIRSCH, JANICE L MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	47529	68	Hematology	0	In state provider	None	3001 COLBY ST	None	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
126654	Fee-for-Service	1518253285	1518253285	1	1	KARAMAT, MEHR N MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133858	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
126685	Fee-for-Service	1518008804	1518008804	1	1	KIM, SCOTT Y MD	10/10/2008	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	103509	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
126690	Fee-for-Service	1740728344	1740728344	1	1	KIM, MICHELLE H MD	7/16/2018	208600000X	NA	General Surgery	026	PHYSICIANS	146184	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
126761	Fee-for-Service	1659652675	1659652675	1	1	KING, ERIN M MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
126799	Fee-for-Service	1366649832	1366649832	1	1	KIM, ALICE R DO	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9216	08	Family Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
126816	Fee-for-Service	1912008087	1912008087	1	1	KHAN, MOHAMMED	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78544	None	None	0	In state provider	None	613 S HOWARD ST	None	CORONA	CA	92879	2254	33	06065	33.87429852	-117.5627049	Riverside County
126864	Fee-for-Service	1689093668	1689093668	1	1	KHANKHANIAN, POUYA MD	4/5/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	169433	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
126917	Fee-for-Service	1497287601	1497287601	1	1	KAO, CHIENWEN PHD	10/27/2021	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126952	Fee-for-Service	1942257712	1942257712	1	1	KHAJAVI, SOHEILA S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44214	36	Psychiatry	0	In state provider	None	666 BAKER ST	STE 303A	COSTA MESA	CA	92626	4409	30	06059	33.6801633	-117.8840821	Orange County
126965	Fee-for-Service	1700128923	1700128923	1	1	KEYSER, EMILY Y MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151425	40	Pediatrics	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
126986	Fee-for-Service	1558903716	1558903716	1	1	KAVIS HOME HEALTH INC	1/31/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3660 WILSHIRE BLVD	SUITE 311	LOS ANGELES	CA	90010	2716	19	06037	34.06170018	-118.3049892	Los Angeles County
127024	Fee-for-Service	1013095595	1013095595	1	1	KENY, SHILPA V MD	12/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86896	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
127040	Fee-for-Service	1396760138	1396760138	1	1	KAISER, CRAIG A DO	1/30/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	8306	None	None	0	In state provider	None	58457 29 PALMS HIGHWAY	STE 200	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
127057	Fee-for-Service	1518004134	1518004134	1	1	KIRSCHBAUM, STEPHANIE J	9/11/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OD	3133 PROFESSIONAL DR	STE 14	AUBURN	CA	95603	2463	31	06061	38.9412	-121.100888	Placer County
127064	Fee-for-Service	1861719544	1861719544	1	1	KRAKER, ALICE A NP	1/8/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
127093	Fee-for-Service	1740560937	1740560937	1	1	KLIMAS, JOSEPH M LCSW	5/4/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	290 REDWOOD SHORES PKWY	None	REDWOOD CITY	CA	94065	1173	41	06081	37.52379393	-122.2527961	San Mateo County
127114	Fee-for-Service	1972746287	1972746287	1	1	KHANDELWAL, KEERTI MD	10/7/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	161504	68	Hematology	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
127153	Fee-for-Service	1336500305	1336500305	1	1	KAYAL MEDICAL GROUP INC.	9/17/2021	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	EDICAL CLINIC	334 VIA VERA CRUZ	SUITE 251	SAN MARCOS	CA	92078	2642	37	06073	33.13698477	-117.1888034	San Diego County
127171	Fee-for-Service	1205848363	1205848363	1	1	KUROSAKA, MOMO C MD	12/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62689	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
127213	Fee-for-Service	1922186014	1922186014	1	1	KHAN, TEHMINA ASIF MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71875	08	Family Practice	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
127217	Fee-for-Service	1902016496	1902016496	1	1	KUJAK, JENNIFER L MD	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106720	30	Radiology	0	In state provider	None	415 ROLLING OAKS DRIVE	STE 125	THOUSAND OAKS	CA	91361	1038	56	06111	34.17439717	-118.8691161	Ventura County
127224	Fee-for-Service	1790030005	1790030005	1	1	KUO, ANN MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127529	41	Internal Medicine	0	In state provider	None	4004 BEYER RD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
127228	Fee-for-Service	1023042454	1023042454	1	1	KASAL, JULIE R LMFT	11/16/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23672 BIRTCHER DRIVE	None	LAKE FOREST	CA	92630	1769	30	06059	33.63359204	-117.7170667	Orange County
127260	Fee-for-Service	1497797443	1497797443	1	1	KURTZ, THEODORE W MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	46628	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
127285	Fee-for-Service	1487364808	1487364808	1	1	KHAVSHABA, ELENA NP	7/4/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18040 SHERMAN WAY	SUITE 304	RESEDA	CA	91335	4656	19	06037	34.20103048	-118.526787	Los Angeles County
127302	Fee-for-Service	1396768958	1396768958	1	1	KUMAR, SHANTHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4838 E BASELINE RD	BLDG 2 STE 110	MESA	AZ	85206	4674	00	None	33.381351	-111.7293165	Maricopa County
127345	Fee-for-Service	1790129427	1790129427	1	1	KYTE, NATASHA N MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148820	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
127368	Fee-for-Service	1720212319	1720212319	1	1	KADERA, SAMANTHA P MD	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114951	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	RM 14-19	LOS ANGELES	CA	90095	3075	19	06037	34.06633051	-118.4452686	Los Angeles County
127373	Fee-for-Service	1710206024	1710206024	1	1	KIM, JOHN	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16333	None	None	0	In state provider	None	9655 MONTE VISTA AVE	SUITE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
127398	Fee-for-Service	1518653484	1518653484	1	1	KIAMA, ROSEMARY WANGUI	9/19/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9050 GENERATIONS DRIVE	None	ELK GROVE	CA	95758	1230	34	06067	38.426211	-121.412889	Sacramento County
127400	Fee-for-Service	1972746287	1972746287	1	1	KHANDELWAL, KEERTI MD	10/7/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	161504	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
127401	Fee-for-Service	1659618312	1659618312	1	1	KIM, NANCI H LMFT	7/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
127411	Fee-for-Service	1487812830	1487812830	1	1	KUGLER, JOHN F MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96473	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
127441	Fee-for-Service	1336500305	1336500305	1	1	KAYAL MEDICAL GROUP INC.	9/17/2021	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	EDICAL CLINIC	334 VIA VERA CRUZ	SUITE 251	SAN MARCOS	CA	92078	2642	37	06073	33.13698477	-117.1888034	San Diego County
127451	Fee-for-Service	1336670025	1336670025	1	1	KANUMILLI, SREERAMYA MD	9/11/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
127461	Fee-for-Service	1003932245	1003932245	1	1	KARY, DONNA M CRNA	5/16/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
127496	Fee-for-Service	1356744163	1356744163	1	1	KLINGER, CHELSEA R	11/29/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41769 ENTERPRISE CIR N	STE 104	TEMECULA	CA	92590	5626	33	06065	33.51823541	-117.1701538	Riverside County
127498	Fee-for-Service	1902051899	1902051899	1	1	KREVITZ, SHARI M MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	103546	41	Internal Medicine	0	In state provider	None	1940 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
127527	Fee-for-Service	1548751290	1548751290	1	1	KONIALIAN, TSOLINE	11/13/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGICAL SERVICES	4519 ROSEMEAD BLVD	2ND FLOOR	ROSEMEAD	CA	91770	1476	19	06037	34.08794122	-118.0734653	Los Angeles County
127547	Fee-for-Service	1497797443	1497797443	1	1	KURTZ, THEODORE W MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	46628	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
127557	Fee-for-Service	1962549220	1962549220	1	1	KAPOOR, MINAL MD	7/24/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	163305	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
127565	Fee-for-Service	1801189048	1801189048	1	1	KO, ELIZABETH S MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131980	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90045	5631	19	06037	34.06527974	-118.4462792	Los Angeles County
127567	Fee-for-Service	1437611860	1437611860	1	1	KELLEY, JONATHAN	12/7/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
127575	Fee-for-Service	1730380718	1730380718	1	1	KHATIBI, MEHRI MD	11/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113691	None	None	0	In state provider	None	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
127587	Fee-for-Service	1942782404	1942782404	1	1	KIGANO, RACHEL NP	11/22/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
127592	Fee-for-Service	1215359534	1215359534	1	1	KECK, DEBORAH K AU	1/2/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3 MEDICAL PLAZA DRIVE	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
127594	Fee-for-Service	1497289938	1497289938	1	1	KUO, BENJAMIN MD	8/1/2021	207L00000X	NA	Other	026	PHYSICIANS	171213	None	None	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
127620	Fee-for-Service	1538774435	1538774435	1	1	KEOWN, ALEXANDER S PT	12/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
127631	Fee-for-Service	1205948288	1205948288	1	1	KUMAR, SANJAY MD	2/8/2015	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51189	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2416 CASTILLO	STE B	SANTA BARBARA	CA	93105	4342	42	06083	34.43092329	-119.7247028	Santa Barbara County
127663	Fee-for-Service	1205319688	1205319688	1	1	KNETGE, TAIANN LCSW	11/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
127686	Fee-for-Service	1518653484	1518653484	1	1	KIAMA, ROSEMARY WANGUI	9/19/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9050 GENERATIONS DRIVE	None	ELK GROVE	CA	95758	1230	34	06067	38.426211	-121.412889	Sacramento County
127764	Fee-for-Service	1083893564	1083893564	1	1	KONG, ALLEN P MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87697	89	Surgery-Traumatic	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
127793	Fee-for-Service	1508800111	1508800111	1	1	KARTEL,DOUGLAS MD	8/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
127850	Fee-for-Service	1336301746	1336301746	1	1	KOPPULA, ANTHONY S MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100501	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE # 365	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
127851	Fee-for-Service	1154528420	1154528420	1	1	KIRAGES, DANIEL	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
127889	Fee-for-Service	1518175868	1518175868	1	1	KOU, JOSEPH X MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99887	20	Orthopedic Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	2883	07	06013	37.9141514	-122.0422089	Contra Costa County
127906	Fee-for-Service	1013306752	1013306752	1	1	KIM, EDA M MD	3/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66699	01	General Practice	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
127920	Fee-for-Service	1417677386	1417677386	1	1	KRISTEN LEW MD MEDICAL CORPO	4/20/2023	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	993 N BROADWAY	SUITE A	LOS ANGELES	CA	90012	1763	19	06037	34.0663686	-118.2361889	Los Angeles County
127930	Fee-for-Service	1962821207	1962821207	1	1	KANGAVARI, PEYMAN MD	4/22/2019	390200000X	NA	Other	026	PHYSICIANS	142937	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
127937	Fee-for-Service	1386923019	1386923019	1	1	KHALED M. EL-SAID MD,INC	1/17/2025	163WG0000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	11882 DE PALMA RD	SUITE 2F-1	CORONA	CA	92883	4008	33	06065	33.74606919	-117.4518861	Riverside County
127953	Fee-for-Service	1346829652	1346829652	1	1	KELLY, LIA Q PT	3/13/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
128028	Fee-for-Service	1568758100	1568758100	1	1	KENNEDY-ETO, KAUAI N MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127206	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1711 N ORANGE STREET	None	REDLANDS	CA	92374	2254	36	06071	34.0796409	-117.1824145	San Bernardino County
128052	Fee-for-Service	1033150933	1033150933	1	1	KEESARA, VINAYA MD	12/31/1992	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44003	None	None	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
128098	Fee-for-Service	1285687350	1285687350	1	1	KHAN, ALIYA I MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50634	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5360 JACKSON DRIVE	SUITE 100	LA MESA	CA	91942	3012	37	06073	32.77680573	-117.0176327	San Diego County
128123	Fee-for-Service	1871112383	1871112383	1	1	KIM, JOY S MD	10/25/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	183214	15	Obstetrics (D.O. only)	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
128145	Fee-for-Service	1407114374	1407114374	1	1	KHAN, QIRATULANNE DO	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14191	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
128207	Fee-for-Service	1053488817	1053488817	1	1	KO, HETTY CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
128209	Fee-for-Service	1376504407	1376504407	1	1	KWAN, WILLIAM W MD	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	73605	07	Dermatology	0	In state provider	None	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
128213	Fee-for-Service	1598385916	1598385916	1	1	KUMARI, KANCHAN MD	9/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188196	None	None	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
128217	Fee-for-Service	1093230070	1093230070	1	1	KHANUJA, SIMRANDEEP MD	9/18/2023	2278C0205X	NA	Other	026	PHYSICIANS	189814	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
128219	Fee-for-Service	1528227717	1528227717	1	1	KIM, HANNA Y MD	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112662	18	Ophthalmology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
128234	Fee-for-Service	1881211456	1881211456	1	1	KABIRI, KOORUSH A DO	6/15/2023	207R00000X	NA	Other	026	PHYSICIANS	20935	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
128280	Fee-for-Service	1619924933	1619924933	1	1	KAIURA, TERRY L MD	1/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78273	18	Ophthalmology	0	In state provider	None	921 OAK PARK BLVD	STE 201B	PISMO BEACH	CA	93449	3400	40	06079	35.13600697	-120.6045995	San Luis Obispo County
128286	Fee-for-Service	1164929642	1164929642	1	1	KRISHAN, ROHEE MD	4/11/2022	208M00000X	NA	Other	026	PHYSICIANS	173893	None	None	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
128317	Fee-for-Service	1568758100	1568758100	1	1	KENNEDY-ETO, KAUAI N MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127206	01	General Practice	0	In state provider	None	1711 N ORANGE STREET	None	REDLANDS	CA	92374	2254	36	06071	34.0796409	-117.1824145	San Bernardino County
128364	Fee-for-Service	1871806711	1871806711	1	1	KARISHEV, NATALIE MD	11/10/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105280	08	Family Practice	0	In state provider	PROFESSIONAL	3021 DANA STREET	None	BERKELEY	CA	94705	2073	01	06001	37.85449339	-122.2585618	Alameda County
128385	Fee-for-Service	1285687350	1285687350	1	1	KHAN, ALIYA I MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50634	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5360 JACKSON DRIVE	SUITE 100	LA MESA	CA	91942	3012	37	06073	32.77680573	-117.0176327	San Diego County
128404	Fee-for-Service	1437405412	1437405412	1	1	KIRESICH, ELEONORE G MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120342	40	Pediatrics	0	In state provider	None	18033 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06391926	-118.4418606	Los Angeles County
128412	Fee-for-Service	1871112383	1871112383	1	1	KIM, JOY S MD	10/25/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	183214	09	Gynecology (D.O. only)	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
128433	Fee-for-Service	1790807436	1790807436	1	1	KALMAR, FRANKLIN MD	11/1/2001	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	60293	25	Physical Medicine and Rehabilitation	0	In state provider	None	6645 ALVARADO RD	STE 253	SAN DIEGO	CA	92120	5208	37	06073	32.7772577	-117.0575222	San Diego County
128476	Fee-for-Service	1396727863	1396727863	1	1	KEATING, RUSSELL B MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	48783	30	Radiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
128531	Fee-for-Service	1336223320	1336223320	1	1	KAELIN, AMY C MD	8/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78541	41	Internal Medicine	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
128544	Fee-for-Service	1750493466	1750493466	1	1	KHAN, JUNAID H MD	10/21/1994	208G00000X	NA	General Surgery	026	PHYSICIANS	71384	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
128547	Fee-for-Service	1578081915	1578081915	1	1	KAWEAH DELTA HEALTH CARE DIS	11/1/2017	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ENTER	202 W WILLOW AVE.	SUITE 202	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
128594	Fee-for-Service	1730380676	1730380676	1	1	KENG-YU CHUANG	4/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
128606	Fee-for-Service	1457614984	1457614984	1	1	KOLB, STEPHEN P MD	10/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147395	05	Anesthesiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
128641	Fee-for-Service	1295781060	1295781060	1	1	KIM, SUSAN HYUN MD	1/11/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85985	05	Anesthesiology	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
128663	Fee-for-Service	1386652840	1386652840	1	1	KINZIE, JOHN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	ROAD	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
128679	Fee-for-Service	1518928829	1518928829	1	1	KOK, YIH J MD	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71806	41	Internal Medicine	0	In state provider	None	711 W COLLEGE ST	STE 300	LOS ANGELES	CA	90012	1093	19	06037	34.06541412	-118.2414102	Los Angeles County
128690	Fee-for-Service	1508212168	1508212168	1	1	KHAN, RAINA MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138798	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
128725	Fee-for-Service	1275573560	1275573560	1	1	KAPLAN, BETH C MD	12/31/1992	207P00000X	NA	Other	026	PHYSICIANS	77564	66	Emergency Medicine (Urgent Care)	0	In state provider	RM 1E21	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
128729	Fee-for-Service	1932196458	1932196458	1	1	KOCH, SARAH L MD	5/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	61504	40	Pediatrics	0	In state provider	None	4120 PRESCOTT RD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
128738	Fee-for-Service	1154376614	1154376614	1	1	KLOFAS, EDWARD S MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41716	66	Emergency Medicine (Urgent Care)	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
128752	Fee-for-Service	1073586624	1073586624	1	1	KATSERES, RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	304 S PARK LN	None	ALTUS	OK	73521	5753	00	None	34.63546743	-99.31646232	Jackson County
128763	Fee-for-Service	1770051906	1770051906	1	1	KIM, HYUN WOO PT	10/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
128785	Fee-for-Service	1134288731	1134288731	1	1	KHOO-MIYAKI, DAISY M DO	7/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6772	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
128791	Fee-for-Service	1730168931	1730168931	1	2	KINGS EYE CTR MED GP INC	12/28/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1395 W LACEY BLVD	None	HANFORD	CA	93230	5904	16	06031	36.32798439	-119.6660001	Kings County
128803	Fee-for-Service	1598250664	1598250664	1	1	KONETI, SWATHI MD	11/29/2021	207R00000X	NA	Other	026	PHYSICIANS	173427	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
128817	Fee-for-Service	1326128539	1326128539	1	1	KRISHNAN, SUBRAMANIAM C	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52052	06	Cardiovascular Disease (M.D. only)	0	In state provider	MD	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
128836	Fee-for-Service	1578081915	1578081915	1	1	KAWEAH DELTA HEALTH CARE DIS	1/17/2019	207T00000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ENTER	202 W WILLOW AVE.	SUITE 202	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
128851	Fee-for-Service	1851144588	1851144588	1	1	KIM, BYUNGIL LPCC	6/4/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	H COUNSELING	16 WILDERNESS PL	None	POMONA	CA	91766	6709	19	06037	34.02171499	-117.7688816	Los Angeles County
128852	Fee-for-Service	1093857757	1093857757	1	1	KENNEDY, RYAN P LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
128855	Fee-for-Service	1649256660	1649256660	1	1	KATHRYN WISEMAN	6/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	77 HOSPITAL AVE	STE 302	NORTH ADAMS	MA	01247	2538	00	None	42.706908	-73.1091915	Berkshire County
128894	Fee-for-Service	1982000352	1982000352	1	1	KICKO, ELIZABETH C CNM	9/24/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	250 BON AIR RD	None	SAN RAFAEL	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
128904	Fee-for-Service	1487129987	1487129987	1	1	KETCHUM, BEVERLY J DOULA	5/10/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
128927	Fee-for-Service	1386759157	1386759157	1	1	KATZ, GREGORY L PHD	9/17/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1663 DOMINICAN WAY	STE 214	SANTA CRUZ	CA	95065	1527	44	06087	36.99029729	-121.9809324	Santa Cruz County
128961	Fee-for-Service	1518928829	1518928829	1	1	KOK, YIH J MD	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71806	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	711 W COLLEGE ST	STE 300	LOS ANGELES	CA	90012	1093	19	06037	34.06541412	-118.2414102	Los Angeles County
128996	Fee-for-Service	1912114349	1912114349	1	1	KINGS VIEW	4/10/2018	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1410 F ST	STE 101	FRESNO	CA	93706	1608	10	06019	36.7347922	-119.7996448	Fresno County
129030	Fee-for-Service	1073775748	1073775748	1	1	KIM, SOOHYUN MD	1/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104531	02	General Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
129070	Fee-for-Service	1477978294	1477978294	1	1	KLOEPPING, CAROLYN H MD	12/13/2021	207LP2900X	NA	Other	026	PHYSICIANS	175601	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
129164	Fee-for-Service	1427349869	1427349869	1	1	KWON, NICOLE B J MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124134	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
129187	Fee-for-Service	1467085688	1467085688	1	1	KUO, JESSICA DO	1/29/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21085	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
129220	Fee-for-Service	1164089355	1164089355	1	1	KLEINJAN, ASHLEIGH J PT	9/21/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	43	06085	37.36777579	-122.0276404	Santa Clara County
129223	Fee-for-Service	1033266358	1033266358	1	1	KAISER PERM PHAR 009	5/19/1980	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1249 S SUNSET AVE	None	WEST COVINA	CA	91790	3960	19	06037	34.06068542	-117.9468692	Los Angeles County
129241	Fee-for-Service	1194735076	1194735076	1	1	KORB, JAMES DENNIS	10/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	56025	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA #265	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
129268	Fee-for-Service	1548703291	1548703291	1	1	KEY TO HEALTH HOMECARE INC	3/6/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	664 W BROADWAY	SUITE G	GLENDALE	CA	91204	1097	19	06037	34.14674052	-118.269936	Los Angeles County
129270	Fee-for-Service	1467404160	1467404160	1	1	KORNFIELD, ROBERT N MD	8/9/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	137597	None	None	0	In state provider	None	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
129310	Fee-for-Service	1437396827	1437396827	1	1	KLEIN INGO MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
129316	Fee-for-Service	1730157843	1730157843	1	1	KEENAN, JOHN G CRNA	9/20/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	250 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
129319	Fee-for-Service	1073775748	1073775748	1	1	KIM, SOOHYUN MD	1/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104531	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
129322	Fee-for-Service	1821150863	1821150863	1	1	KADAMBI, ANDAL V MD	12/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93726	41	Internal Medicine	0	In state provider	None	350 30TH ST	STE 411	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
129332	Fee-for-Service	1063722866	1063722866	1	1	KOCH, KORBIN J OD	8/20/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	1	Border provider	None	3600 WASHBURN WAY	None	KLAMATH FALLS	OR	97603	4539	00	None	42.193215	-121.760604	Klamath County
129342	Fee-for-Service	1639175672	1639175672	1	1	KRONE, KENNETH MD	2/1/1984	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23988	01	General Practice	0	In state provider	FRESNO COMM HOSP	FRESNO AND R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
129377	Fee-for-Service	1477846947	1477846947	1	1	KU, STEPHEN MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121292	67	Endocrinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
129418	Fee-for-Service	1366101610	1366101610	1	1	KAESTNER, BRIAN H PT	12/15/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1020 TIERRA DEL REY	A1	CHULA VISTA	CA	91910	7886	37	06073	32.6377383	-117.0196092	San Diego County
129472	Fee-for-Service	1619302486	1619302486	1	1	KOVARKIZI-NATNEIL, MELANI L	3/1/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
129475	Fee-for-Service	1558724930	1558724930	1	1	K & S KAPLAN INC	12/14/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2200 N GLENOAKS BLVD	None	BURBANK	CA	91504	2829	19	06037	34.19926159	-118.328214	Los Angeles County
129477	Fee-for-Service	1205845583	1205845583	1	1	KIM, HYUK DO INC	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7982	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13563 VAN NUYS BLVD	None	PACOIMA	CA	91331	3029	19	06037	34.26130021	-118.4287303	Los Angeles County
129524	Fee-for-Service	1720407588	1720407588	1	1	KILSY CUELLO PICHARDO	4/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	157 CLINIC AVE	STE 203	CARROLLTON	GA	30117	4454	00	None	33.56904748	-85.0763745	Carroll County
129569	Fee-for-Service	1376795617	1376795617	1	1	KHAN, SEEMA MD	6/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122974	41	Internal Medicine	0	In state provider	None	1300 AVENIDA VIS HERMOSA	STE 250	SAN CLEMENTE	CA	92673	6340	30	06059	33.45853705	-117.5921398	Orange County
129584	Fee-for-Service	1841458726	1841458726	1	1	KIM, HAHNS Y MD	11/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113034	24	Plastic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
129589	Fee-for-Service	1316267727	1316267727	1	1	KANALLAKAN, TIMOTHY D CP	6/22/2010	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3520 E SHIELDS AVE	#2	FRESNO	CA	93726	6909	10	06019	36.77947947	-119.765781	Fresno County
129595	Fee-for-Service	1316063480	1316063480	1	1	KRISMAN, REBECCA K MD	2/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89579	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
129625	Fee-for-Service	1922185768	1922185768	1	1	KLEINMAN, KENNETH S MD	10/3/2007	174400000X	NA	Other	026	PHYSICIANS	50719	45	Nephrology (Renal-Kidney)	0	In state provider	INC	5525 ETIWANDA AVE	STE 305	TARZANA	CA	91356	6123	19	06037	34.17046451	-118.5308463	Los Angeles County
129634	Fee-for-Service	1639175672	1639175672	1	1	KRONE, KENNETH MD	2/1/1984	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23988	70	Clinic (mixed specialty)	0	In state provider	FRESNO COMM HOSP	FRESNO AND R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
129648	Fee-for-Service	1427612373	1427612373	1	1	KM NETWORK, INC.	5/30/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23693 CALABASAS RD	STE. B	CALABASAS	CA	91302	3431	19	06037	34.15608673	-118.6429399	Los Angeles County
129652	Fee-for-Service	1053469098	1053469098	1	1	KITABJIAN, LORETTA F CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
129655	Fee-for-Service	1285785154	1285785154	1	1	KRISHNAMOORTHI, MD INC	4/1/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	850 CALIFORNIA ST	None	ESCALON	CA	95320	1506	39	06077	37.79658547	-121.001526	San Joaquin County
129663	Fee-for-Service	1184636235	1184636235	1	1	KASTOON, TONY MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55100	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 227	SAN BERNARDINO	CA	92404	3851	36	06071	34.1358627	-117.2757898	San Bernardino County
129664	Fee-for-Service	1477846947	1477846947	1	1	KU, STEPHEN MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121292	41	Internal Medicine	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
129685	Fee-for-Service	1912165655	1912165655	1	1	KAO, ERIC I MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117948	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
129687	Fee-for-Service	1417968173	1417968173	1	1	KERR, DOUGLAS P MD	7/31/1996	207P00000X	NA	Other	026	PHYSICIANS	69670	66	Emergency Medicine (Urgent Care)	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
129712	Fee-for-Service	1043559859	1043559859	1	1	KAREN E ANDERSON	3/5/2020	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5565 GROSSMONT CENTER DR	SUITE 152	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
129805	Fee-for-Service	1013983246	1013983246	1	1	KHAN, NAGUIB MD	11/3/2022	207L00000X	NA	Other	026	PHYSICIANS	37775	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
129841	Fee-for-Service	1295753820	1295753820	1	1	KO, ALBERT C MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64324	08	Family Practice	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
129868	Fee-for-Service	1154731818	1154731818	1	1	KHAN, SUMERRA DO	11/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14382	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
129905	Fee-for-Service	1821195140	1821195140	1	1	KUBEJA, MARTIN A MD	5/18/2020	207L00000X	NA	Other	026	PHYSICIANS	137499	05	Anesthesiology	0	In state provider	None	6601 WHITE FEATHER	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
129912	Fee-for-Service	1922185768	1922185768	1	1	KLEINMAN, KENNETH S MD	10/3/2007	174400000X	NA	Other	026	PHYSICIANS	50719	41	Internal Medicine	0	In state provider	INC	5525 ETIWANDA AVE	STE 305	TARZANA	CA	91356	6123	19	06037	34.17046451	-118.5308463	Los Angeles County
129928	Fee-for-Service	1184102287	1184102287	1	1	KOREATOWN COMM BASED ADULT	8/8/2019	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	SERVICE INC	2140 W OLYMPIC BLVD	STE 100	LOS ANGELES	CA	90006	2207	19	06037	34.05206987	-118.2806804	Los Angeles County
129943	Fee-for-Service	1285785154	1285785154	1	1	KRISHNAMOORTHI, MD INC	4/1/2007	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	850 CALIFORNIA ST	None	ESCALON	CA	95320	1506	39	06077	37.79658547	-121.001526	San Joaquin County
129948	Fee-for-Service	1184636235	1184636235	1	1	KASTOON, TONY MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55100	67	Endocrinology	0	In state provider	None	399 E HIGHLAND AVE	STE 227	SAN BERNARDINO	CA	92404	3851	36	06071	34.1358627	-117.2757898	San Bernardino County
129955	Fee-for-Service	1801929310	1801929310	1	1	KHOURY, PHILIP E LMFT	6/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
129969	Fee-for-Service	1073582482	1073582482	1	1	KATARIA, PURSHOTAM B MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43456	36	Psychiatry	0	In state provider	None	112 WEST GRAND BLVD	None	CORONA	CA	92882	2006	33	06065	33.88122071	-117.5696654	Riverside County
129973	Fee-for-Service	1255501474	1255501474	1	1	KOBAYASHI, LESLIE M MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90700	02	General Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130005	Fee-for-Service	1407990955	1407990955	1	1	KIM, TERRENCE T MD	10/21/2008	390200000X	NA	Other	026	PHYSICIANS	103614	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
130010	Fee-for-Service	1861771222	1861771222	1	1	KIRZHNER, IGOR MD	8/11/2021	207L00000X	NA	Other	026	PHYSICIANS	173510	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
130072	Fee-for-Service	1144563602	1144563602	1	1	KIM, JOEY MD	4/27/2020	207RR0500X	NA	Other	026	PHYSICIANS	146832	83	Rheumatology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
130129	Fee-for-Service	1184799892	1184799892	1	1	KOSSMAN, CHARLES R.	12/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	28857	68	Hematology	0	In state provider	None	5555 RESERVOIR DR	STE 306	SAN DIEGO	CA	92120	5178	37	06073	32.77628471	-117.0563688	San Diego County
130137	Fee-for-Service	1023363157	1023363157	1	1	KARANDIKAR, MANJIREE V MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126665	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
130154	Fee-for-Service	1194176594	1194176594	1	1	KHIEU, MIKE V MD	3/3/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	168148	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
130161	Fee-for-Service	1184772980	1184772980	1	1	KHATIBI-ARNOLD, NILOOFAR	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8223	08	Family Practice	0	In state provider	DO	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
130166	Fee-for-Service	1568660165	1568660165	1	1	KREULEN, CHRISTOPHER D MD	1/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100646	20	Orthopedic Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2801	34	06067	38.555181	-121.4566785	Sacramento County
130200	Fee-for-Service	1235205592	1235205592	1	1	KHOI DINH NGUYEN MD INC	3/15/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	905 S A ST	#1	OXNARD	CA	93030	9253	56	06111	34.19225229	-119.178671	Ventura County
130208	Fee-for-Service	1578918264	1578918264	1	1	KELLER, JAROD M MD	4/10/2019	390200000X	NA	Other	026	PHYSICIANS	145437	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
130216	Fee-for-Service	1851651962	1851651962	1	1	KHANDABI, DAVID S MD INC	5/29/2012	207L00000X	NA	Other	026	PHYSICIANS	92761	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
130321	Fee-for-Service	1659342236	1659342236	1	1	KANNAN, CHAKRAVARTHY R	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	MD	1701 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15878847	-115.163703	Clark County
130325	Fee-for-Service	1447232996	1447232996	1	1	KRUSZYNSKA, YOLANTA MD	11/22/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	65949	None	None	0	In state provider	None	1000 PAJARO ST	SUITE B	SALINAS	CA	93901	3060	27	06053	36.66179575	-121.6553489	Monterey County
130360	Fee-for-Service	1144563602	1144563602	1	1	KIM, JOEY MD	4/27/2020	207RR0500X	NA	Other	026	PHYSICIANS	146832	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
130367	Fee-for-Service	1326667619	1326667619	1	1	KOZMINSKI, ANDREW MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185827	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130394	Fee-for-Service	1457764789	1457764789	1	1	KHAN, ELLA K MD	9/5/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138345	08	Family Practice	0	In state provider	None	500 SAN PABLO AVE	None	ALBANY	CA	94706	1127	01	06001	37.89781848	-122.3014067	Alameda County
130426	Fee-for-Service	1023363157	1023363157	1	1	KARANDIKAR, MANJIREE V MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126665	77	Infectious Disease	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
130448	Fee-for-Service	1184772980	1184772980	1	1	KHATIBI-ARNOLD, NILOOFAR	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8223	66	Emergency Medicine (Urgent Care)	0	In state provider	DO	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
130449	Fee-for-Service	1790734309	1790734309	1	1	KARIM B GODAMUNNE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1170 CLEVELAND AVE	None	EAST POINT	GA	30344	3615	00	None	33.68127228	-84.42742435	Fulton County
130470	Fee-for-Service	1912157132	1912157132	1	1	KANTAK, SUMEETA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3300 GALLOWS RD	None	FALLS CHURCH	VA	22042	3307	00	None	38.858193	-77.226426	City of Fairfax
130483	Fee-for-Service	1396921060	1396921060	1	1	KONANKI, VENKATA N MD	3/19/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
130491	Fee-for-Service	1972690543	1972690543	1	2	KAPLAN, DAVID J DPM	9/5/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	39 N SAN MATEO DRIVE	#4	SAN MATEO	CA	94401	2832	41	06081	37.56748642	-122.327359	San Mateo County
130499	Fee-for-Service	1982675682	1982675682	1	1	KIDNEY CENTER OF	3/12/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES, LLC	2100 W 3RD ST	STE 110 AND 105	LOS ANGELES	CA	90057	1944	19	06037	34.06308947	-118.2733326	Los Angeles County
130507	Fee-for-Service	1558837831	1558837831	1	1	KAISER FOUNDATION HEALTH PLA	3/18/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	453	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
130549	Fee-for-Service	1003491671	1003491671	1	1	KESSERMAN, JACQUELYN N LCSW	7/20/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
130598	Fee-for-Service	1750328720	1750328720	1	1	KLAUSE, ELVIRA MD INC	11/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81744	02	General Surgery	0	In state provider	None	665 CAMINO DE LOS MARES	STE 202	SAN CLEMENTE	CA	92673	2838	30	06059	33.45730192	-117.6483252	Orange County
130600	Fee-for-Service	1396185161	1396185161	1	1	KUSNEZOV, NICHOLAS A MD	8/1/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	155908	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
130608	Fee-for-Service	1659342236	1659342236	1	1	KANNAN, CHAKRAVARTHY R	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	67	Endocrinology	1	Border provider	MD	1701 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15878847	-115.163703	Clark County
130645	Fee-for-Service	1396846721	1396846721	1	1	KOSARI, KAMBIZ MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94773	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
130659	Fee-for-Service	1659065738	1659065738	1	1	KAO, LING-JUNG LAC	8/23/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	920 SARATOGA AVE	105A	SAN JOSE	CA	95129	3403	43	06085	37.30971921	-121.9773167	Santa Clara County
130678	Fee-for-Service	1306057989	1306057989	1	2	KRONLAND, RENE C MD	11/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85096	01	General Practice	0	In state provider	None	355 JOERSCHKE DR	None	GRASS VALLEY	CA	95945	5288	29	06057	39.23053182	-121.0423053	Nevada County
130686	Fee-for-Service	1679849574	1679849574	1	1	KIDAMBI, TRILOKESH D MD	5/14/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	129676	10	Gastroenterology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
130716	Fee-for-Service	1700833951	1700833951	1	1	KEDHAR, SANJAY R MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141299	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
130768	Fee-for-Service	1396921060	1396921060	1	1	KONANKI, VENKATA N MD	3/19/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
130773	Fee-for-Service	1558884833	1558884833	1	1	KIM, EUN JUNG LMFT	6/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
130796	Fee-for-Service	1063560845	1063560845	1	1	KAISER FOUND HOSP PHCY	5/15/1982	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
130813	Fee-for-Service	1104804426	1104804426	1	1	KAN, EDWARD Y MD	8/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90811	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
130821	Fee-for-Service	1861607665	1861607665	1	1	KEUP, CHRISTOPHER P MD	12/29/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175409	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130827	Fee-for-Service	1518967702	1518967702	1	1	KUSHNER, KENNETH D MD	10/31/1987	208600000X	NA	General Surgery	026	PHYSICIANS	47729	None	None	0	In state provider	None	27800 MEDICAL CENTER RD	STE 310	MISSION VIEJO	CA	92691	6461	30	06059	33.55952733	-117.6645199	Orange County
130858	Fee-for-Service	1962816694	1962816694	1	1	KUNASEELAN, YANJAPRIYA MD	2/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145311	None	None	0	In state provider	None	4646 BROCKTON AVE	STE 101	RIVERSIDE	CA	92506	0103	33	06065	33.9760171	-117.3860626	Riverside County
130862	Fee-for-Service	1609207281	1609207281	1	1	KO, RYAN L MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128029	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
130865	Fee-for-Service	1023500493	1023500493	1	1	KRISTINSSON, HAYLEY B PSYD	9/2/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
130896	Fee-for-Service	1972827400	1972827400	1	1	KRUETH, STACY B MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118109	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
130917	Fee-for-Service	1265758262	1265758262	1	1	KING, DON FRIDAY MD INC	1/1/1983	207N00000X	NA	Dermatology	026	PHYSICIANS	34207	07	Dermatology	0	In state provider	None	7947 PAINTER AVE	None	WHITTIER	CA	90602	2414	19	06037	33.96860447	-118.0327317	Los Angeles County
130938	Fee-for-Service	1972789774	1972789774	1	1	KAINE, LARS MD	8/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176841	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
130953	Fee-for-Service	1790713071	1790713071	1	1	KAUL, SANJAY MD	1/1/1997	174400000X	NA	Other	026	PHYSICIANS	45783	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
131021	Fee-for-Service	1659432870	1659432870	1	1	KAHNG, DAVID MD	3/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75005	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
131039	Fee-for-Service	1366709115	1366709115	1	1	KASSABIAN, VAHE T MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131992	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
131061	Fee-for-Service	1477971471	1477971471	1	1	KAMEL, DINA MD	6/19/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	139233	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
131095	Fee-for-Service	1598851396	1598851396	1	1	KLIPPER, DAVID M DO	1/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8144	None	None	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
131099	Fee-for-Service	1811906571	1811906571	1	1	KARDASSAKIS, DEAN G MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	62905	03	Allergy	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
131168	Fee-for-Service	1215944418	1215944418	1	1	KIM, BRYCE D MD	7/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61045	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
131204	Fee-for-Service	1265758262	1265758262	1	1	KING, DON FRIDAY MD INC	1/1/1983	207N00000X	NA	Dermatology	026	PHYSICIANS	34207	22	Pathology (M.D. only)	0	In state provider	None	7947 PAINTER AVE	None	WHITTIER	CA	90602	2414	19	06037	33.96860447	-118.0327317	Los Angeles County
131250	Fee-for-Service	1114080918	1114080918	1	2	KNIGHT, SUSAN E LCSW	8/10/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1544 LONDONCIRCLE	None	BENICIA	CA	94510	1359	48	06095	38.07204885	-122.184206	Solano County
131256	Fee-for-Service	1831182971	1831182971	1	1	KOOISTRA, DALE A. MD	11/30/1986	207N00000X	NA	Dermatology	026	PHYSICIANS	55734	07	Dermatology	0	In state provider	None	15525 POMERADO RD	STE D5	POWAY	CA	92064	2426	37	06073	32.99479918	-117.0579468	San Diego County
131335	Fee-for-Service	1235525460	1235525460	1	1	KUROKI, MARCOS T MD	10/31/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	177831	02	General Surgery	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
131372	Fee-for-Service	1467478909	1467478909	1	1	KIM, WON WOO MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84837	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
131391	Fee-for-Service	1083839930	1083839930	1	1	KASRAEIAN, SINA MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94268	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
131437	Fee-for-Service	1194368829	1194368829	1	1	KAHROBAEI, YASAMAN OD	10/19/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
131444	Fee-for-Service	1477681567	1477681567	1	1	KARLEN, JUDSON W MD	3/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95533	20	Orthopedic Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
131481	Fee-for-Service	1912685611	1912685611	1	1	KIGGUNDU, ALEXANDRIA NANTONG	7/2/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	26565 MAPLE LEAF DRIVE	None	MORENO VALLEY	CA	92555	3515	33	06065	33.9363075	-117.1986474	Riverside County
131548	Fee-for-Service	1942798061	1942798061	1	1	KOOPMAN, JACOB A DO	8/3/2021	207R00000X	NA	Other	026	PHYSICIANS	17659	None	None	0	In state provider	None	3828 SCHAUFELE AVENUE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
131551	Fee-for-Service	1386280980	1386280980	1	1	KWIATKOWSKI, MARGO PT	12/2/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
131562	Fee-for-Service	1003262874	1003262874	1	1	KIM, ARNOLD MD	10/30/2020	207L00000X	NA	Other	026	PHYSICIANS	168456	None	None	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
131616	Fee-for-Service	1861465874	1861465874	1	1	KONIA, MOJCA R MD	7/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88185	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
131626	Fee-for-Service	1558382093	1558382093	1	1	KEEGSTRA, BETH R MD	1/31/1991	207P00000X	NA	Other	026	PHYSICIANS	71225	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
131653	Fee-for-Service	1154497204	1154497204	1	1	KONDO, MEREDITH C S	3/3/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
131718	Fee-for-Service	1932271749	1932271749	1	1	KANG, JUNE H MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63530	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
131749	Fee-for-Service	1316120934	1316120934	1	1	KALRA, VANEET K MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138258	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
131755	Fee-for-Service	1306291562	1306291562	1	1	KARAS, ANDREW	11/2/2020	207R00000X	NA	Other	026	PHYSICIANS	158010	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
131766	Fee-for-Service	1063497741	1063497741	1	1	KLEEN, STEVEN R OD	10/28/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31685 HWY 79 SO	SUITE A	TEMECULA	CA	92592	0000	33	06065	33.47927823	-117.1050037	Riverside County
131771	Fee-for-Service	1912685611	1912685611	1	1	KIGGUNDU, ALEXANDRIA NANTONG	7/2/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	26565 MAPLE LEAF DRIVE	None	MORENO VALLEY	CA	92555	3515	33	06065	33.9363075	-117.1986474	Riverside County
131772	Fee-for-Service	1144540451	1144540451	1	1	KAPLAN, LAWRENCE E DO	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14158	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
131802	Fee-for-Service	1417125477	1417125477	1	1	KIM PHARMACY	7/1/1994	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ATTN: KIM-OANH T TRAN	14536 BROOKHURST ST	STE 101	WESTMINSTER	CA	92683	5788	30	06059	33.751737	-117.9548845	Orange County
131809	Fee-for-Service	1134652753	1134652753	1	1	KIHIRA, SHINGO	2/10/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175798	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
131834	Fee-for-Service	1427214055	1427214055	1	1	KIM, JUNG H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	STATE UNIV OF IOWA	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
131844	Fee-for-Service	1306994041	1306994041	1	1	KELLY TRAN OPTOMETRY, INC	3/20/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2923 EL CAMINO REAL	None	TUSTIN	CA	92782	8909	30	06059	33.72388881	-117.7938837	Orange County
131870	Fee-for-Service	1720303613	1720303613	1	1	KAIR, LAURA R MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143376	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
131886	Fee-for-Service	1063443208	1063443208	1	1	KAMMEN, BAMIDELE F MD	2/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85150	30	Radiology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
131889	Fee-for-Service	1396954392	1396954392	1	1	KHELFA, YOUSEF	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	138847	68	Hematology	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
131915	Fee-for-Service	1508830589	1508830589	1	1	KAO, LILLY I MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53602	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
131917	Fee-for-Service	1639131154	1639131154	1	1	KIM, JIENSUP MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75806	25	Physical Medicine and Rehabilitation	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
131920	Fee-for-Service	1851591572	1851591572	1	1	KWONG, MARY S OD	8/3/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
131942	Fee-for-Service	1326217829	1326217829	1	1	KIMAW MEDICAL CENTER	2/26/1999	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	1200 AIRPORT RD	None	HOOPA	CA	95546	0000	12	06023	41.04526615	-123.6661741	Humboldt County
131948	Fee-for-Service	1285807933	1285807933	1	1	KHAN, WAJEEHA Y LMFT	11/4/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2299 MOWRY AVE	None	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
131964	Fee-for-Service	1720640337	1720640337	1	1	KINAMI, HIROO	10/23/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
131971	Fee-for-Service	1073648192	1073648192	1	1	KARNIK, NIRANJAN S MD	8/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85259	26	Psychiatry (child)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
132005	Fee-for-Service	1881328730	1881328730	1	1	K2 PHARMACY, INC	8/11/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11010 MAGNOLIA ST	None	GARDEN GROVE	CA	92841	1046	30	06059	33.80272077	-117.9756156	Orange County
132072	Fee-for-Service	1184170417	1184170417	1	1	KHAN, UROOJ MD	11/16/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	191784	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
132108	Fee-for-Service	1861427437	1861427437	1	1	KANO, HENRY L MD	7/31/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74908	40	Pediatrics	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
132161	Fee-for-Service	1649318023	1649318023	1	1	KATIKIREDDY, CHANDRA K	10/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82981	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
132172	Fee-for-Service	1205803947	1205803947	1	1	KATHLEEN HARGARTEN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	WATERTOWN EMERGENCY PHYS	125 HOSPITAL DR	None	WATERTOWN	WI	53098	0000	00	None	43.20015336	-88.69897782	Dodge County
132180	Fee-for-Service	1962443945	1962443945	1	1	KNOLL, CHARLES I MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100046	25	Physical Medicine and Rehabilitation	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
132189	Fee-for-Service	1548459811	1548459811	1	1	KWAN, FRANCES C PT	3/25/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
132233	Fee-for-Service	1265730618	1265730618	1	1	KENDRICK, EDWIN N III MD	11/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56176	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	315 N THIRD AVE	STE 304	COVINA	CA	91723	1905	19	06037	34.08873786	-117.8923869	Los Angeles County
132237	Fee-for-Service	1609902386	1609902386	1	1	KUBA, MEGAN H MD	12/17/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	135083	20	Orthopedic Surgery	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	9999	30	06059	33.85429451	-117.8446551	Orange County
132338	Fee-for-Service	1538216858	1538216858	1	1	KAISER FNDATION HLTH PLN	12/12/2001	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #402	20940 BURBANK BLVD	None	WOODLAND HILLS	CA	91367	6601	19	06037	34.1719401	-118.5881418	Los Angeles County
132340	Fee-for-Service	1265509095	1265509095	1	1	KUMAR, ANSHU MD	3/12/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	67505	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
132353	Fee-for-Service	1235300666	1235300666	1	1	KWAK, JENNIFER J MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
132367	Fee-for-Service	1245973163	1245973163	1	1	KYAW MIN MD INC	1/4/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	200 JOSE FIGUERES AVE ST	None	SAN JOSE	CA	95116	1593	43	06085	37.36122014	-121.8505998	Santa Clara County
132412	Fee-for-Service	1427092428	1427092428	1	1	KECK, KEVIN W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32520	08	Family Practice	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
132417	Fee-for-Service	1225058951	1225058951	1	1	KENNEDY, THOMAS E MD	10/15/1981	2084N0400X	NA	Neurology	026	PHYSICIANS	27311	13	Neurology (M.D. only)	0	In state provider	None	10720 PARAMOUNT BLVD	None	DOWNEY	CA	90241	3346	19	06037	33.94732999	-118.1345312	Los Angeles County
132421	Fee-for-Service	1306835020	1306835020	1	1	KAREN B. GARBY, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
132426	Fee-for-Service	1578502704	1578502704	1	1	KAHN, HENRY J MD INC	7/31/1993	207R00000X	NA	Other	026	PHYSICIANS	32905	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
132452	Fee-for-Service	1396964110	1396964110	2	1	KOREAN HEALTH, EDUCATION	2/25/2022	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	717 S WESTERN AVE	None	LOS ANGELES	CA	90005	0000	19	06037	34.059042	-118.3091185	Los Angeles County
132462	Fee-for-Service	1538424296	1538424296	1	1	KHAGHANI, SARA MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130265	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
132477	Fee-for-Service	1891006714	1891006714	1	1	KABANSKAYA, YELENA A MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112330	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
132488	Fee-for-Service	1962559294	1962559294	1	1	KORY, LEAH R MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75309	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
132502	Fee-for-Service	1184629479	1184629479	1	1	KENNEY, COLLEEN M DPM	7/1/1986	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2485 HIGH SCHOOL AVENUE	SUITE 222	CONCORD	CA	94520	1813	07	06013	37.98507961	-122.034189	Contra Costa County
132511	Fee-for-Service	1710229380	1710229380	1	1	KAHLON, PUSHPINDERDEEP S MD	5/23/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	159473	41	Internal Medicine	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
132581	Fee-for-Service	1184068405	1184068405	1	1	KWON, ANASTASIA E MD	10/31/2018	207L00000X	NA	Other	026	PHYSICIANS	134172	05	Anesthesiology	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
132615	Fee-for-Service	1972609352	1972609352	1	1	KEEFER, MATTHEW MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74609	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
132617	Fee-for-Service	1205146289	1205146289	1	1	KND DEVELOPMENT 55 LLC	11/1/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	10841 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	3811	36	06071	34.10467596	-117.5661881	San Bernardino County
132619	Fee-for-Service	1609021849	1609021849	2	1	KOZIN, ELIANA L MD	7/11/2022	207RX0202X	NA	Oncology	026	PHYSICIANS	172120	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
132620	Fee-for-Service	1508951377	1508951377	1	1	KIM, ANNA Y MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61100	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
132630	Fee-for-Service	1881616704	1881616704	1	2	KIM, GLORIA S MD	4/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	52949	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
132632	Fee-for-Service	1316951171	1316951171	1	1	KAWANA, ALEX Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68665	78	Neoplastic Diseases/Oncology	0	In state provider	None	5901 W OLYMPIC BLVD	STE 407	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
132636	Fee-for-Service	1235494089	1235494089	1	1	KAK, MANISHA MD	2/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149986	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
132689	Fee-for-Service	1952425936	1952425936	1	1	KANKAR, PADMAJA R MD	9/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98001	None	None	0	In state provider	None	2618 S WESTERN AVE	None	LOS ANGELES	CA	90018	2627	19	06037	34.03197	-118.3089435	Los Angeles County
132707	Fee-for-Service	1225058951	1225058951	1	1	KENNEDY, THOMAS E MD	10/15/1981	2084N0400X	NA	Neurology	026	PHYSICIANS	27311	41	Internal Medicine	0	In state provider	None	10720 PARAMOUNT BLVD	None	DOWNEY	CA	90241	3346	19	06037	33.94732999	-118.1345312	Los Angeles County
132774	Fee-for-Service	1316309354	1316309354	1	1	KHOO, CATHERINE P MD	4/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153067	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
132807	Fee-for-Service	1386718831	1386718831	1	1	KURERA, THEOMAL D MD	6/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	88894	66	Emergency Medicine (Urgent Care)	0	In state provider	None	210 SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
132808	Fee-for-Service	1851825061	1851825061	1	1	KLEIN, ADRIAN M MD	8/23/2021	207L00000X	NA	Other	026	PHYSICIANS	171518	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
132810	Fee-for-Service	1104922038	1104922038	1	1	KHAMISHON, BORIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56165	13	Neurology (M.D. only)	0	In state provider	None	4276 54TH PL	STE C	SAN DIEGO	CA	92115	6011	37	06073	32.75444691	-117.0788921	San Diego County
132811	Fee-for-Service	1356805436	1356805436	1	1	KATSURA, JENNIFER CRNA	6/7/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
132812	Fee-for-Service	1215084538	1215084538	1	1	KAISER FOUNDATION HEALTH	7/1/1996	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN OAKHURST PHARM 801	40595 WESTLAKE DR	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
132858	Fee-for-Service	1790752343	1790752343	1	1	KOEHLER, SARA L MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88973	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
132885	Fee-for-Service	1063779171	1063779171	1	1	KIM, LAWRENCE MD	6/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129016	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
132905	Fee-for-Service	1205146289	1205146289	1	1	KND DEVELOPMENT 55 LLC	11/1/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	10841 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	3811	36	06071	34.10467596	-117.5661881	San Bernardino County
132906	Fee-for-Service	1972609352	1972609352	1	1	KEEFER, MATTHEW MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74609	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
132920	Fee-for-Service	1316951171	1316951171	1	1	KAWANA, ALEX Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68665	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 407	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
132942	Fee-for-Service	1023577285	1023577285	1	1	KIM, BORA MD	6/11/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	181264	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
132997	Fee-for-Service	1538130877	1538130877	1	1	KING, NAPOLEON J III MD	11/3/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE 100	LAS VEGAS	NV	89106	4812	00	None	36.16257648	-115.170696	Clark County
133002	Fee-for-Service	1932649563	1932649563	1	1	KORDE, RUNA PSYD	5/25/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
133032	Fee-for-Service	1881860260	1881860260	1	1	KELLY, MICHAEL B MD	8/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121242	26	Psychiatry (child)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
133049	Fee-for-Service	1811420698	1811420698	1	1	KIM, SOLOMON MD	6/23/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176102	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133057	Fee-for-Service	1942663216	1942663216	1	1	KOVAR, ALEXANDRA F MD	7/14/2023	208600000X	NA	General Surgery	026	PHYSICIANS	187141	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133061	Fee-for-Service	1609098540	1609098540	1	1	KIM, HYUNG S MD	3/4/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	80567	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
133098	Fee-for-Service	1104922038	1104922038	1	1	KHAMISHON, BORIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56165	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4276 54TH PL	STE C	SAN DIEGO	CA	92115	6011	37	06073	32.75444691	-117.0788921	San Diego County
133110	Fee-for-Service	1598912487	1598912487	1	1	KERN, LEAH D MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107537	40	Pediatrics	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
133133	Fee-for-Service	1841256153	1841256153	1	1	KIVITZ, PHILIP B MD	1/1/2001	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	7829	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133166	Fee-for-Service	1881071868	1881071868	1	1	KUO, GRACE Y MD	7/10/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	148658	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000A	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
133175	Fee-for-Service	1194714030	1194714030	1	1	KABINS, MARK B MD	8/14/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	600 S RANCHO DR	STE 107	LAS VEGAS	NV	89106	4806	00	None	36.16385627	-115.1727818	Clark County
133209	Fee-for-Service	1316951171	1316951171	1	1	KAWANA, ALEX Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68665	68	Hematology	0	In state provider	None	5901 W OLYMPIC BLVD	STE 407	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
133244	Fee-for-Service	1699037663	1699037663	1	1	KO, JEFFREY K LCSW	2/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
133259	Fee-for-Service	1801841812	1801841812	1	1	KOHANIM, SHAHROKH DO	7/11/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	7227	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
133286	Fee-for-Service	1003322835	1003322835	2	1	KM2 HEALTHCARE INC	7/5/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	846 W DUARTE RD	None	ARCADIA	CA	91007	7523	19	06037	34.12532164	-118.0596038	Los Angeles County
133303	Fee-for-Service	1285013037	1285013037	1	1	KANAL, ABRAHAM MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155927	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
133305	Fee-for-Service	1184772014	1184772014	1	1	KHOSHINI, REZA MD	11/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77202	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
133307	Fee-for-Service	1871785220	1871785220	1	1	KING, BRYAN O MD	7/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97167	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	30250 RANCHO VIEJO RD	STE G	SAN JUAN CAPISTRA	CA	92675	1555	30	06059	33.52319034	-117.6657717	Orange County
133322	Fee-for-Service	1881860260	1881860260	1	1	KELLY, MICHAEL B MD	8/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121242	36	Psychiatry	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
133340	Fee-for-Service	1124461736	1124461736	1	1	KOROLYOV, JUSTINE K MD	4/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145819	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
133391	Fee-for-Service	1033761069	1033761069	1	1	KHADR, TARA Y LMFT	4/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16055 VENTURA BLVD	STE 1010	ENCINO	CA	91436	2611	19	06037	34.15632563	-118.4832351	Los Angeles County
133406	Fee-for-Service	1952447716	1952447716	1	1	KIVLAHAN, COLEEN H MD	3/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140099	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
133443	Fee-for-Service	1912436452	1912436452	1	1	KAHALE, KRISTIN MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	169391	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
133475	Fee-for-Service	1093143554	1093143554	1	1	KANCLEROWICZ, KELLY S LMFT	9/24/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3438 MENDOCINO AVE	SUITE B	SANTA ROSA	CA	95403	2275	49	06097	38.472282	-122.723991	Sonoma County
133487	Fee-for-Service	1134210727	1134210727	1	1	KUNTZE, JOSEPH R MD	10/29/1994	208800000X	NA	Other	026	PHYSICIANS	46309	34	Urology and Urological Surgery	0	In state provider	None	1105 LAS TABLAS RD	STE A	TEMPLETON	CA	93465	9731	40	06079	35.55437047	-120.7191105	San Luis Obispo County
133515	Fee-for-Service	1770282402	1770282402	1	1	KIM, JINHO NP	1/9/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
133550	Fee-for-Service	1063928711	1063928711	1	1	KNOWLES, ERICA NP	10/20/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
133562	Fee-for-Service	1477086866	1477086866	1	1	KIM, JESSICA N MD	10/29/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157835	None	None	0	In state provider	None	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
133564	Fee-for-Service	1063925691	1063925691	1	1	KWON, HAEMIN	9/12/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
133578	Fee-for-Service	1477589257	1477589257	1	2	KHAN, MOHAMMAD SHAHID A MD	10/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	81486	-	NOT APPLICABLE	0	In state provider	None	83-912 AVENUE 45	SUITE 9	INDIO	CA	92201	7351	33	06065	33.722208	-116.2097446	Riverside County
133589	Fee-for-Service	1871785220	1871785220	1	1	KING, BRYAN O MD	7/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97167	41	Internal Medicine	0	In state provider	None	30250 RANCHO VIEJO RD	STE G	SAN JUAN CAPISTRA	CA	92675	1555	30	06059	33.52319034	-117.6657717	Orange County
133590	Fee-for-Service	1033104203	1033104203	1	1	KUNG, ROBERTA MD	9/30/1994	207L00000X	NA	Other	026	PHYSICIANS	74712	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
133628	Fee-for-Service	1659549400	1659549400	1	1	KAYVANFAR, JOHN MD	7/1/1994	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	OLYMPIC ORTHOPAEDIC & SP	1224 E AVENUE S	STE C	PALMDALE	CA	93550	6180	19	06037	34.55794829	-118.1054823	Los Angeles County
133636	Fee-for-Service	1093814568	1093814568	1	1	KING,CHRISTOPHER G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	407 ULUNIU ST	4TH FLOOR	KAILUA	HI	96734	0000	00	None	21.39646318	-157.7434882	Honolulu County
133669	Fee-for-Service	1235206053	1235206053	1	1	KUMAR, PREM MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44151	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
133687	Fee-for-Service	1730271669	1730271669	1	1	KAISAKI, DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	45 10TH ST W	None	SAINT PAUL	MN	55102	1062	00	None	44.94882525	-93.10059843	Ramsey County
133695	Fee-for-Service	1982281267	1982281267	1	1	KAISER FOUNDATION HEALTH PLA	7/16/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	910	2621 TENTH ST	FL 2 RM 2505	BERKELEY	CA	94710	0000	01	06001	37.85811852	-122.2898175	Alameda County
133702	Fee-for-Service	1205920931	1205920931	1	1	KURLAWALLA-MARTINEZ, C	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72247	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
133718	Fee-for-Service	1003183237	1003183237	1	1	KANDDID HEALTHCARE INC	3/1/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9161 SIERRA AVE	STE 200	FONTANA	CA	92335	4779	36	06071	34.08720678	-117.4356898	San Bernardino County
133731	Fee-for-Service	1205892767	1205892767	1	1	KIRCHER, STEPHEN W MD	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.812245	-96.841584	Dallas County
133747	Fee-for-Service	1194873166	1194873166	1	1	KENT, PENELOPE J MD	5/31/1993	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	74128	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
133764	Fee-for-Service	1649358458	1649358458	1	1	KEYHAN, GOLYAR MD	1/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91699	67	Endocrinology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
133805	Fee-for-Service	1942072038	1942072038	1	1	KANE, LAURA A CNP	11/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
133878	Fee-for-Service	1871119172	1871119172	1	1	KOMISSAROVA, IRINA MD	8/1/2023	207R00000X	NA	Other	026	PHYSICIANS	186152	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
133886	Fee-for-Service	1619450921	1619450921	1	1	KNIGHT, ROBIN M LMFT	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
133957	Fee-for-Service	1235206053	1235206053	1	1	KUMAR, PREM MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44151	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
134044	Fee-for-Service	1427176569	1427176569	2	2	KERN COUNTY HOSPITAL AUTHORI	7/1/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1420 H STREET	None	BAKERSFIELD	CA	93301	5116	15	06029	35.37072	-119.021192	Kern County
134049	Fee-for-Service	1811217037	1811217037	1	1	KHANIFAR, ELHAM MD	1/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	106655	22	Pathology (M.D. only)	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
134052	Fee-for-Service	1831966035	1831966035	1	1	KESEL, KELSEY T PT	12/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30141 ANTELOPE RD.	STE A	MENIFEE	CA	92584	7001	33	06065	33.68176015	-117.1680307	Riverside County
134113	Fee-for-Service	1366109050	1366109050	1	1	KAUR, PUSHPINDER CNP	7/31/2024	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
134133	Fee-for-Service	1215262563	1215262563	1	1	KHAN, AMNA M MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120103	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
134134	Fee-for-Service	1336315316	1336315316	2	1	KUO, PHILLIP H MD	5/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	77707	30	Radiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
134148	Fee-for-Service	1669736427	1669736427	1	1	KAPADIA, RAVI N MD	2/15/2022	208600000X	NA	General Surgery	026	PHYSICIANS	175799	None	None	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
134177	Fee-for-Service	1366467771	1366467771	1	1	KRABBENHOFT, JOHN R	2/25/2009	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1792 TRIBUTE ROAD	STE 350	SACRAMENTO	CA	95815	4322	34	06067	38.598219	-121.445964	Sacramento County
134198	Fee-for-Service	1366999021	1366999021	1	1	KAISER FOUNDATION HEALTH PLA	1/20/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	FL 1	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
134222	Fee-for-Service	1821441791	1821441791	1	1	KWON, EUGENIA Y MD	10/16/2024	208600000X	NA	General Surgery	026	PHYSICIANS	153210	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
134242	Fee-for-Service	1912223850	1912223850	1	1	KYAW, KAY K MD	11/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125382	41	Internal Medicine	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
134243	Fee-for-Service	1972797637	1972797637	1	1	KRONSTAD, DEBORAH A MD	5/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104865	40	Pediatrics	0	In state provider	None	11370 ANDERSON STREET	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
134278	Fee-for-Service	1750519708	1750519708	1	1	KAHN, DANIEL G MD	2/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115196	None	None	0	In state provider	None	200 MED PLAZA	365#	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
134288	Fee-for-Service	1669768073	1669768073	1	1	KIM, TIFFANY Y MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125170	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
134306	Fee-for-Service	1487991576	1487991576	1	2	KARANDEEP SINGH, MD PC	4/5/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	EDICAL GROUP	915 W 7TH ST	None	OXNARD	CA	93030	5766	56	06111	34.19516388	-119.1889217	Ventura County
134333	Fee-for-Service	1912022559	1912022559	1	1	KATHERIA, ANUP C MD	6/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92926	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
134343	Fee-for-Service	1154716207	1154716207	1	1	KELLY, YVONNE M MD	1/28/2019	208600000X	NA	General Surgery	026	PHYSICIANS	145671	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
134377	Fee-for-Service	1336387018	1336387018	1	1	KALU, CHIOMA A	8/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102218	None	None	0	In state provider	None	8781 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2406	19	06037	34.22960628	-118.4502708	Los Angeles County
134383	Fee-for-Service	1174527766	1174527766	1	1	KHALID SHAFIQ, MD,	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1775 FARM ROAD 195	None	PARIS	TX	75462	0000	00	None	33.6775928	-95.52753188	Lamar County
134417	Fee-for-Service	1447308275	1447308275	1	1	KAISER FOUNDATION HOSP	5/24/1989	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #501	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3000	33	06065	33.904782	-117.469323	Riverside County
134422	Fee-for-Service	1336315316	1336315316	2	1	KUO, PHILLIP H MD	5/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	77707	42	Nuclear Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
134446	Fee-for-Service	1285706259	1285706259	2	1	KAUSHAL, RAJINDER MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	40695	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
134467	Fee-for-Service	1649934837	1649934837	1	1	KIM, EUNHYE CNP	12/28/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
134468	Fee-for-Service	1942295134	1942295134	1	1	KAHN, FREDERICK W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2900 12TH AVE N	STE 300E	BILLINGS	MT	59101	7509	00	None	45.792225	-108.518706	Yellowstone County
134472	Fee-for-Service	1326452087	1326452087	1	1	KUO, JAMES DO	8/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14832	41	Internal Medicine	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
134491	Fee-for-Service	1730172693	1730172693	1	2	KIM,TOMMY Y MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74005	40	Pediatrics	0	In state provider	ATTN MGA OFFICE	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
134493	Fee-for-Service	1952175556	1952175556	1	1	KARIITHI, GATIMU	12/6/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	716 TURQUOISE DRIVE	None	HERCULES	CA	94547	1763	07	06013	37.99654457	-122.2723606	Contra Costa County
134530	Fee-for-Service	1912223850	1912223850	1	1	KYAW, KAY K MD	11/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125382	45	Nephrology (Renal-Kidney)	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
134566	Fee-for-Service	1427059971	1427059971	1	1	KLAS, WILLIAM A MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	65747	08	Family Practice	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
134574	Fee-for-Service	1164746012	1164746012	1	1	KIRK, MICHELE LMFT	6/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
134594	Fee-for-Service	1457305344	1457305344	1	1	KUHN, NANCY J MD	7/31/1991	207P00000X	NA	Other	026	PHYSICIANS	38156	66	Emergency Medicine (Urgent Care)	0	In state provider	None	725 S SAN FERNANDO BLVD	None	BURBANK	CA	91502	1445	19	06037	34.17597706	-118.3020251	Los Angeles County
134651	Fee-for-Service	1356498687	1356498687	1	1	KAISER FND HLTH PLAN INC	10/28/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #281	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
134689	Fee-for-Service	1487460622	1487460622	1	1	KWONG, WING KEI RCP	2/2/2025	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
134718	Fee-for-Service	1063610590	1063610590	1	1	KELLY, SUKESHINI P	4/4/2007	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2033 E COLUNGA ST	None	COLTON	CA	92324	7510	36	06071	34.05520144	-117.2918855	San Bernardino County
134726	Fee-for-Service	1376905869	1376905869	1	1	KLEKMAN, MATTHEW S MD	1/21/2022	207L00000X	NA	Other	026	PHYSICIANS	153392	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
134767	Fee-for-Service	1639244262	1639244262	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	WALNUT CREEK	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
134772	Fee-for-Service	1780860536	1780860536	1	1	KARI, ELINA MD	7/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116411	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
134773	Fee-for-Service	1134670375	1134670375	1	1	KLOTZ, RACHEL E	12/5/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
134781	Fee-for-Service	1952175556	1952175556	1	1	KARIITHI, GATIMU	12/6/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	716 TURQUOISE DRIVE	None	HERCULES	CA	94547	1763	07	06013	37.99654457	-122.2723606	Contra Costa County
134792	Fee-for-Service	1639178692	1639178692	2	1	KAVALICH, ALLAN G MD	7/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	29326	45	Nephrology (Renal-Kidney)	0	In state provider	None	1500 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5111	36	06071	34.127181	-117.2788055	San Bernardino County
134800	Fee-for-Service	1588656631	1588656631	1	1	KOSINSKI, ANTHONY P MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88554	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRNACISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco
134806	Fee-for-Service	1922092923	1922092923	1	1	KRUBA, JOHN A MD	11/5/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
134820	Fee-for-Service	1689620676	1689620676	1	1	KAMSON, OLAYINKA MD	2/1/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	62099	None	None	0	In state provider	None	2220 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2514	19	06037	33.9598587	-118.318258	Los Angeles County
134857	Fee-for-Service	1902664915	1902664915	1	1	KHADER, AMBARENE PT	8/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
134863	Fee-for-Service	1194277087	1194277087	1	1	KOVARIK, MEGAN J	11/15/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1225 EUREKA WY	STE B	REDDING	CA	96001	0815	45	06089	40.58819524	-122.3900343	Shasta County
134894	Fee-for-Service	1003170986	1003170986	1	1	KIPP BRIDGE CHARTER SCHOOL	7/1/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ATTN: DISTRICT	1000 BROADWAY ST	SUITE 460	OAKLAND	CA	94607	4033	01	06001	37.80185548	-122.2726866	Alameda County
134895	Fee-for-Service	1588930879	1588930879	1	1	KERN, JOHN M DO	10/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14704	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
134906	Fee-for-Service	1861536435	1861536435	1	1	KLEEMAN, JOHN J MD	5/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1901 MAIN STREET	None	KLAMATH FALLS	OR	97601	2638	00	None	42.22840943	-121.7692762	Klamath County
134907	Fee-for-Service	1033205463	1033205463	1	1	KHEHAR, BS MD INC	3/2/2010	207R00000X	NA	Other	026	PHYSICIANS	61891	41	Internal Medicine	0	In state provider	None	4060 4TH AVE	STE 335	SAN DIEGO	CA	92103	2183	37	06073	32.75053673	-117.1616539	San Diego County
134910	Fee-for-Service	1114468204	1114468204	1	1	KASSAR, JOANNA M	2/8/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4035 MISSION OAKS BLVD	UNIT B	CAMARILLO	CA	93012	5156	56	06111	34.21640664	-119.0170311	Ventura County
134935	Fee-for-Service	1376552174	1376552174	1	1	KATZEN, ROBERT I MD INC	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	31016	41	Internal Medicine	0	In state provider	None	19582 BEACH BLVD	STE 206	HUNTINGTON BEACH	CA	92648	5950	30	06059	33.67831649	-117.9885198	Orange County
134942	Fee-for-Service	1588663769	1588663769	1	10	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1633 S COURT ST	None	VISALIA	CA	93277	4911	54	06107	36.315972	-119.292237	Tulare County
134947	Fee-for-Service	1366787053	1366787053	1	1	KUCEJKO, ROBERT MD	9/1/2022	208600000X	NA	General Surgery	026	PHYSICIANS	178559	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
134957	Fee-for-Service	1285058909	1285058909	1	1	KRETZSCHMAR, ASHLEY P LMFT	5/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	624 W 9TH ST	103	SAN PEDRO	CA	90731	3158	19	06037	33.73607853	-118.290789	Los Angeles County
135050	Fee-for-Service	1104939172	1104939172	1	1	KUDTARKAR, SWAPNA S MD	6/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	67887	40	Pediatrics	0	In state provider	None	17051 SIERRA LAKES PKWY	STE 101	FONTANA	CA	92336	1274	36	06071	34.13797332	-117.4324372	San Bernardino County
135073	Fee-for-Service	1285654202	1285654202	1	1	KING, BENJAMIN N MD	4/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76736	40	Pediatrics	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
135078	Fee-for-Service	1639178692	1639178692	2	1	KAVALICH, ALLAN G MD	7/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	29326	41	Internal Medicine	0	In state provider	None	1500 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5111	36	06071	34.127181	-117.2788055	San Bernardino County
135094	Fee-for-Service	1669522264	1669522264	1	1	KU, HONG K OD	11/19/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 N RIVERSIDE AVE	SUITE 100	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
135125	Fee-for-Service	1972747384	1972747384	1	1	KELLERMAN, ALAN S MD	6/18/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	24844	-	NOT APPLICABLE	0	In state provider	None	180 SIERRA COLLEGE DR	None	GRASS VALLEY	CA	95945	5768	29	06057	39.23235449	-121.0475561	Nevada County
135126	Fee-for-Service	1730708447	1730708447	1	1	KIM, RACHEL Y OD	11/30/2021	390200000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
135145	Fee-for-Service	1437707387	1437707387	1	1	KELADA PHYSICIANS GROUP, INC	4/23/2020	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	680 SUNRISE AVE	None	ROSEVILLE	CA	95661	4110	31	06061	38.7360182	-121.2720418	Placer County
135181	Fee-for-Service	1134280431	1134280431	1	1	KLEIN, ALLYSON L LCSW	6/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
135215	Fee-for-Service	1437288073	1437288073	1	1	KARIMIAN, SIAVASH MD	4/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98867	08	Family Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
135272	Fee-for-Service	1497258073	1497258073	1	1	KHOSHNOOD, MELLAD M MD	6/27/2022	390200000X	NA	Other	026	PHYSICIANS	161334	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
135298	Fee-for-Service	1306101464	1306101464	1	1	KAREN L SAPIENZA MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
135333	Fee-for-Service	1134469562	1134469562	1	1	KRALL, TERESA A PHD	4/23/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
135342	Fee-for-Service	1336669803	1336669803	1	1	K&J 1602 MANAGEMENT	8/14/2024	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATE	1602 REGENE STREET	None	POMONA	CA	91766	5316	19	06037	34.0425026	-117.7418883	Los Angeles County
135376	Fee-for-Service	1497316814	1497316814	1	1	KARIMI, ASHLEY PA-C	2/20/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	56968	-	NOT APPLICABLE	0	In state provider	None	7101 BAIRD AVENUE	None	RESEDA	CA	91335	4150	19	06037	34.1995012	-118.5373824	Los Angeles County
135425	Fee-for-Service	1285926618	1285926618	1	1	KNOWLES, JULIET K MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122159	13	Neurology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
135482	Fee-for-Service	1982886107	1982886107	1	1	KATZ, RICHARD A MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	22825	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5555 RESERVOIR DRIVE	SUITE 112	SAN DIEGO	CA	92120	5195	37	06073	32.77628471	-117.0563688	San Diego County
135613	Fee-for-Service	1568972941	1568972941	1	1	KNAPP, ANDREA N AU	7/17/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
135637	Fee-for-Service	1104077734	1104077734	1	1	KIDANE, SENAI MD	5/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100641	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
135665	Fee-for-Service	1154360170	1154360170	1	1	KIM, PAUL E MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61757	30	Radiology	0	In state provider	None	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
135687	Fee-for-Service	1366827685	1366827685	1	1	KAIN, SIMONE MONIQUE	3/23/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12406 DEBORAH DR	None	VICTORVILLE	CA	92392	4861	36	06071	34.45146279	-117.3929494	San Bernardino County
135739	Fee-for-Service	1245289594	1245289594	1	1	KOO, JOHN M MD	6/19/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	48584	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	# 316	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135812	Fee-for-Service	1093795239	1093795239	1	1	KABEER, MUSTAFA H MD	6/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86862	02	General Surgery	0	In state provider	None	1310 W STEWART DR	STE 308	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
135859	Fee-for-Service	1952719122	1952719122	1	1	KENNEDY, CARRIE A LPCC	1/7/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
135885	Fee-for-Service	1124708177	1124708177	1	1	KEROLES, AMBER L PSYD	9/18/2023	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39650 LIBERTY ST	SUITE 140	FREMONT	CA	94538	2225	01	06001	37.54662058	-121.9736002	Alameda County
135896	Fee-for-Service	1457398695	1457398695	1	1	KIMBALL, STEVEN T MD	8/14/1995	207L00000X	NA	Other	026	PHYSICIANS	61543	05	Anesthesiology	0	In state provider	None	6403 COYLE AVE	STE 150	CARMICHAEL	CA	95608	0311	34	06067	38.668347	-121.3148745	Sacramento County
135901	Fee-for-Service	1588213029	1588213029	1	1	KHALEGHIFAR, MOHAMMAD PT	3/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
135905	Fee-for-Service	1437188380	1437188380	1	1	KILANI, MARWA W MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77118	41	Internal Medicine	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
135909	Fee-for-Service	1508993593	1508993593	1	1	KOGON, MANUELA M MD	4/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76902	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135915	Fee-for-Service	1871872556	1871872556	1	1	KOVACS, EVELYN LMFT	3/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
135951	Fee-for-Service	1790794790	1790794790	1	1	KLINK, ARLENE MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85095	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
135974	Fee-for-Service	1366827685	1366827685	1	1	KAIN, SIMONE MONIQUE	3/23/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12406 DEBORAH DR	None	VICTORVILLE	CA	92392	4861	36	06071	34.45146279	-117.3929494	San Bernardino County
135979	Fee-for-Service	1619600939	1619600939	1	1	KNOPF, EHSAN LCSW	11/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
135980	Fee-for-Service	1942819552	1942819552	1	1	KIM, VERONICA LMFT	11/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
136016	Fee-for-Service	1174783260	1174783260	1	1	KARAYEV, DMITRY	6/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103031	83	Rheumatology	0	In state provider	None	8640 WEST THIRD STREET	SUITE 300	LOS ANGELES	CA	90048	3386	19	06037	34.07357646	-118.3813447	Los Angeles County
136023	Fee-for-Service	1972759843	1972759843	1	2	KONZEVIK, CLARA LMFT	3/21/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3685 MOTOR AVE	STE 220	LOS ANGELES	CA	90034	5746	19	06037	34.02287002	-118.4058288	Los Angeles County
136037	Fee-for-Service	1104220102	1104220102	1	1	KIM, JONATHAN D DPM	3/12/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	39000 BOB HOPE DR	PROBST BUILDING SUITE 20	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
136046	Fee-for-Service	1154718526	1154718526	1	1	KADAKIA, RIKIN S	1/20/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	170650	None	None	0	In state provider	None	230 SAN JOSE STREET	None	SALINAS	CA	93901	3901	27	06053	36.65837657	-121.6469645	Monterey County
136055	Fee-for-Service	1467486050	1467486050	1	1	KIHICZAK, DANYLO MD	4/1/2001	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	84422	30	Radiology	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
136068	Fee-for-Service	1346733946	1346733946	1	1	KIM, CHRISTINE S MD	10/6/2022	208M00000X	NA	Other	026	PHYSICIANS	166127	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
136102	Fee-for-Service	1861719221	1861719221	1	1	KHALIGHI, KATAYOUN MD	7/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110976	08	Family Practice	0	In state provider	None	2140 GRAND AVE	SUITE 125	CHINO HILLS	CA	91709	6802	36	06071	33.99623518	-117.7579477	San Bernardino County
136165	Fee-for-Service	1225103930	1225103930	1	1	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4501 BROADWAY	1ST FL	OAKLAND	CA	94611	5613	01	06001	37.833289	-122.2531244	Alameda County
136176	Fee-for-Service	1942319918	1942319918	1	1	KAN, DAVID Y MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73621	36	Psychiatry	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
136212	Fee-for-Service	1275790784	1275790784	1	1	KHAFAF, MANA MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114872	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
136221	Fee-for-Service	1992872907	1992872907	1	1	KREBS, JEFFREY S MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	61376	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
136269	Fee-for-Service	1992112684	1992112684	1	1	KUO, BELINDA OD	8/28/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
136276	Fee-for-Service	1609073071	1609073071	1	1	KHANNA, DEEPAK MD	12/1/2000	174400000X	NA	Other	026	PHYSICIANS	71712	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
136280	Fee-for-Service	1578581245	1578581245	1	1	KUO, MEI-SHI CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7548 GARVEY AVE	None	ROSEMEAD	CA	91770	2960	19	06037	34.06258954	-118.1042325	Los Angeles County
136310	Fee-for-Service	1124265822	1124265822	1	1	KHARAIT, SOURABH P MD	7/21/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	107133	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
136324	Fee-for-Service	1194820456	1194820456	1	1	KELLY,TRACY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MARTIN LUTHER KING	JR	TACOMA	WA	98415	0299	00	None	47.25960844	-122.4534238	Pierce County
136346	Fee-for-Service	1083903173	1083903173	1	1	KAGODA, MERCY MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125870	01	General Practice	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
136394	Fee-for-Service	1770787020	1770787020	1	1	KOINONIA FOSTER HOMES, INC	1/22/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5980 WEBB STREET	None	LOOMIS	CA	95650	7625	31	06061	38.8221281	-121.1921002	Placer County
136417	Fee-for-Service	1578740718	1578740718	1	1	KWONG, BRIAN M MD	9/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102537	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	95611	5642	01	06001	37.8242017	-122.2578306	Alameda County
136420	Fee-for-Service	1679967210	1679967210	1	1	KEEGAN, RAPHAEL JOHN H DO	10/11/2021	390200000X	NA	Other	026	PHYSICIANS	17251	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
136453	Fee-for-Service	1225103930	1225103930	1	1	KAISER FOUNDATION HOSPITALS	12/8/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4501 BROADWAY	1ST FL	OAKLAND	CA	94611	5613	01	06001	37.833289	-122.2531244	Alameda County
136458	Fee-for-Service	1821262742	1821262742	1	1	KAR, SUBRARTA DO	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13531	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16850 BEAR VALLEY ROAD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
136479	Fee-for-Service	1134231293	1134231293	1	1	KOHLER, JONATHAN E MD	12/1/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	170636	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
136511	Fee-for-Service	1992872907	1992872907	1	1	KREBS, JEFFREY S MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	61376	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
136541	Fee-for-Service	1184798498	1184798498	1	1	KUMAR, MUNISH MD	6/11/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93174	08	Family Practice	0	In state provider	None	6650 FAIR OAKS BLVD	None	SACRAMENTO	CA	95608	4026	34	06067	38.622177	-121.328172	Sacramento
136561	Fee-for-Service	1508111295	1508111295	1	1	KONSTANTINIDIS, BIANCA LMFT	10/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
136571	Fee-for-Service	1215530290	1215530290	1	1	KRINJAK, KAYLA H LCSW	8/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
136573	Fee-for-Service	1528005535	1528005535	1	1	KANE,JON P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1221 NICOLLET MALL 600	None	MINNEAPOLIS	MN	55403	0000	00	None	44.9713607	-93.27681899	Hennepin County
136645	Fee-for-Service	1386815074	1386815074	1	1	KRONE, CHRISTOPHER N MD	12/20/2017	174400000X	NA	Other	026	PHYSICIANS	119946	41	Internal Medicine	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
136659	Fee-for-Service	1659803856	1659803856	1	1	KIM, ROBERT K MD	6/4/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
136661	Fee-for-Service	1750327102	1750327102	1	1	KUHN, DENISE PT	4/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17270 BEAR VALLEY RD	STE 105	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
136740	Fee-for-Service	1275063976	1275063976	1	1	KALAMKARIAN, ARMAN H MD	10/5/2020	207R00000X	NA	Other	026	PHYSICIANS	164007	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
136746	Fee-for-Service	1821262742	1821262742	1	1	KAR, SUBRARTA DO	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13531	41	Internal Medicine	0	In state provider	None	16850 BEAR VALLEY ROAD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
136756	Fee-for-Service	1609025865	1609025865	1	1	KATO, SHU MEI MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111322	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
136785	Fee-for-Service	1992904395	1992904395	1	1	KHAN, HAMMAD O MD	9/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92889	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
136790	Fee-for-Service	1386887735	1386887735	1	1	KHOE, SYDEL F	2/8/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	314 E SAN BERNARDINO RD	None	COVINA	CA	91723	1641	19	06037	34.09044506	-117.8854319	Los Angeles County
136803	Fee-for-Service	1487919528	1487919528	1	1	KINNAIRD, SHERRY C MD	4/11/2018	208VP0014X	NA	Other	026	PHYSICIANS	147036	05	Anesthesiology	0	In state provider	None	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	37	06073	32.77677653	-117.1592911	San Diego County
136886	Fee-for-Service	1952472888	1952472888	1	1	KAMM, KEIRA L MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95532	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
136919	Fee-for-Service	1184242976	1184242976	1	1	KIM, HEEJIN E	9/20/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
136923	Fee-for-Service	1952578262	1952578262	1	1	KABUTEY, NII-KABU MD	6/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124702	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	90051	0347	30	06059	33.78674051	-117.8888713	Orange County
136948	Fee-for-Service	1710278395	1710278395	1	1	KARU, ANOUKI N MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104046	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
136956	Fee-for-Service	1467458182	1467458182	1	1	KHONA, RAJESH S MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
136959	Fee-for-Service	1831736958	1831736958	1	1	KAUR, JASDEEP NP	3/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
137028	Fee-for-Service	1578068631	1578068631	1	1	KAUR, VARINDERJIT MD	7/14/2023	207R00000X	NA	Other	026	PHYSICIANS	176736	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
137042	Fee-for-Service	1609025865	1609025865	1	1	KATO, SHU MEI MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111322	68	Hematology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
137047	Fee-for-Service	1639268568	1639268568	1	1	KULICK, MICHAEL I MD	10/1/1985	208200000X	NA	General Surgery	026	PHYSICIANS	42210	24	Plastic Surgery	0	In state provider	None	450 SUTTER ST	RM 2620	SAN FRANCISCO	CA	94108	4205	38	06075	37.78934929	-122.4077786	San Francisco County
137054	Fee-for-Service	1003801358	1003801358	1	1	KHASHAYAR, RAMIN MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	77458	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
137058	Fee-for-Service	1194229187	1194229187	1	1	KOPP, ZOE M	6/28/2021	207R00000X	NA	Other	026	PHYSICIANS	165963	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
137075	Fee-for-Service	1992904395	1992904395	1	1	KHAN, HAMMAD O MD	9/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92889	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
137089	Fee-for-Service	1578623062	1578623062	1	1	KAO, CHANNON W OD	3/19/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
137096	Fee-for-Service	1346297249	1346297249	1	2	KWIATKOWSKI, FERNANDO D MD	4/22/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42646	36	Psychiatry	0	In state provider	None	5353 MISSION CENTER RD	SUITE 224	SAN DIEGO	CA	92108	1306	37	06073	32.77207362	-117.154699	San Diego County
137115	Fee-for-Service	1447288543	1447288543	1	1	KIM, IL YOUNG MD INC	2/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	33707	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3919 BEVERLY BLVD	STE 100	LOS ANGELES	CA	90004	3432	19	06037	34.07634552	-118.294164	Los Angeles County
137145	Fee-for-Service	1073706966	1073706966	1	1	KERHULAS, IKE LMFT	6/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
137150	Fee-for-Service	1982688982	1982688982	1	1	KARLAN, SCOTT R MD	8/24/2004	174400000X	NA	Other	026	PHYSICIANS	57520	02	General Surgery	0	In state provider	None	416 N BEDFORD DR	STE 400	BEVERLY HILLS	CA	90210	4318	19	06037	34.06819809	-118.4052828	Los Angeles County
137176	Fee-for-Service	1346464765	1346464765	1	1	KHAN, RANA M A MD	6/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54497	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
137202	Fee-for-Service	1285958280	1285958280	1	1	KAVINOKY, BENJAMIN R DO	3/26/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	880 ALDER AVE	None	INCLINE VILLAGE	NV	89451	8335	00	None	39.25092003	-119.9543846	Washoe County
137205	Fee-for-Service	1902434673	1902434673	1	1	KATSAGGELOS, ERENI R MD	7/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185991	None	None	0	In state provider	None	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
137247	Fee-for-Service	1366938953	1366938953	1	1	KIM, JASON	8/20/2022	207L00000X	NA	Other	026	PHYSICIANS	17879	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
137248	Fee-for-Service	1295127835	1295127835	1	1	KHANNA, SHEENA MD	6/9/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	179181	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
137263	Fee-for-Service	1275545543	1275545543	1	1	KIM, ROY MD	4/27/2006	208200000X	NA	General Surgery	026	PHYSICIANS	84287	84	Surgery-Head and Neck	0	In state provider	None	45 CASTRO ST	STE 117	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
137293	Fee-for-Service	1609830637	1609830637	1	1	KRASNE, DAVID L MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	58882	22	Pathology (M.D. only)	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
137307	Fee-for-Service	1063715860	1063715860	1	1	KO, ALBERT MD	3/7/2011	207P00000X	NA	Other	026	PHYSICIANS	104809	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
137313	Fee-for-Service	1588680094	1588680094	2	1	KANAYA, SADAYO A MD	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	46158	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
137315	Fee-for-Service	1689632747	1689632747	1	1	KOEHLER, JANE	8/30/1991	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	56733	77	Infectious Disease	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
137361	Fee-for-Service	1770960809	1770960809	1	1	KIM, KHIJOO MD	8/15/2017	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	145961	40	Pediatrics	0	In state provider	None	1801 W ROMNEYA DR	STE 606	ANAHEIM	CA	92801	1828	30	06059	33.8506615	-117.946413	Orange County
137369	Fee-for-Service	1720427354	1720427354	1	1	KRIOGHLIAN, TAMAR LMFT	8/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6089 N 1ST ST	104	FRESNO	CA	93710	5464	10	06019	36.82574354	-119.7724848	Fresno County
137401	Fee-for-Service	1447288543	1447288543	1	1	KIM, IL YOUNG MD INC	2/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	33707	41	Internal Medicine	0	In state provider	None	3919 BEVERLY BLVD	STE 100	LOS ANGELES	CA	90004	3432	19	06037	34.07634552	-118.294164	Los Angeles County
137415	Fee-for-Service	1508282807	1508282807	1	1	KERKHOFF, LARRY B LMFT	10/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	157 SARGENT CT.	None	MONTEREY	CA	93940	0157	27	06053	36.5944891	-121.8945366	Monterey County
137431	Fee-for-Service	1922232214	1922232214	1	1	KNEITEL, ANNA W MD	9/28/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	115530	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
137470	Fee-for-Service	1730640053	1730640053	1	1	KHA, STEPHANIE T MD	8/1/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	178623	20	Orthopedic Surgery	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
137476	Fee-for-Service	1003336868	1003336868	1	1	KIRITSIS, PAUL PSYD	10/13/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 DEERWOOD RD	STE 200	SAN RAMON	CA	94583	4445	07	06013	37.77475997	-121.9892508	Contra Costa County
137483	Fee-for-Service	1790207579	1790207579	1	1	KIM, YUNHA MD	8/1/2020	207R00000X	NA	Other	026	PHYSICIANS	169549	41	Internal Medicine	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
137516	Fee-for-Service	1164577086	1164577086	1	1	KAISER FOUNDATION HOSPITALS	6/17/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1830 CALIFORNIA AVE	None	CORONA	CA	92881	3378	33	06065	33.85789752	-117.5390741	Riverside County
137547	Fee-for-Service	1275545543	1275545543	1	1	KIM, ROY MD	4/27/2006	208200000X	NA	General Surgery	026	PHYSICIANS	84287	24	Plastic Surgery	0	In state provider	None	45 CASTRO ST	STE 117	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
137591	Fee-for-Service	1245692250	1245692250	1	1	KARI, SWATHI S MD	8/7/2019	208M00000X	NA	Other	026	PHYSICIANS	159556	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
137612	Fee-for-Service	1700879384	1700879384	1	1	KOJOGLANIAN, SAMUEL A MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60872	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15243 VANOWEN ST	STE 301	VAN NUYS	CA	91405	3646	19	06037	34.19394848	-118.4654115	Los Angeles County
137622	Fee-for-Service	1912496878	1912496878	1	1	KHOSA, DILSHAN MD	7/1/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
137654	Fee-for-Service	1952032682	1952032682	1	1	KITTEL, MEGAN LMFT	12/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
137706	Fee-for-Service	1477692085	1477692085	1	1	KANEVSKY, MAX MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82544	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
137725	Fee-for-Service	1285016113	1285016113	1	1	KIM, CHANGHYUN MD	8/8/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	160605	07	Dermatology	0	In state provider	None	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
137742	Fee-for-Service	1457360836	1457360836	1	1	KHEMANI, PRAVIN MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98698	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
137781	Fee-for-Service	1598036949	1598036949	1	1	KLEIN, MARTHA J LCSW	4/13/2021	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
137805	Fee-for-Service	1225586662	1225586662	1	1	KNOWLES, BYRON A MD	6/12/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	152031	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
137810	Fee-for-Service	1285756817	1285756817	1	1	KOSURI,KALYAN MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112973	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3398 N G ST	STE B	MERCED	CA	95340	0982	24	06047	37.32601927	-120.4691188	Merced County
137815	Fee-for-Service	1508852799	1508852799	1	1	KLEIN, LORRIE J MD	4/29/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	58945	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
137831	Fee-for-Service	1396777538	1396777538	1	1	KAYALI, ZEID K MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71164	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
137844	Fee-for-Service	1902957442	1902957442	1	1	KING CITY UNION SCH DIST	12/26/2003	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	435 PEARL STREET	None	KING CITY	CA	93930	2919	27	06053	36.20965901	-121.1276277	Monterey County
137856	Fee-for-Service	1841873056	1841873056	1	1	KVRGIC, ZORAN MD	9/13/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
137926	Fee-for-Service	1568142909	1568142909	1	1	K & D HOMECARE INC	10/12/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8283 N GROVE AVE	STE 108 & 109	RANCHO CUCAMONGA	CA	91730	3137	36	06071	34.10380433	-117.6285116	San Bernardino County
137931	Fee-for-Service	1619001245	1619001245	1	1	KERAMATI, SHAHNAZ MD	10/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78117	40	Pediatrics	0	In state provider	None	10507 HAWTHORNE BLVD	None	LENNOX	CA	90304	1911	19	06037	33.940728	-118.3527455	Los Angeles County
137942	Fee-for-Service	1912012923	1912012923	1	1	KRAUSZ, HOWARD I MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	47728	18	Ophthalmology	0	In state provider	None	810 E OHIO AVE	None	ESCONDIDO	CA	92025	3421	37	06073	33.12651511	-117.0715892	San Diego County
137969	Fee-for-Service	1821143777	1821143777	1	1	KAISER FOUNDATION HOSP	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
137983	Fee-for-Service	1669547857	1669547857	1	1	KROONEN, LEO T MD	12/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82114	20	Orthopedic Surgery	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
138048	Fee-for-Service	1659654663	1659654663	1	1	KAI, PATRICIA A C NP	12/14/2012	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15747 WOODRUFF AVE	None	BELLFLOWER	CA	90706	4017	19	06037	33.889995	-118.1174155	Los Angeles County
138051	Fee-for-Service	1306904222	1306904222	1	1	KIMA W MEDICAL CENTER	7/9/2009	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	535 AIRPORT ROAD	None	HOOPA	CA	95546	0000	12	06023	41.04169689	-123.6656063	Humboldt County
138077	Fee-for-Service	1063462521	1063462521	1	1	KOENIG, PETER P MD INC	8/31/1992	193200000X	NA	Other	026	PHYSICIANS	23943	01	General Practice	0	In state provider	None	4940 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
138090	Fee-for-Service	1629029194	1629029194	1	1	KHADEMI, TALAKSOON S DO	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9077	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
138101	Fee-for-Service	1285756817	1285756817	1	1	KOSURI,KALYAN MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112973	41	Internal Medicine	0	In state provider	None	3398 N G ST	STE B	MERCED	CA	95340	0982	24	06047	37.32601927	-120.4691188	Merced County
138169	Fee-for-Service	1740622984	1740622984	1	1	KAMINO, LISA B OD	4/19/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5922 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3826	37	06073	32.75990298	-117.0701681	San Diego County
138170	Fee-for-Service	1033241658	1033241658	1	1	KU, GREGORY M MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95072	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138179	Fee-for-Service	1043228042	1043228042	1	1	KATZMAN, MARA LYNN	10/31/1988	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8813 CAMINITO SUENO	None	LA JOLLA	CA	92037	1611	37	06073	32.86714008	-117.238445	San Diego County
138188	Fee-for-Service	1164884797	1164884797	1	1	KAN, MATTHEW J MD	6/9/2022	2080P0201X	NA	Neurology	026	PHYSICIANS	160290	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
138215	Fee-for-Service	1346473295	1346473295	1	1	KASTEEN, KARA R LCSW	4/12/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4113 SCOTTS VALLEY DR	SUITE 212	SCOTTS VALLEY	CA	95066	4547	44	06087	37.04534733	-122.0217086	Santa Cruz County
138226	Fee-for-Service	1790826279	1790826279	1	1	KO, SAMUEL MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78138	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
138260	Fee-for-Service	1215967054	1215967054	1	1	KHODAVERDIAN, HAYKANOUSH	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43787	40	Pediatrics	0	In state provider	None	6327 N FRESNO ST	STE 108	FRESNO	CA	93710	5236	10	06019	36.82875536	-119.781417	Fresno County
138272	Fee-for-Service	1245256007	1245256007	1	1	KARAM, ANTHONY B DO	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9178	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
138303	Fee-for-Service	1205561420	1205561420	1	1	KIRBY, AMANDA K CNP	12/13/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	3001 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1114	00	None	42.25288307	-121.7896138	Klamath County
138332	Fee-for-Service	1487996492	1487996492	1	1	KATAMURA, MONICA L MD	6/29/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176845	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
138349	Fee-for-Service	1952495376	1952495376	1	1	KING, DAVID R	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
138366	Fee-for-Service	1063462521	1063462521	1	1	KOENIG, PETER P MD INC	8/31/1992	193200000X	NA	Other	026	PHYSICIANS	23943	41	Internal Medicine	0	In state provider	None	4940 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
138378	Fee-for-Service	1154328771	1154328771	1	1	KARP, DENIS P MD	9/30/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53535	40	Pediatrics	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
138380	Fee-for-Service	1841797610	1841797610	1	1	KIDON, MICHAEL DO	8/27/2024	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
138397	Fee-for-Service	1740519370	1740519370	1	1	KANE COUNTY HOSPITAL	9/25/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	355 N MAIN ST	None	KANAB	UT	84741	3260	00	None	37.054485	-112.5286185	Kane County
138408	Fee-for-Service	1275822413	1275822413	1	1	KHANNA, ROHIT MD	6/18/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160712	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
138412	Fee-for-Service	1922419373	1922419373	1	1	KRALER, LIRONN D MD	7/1/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	142306	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
138497	Fee-for-Service	1083975460	1083975460	1	1	KUWABARA, MICHAEL MD	3/31/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
138507	Fee-for-Service	1497015440	1497015440	1	1	KREMEN, JESSICA S MD	8/20/2023	2080P0205X	NA	Endocrinology	026	PHYSICIANS	188290	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
138551	Fee-for-Service	1750775680	1750775680	1	1	KWITTKEN, BENJAMIN MD	7/8/2019	390200000X	NA	Other	026	PHYSICIANS	146802	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
138578	Fee-for-Service	1427029123	1427029123	1	1	KWONG, AVON W	12/25/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 BROADWAY	None	SAN FRANCISCO	CA	94133	4405	38	06075	37.79779175	-122.4073064	San Francisco County
138588	Fee-for-Service	1568561157	1568561157	1	1	KOPARDEKAR, SANGEETA P MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	79734	38	Geriatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
138654	Fee-for-Service	1063462521	1063462521	1	1	KOENIG, PETER P MD INC	8/31/1992	193200000X	NA	Other	026	PHYSICIANS	23943	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4940 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
138670	Fee-for-Service	1841797610	1841797610	1	1	KIDON, MICHAEL DO	8/27/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
138718	Fee-for-Service	1225006687	1225006687	1	1	KOLIWAD, SUNEIL K MD	3/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83308	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138763	Fee-for-Service	1215375373	1215375373	1	1	KELLEY, RUSSELL P MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135999	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138774	Fee-for-Service	1467416453	1467416453	1	1	KEVIN R GILLESPIE M.D.	3/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7601 PIONEERS BLVD	None	LINCOLN	NE	68506	4675	00	None	40.76963969	-96.61649495	Lancaster County
138780	Fee-for-Service	1790973592	1790973592	1	1	KORNSAND, DAVID S MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89694	84	Surgery-Head and Neck	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
138860	Fee-for-Service	1932604345	1932604345	1	1	KUMAR, RACHNA MD	2/14/2022	390200000X	NA	Other	026	PHYSICIANS	174971	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
138872	Fee-for-Service	1922041052	1922041052	1	1	KORN, ERROL R MD	8/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	15481	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL CORPORATION	752 MEDICAL CENTER CT	STE 200	CHULA VISTA	CA	91911	6659	37	06073	32.61800405	-117.0232585	San Diego County
138875	Fee-for-Service	1811988876	1811988876	1	1	KARAPETIAN,GEORGE MD	3/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	47956	66	Emergency Medicine (Urgent Care)	0	In state provider	None	380 W CENTRAL AVE	None	BREA	CA	92821	3002	30	06059	33.93197087	-117.901779	Orange County
138903	Fee-for-Service	1972946432	1972946432	1	1	KUPPERMAN, ELI S MD	6/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	134737	20	Orthopedic Surgery	0	In state provider	None	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
138904	Fee-for-Service	1265750137	1265750137	1	1	KIS, ERICKA PHD	1/8/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 DEERWOOD RD	STE 200	SAN RAMON	CA	94583	4445	07	06013	37.77475997	-121.9892508	Contra Costa County
138911	Fee-for-Service	1780259655	1780259655	1	1	KING, CAROLETTE Y LCSW	6/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
138929	Fee-for-Service	1326159633	1326159633	1	2	KORVER, KENNETH MD	2/14/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21330	01	General Practice	0	In state provider	None	575 HOSPITAL LN	None	SUSANVILLE	CA	96130	4808	18	06035	40.40760229	-120.6662006	Lassen County
138934	Fee-for-Service	1215154976	1215154976	1	1	KUO, JAMES MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97919	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
139002	Fee-for-Service	1225006687	1225006687	1	1	KOLIWAD, SUNEIL K MD	3/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83308	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
139023	Fee-for-Service	1073811378	1073811378	1	1	KAISER FOUNDATION HOSPITALS	9/27/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
139099	Fee-for-Service	1629497037	1629497037	1	1	KOCH, RACHEL A MD	11/21/2023	208600000X	NA	General Surgery	026	PHYSICIANS	192022	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
139120	Fee-for-Service	1952334385	1952334385	2	1	KATAN, RAMSEY OD	2/5/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	28401 DATE PALM DR	SUITE B	CATHEDRAL CITY	CA	92234	3101	33	06065	33.84161603	-116.4584599	Riverside County
139129	Fee-for-Service	1922346261	1922346261	1	1	KONSTANTINIDIS, ANTHONY LMF	4/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
139150	Fee-for-Service	1821530486	1821530486	1	1	KELLEHER, KATI A LCSW	4/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
139163	Fee-for-Service	1811988876	1811988876	1	1	KARAPETIAN,GEORGE MD	3/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	47956	08	Family Practice	0	In state provider	None	380 W CENTRAL AVE	None	BREA	CA	92821	3002	30	06059	33.93197087	-117.901779	Orange County
139182	Fee-for-Service	1952660599	1952660599	1	1	KNOWLES, LACY L DO	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15521	08	Family Practice	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
139195	Fee-for-Service	1548312374	1548312374	1	1	KRUPER, LAURA L MD	10/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100428	02	General Surgery	0	In state provider	None	1328 2ND ST	FLR 3	SANTA MONICA	CA	90404	2032	19	06037	34.01557114	-118.497924	Los Angeles County
139199	Fee-for-Service	1992945240	1992945240	1	1	KAUSHIK, VASUDHA MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115333	01	General Practice	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
139226	Fee-for-Service	1538109343	1538109343	1	1	KOZAK, BLAINE E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
139265	Fee-for-Service	1770171837	1770171837	1	1	KAM, CHRISTINA LMFT	1/13/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
139270	Fee-for-Service	1700142411	1700142411	1	1	KWAN, DEREK D MD	8/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112730	05	Anesthesiology	0	In state provider	None	87OO BEVERLY BLVD	#8211	LOS ANGELES	CA	90048	1804	19	06037	34.076079	-118.3695821	Los Angeles County
139276	Fee-for-Service	1396122156	1396122156	1	1	KIM, FLORENCE NP	10/4/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1893 W MALVERN AVE	None	FULLERTON	CA	92833	2403	30	06059	33.87987	-117.9611415	Orange County
139285	Fee-for-Service	1316987050	1316987050	1	1	KHORSANDI, MOEZ MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	6773	34	Urology and Urological Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 408	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
139292	Fee-for-Service	1689637506	1689637506	1	1	KIM, KIHYUN DO	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9251	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3801 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	5731	15	06029	35.39450879	-119.0082635	Kern County
139296	Fee-for-Service	1801960182	1801960182	1	1	KIM, MINH Q MD	12/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8545	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
139310	Fee-for-Service	1073811378	1073811378	1	1	KAISER FOUNDATION HOSPITALS	9/27/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
139360	Fee-for-Service	1285790899	1285790899	1	1	KLEIBER, ANGELA K MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135264	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
139369	Fee-for-Service	1790009306	1790009306	1	1	KIM, YOONJEE MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118452	41	Internal Medicine	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
139422	Fee-for-Service	1497194468	1497194468	1	1	KIT, LINDA OD	5/18/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 E COLLEY DR	None	COLTON	CA	92324	3905	36	06071	34.0544745	-117.306315	San Bernardino County
139462	Fee-for-Service	1548479140	1548479140	1	1	KRISHNASWAMY, ARUNA MD	12/3/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50217	41	Internal Medicine	0	In state provider	None	1045 ATLANTIC AVE	STE 902	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
139479	Fee-for-Service	1114225539	1114225539	1	1	KIM, HUISOON PROFESSIONAL	10/15/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ACUPUNCTURE CORP	1619 S H ST	None	BAKERSFIELD	CA	93304	4931	15	06029	35.338986	-119.021336	Kern County
139484	Fee-for-Service	1962454140	1962454140	1	1	KERN NEPHROLOGY MED GRP	2/3/1982	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	2535 16TH ST	None	BAKERSFIELD	CA	93301	3417	15	06029	35.37233049	-119.0317275	Kern County
139521	Fee-for-Service	1447309505	1447309505	1	1	KELLY, DEVLIN PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
139530	Fee-for-Service	1164593042	1164593042	1	1	KUNITAKE, JILL M MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56150	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
139579	Fee-for-Service	1619049947	1619049947	1	1	KIM, DAVID B MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63759	46	Hand Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
139581	Fee-for-Service	1275063422	1275063422	1	1	KIM, DANIEL DO	1/9/2025	208M00000X	NA	Other	026	PHYSICIANS	16725	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
139602	Fee-for-Service	1982100020	1982100020	1	1	KNOELL, OLIVER MD	8/8/2023	208600000X	NA	General Surgery	026	PHYSICIANS	187035	None	None	0	In state provider	None	205 RIVER PARK CIR	None	FRESNO	CA	93720	1571	10	06019	36.85456375	-119.7863981	Fresno County
139607	Fee-for-Service	1518148790	1518148790	1	1	KISHNER, DANIEL	2/21/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1850 S WATERMAN AVE	STE A	SAN BERNARDINO	CA	92408	2852	36	06071	34.06837701	-117.2788714	San Bernardino County
139611	Fee-for-Service	1003927567	1003927567	1	1	KANO, CHARLIE L MD	7/31/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74907	08	Family Practice	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95340	6242	24	06047	37.29309532	-120.4748791	Merced County
139627	Fee-for-Service	1861488843	1861488843	1	1	KOH, PETER Y OD	7/23/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1749	19	06037	34.06343546	-118.3835578	Los Angeles County
139639	Fee-for-Service	1811325244	1811325244	1	1	KORDESCH, KRISTINA C NP	1/6/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
139661	Fee-for-Service	1235542788	1235542788	1	1	KIM, JASON H DPM	10/13/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
139714	Fee-for-Service	1407936032	1407936032	1	1	KARU, RANDY MD INC	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41836	02	General Surgery	0	In state provider	None	1900 ROYALTY DR	STE 250	POMONA	CA	91767	3043	19	06037	34.07754346	-117.7463466	Los Angeles County
139716	Fee-for-Service	1306444765	1306444765	1	1	KINTER DIALYSIS, LLC	11/19/2021	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1055 EL CAMINO REAL	None	COLMA	CA	94014	3234	41	06081	37.67846474	-122.4600309	San Mateo County
139750	Fee-for-Service	1548479140	1548479140	1	1	KRISHNASWAMY, ARUNA MD	12/3/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50217	01	General Practice	0	In state provider	None	1045 ATLANTIC AVE	STE 902	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
139758	Fee-for-Service	1760897300	1760897300	1	1	KOH, DUANE MD	6/3/2019	207L00000X	NA	Other	026	PHYSICIANS	139875	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
139770	Fee-for-Service	1295024693	1295024693	1	1	KOHLBRENNER, AMANDA H MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125334	02	General Surgery	0	In state provider	None	3838 CALIFORNIA ST	STE 612	SAN FRANCISCO	CA	94118	1508	38	06075	37.78591809	-122.4575439	San Francisco County
139772	Fee-for-Service	1891985156	1891985156	1	1	KIM, LYNN S LCSW	4/1/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
139812	Fee-for-Service	1881897494	1881897494	1	1	KRISTEDJA, TIMOTHY S MD	2/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108522	68	Hematology	0	In state provider	None	2021 SANTA MONICA BLVD	SUITE 400E	SANTA MONICA	CA	90404	2103	19	06037	34.02922048	-118.4793681	Los Angeles County
139838	Fee-for-Service	1386173698	1386173698	1	1	KOO, SUSAN T MD	9/18/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	87500	-	NOT APPLICABLE	0	In state provider	None	8626 LOWER SACRAMENTO RD	SUITE 41	STOCKTON	CA	95210	1835	39	06077	38.02905449	-121.3226622	San Joaquin County
139850	Fee-for-Service	1538255765	1538255765	1	1	KESSLER, DAVID A MD	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87076	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
139936	Fee-for-Service	1285297218	1285297218	1	1	KAMASSAH, MAWUSI E MD	10/16/2024	207L00000X	NA	Other	026	PHYSICIANS	179114	05	Anesthesiology	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
139970	Fee-for-Service	1649689175	1649689175	1	1	KAISER FOUNDATION HEALTH	4/17/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	615 W AVENUE L	None	LANCASTER	CA	93534	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
139988	Fee-for-Service	1992913859	1992913859	1	1	KWAN, DIANE G MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117525	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
139999	Fee-for-Service	1790115301	1790115301	1	1	KOUFOS, MITCHELL T LMFT	8/23/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2751 NAPA VALLEY CORPORA	BLDG A, SUITES A201, A20	NAPA	CA	94558	6216	28	06055	38.24829023	-122.2745626	Napa County
140001	Fee-for-Service	1407936032	1407936032	1	1	KARU, RANDY MD INC	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41836	08	Family Practice	0	In state provider	None	1900 ROYALTY DR	STE 250	POMONA	CA	91767	3043	19	06037	34.07754346	-117.7463466	Los Angeles County
140021	Fee-for-Service	1538650544	1538650544	1	2	KORDIC MARRIAGE & FAMILY COU	5/14/2024	261Q00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2386 BRIARWOOD CIR	None	EUREKA	CA	95503	7500	12	06023	40.73131725	-124.1415582	Humboldt County
140028	Fee-for-Service	1205928348	1205928348	1	1	KHIDEKEL, IRINA MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	51703	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	3635 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1701	38	06075	37.78631707	-122.4538903	San Francisco County
140052	Fee-for-Service	1568233229	1568233229	1	1	KUFFOUR, ISAAC O NP	3/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
140056	Fee-for-Service	1336574623	1336574623	1	1	KARSTING, DARLENE A OD	12/11/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
140083	Fee-for-Service	1992712715	1992712715	1	1	KHAN, SHERAH H LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
140087	Fee-for-Service	1629454673	1629454673	1	1	KUE, PANG L NP	4/12/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
140089	Fee-for-Service	1447338116	1447338116	1	1	KHAZAIELI, AMIR M MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85856	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
140098	Fee-for-Service	1881897494	1881897494	1	1	KRISTEDJA, TIMOTHY S MD	2/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108522	78	Neoplastic Diseases/Oncology	0	In state provider	None	2021 SANTA MONICA BLVD	SUITE 400E	SANTA MONICA	CA	90404	2103	19	06037	34.02922048	-118.4793681	Los Angeles County
140100	Fee-for-Service	1437188018	1437188018	1	1	KIM, STANLEY MD	10/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71763	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
140104	Fee-for-Service	1356424329	1356424329	1	1	KRAUSE, PAUL E MD	7/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80285	04	Otology, Laryngology, Rhinology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
140141	Fee-for-Service	1972510048	1972510048	1	1	KIPPS, DAVID L MD	8/19/1993	207RP1001X	NA	Pulmonology	026	PHYSICIANS	33598	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	700 FREDERICK ST	STE 203	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
140150	Fee-for-Service	1942388798	1942388798	1	1	KIM, EMILY MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	64503	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
140186	Fee-for-Service	1083849327	1083849327	1	2	KADERA, BRIAN E MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	113956	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
140230	Fee-for-Service	1144271321	1144271321	1	1	KJELDSBERG,KRISTINA M MD	3/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82343	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
140236	Fee-for-Service	1770681116	1770681116	1	1	KOWBLANSKY, ALEXANDER MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	51029	66	Emergency Medicine (Urgent Care)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
140254	Fee-for-Service	1689707713	1689707713	1	1	KOMURE, MARK SHIGEO OD	6/1/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2087 GRAND CANAL BLVD	STE 15	STOCKTON	CA	95207	6651	39	06077	37.98552607	-121.3315122	San Joaquin County
140296	Fee-for-Service	1437153384	1437153384	1	1	KOLPACOFF, STEPHEN E MD	7/31/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61132	01	General Practice	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
140323	Fee-for-Service	1306115001	1306115001	1	1	KEYSTONE, JAY S MD	11/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	29865	41	Internal Medicine	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
140343	Fee-for-Service	1649837568	1649837568	1	1	KOGA, JARED OD	9/1/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
140372	Fee-for-Service	1588280101	1588280101	1	1	KARAKAS, CANSU MD	7/11/2024	207ZP0101X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
140381	Fee-for-Service	1568143790	1568143790	1	1	KISILER, JENNIFER I NP	1/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
140457	Fee-for-Service	1215016985	1215016985	1	1	KANG, DIANA C PSYD	8/28/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
140478	Fee-for-Service	1861672941	1861672941	1	1	KHAN, MOHAMMED A MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99499	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
140482	Fee-for-Service	1447453808	1447453808	1	1	KINI, VINAY U MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
140489	Fee-for-Service	1104023688	1104023688	1	1	KIET, GRACE T MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	97564	77	Infectious Disease	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
140495	Fee-for-Service	1447374848	1447374848	1	1	KAUL, ERIK I LMFT	10/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	149 JOSEPHINE ST	SUITE B	SANTA CRUZ	CA	95060	2775	44	06087	36.98158	-122.0284528	Santa Cruz County
140496	Fee-for-Service	1508913831	1508913831	1	1	KAISER FOUNDATION HEALTH	6/24/2003	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMNTE PHRM 841	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
140510	Fee-for-Service	1942820485	1942820485	1	1	KAISER FOUNDATION HEALTH PLA	4/28/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	341	5300 MCCONNELL AVE FL 1	RM 1150	LOS ANGELES	CA	90066	7026	19	06037	33.97927498	-118.4207099	Los Angeles County
140561	Fee-for-Service	1760668073	1760668073	1	1	KIRK, MARY P NP	6/9/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
140563	Fee-for-Service	1467209551	1467209551	1	1	KAUFMAN, NERICE L LMFT	7/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
140573	Fee-for-Service	1922629112	1922629112	1	1	KEBBEH, SAMER	8/19/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	183194	13	Neurology (M.D. only)	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
140597	Fee-for-Service	1801963624	1801963624	1	1	KUNANI, POORNIMA MD	12/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75558	84	Surgery-Head and Neck	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
140621	Fee-for-Service	1275695413	1275695413	1	1	KELLER, ANNELI K	6/5/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
140630	Fee-for-Service	1265628770	1265628770	1	1	KERECMANMARTIN, JENNIFER A L	8/12/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
140646	Fee-for-Service	1225084213	1225084213	2	1	KATIRAIE, SEPEHR MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	2625 E FLORENCE AVE	STE D	HUNTINGTON PARK	CA	90255	4756	19	06037	33.9741418	-118.2241636	Los Angeles County
140674	Fee-for-Service	1770587131	1770587131	1	1	KERN, MORTON J MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87067	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
140698	Fee-for-Service	1699380667	1699380667	1	1	KANG, SEYEON CNP	2/15/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
140732	Fee-for-Service	1518066802	1518066802	1	1	KNOBLICH, BERNHARD P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	0000	00	None	32.175801	-110.9306925	Pima County
140747	Fee-for-Service	1538571294	1538571294	1	1	KIM, SHAWN J MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137995	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
140748	Fee-for-Service	1588842140	1588842140	1	1	KAZMAR, SCOTT C CRNA	11/7/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
140762	Fee-for-Service	1295893824	1295893824	1	1	KING, DON R MD	12/9/1975	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	34425	40	Pediatrics	0	In state provider	None	505 E ROMIE LN	None	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
140765	Fee-for-Service	1518123512	1518123512	1	1	KUO, JA-LYNN MD	2/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119570	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
140770	Fee-for-Service	1447453808	1447453808	1	1	KINI, VINAY U MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
140805	Fee-for-Service	1760433296	1760433296	1	1	KIM, PAUL S MD	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77030	30	Radiology	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 103	GARDEN GROVE	CA	92843	1915	30	06059	33.77450141	-117.9123364	Orange County
140819	Fee-for-Service	1023410503	1023410503	1	1	KIM, JEANNIE L	3/19/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
140830	Fee-for-Service	1396779625	1396779625	1	1	KURMIS, GARY F MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82257	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
140848	Fee-for-Service	1063540003	1063540003	1	1	KOOK, HANNAH S LMFT	6/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
140916	Fee-for-Service	1972755973	1972755973	1	1	KEARNS, MEAGHAN CCC-SLP	6/14/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
140942	Fee-for-Service	1992036339	1992036339	1	1	KOPPERUD, LINDSEY D NP	1/11/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
140990	Fee-for-Service	1710688437	1710688437	1	1	KOONER, RAVINDER K	4/1/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12150 PIGEON PASS RD	APT H170	MORENO VALLEY	CA	92557	6972	33	06065	33.9452253	-117.2614495	Riverside County
141008	Fee-for-Service	1972230126	1972230126	1	1	KLISE, GUADALUPE NP	3/20/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6121 N THESTA AVE	SUITE 204	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
141013	Fee-for-Service	1063092146	1063092146	1	1	KU, KATHERINE DO	10/7/2024	207P00000X	NA	Other	026	PHYSICIANS	22117	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
141022	Fee-for-Service	1225271125	1225271125	1	1	KHAN, SADIA S MD	3/12/2015	207R00000X	NA	Other	026	PHYSICIANS	113528	41	Internal Medicine	0	In state provider	None	9655 MONTE VISTA AVE	SUITE 405	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
141043	Fee-for-Service	1891080263	1891080263	1	1	KAYLA GRAY MD	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2220 CANTERBURY DR	None	HAYS	KS	67601	2370	00	None	38.880486	-99.2961225	Ellis County
141082	Fee-for-Service	1346860566	1346860566	1	1	KIM, PETER MD	11/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191196	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
141094	Fee-for-Service	1760433296	1760433296	1	1	KIM, PAUL S MD	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77030	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 103	GARDEN GROVE	CA	92843	1915	30	06059	33.77450141	-117.9123364	Orange County
141118	Fee-for-Service	1396779625	1396779625	1	1	KURMIS, GARY F MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82257	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
141153	Fee-for-Service	1629562749	1629562749	1	1	KNOX, HANNAH A MD	8/13/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	174360	67	Endocrinology	0	In state provider	None	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
141154	Fee-for-Service	1912941956	1912941956	1	1	KHILNANI, HARESH MOHAN	1/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	50550	45	Nephrology (Renal-Kidney)	0	In state provider	None	500 N GARFIELD AVE	STE 209	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
141221	Fee-for-Service	1689297236	1689297236	1	1	KAUR, AMANPREET RCP	8/11/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
141262	Fee-for-Service	1083694947	1083694947	1	1	KALLMEYER,IAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	2901 N CENTRAL AVE	STE # 500	None	PHOENIX	AZ	85012	2738	00	None	0	0	None
141268	Fee-for-Service	1629145545	1629145545	1	1	KIM, DENNIS Y MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43647	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
141275	Fee-for-Service	1508050220	1508050220	1	1	KIM, JOHN J MD	4/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111549	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	90051	5355	30	06059	33.78674051	-117.8888713	Orange County
141286	Fee-for-Service	1043250251	1043250251	1	1	KLINT, REBECCA JO MD	3/30/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50635	40	Pediatrics	0	In state provider	None	3100 TELEGRAPH AVE	None	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
141332	Fee-for-Service	1255315610	1255315610	1	1	KHAN HAWKINS, AYESHA PT	11/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1500 16TH ST FL 2	None	SAN FRANCISCO	CA	94103	5112	38	06075	37.76615387	-122.4020523	San Francisco County
141365	Fee-for-Service	1134210008	1134210008	1	1	KIETURAKIS, MACIEJ J MD	6/10/2019	208600000X	NA	General Surgery	026	PHYSICIANS	40880	02	General Surgery	0	In state provider	None	305 SOUTH DR	#7	MOUNTAIN VIEW	CA	94040	4207	43	06085	37.36724311	-122.0815284	Santa Clara County
141366	Fee-for-Service	1013464288	1013464288	1	1	KELLY, KARESSA J LMFT	8/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3436 AMERICAN RIVER DRIV	SUITE 5	SACRAMENTO	CA	95864	5793	34	06067	38.568285	-121.3834905	Sacramento County
141378	Fee-for-Service	1558467845	1558467845	1	1	KAUR, SHANINDER MD	7/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	41188	41	Internal Medicine	0	In state provider	None	165 ROWLAND WAY	STE 301	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
141404	Fee-for-Service	1396779625	1396779625	1	1	KURMIS, GARY F MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82257	08	Family Practice	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
141424	Fee-for-Service	1295880706	1295880706	1	1	KIM, DANIEL Y MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123474	30	Radiology	0	In state provider	None	1601 YAGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
141431	Fee-for-Service	1922082916	1922082916	1	1	KASS, ROBERT M MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	35162	47	Miscellaneous	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
141439	Fee-for-Service	1629562749	1629562749	1	1	KNOX, HANNAH A MD	8/13/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	174360	41	Internal Medicine	0	In state provider	None	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
141444	Fee-for-Service	1912941956	1912941956	1	1	KHILNANI, HARESH MOHAN	1/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	50550	41	Internal Medicine	0	In state provider	None	500 N GARFIELD AVE	STE 209	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
141452	Fee-for-Service	1558329920	1558329920	1	1	KRENEK, THOMAS F MD	3/31/1984	2084N0400X	NA	Neurology	026	PHYSICIANS	43797	13	Neurology (M.D. only)	0	In state provider	None	2828 ONEIL LN	None	EUREKA	CA	95503	4870	12	06023	40.782087	-124.1350885	Humboldt County
141455	Fee-for-Service	1487916359	1487916359	1	1	KAMAL, OENDRILA	10/24/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
141469	Fee-for-Service	1013221654	1013221654	1	1	KAISER FOUNDATION HEALTH	8/10/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #220	5893 COPLEY DR	FLR 1	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
141517	Fee-for-Service	1588369086	1588369086	1	1	KEYS, KYWAITA CNP	6/23/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1350 FLORIN RD	None	SACRAMENTO	CA	95822	4202	34	06067	38.495232	-121.505409	Sacramento County
141560	Fee-for-Service	1295093292	1295093292	1	1	KUNG, JENNIFER S MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122320	18	Ophthalmology	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
141562	Fee-for-Service	1801283767	1801283767	1	1	KUMAR, ASWATHI M MD	9/2/2020	207R00000X	NA	Other	026	PHYSICIANS	169772	41	Internal Medicine	0	In state provider	None	5725 W LAS POSITAS BLVD	STE 110	PLEASANTON	CA	94588	4016	01	06001	37.688107	-121.8861427	Alameda County
141638	Fee-for-Service	1679639090	1679639090	1	1	KLEINBERG, JOHN I MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39453	18	Ophthalmology	0	In state provider	None	1310 W STEWART DR	STE 505	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
141639	Fee-for-Service	1407313737	1407313737	1	1	KEENAN, ILKA PT	5/29/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
141653	Fee-for-Service	1477753903	1477753903	1	1	KHAN, NAWAZISH A MD	9/20/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	118411	68	Hematology	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
141654	Fee-for-Service	1003378548	1003378548	1	1	KOURANG-BEHESHTI, NIMA DO	7/20/2023	390200000X	NA	Other	026	PHYSICIANS	19974	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
141656	Fee-for-Service	1619264629	1619264629	1	1	KURT PEDROTTY	3/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
141665	Fee-for-Service	1558467845	1558467845	1	1	KAUR, SHANINDER MD	7/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	41188	68	Hematology	0	In state provider	None	165 ROWLAND WAY	STE 301	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
141732	Fee-for-Service	1912941956	1912941956	1	1	KHILNANI, HARESH MOHAN	1/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	50550	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 N GARFIELD AVE	STE 209	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
141745	Fee-for-Service	1447542238	1447542238	1	1	KAUSHAL, NEAL MD	12/23/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	124760	10	Gastroenterology (M.D. only)	0	In state provider	None	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
141750	Fee-for-Service	1992753537	1992753537	1	1	KOCH, LAURA D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6545 FRANCE AVE S STE160	None	EDINA	MN	55424	2131	00	None	44.884494	-93.32881402	Hennepin County
141770	Fee-for-Service	1346465838	1346465838	1	1	KIDWAI, ATIF A MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108255	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
141832	Fee-for-Service	1366403321	1366403321	1	1	KOUMJIAN, MICHAEL P MD	1/28/2010	208G00000X	NA	General Surgery	026	PHYSICIANS	37886	66	Emergency Medicine (Urgent Care)	0	In state provider	MED CORP	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
141849	Fee-for-Service	1124256904	1124256904	1	1	KUMBHANI, SHYAM A DO	11/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	10784	36	Psychiatry	0	In state provider	None	1860 HAMNER AVE	None	NORCO	CA	92860	2945	33	06065	33.9090675	-117.5612393	Riverside County
141879	Fee-for-Service	1568723062	1568723062	1	1	KUCHTA, KRISTA R NP	12/18/2019	363LP0222X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
141883	Fee-for-Service	1417158957	1417158957	1	1	KAZEMI, SIAMAK DO	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16087	01	General Practice	0	In state provider	None	2 WEST FERN	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
141974	Fee-for-Service	1457324808	1457324808	1	1	KOMMINENI, BHUPAL MD INC	12/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34651	41	Internal Medicine	0	In state provider	None	1330 SAN BERNARDINO RD	STE G	UPLAND	CA	91786	4974	36	06071	34.10294486	-117.6325059	San Bernardino County
142016	Fee-for-Service	1730241100	1730241100	1	1	KEIGHTLEY, WILLIAM C MD	4/2/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	39138	36	Psychiatry	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93454	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
142043	Fee-for-Service	1730343633	1730343633	1	1	KHATIBI, BITA MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117074	08	Family Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
142059	Fee-for-Service	1346465838	1346465838	1	1	KIDWAI, ATIF A MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108255	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
142072	Fee-for-Service	1750033676	1750033676	1	1	KAUFFMAN, CORINNA CNM	8/16/2022	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
142083	Fee-for-Service	1366403321	1366403321	1	1	KOUMJIAN, MICHAEL P MD	1/28/2010	208G00000X	NA	General Surgery	026	PHYSICIANS	37886	33	Thoracic Surgery	0	In state provider	MED CORP	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
142128	Fee-for-Service	1649471202	1649471202	1	1	KIM, SEA-JIN MD	2/11/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	100426	13	Neurology (M.D. only)	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
142181	Fee-for-Service	1619363900	1619363900	1	1	KNEEN, ROXIE NP	6/13/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
142238	Fee-for-Service	1700345709	1700345709	1	1	KORAND, SRIDEVI K MD	7/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178658	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
142244	Fee-for-Service	1710120506	1710120506	1	1	KAISER FOUNDATION HELATH	6/18/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #249	17140 BERNARDO CENTER DR	STE 160	SAN DIEGO	CA	92128	2093	37	06073	33.0249487	-117.0758524	San Diego County
142283	Fee-for-Service	1740209303	1740209303	1	1	KARAMLOU, KATHY MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72397	83	Rheumatology	0	In state provider	None	200 MED PLAZA	#365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
142285	Fee-for-Service	1164588760	1164588760	1	1	KIM, HEI PAIK MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	33208	41	Internal Medicine	0	In state provider	None	3663 W 6TH ST	STE 203	LOS ANGELES	CA	90020	3048	19	06037	34.06360557	-118.30199	Los Angeles County
142337	Fee-for-Service	1073609681	1073609681	1	1	KRAUS, STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
142343	Fee-for-Service	1215956636	1215956636	1	1	KLEERUP, ERIC MD	7/1/1991	207RP1001X	NA	Pulmonology	026	PHYSICIANS	68275	01	General Practice	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
142376	Fee-for-Service	1366403321	1366403321	1	1	KOUMJIAN, MICHAEL P MD	1/28/2010	208G00000X	NA	General Surgery	026	PHYSICIANS	37886	06	Cardiovascular Disease (M.D. only)	0	In state provider	MED CORP	5525 GROSSMONT CENTER DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
142422	Fee-for-Service	1861804379	1861804379	1	1	KANG, DAVID J DO	9/27/2023	208600000X	NA	General Surgery	026	PHYSICIANS	18970	None	None	0	In state provider	None	1234 E NORTH ST	SUITE 102	MANTECA	CA	95336	4961	39	06077	37.80105524	-121.1968581	San Joaquin County
142490	Fee-for-Service	1639481385	1639481385	1	1	KING, JACQUELINE O MD	9/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
142521	Fee-for-Service	1982702130	1982702130	1	1	KORNFELD, HOWARD G MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	34976	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
142546	Fee-for-Service	1003441262	1003441262	1	1	KIM, KENNETH T MD	11/5/2024	207P00000X	NA	Other	026	PHYSICIANS	183373	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
142554	Fee-for-Service	1174573760	1174573760	1	1	KNOBEL, KEVIN R MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78079	01	General Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
142560	Fee-for-Service	1871631853	1871631853	1	1	KASPAR, RUTH H	10/26/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
142568	Fee-for-Service	1811317175	1811317175	1	1	KALASH, RONNY DO	10/31/2019	2085R0001X	NA	Other	026	PHYSICIANS	17620	30	Radiology	0	In state provider	None	15031 RINALDI ST	100	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
142572	Fee-for-Service	1740487347	1740487347	1	1	KUO, ISABELLA J MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105795	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	B10	ORANGE	CA	90051	0347	30	06059	33.78674051	-117.8888713	Orange County
142595	Fee-for-Service	1326095373	1326095373	1	1	KRZYSIAK, LUCJAN MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75015	41	Internal Medicine	0	In state provider	None	44469 10TH STREET WEST	None	LANCASTER	CA	93534	3396	19	06037	34.691454	-118.148068	Los Angeles County
142610	Fee-for-Service	1780900068	1780900068	1	1	KF ONTARIO HEALTHCARE LLC	7/1/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1661 SOUTH EUCLID AVE	None	ONTARIO	CA	91762	5826	36	06071	34.042734	-117.650484	San Bernardino County
142633	Fee-for-Service	1588663769	1588663769	1	19	KAWEAH DELTA HEALTH CARE	8/9/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	820 SOUTH AKERS	SUITE 130	VISALIA	CA	93277	8346	54	06107	36.323757	-119.3491755	Tulare County
142645	Fee-for-Service	1407817471	1407817471	1	1	KEDDINGTON,ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3460 S. PIONEER PARKWAY	None	WEST VALLEY CITY	UT	84010	4908	00	None	40.697982	-111.9903965	Salt Lake County
142681	Fee-for-Service	1588845457	1588845457	1	1	KHAN, IFTIKHAR A MD INC	8/11/2010	207R00000X	NA	Other	026	PHYSICIANS	36824	45	Nephrology (Renal-Kidney)	0	In state provider	None	101 E BEVERLY BLVD	SUITE #406	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
142687	Fee-for-Service	1750479929	1750479929	1	1	KOUKKARI, MARK W. MD	9/13/1994	174400000X	NA	Other	026	PHYSICIANS	74711	79	Neurology-Child	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
142697	Fee-for-Service	1437263068	1437263068	1	1	KROES, IAN T MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73577	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
142700	Fee-for-Service	1225032212	1225032212	2	1	KAZI, MANZOOR A MD	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	64106	41	Internal Medicine	0	In state provider	None	73345 HIGHWAY 111	STE 202	PALM DESERT	CA	92260	4215	33	06065	33.72092199	-116.384896	Riverside County
142754	Fee-for-Service	1467482927	1467482927	1	1	KIM, PAUL D MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70790	84	Surgery-Head and Neck	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
142759	Fee-for-Service	1194126524	1194126524	1	1	KLIMCZAK, JENNIFER A	5/3/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1555 RIVER PARK DR	STE 206L	SACRAMENTO	CA	95815	4604	34	06067	38.600019	-121.434687	Sacramento County
142780	Fee-for-Service	1528406527	1528406527	1	1	KANE, MOLLY M MD	6/24/2022	261QU0200X	NA	Other	026	PHYSICIANS	177158	None	None	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
142783	Fee-for-Service	1720303811	1720303811	1	1	KAY, JOY MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125511	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
142812	Fee-for-Service	1528022852	1528022852	1	1	KHALILNEJAD, HEIDEH S MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65025	08	Family Practice	0	In state provider	MED CLINIC KHALILNEJAD	1210 E ARQUES AVE	STE 203	SUNNYVALE	CA	94085	5422	43	06085	37.38040351	-121.994748	Santa Clara County
142833	Fee-for-Service	1386874964	1386874964	1	1	KHOO, LARRY T MD INC	11/9/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 717	LOS ANGELES	CA	90017	4810	19	06037	34.05362775	-118.2661889	Los Angeles County
142841	Fee-for-Service	1174573760	1174573760	1	1	KNOBEL, KEVIN R MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78079	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
142894	Fee-for-Service	1437309275	1437309275	1	1	KENYOTA, GEOFFREY K MD	1/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106855	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
142909	Fee-for-Service	1750611810	1750611810	1	1	KELLY M. PORTER NP	7/29/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
142950	Fee-for-Service	1205904646	1205904646	1	1	KATO, DEIRDRE U MD	5/13/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54023	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
142971	Fee-for-Service	1942526405	1942526405	1	1	KHALILI, SEYED PARHAM MD	8/7/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169047	08	Family Practice	0	In state provider	None	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
142974	Fee-for-Service	1750479929	1750479929	1	1	KOUKKARI, MARK W. MD	9/13/1994	174400000X	NA	Other	026	PHYSICIANS	74711	40	Pediatrics	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
143032	Fee-for-Service	1245220391	1245220391	3	1	K & J RX INC	9/13/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y PHARMACY	2900 FULTON AVE	None	SACRAMENTO	CA	95821	4910	34	06067	38.619288	-121.399884	Sacramento County
143060	Fee-for-Service	1700812211	1700812211	2	1	KWUN, SOON YULL MD	11/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33048	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3131 SANTA ANITA AVENUE	#105	EL MONTE	CA	91733	0927	19	06037	34.064991	-118.0427595	Los Angeles County
143068	Fee-for-Service	1417068081	1417068081	1	1	KO,WEI-FANG MD	10/1/2000	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	62022	10	Gastroenterology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
143102	Fee-for-Service	1376505263	1376505263	1	1	KOTRAPPA, KAVITAH S MD	3/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	53418	01	General Practice	0	In state provider	None	2025 E ROUTE 66	None	GLENDORA	CA	91740	4670	19	06037	34.12802719	-117.8255325	Los Angeles County
143116	Fee-for-Service	1386907509	1386907509	1	1	KHALEEL, HUDA S MD	5/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144566	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
143134	Fee-for-Service	1497747943	1497747943	1	2	KAO, SAMUEL D MD	4/14/2020	2086S0105X	NA	General Surgery	026	PHYSICIANS	74093	46	Hand Surgery	0	In state provider	None	1620 PENNSYLVANIA	STE A	FAIRFIELD	CA	94533	3551	48	06095	38.2594713	-122.0498661	Solano County
143141	Fee-for-Service	1912389396	1912389396	1	1	KHUSRO, SYEDA SIMRA	9/1/2018	208M00000X	NA	Other	026	PHYSICIANS	153571	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
143148	Fee-for-Service	1093932568	1093932568	1	1	KOLODJI, DAVID J CRNA	9/1/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
143164	Fee-for-Service	1790313591	1790313591	1	1	KING, MENG DO	8/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21273	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
143168	Fee-for-Service	1962886358	1962886358	1	1	KUZNETSOVA, JULIA A DO	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16505	40	Pediatrics	0	In state provider	None	595 BUCKINGHAM WAY	STE 300	SAN FRANCISCO	CA	94132	1911	38	06075	37.73012679	-122.4767395	San Francisco County
143205	Fee-for-Service	1528058724	1528058724	1	1	KAM-SYD, LTD D/B/A BAY STAR	6/30/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3103 N HIGHWAY 146	None	BAYTOWN	TX	77520	2669	00	None	29.75756162	-94.93938288	Harris County
143266	Fee-for-Service	1588663769	1588663769	1	4	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	5105 W CYPRESS AVE	None	VISALIA	CA	93277	8304	54	06107	36.323604	-119.347947	Tulare County
143267	Fee-for-Service	1043749039	1043749039	1	1	KALSI, RAMNEEK SINGH MD	10/6/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164858	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
143268	Fee-for-Service	1710065453	1710065453	1	1	KURTZ, RONALD M	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85877	18	Ophthalmology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
143277	Fee-for-Service	1356770168	1356770168	1	1	KAZEMI, MINA DO	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12740	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
143286	Fee-for-Service	1275775173	1275775173	1	1	KAMBOJ, AMOL P MD	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106043	43	Pediatric Allergy	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
143289	Fee-for-Service	1124054267	1124054267	1	1	KLEBANOW, JANI L PHD	8/14/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
143291	Fee-for-Service	1902040777	1902040777	1	1	KULKARNI, RAJAN P MD	8/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113764	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 450	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
143345	Fee-for-Service	1265699185	1265699185	1	1	KAKAL, KHADIR MD	4/27/2024	207R00000X	NA	Other	026	PHYSICIANS	125167	41	Internal Medicine	0	In state provider	None	18040 SHERMAN WAY	SUITE 304	RESEDA	CA	91335	4656	19	06037	34.20103048	-118.526787	Los Angeles County
143354	Fee-for-Service	1417068081	1417068081	1	1	KO,WEI-FANG MD	10/1/2000	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	62022	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
143359	Fee-for-Service	1184752248	1184752248	1	1	KHAWAJA, JOE	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
143376	Fee-for-Service	1427411206	1427411206	1	1	KUO, KEVIN MD	8/2/2019	207R00000X	NA	Other	026	PHYSICIANS	155125	41	Internal Medicine	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
143396	Fee-for-Service	1356494397	1356494397	1	1	KENNY, KATHERINE A MD	11/4/2008	207R00000X	NA	Other	026	PHYSICIANS	105752	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DRIVE	SUITE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
143426	Fee-for-Service	1497747943	1497747943	1	2	KAO, SAMUEL D MD	4/14/2020	2086S0105X	NA	General Surgery	026	PHYSICIANS	74093	24	Plastic Surgery	0	In state provider	None	1620 PENNSYLVANIA	STE A	FAIRFIELD	CA	94533	3551	48	06095	38.2594713	-122.0498661	Solano County
143435	Fee-for-Service	1831201326	1831201326	1	1	KAUFFMAN, MARCUS R MD	8/1/2023	208800000X	NA	Other	026	PHYSICIANS	181699	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
143501	Fee-for-Service	1780804583	1780804583	1	1	KELLEY, WILLIAM R MD	3/29/2005	193400000X	NA	Other	026	PHYSICIANS	51795	30	Radiology	0	In state provider	PROFESSIONAL CORPORATION	1401 BAILEY AVE	None	NEEDLES	CA	92363	3103	36	06071	34.832997	-114.618293	San Bernardino County
143509	Fee-for-Service	1306827944	1306827944	1	2	KUTZ, DAVID L MD	2/4/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80373	-	NOT APPLICABLE	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
143565	Fee-for-Service	1629133368	1629133368	1	2	KIRKLAND, PURNELL MD INC	10/28/1993	207RR0500X	NA	Other	026	PHYSICIANS	39834	01	General Practice	0	In state provider	None	575 E HARDY ST	STE 306	INGLEWOOD	CA	90301	4049	19	06037	33.94909392	-118.3477665	Los Angeles County
143573	Fee-for-Service	1407032824	1407032824	1	1	KNUDSEN, RICHARD P MD	2/17/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43057	40	Pediatrics	0	In state provider	None	147 BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
143578	Fee-for-Service	1104998434	1104998434	1	1	KASHANIAN, ALONA DPM	6/20/1995	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3984 S FIGUEROA ST	None	LOS ANGELES	CA	90037	1222	19	06037	34.01156896	-118.2827199	Los Angeles County
143673	Fee-for-Service	1043743248	1043743248	1	1	KIM, SHIRLEY DO	6/17/2021	207R00000X	NA	Other	026	PHYSICIANS	16911	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
143677	Fee-for-Service	1265836191	1265836191	1	1	KOES, MARGARET M M NP	7/12/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143699	Fee-for-Service	1235542226	1235542226	1	1	KUTIK, SETH J MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148050	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
143733	Fee-for-Service	1447338082	1447338082	1	1	KIEST, CURTIS A MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46626	20	Orthopedic Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
143777	Fee-for-Service	1548341944	1548341944	1	1	KONG, ERIN MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93173	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
143816	Fee-for-Service	1982879896	1982879896	1	1	KAMDAR, MONA C MD	11/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98206	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
143820	Fee-for-Service	1518416312	1518416312	1	1	KELMAN, ALEX PSYD	1/28/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
143842	Fee-for-Service	1871574772	1871574772	1	1	KIM, JANE C MD	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92525	45	Nephrology (Renal-Kidney)	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
143849	Fee-for-Service	1548312911	1548312911	1	1	KAIDEN, DAVID MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64240	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
143852	Fee-for-Service	1992954366	1992954366	1	1	KARA GEREN M.D	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
143853	Fee-for-Service	1629133368	1629133368	1	2	KIRKLAND, PURNELL MD INC	10/28/1993	207RR0500X	NA	Other	026	PHYSICIANS	39834	41	Internal Medicine	0	In state provider	None	575 E HARDY ST	STE 306	INGLEWOOD	CA	90301	4049	19	06037	33.94909392	-118.3477665	Los Angeles County
143861	Fee-for-Service	1407032824	1407032824	1	1	KNUDSEN, RICHARD P MD	2/17/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43057	79	Neurology-Child	0	In state provider	None	147 BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
143866	Fee-for-Service	1952459984	1952459984	1	1	KIRAN, RAVI V MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95437	46	Hand Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
143889	Fee-for-Service	1396897070	1396897070	1	1	KAZI, SHAZIA B MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100731	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
143915	Fee-for-Service	1427041466	1427041466	1	1	KANTER, IRA E MD	1/7/1984	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	8758	30	Radiology	0	In state provider	None	450 30TH ST	None	OAKLAND	CA	94609	3302	01	06001	37.81935255	-122.2664506	Alameda County
143999	Fee-for-Service	1588761233	1588761233	1	1	KIM, MILAN MD	8/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62021	40	Pediatrics	0	In state provider	None	18895 COLIMA RD	STE A	ROWLAND HEIGHTS	CA	91748	2978	19	06037	33.98772522	-117.8915158	Los Angeles County
144005	Fee-for-Service	1184719684	1184719684	1	1	KUHFAHL, PETRA MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85976	None	None	0	In state provider	None	1727 CENTRAL AVE	None	MCKINLEYVILLE	CA	95519	3601	12	06023	40.93670432	-124.1008977	Humboldt County
144029	Fee-for-Service	1659803617	1659803617	1	1	KIM, JOHNNY M MD	9/12/2023	2085B0100X	NA	MRI Provider	026	PHYSICIANS	159579	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
144042	Fee-for-Service	1104810738	1104810738	1	1	KUPPERMAN, JEFFREY L MD	3/1/1998	207RP1001X	NA	Pulmonology	026	PHYSICIANS	34672	41	Internal Medicine	0	In state provider	None	2403 CASTILLO ST	STE 206	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
144046	Fee-for-Service	1417034984	1417034984	1	1	KEVIN BRANCH	3/10/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	390 E LONGVIEW ST	None	FAYETTEVILLE	AR	72703	4618	00	None	36.111726	-94.1517135	Washington County
144056	Fee-for-Service	1740513522	1740513522	1	1	KHODER, WASEEM MD	12/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144858	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
144064	Fee-for-Service	1003068321	1003068321	1	1	KOHLI, REEBU MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101494	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
144098	Fee-for-Service	1821209222	1821209222	1	1	KERR, MERLAND D DC	6/1/1998	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	13039 7TH ST	None	CHINO	CA	91710	4112	36	06071	34.016517	-117.6905445	San Bernardino County
144110	Fee-for-Service	1053553511	1053553511	1	1	KLEIN, ORLY R MD	1/27/2021	2080P0207X	NA	Hematology	026	PHYSICIANS	170947	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
144130	Fee-for-Service	1306904222	1306904222	1	3	KIMA W MEDICAL CENTER	10/30/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	535 AIRPORT ROAD	None	HOOPA	CA	95546	0000	12	06023	41.04169689	-123.6656063	Humboldt County
144149	Fee-for-Service	1407032824	1407032824	1	1	KNUDSEN, RICHARD P MD	2/17/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43057	13	Neurology (M.D. only)	0	In state provider	None	147 BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
144172	Fee-for-Service	1396897070	1396897070	1	1	KAZI, SHAZIA B MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100731	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
144183	Fee-for-Service	1033365341	1033365341	1	1	KIM, PHILLIP J MD	11/4/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105129	08	Family Practice	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
144205	Fee-for-Service	1982792651	1982792651	1	1	KO, VIRGINIA OD	4/23/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
144220	Fee-for-Service	1184889859	1184889859	1	1	KHAN, SAMINA MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115193	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
144223	Fee-for-Service	1255404828	1255404828	1	1	KANG, GLARA J MD	5/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79884	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
144246	Fee-for-Service	1235836859	1235836859	1	1	KAIYARE, DANIEL NJOROGE	9/6/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14072 SPRINGWATER LANE	None	EASTVALE	CA	92880	8596	33	06065	33.94259429	-117.5901375	Riverside County
144333	Fee-for-Service	1619926391	1619926391	1	1	KIM, JOON MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77889	30	Radiology	0	In state provider	None	1100 W STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
144346	Fee-for-Service	1316125131	1316125131	1	1	KELLY, WILLIAM M MD INC	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	34125	30	Radiology	0	In state provider	HEALTH SCAN IMAGING MED	74000 COUNTRY CLUB DR	STE E-1	PALM DESERT	CA	92260	1685	33	06065	33.75805952	-116.373249	Riverside County
144358	Fee-for-Service	1720150568	1720150568	1	1	KWAN, YUEN W MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77752	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
144364	Fee-for-Service	1437235942	1437235942	1	1	KWAIBEN, VALERIE MD	12/20/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	72425	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
144377	Fee-for-Service	1982092763	1982092763	1	1	KHATIBLOO, SHOURA PHD	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DRIVE	STE 550	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
144387	Fee-for-Service	1134524093	1134524093	1	1	KAUP, ALLISON R PHD	1/14/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
144418	Fee-for-Service	1306904222	1306904222	1	3	KIMA W MEDICAL CENTER	10/30/2023	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	535 AIRPORT ROAD	None	HOOPA	CA	95546	0000	12	06023	41.04169689	-123.6656063	Humboldt County
144419	Fee-for-Service	1033538632	1033538632	1	1	KWAK, KEVIN W MD	7/14/2017	207R00000X	NA	Other	026	PHYSICIANS	68495	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
144464	Fee-for-Service	1588663769	1588663769	1	16	KAWEAH DELTA HEALTH CARE	11/18/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	202 WEST WILLOW	SUITE 502	VISALIA	CA	93291	6268	54	06107	36.328536	-119.293569	Tulare County
144472	Fee-for-Service	1417145459	1417145459	1	1	KASUYAMA, CANDICE I CO	4/1/1995	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 S FLOWER ST	None	LOS ANGELES	CA	90007	2631	19	06037	34.02831849	-118.2741777	Los Angeles County
144518	Fee-for-Service	1932477106	1932477106	1	1	KIM, MINSU	12/23/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
144528	Fee-for-Service	1811984123	1811984123	1	1	KIM, JAYHA MD	7/13/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53285	01	General Practice	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
144531	Fee-for-Service	1861540999	1861540999	1	1	KAPLAN, ELISE P LMFT	11/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15650 DEVONSHIRE ST	SUITE 212	GRANADA HILLS	CA	91344	7245	19	06037	34.2573035	-118.473615	Los Angeles County
144534	Fee-for-Service	1235836859	1235836859	1	1	KAIYARE, DANIEL NJOROGE	9/6/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14072 SPRINGWATER LANE	None	EASTVALE	CA	92880	8596	33	06065	33.94259429	-117.5901375	Riverside County
144679	Fee-for-Service	1932125317	1932125317	1	1	KOCSIS, LINDA C MD	9/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	48473	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
144682	Fee-for-Service	1972294460	1972294460	1	1	KINETICS REHAB LLC	5/13/2024	193200000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2122 N BROADWAY	STE 200	SANTA ANA	CA	92706	2614	30	06059	33.76532544	-117.8695743	Orange County
144710	Fee-for-Service	1104904812	1104904812	1	1	KRAAS, JONATHAN R MD	2/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54582	30	Radiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
144714	Fee-for-Service	1558142331	1558142331	1	1	KAUR, NAVNEET NP	2/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4043 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	0000	15	06029	35.35411151	-119.0532915	Kern County
144756	Fee-for-Service	1821680331	1821680331	1	1	KANGAS, KRISTI LCSW	9/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
144762	Fee-for-Service	1043221138	1043221138	1	1	KIELICH, CHRISTOPHER MD	12/31/1992	207L00000X	NA	Other	026	PHYSICIANS	60631	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
144779	Fee-for-Service	1780109165	1780109165	1	1	KOPPULA, VANDANA LMFT	11/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
144792	Fee-for-Service	1417274614	1417274614	1	1	KAZEM HAGHIGHI, ASIEH MD	11/17/2019	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	156054	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
144832	Fee-for-Service	1154684777	1154684777	1	1	KOSHKIN, VADIM S MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156201	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
144841	Fee-for-Service	1134107550	1134107550	1	1	KUANG, TIMOTHY MD	9/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72780	25	Physical Medicine and Rehabilitation	0	In state provider	None	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	40	06079	35.29325417	-120.667547	San Luis Obispo County
144856	Fee-for-Service	1073824892	1073824892	1	1	KOHLBRENNER, RYAN M MD	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119006	30	Radiology	0	In state provider	None	400 PARNASSUS	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
144901	Fee-for-Service	1801203559	1801203559	1	1	KELLY, TAMARA P MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139959	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
144905	Fee-for-Service	1578727509	1578727509	1	1	KALEEM ASLAM M.D.	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
144992	Fee-for-Service	1255051322	1255051322	1	1	KLEIN, REBEKAH R OD	9/26/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1280 S VICTORIA AVE	STE 100	VENTURA	CA	93003	6550	56	06111	34.26344767	-119.2119344	Ventura County
145020	Fee-for-Service	1083055206	1083055206	1	1	KOROMPIS, BYRON T PT	2/16/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2295 S VINEYARD AVE	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
145025	Fee-for-Service	1306181854	1306181854	1	1	KUILANOFF, ELIZABETH MD	12/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138920	40	Pediatrics	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
145050	Fee-for-Service	1861525602	1861525602	1	4	KOREAN COMMUNITY SERVICES	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8352 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2526	30	06059	33.8698947	-117.9872467	Orange County
145096	Fee-for-Service	1003859414	1003859414	1	1	KUMAR, RAVI I MD	4/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	67010	08	Family Practice	0	In state provider	None	1001 VAN DORSTEN AVE	None	CORCORAN	CA	93212	2321	16	06031	36.099531	-119.5635525	Kings County
145103	Fee-for-Service	1831617208	1831617208	1	1	KANABUR, PRATIK MD	6/29/2023	208800000X	NA	Other	026	PHYSICIANS	187326	None	None	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
145157	Fee-for-Service	1578683082	1578683082	1	1	KENT, SUZANNE PA	9/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	10537	-	NOT APPLICABLE	0	In state provider	None	200 7TH AVENUE	SUITE 150	SANTA CRUZ	CA	95060	4669	44	06087	36.96438797	-121.998448	Santa Cruz County
145190	Fee-for-Service	1982797478	1982797478	1	1	KOPPLIN, MALIE KAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	BILLINGS CLINIC	2800 10TH AVE NORTH	None	BILLINGS	MT	85080	0703	00	None	45.789696	-108.5132835	Yellowstone County
145191	Fee-for-Service	1225628928	1225628928	1	1	KIM, ENA MD	3/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	191837	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
145198	Fee-for-Service	1518345453	1518345453	1	1	KACHOUEI, BEHNAM H DO	11/12/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17361	70	Clinic (mixed specialty)	0	In state provider	None	1113 S PARK VICTORIA DR	None	MILPITAS	CA	95035	6942	43	06085	37.42027718	-121.8763416	Santa Clara County
145204	Fee-for-Service	1679630271	1679630271	1	1	KNOLLER, BOBBE L LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
145220	Fee-for-Service	1679985535	1679985535	1	1	KIM, YONGHA PT	4/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	520 S. VIRGIL AVE	201	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
145226	Fee-for-Service	1043657562	1043657562	1	1	KEYFES, VADIM MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148311	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
145287	Fee-for-Service	1437449303	1437449303	1	1	KEMP, RECHEL DO	2/1/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	340 W. EAST AVE	None	CHICO	CA	95926	7238	04	06007	39.75353271	-121.8668176	Butte County
145288	Fee-for-Service	1043430572	1043430572	1	1	KELLY STEFFEN DO	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
145291	Fee-for-Service	1629356845	1629356845	1	1	KIM, NICHOLAS K MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149987	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
145301	Fee-for-Service	1497018238	1497018238	1	1	KEEBLER BLOOM, CHANDRA N MD	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131366	41	Internal Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145303	Fee-for-Service	1083091748	1083091748	1	1	KONG, STEPHANIE F MD	5/6/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	135667	09	Gynecology (D.O. only)	0	In state provider	None	8631 W THIRD STREET	SUITE 444E	LOS ANGELES	CA	90048	5908	19	06037	34.07361928	-118.3803143	Los Angeles County
145338	Fee-for-Service	1861525602	1861525602	1	4	KOREAN COMMUNITY SERVICES	12/23/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8352 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2526	30	06059	33.8698947	-117.9872467	Orange County
145386	Fee-for-Service	1992560072	1992560072	1	1	KARPINSKI, MIKAELA N LCSW	2/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
145391	Fee-for-Service	1477600799	1477600799	1	1	KAISER FOUNDATION HEALTH	9/3/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMNTE PHRM #117	20790 MADRONA AVE	None	TORRANCE	CA	90503	3777	19	06037	33.84145481	-118.344603	Los Angeles County
145398	Fee-for-Service	1114987658	1114987658	1	1	KEEFE, KELLY S MD	12/6/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	48069	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
145402	Fee-for-Service	1518288422	1518288422	1	1	KIM, HYUNG KOO MD	12/23/2019	207R00000X	NA	Other	026	PHYSICIANS	151981	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
145413	Fee-for-Service	1407975501	1407975501	1	1	KADAKIA, RAJESH J MD	7/1/1985	207P00000X	NA	Other	026	PHYSICIANS	41855	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
145447	Fee-for-Service	1730153172	1730153172	1	1	KRISHNA, PRIYA D MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54823	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
145456	Fee-for-Service	1366652455	1366652455	1	1	KANDAVARA, SUNITHA S MD	3/17/2008	207R00000X	NA	Other	026	PHYSICIANS	99270	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
145464	Fee-for-Service	1184688475	1184688475	1	1	KARIMI, KAMBIZ V MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91125	41	Internal Medicine	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
145491	Fee-for-Service	1396733994	1396733994	1	1	KATHERINE HUG, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10500 MONTGOMERY RD	None	CINCINNATI	OH	45242	4402	00	None	39.252267	-84.3413535	Hamilton County
145524	Fee-for-Service	1144397985	1144397985	1	1	KONGARA, NANDITHA MD	3/21/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	92556	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
145528	Fee-for-Service	1700097862	1700097862	1	1	KAHLON, SURJIT K MD PC	3/24/2009	174400000X	NA	Other	026	PHYSICIANS	31422	13	Neurology (M.D. only)	0	In state provider	None	630 N 13TH AVE	STE B	UPLAND	CA	91786	4975	36	06071	34.10137569	-117.6336729	San Bernardino County
145543	Fee-for-Service	1093738403	1093738403	1	1	KEARSLEY, LAURA S MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95587	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
145550	Fee-for-Service	1053798629	1053798629	1	1	KHAN, ASFAND MD	12/28/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170099	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
145552	Fee-for-Service	1881801835	1881801835	1	2	KIDS-CARE PEDIATRIC	11/1/1998	2080H0002X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	1125 E 17TH ST	STE N351	SANTA ANA	CA	92701	2269	30	06059	33.76004145	-117.854838	Orange County
145562	Fee-for-Service	1871537340	1871537340	1	1	KOTZEN, MICHAEL D DPM	4/3/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	27 W MAIN ST	STE G	ALHAMBRA	CA	91801	3500	19	06037	34.09489351	-118.1274697	Los Angeles County
145570	Fee-for-Service	1881852051	1881852051	1	1	KUO, KEVIN W MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108896	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
145586	Fee-for-Service	1871538710	1871538710	1	1	KRISHNAREDDY, DIVAKAR MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	35665	20	Orthopedic Surgery	0	In state provider	A PROFESSIONAL CORP	1669 W AVENUE J	STE 201	LANCASTER	CA	93534	2869	19	06037	34.68944746	-118.1608785	Los Angeles County
145590	Fee-for-Service	1083091748	1083091748	1	1	KONG, STEPHANIE F MD	5/6/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	135667	15	Obstetrics (D.O. only)	0	In state provider	None	8631 W THIRD STREET	SUITE 444E	LOS ANGELES	CA	90048	5908	19	06037	34.07361928	-118.3803143	Los Angeles County
145594	Fee-for-Service	1356465793	1356465793	1	1	KENNETH GOLDBERG	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CTY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
145625	Fee-for-Service	1861525602	1861525602	1	4	KOREAN COMMUNITY SERVICES	10/17/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8352 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2526	30	06059	33.8698947	-117.9872467	Orange County
145628	Fee-for-Service	1396819991	1396819991	1	1	KIRTI, SHAILAJA G MD	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82552	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
145698	Fee-for-Service	1518120211	1518120211	1	1	KUNDHUR, DIVYA R MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103547	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
145710	Fee-for-Service	1609185818	1609185818	1	1	KASARLA, MADHUKAR R MD	10/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2735 SILVER CREEK ROAD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
145730	Fee-for-Service	1659383149	1659383149	1	1	KORN, TOMMY S MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64671	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
145731	Fee-for-Service	1003458217	1003458217	1	1	KILGORE, ROBERT LMFT	3/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1619 N LA BREA AVE	UNIT 331	LOS ANGELES	CA	90028	3984	19	06037	34.10072537	-118.3450155	Los Angeles County
145776	Fee-for-Service	1235371857	1235371857	1	1	KNECHT, THOMAS P MD	4/30/1993	207RE0101X	NA	Endocrinology	026	PHYSICIANS	77982	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
145802	Fee-for-Service	1528476546	1528476546	1	2	KHORRAMI, ROXANA OD	4/2/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
145810	Fee-for-Service	1871896274	1871896274	1	1	KANDPAL, ANJALI MD	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113029	08	Family Practice	0	In state provider	None	3755 BEACON AVE	None	FREMONT	CA	94538	1411	01	06001	37.54813209	-121.9825183	Alameda County
145816	Fee-for-Service	1700097862	1700097862	1	1	KAHLON, SURJIT K MD PC	3/24/2009	174400000X	NA	Other	026	PHYSICIANS	31422	79	Neurology-Child	0	In state provider	None	630 N 13TH AVE	STE B	UPLAND	CA	91786	4975	36	06071	34.10137569	-117.6336729	San Bernardino County
145818	Fee-for-Service	1669869996	1669869996	1	1	KULKARNI, SHRADHA A MD	7/2/2019	208M00000X	NA	Other	026	PHYSICIANS	161134	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
145831	Fee-for-Service	1669402228	1669402228	1	1	KORCHEK, JEFFREY MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	50547	20	Orthopedic Surgery	0	In state provider	None	10749 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91602	2324	19	06037	34.15228374	-118.365296	Los Angeles County
145845	Fee-for-Service	1831308881	1831308881	1	1	KOO, BON W CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	KOO'S ACUPUNCTURE & HERB	2833 W 8TH ST	STE 101	LOS ANGELES	CA	90005	1289	19	06037	34.05777745	-118.28772	Los Angeles County
145850	Fee-for-Service	1790863561	1790863561	1	1	KAPUR, SHABNAM MD	3/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76169	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
145857	Fee-for-Service	1255419073	1255419073	1	1	KIM, JAMES MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78042	24	Plastic Surgery	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
145859	Fee-for-Service	1952940603	1952940603	1	1	KNUDSON, LENORA J CRNA	12/11/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
145873	Fee-for-Service	1164115986	1164115986	1	2	KAREN RIGHTLER, PMHNP-BC, A	4/15/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	12371 LEWIS ST	STE 201	GARDEN GROVE	CA	92840	4687	30	06059	33.78341032	-117.8984137	Orange County
145879	Fee-for-Service	1467446419	1467446419	1	1	KAZ, SHARON LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4019 ALTA MESA DR	None	STUDIO CITY	CA	91604	4012	19	06037	34.13513304	-118.4099533	Los Angeles County
145901	Fee-for-Service	1598044794	1598044794	1	1	KOLTER, ANGELA PSYD	8/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3655 ALAMO ST	202	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
145922	Fee-for-Service	1740468834	1740468834	1	1	KOBAYASHI, ANTARA	10/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	SUITE 210	SAN DIEGO	CA	92108	3104	37	06073	32.76632791	-117.1616245	San Diego County
145934	Fee-for-Service	1881801835	1881801835	1	1	KIDS-CARE PEDIATRIC	11/1/1998	2080H0002X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	947 S ANAHEIM BLVD	STE 200	ANAHEIM	CA	92805	5584	30	06059	33.82164135	-117.909385	Orange County
145941	Fee-for-Service	1649207523	1649207523	1	1	KOHLERITER, ERIC MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	27118	41	Internal Medicine	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
146027	Fee-for-Service	1306276704	1306276704	1	1	KOPELMAN, WILLIAM J INC	4/29/2015	261QP2300X	NA	Other	026	PHYSICIANS	53462	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3010 W ORANGE AVE	STE 503	ANAHEIM	CA	92804	3169	30	06059	33.82472315	-117.994133	Orange County
146050	Fee-for-Service	1578537122	1578537122	1	1	KAHOOK, MALIK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
146098	Fee-for-Service	1457483331	1457483331	1	1	KIRMANI,KHAVER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 W CLARENDON AVE	375	PHOENIX	AZ	85013	0000	00	None	33.49179	-112.07844	Maricopa County
146102	Fee-for-Service	1760539084	1760539084	1	1	KAISER FOUNDATION HEALTH PLA	2/19/1982	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 N LA BREA AVE	None	INGLEWOOD	CA	90301	1708	19	06037	33.96345848	-118.3533454	Los Angeles County
146118	Fee-for-Service	1275988768	1275988768	1	1	KARIM, SHADIA MD	7/22/2019	390200000X	NA	Other	026	PHYSICIANS	151047	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
146121	Fee-for-Service	1548306244	1548306244	1	1	KIM, JULIUS J MFT	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	77380	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
146135	Fee-for-Service	1114210994	1114210994	1	1	KAUR, JASLEEN MD	2/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	147736	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
146147	Fee-for-Service	1578894911	1578894911	1	1	KASHANIAN, ALBERT MD	2/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115426	41	Internal Medicine	0	In state provider	None	3160 E DEL MAR BLVD	STE 110	PASADENA	CA	91107	4649	19	06037	34.14217551	-118.085292	Los Angeles County
146149	Fee-for-Service	1902442148	1902442148	1	1	KRUPINSKI, LINDSEY CNP	1/21/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
146172	Fee-for-Service	1013043314	1013043314	1	1	KELLEY, LEAH M MD	8/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89531	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
146179	Fee-for-Service	1437146578	1437146578	2	1	KCI USA INC	12/5/2011	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7925 DUNBROOK RD	SUITE C	SAN DIEGO	CA	92126	6306	37	06073	32.8925295	-117.150642	San Diego County
146184	Fee-for-Service	1972920825	1972920825	1	1	KAPADIA, TINA P DO	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15481	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
146249	Fee-for-Service	1750719001	1750719001	1	1	KELLIE OLIVE JOBES NP	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
146266	Fee-for-Service	1164791265	1164791265	1	1	KOSTOVA-ABADJIEVA, STELA G	11/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121900	41	Internal Medicine	0	In state provider	MD	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
146307	Fee-for-Service	1144332487	1144332487	1	1	KANWAL, TEHMINA MD	6/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90031	41	Internal Medicine	0	In state provider	None	3755 BEACON AVE	None	FREMONT	CA	94538	1411	01	06001	37.54813209	-121.9825183	Alameda County
146341	Fee-for-Service	1457594160	1457594160	1	1	KADIN, NATALIE E MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119803	None	None	0	In state provider	None	200 MEDICAL PLAZA	550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
146377	Fee-for-Service	1841523545	1841523545	1	1	KAMARINOS, SPYROS MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
146427	Fee-for-Service	1902878556	1902878556	1	1	KLATT, DONALD S MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78119	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 S FOREST RD	None	SONORA	CA	95370	4816	55	06109	37.98218745	-120.3911521	Tuolumne County
146445	Fee-for-Service	1548551484	1548551484	1	1	KALRA, AMITA MD	11/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127732	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
146453	Fee-for-Service	1760411946	1760411946	1	1	KIM, PETER K MD INC	10/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67819	13	Neurology (M.D. only)	0	In state provider	None	1195 ROADRUNNER WAY	None	SIMI VALLEY	CA	93065	3159	56	06111	34.26045263	-118.7955591	Ventura County
146460	Fee-for-Service	1013043314	1013043314	1	1	KELLEY, LEAH M MD	8/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89531	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
146470	Fee-for-Service	1306911342	1306911342	1	1	KELLENBERGER, KARI R	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
146503	Fee-for-Service	1336429455	1336429455	1	1	KATUZNY, KATHRYN E PHD	9/9/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
146542	Fee-for-Service	1235218967	1235218967	1	1	KIM, SUNG J MD	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60619	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
146576	Fee-for-Service	1053817692	1053817692	1	1	KIRK, PETER S MD	10/9/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	525 EAST PLAZA DR	STE 304	SANTA MARIA	CA	93465	9747	42	06083	34.9373822	-120.4296004	Santa Barbara County
146608	Fee-for-Service	1780729772	1780729772	1	1	KARAKASHIAN, GARO MD INC	10/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81168	None	None	0	In state provider	None	500 N CENTRAL AVE	STE 900	GLENDALE	CA	91203	1847	19	06037	34.15321627	-118.2578985	Los Angeles County
146642	Fee-for-Service	1376770925	1376770925	1	1	KIM, DEBORAH MD	6/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125270	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
146647	Fee-for-Service	1073248597	1073248597	1	1	KCE FAMILY THERAPY COUNSELIN	7/22/2024	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR	201	PALM DESERT	CA	92211	0484	33	06065	33.75833451	-116.3114325	Riverside County
146667	Fee-for-Service	1992905178	1992905178	1	1	KUNDE, SANKET S MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126521	01	General Practice	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
146684	Fee-for-Service	1104973437	1104973437	1	1	KAISER FOUNDATION HEALTH	5/16/1994	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN SKYVIEW PHARMACY	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
146691	Fee-for-Service	1245342492	1245342492	1	1	KRASINSKI, WIESLAWA MD	7/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83048	08	Family Practice	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
146718	Fee-for-Service	1386707131	1386707131	1	1	KARDONG, GLORIA M MD	9/30/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	60805	36	Psychiatry	0	In state provider	None	900 WELCH RD	STE 400	PALO ALTO	CA	94304	1804	43	06085	37.43619156	-122.1779694	Santa Clara County
146728	Fee-for-Service	1720159973	1720159973	1	1	KURT GERARD DATZ, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 E BROADWAY AVE	None	BISMARCK	ND	58501	4520	00	None	46.807119	-100.7778375	Burleigh County
146731	Fee-for-Service	1548551484	1548551484	1	1	KALRA, AMITA MD	11/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127732	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
146737	Fee-for-Service	1760411946	1760411946	1	1	KIM, PETER K MD INC	10/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67819	79	Neurology-Child	0	In state provider	None	1195 ROADRUNNER WAY	None	SIMI VALLEY	CA	93065	3159	56	06111	34.26045263	-118.7955591	Ventura County
146784	Fee-for-Service	1952715518	1952715518	1	1	KARMARKAR, ELLORA N MD	8/12/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	156669	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
146798	Fee-for-Service	1598044794	1598044794	1	2	KOLTER, ANGELA PSYD	7/7/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8170 BEVERLY BLVD	106	LOS ANGELES	CA	90048	4524	19	06037	34.07606549	-118.36773	Los Angeles County
146799	Fee-for-Service	1629233234	1629233234	1	1	KIM, YOUNGHOON	2/10/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	42301 10TH ST WEST	None	LANCASTER	CA	93534	7000	19	06037	34.6512813	-118.1478396	Los Angeles County
146813	Fee-for-Service	1922140235	1922140235	1	1	KRUMMEL, THOMAS M MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85049	85	Surgery-Pediatric	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
146844	Fee-for-Service	1881012656	1881012656	1	1	KATHERINE BAO-SHIAN LEE, M.D	8/7/2018	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	24431 CALLE DE LA LOUISA	SUITE 200	LAGUNA HILLS	CA	92653	7641	30	06059	33.60954397	-117.7084741	Orange County
146853	Fee-for-Service	1326492679	1326492679	1	1	KESHAV, NANDAN MD	6/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172341	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
146869	Fee-for-Service	1629082821	1629082821	1	1	KUMAR, AVTAR S MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	36913	05	Anesthesiology	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
146891	Fee-for-Service	1841808854	1841808854	1	1	KAIS, LORRI A PHD	10/19/2020	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
146895	Fee-for-Service	1760201644	1760201644	1	1	KAUR, TEGJIT NP	12/20/2024	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
146937	Fee-for-Service	1073248597	1073248597	1	1	KCE FAMILY THERAPY COUNSELIN	7/22/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR	201	PALM DESERT	CA	92211	0484	33	06065	33.75833451	-116.3114325	Riverside County
146974	Fee-for-Service	1710082805	1710082805	2	1	KWAN, STEPHEN K MD	4/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35371	41	Internal Medicine	0	In state provider	None	711 W COLLEGE STREET	SUITE 200	LOS ANGELES	CA	90012	1093	19	06037	34.06541412	-118.2414102	Los Angeles County
146990	Fee-for-Service	1023092103	1023092103	1	1	KHALILI, THEODORE M MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81066	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
147000	Fee-for-Service	1023645751	1023645751	1	1	KOKALY, ALEX N MD	3/10/2023	207R00000X	NA	Other	026	PHYSICIANS	178074	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
147038	Fee-for-Service	1578661955	1578661955	1	1	KELEDJIAN, VARUJAN A MD	3/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	46647	41	Internal Medicine	0	In state provider	None	3903 LONE TREE WAY	STE 205	ANTIOCH	CA	94509	6269	07	06013	37.98216807	-121.8054744	Contra Costa County
147086	Fee-for-Service	1558660225	1558660225	1	1	KWAN, JASON G	10/14/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 BROADWAY	None	REDWOOD CITY	CA	94063	2086	41	06081	37.4867809	-122.2236863	San Mateo County
147087	Fee-for-Service	1588742316	1588742316	1	1	KAGAN, CHRISTOPHER MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29757	30	Radiology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
147139	Fee-for-Service	1508866575	1508866575	1	1	KARICH, ANDREW C MD	12/21/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	69440	20	Orthopedic Surgery	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
147164	Fee-for-Service	1750340667	1750340667	1	1	KELSAY, DAMON E MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	72172	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39600 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3265	33	06065	33.7614267	-116.4080191	Riverside County
147210	Fee-for-Service	1437293008	1437293008	1	1	KANG, YOUNG-HWA LMFT	12/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1901 E LAMBERT RD	203P	LA HABRA	CA	90631	0504	30	06059	33.92464653	-117.92502	Orange County
147217	Fee-for-Service	1952581738	1952581738	1	1	KIM, JANICE C	9/26/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
147221	Fee-for-Service	1134278138	1134278138	1	1	KICSKA, GREGORY A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	None	SEATTLE	WA	98195	0001	00	None	47.65080692	-122.3081828	King County
147224	Fee-for-Service	1346802550	1346802550	1	1	KLIGIS, GABRIELLE LCSW	9/23/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
147247	Fee-for-Service	1356729792	1356729792	1	1	KORMAN, ROSALYNNE R MD	5/16/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146208	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
147254	Fee-for-Service	1679526164	1679526164	1	1	KATSIVAS, THEODOROS F MD	11/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78543	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
147263	Fee-for-Service	1710082805	1710082805	2	1	KWAN, STEPHEN K MD	4/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35371	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	711 W COLLEGE STREET	SUITE 200	LOS ANGELES	CA	90012	1093	19	06037	34.06541412	-118.2414102	Los Angeles County
147274	Fee-for-Service	1740337062	1740337062	1	1	KAISER PERM PHCY #108	10/27/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15446 S WESTERN AVE	None	GARDENA	CA	90249	4319	19	06037	33.89042107	-118.3091303	Los Angeles County
147299	Fee-for-Service	1780763482	1780763482	1	3	KAMRAN MATIN, MD, INC	11/7/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4201 TORRANCE BLVD	SUITE 790	TORRANCE	CA	90503	4561	19	06037	33.8375955	-118.358748	Los Angeles County
147301	Fee-for-Service	1447334826	1447334826	1	1	KUO, MORMAN MD APC	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	37079	41	Internal Medicine	0	In state provider	None	5471 LA PALMA AVE	SUITE 105	LA PALMA	CA	90623	1773	30	06059	33.84643649	-118.0377675	Orange County
147312	Fee-for-Service	1174527717	1174527717	1	1	KINDRACHUK, ROBERT W MD	9/23/1996	193400000X	NA	Other	026	PHYSICIANS	42539	34	Urology and Urological Surgery	0	In state provider	None	501 S SHORE CTR W	None	ALAMEDA	CA	94501	5725	01	06001	37.75884896	-122.2528366	Alameda County
147324	Fee-for-Service	1578661955	1578661955	1	1	KELEDJIAN, VARUJAN A MD	3/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	46647	10	Gastroenterology (M.D. only)	0	In state provider	None	3903 LONE TREE WAY	STE 205	ANTIOCH	CA	94509	6269	07	06013	37.98216807	-121.8054744	Contra Costa County
147344	Fee-for-Service	1124195953	1124195953	1	1	KALINOWSKI, EDWARD A MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65872	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
147383	Fee-for-Service	1124058805	1124058805	1	1	KANAKARAJ, KAVITHA MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79279	45	Nephrology (Renal-Kidney)	0	In state provider	None	3106 W BEVELRY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02373532	-118.1368368	Los Angeles County
147402	Fee-for-Service	1184831273	1184831273	1	1	KABOLIZADEH, KAMRAN MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131820	13	Neurology (M.D. only)	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
147414	Fee-for-Service	1548883382	1548883382	1	1	KAWASHITA, TAKUMI DO	9/25/2024	208M00000X	NA	Other	026	PHYSICIANS	22563	41	Internal Medicine	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
147440	Fee-for-Service	1346769981	1346769981	1	1	KNADLER, SARAH LCSW	7/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	1	Border provider	None	187 WARM SPRINGS	SUITE B157	LAS VEGAS	NV	89119	4110	00	None	36.05690954	-115.164216	Clark County
147474	Fee-for-Service	1558018200	1558018200	1	1	K PHUN MEDICAL CLINIC INC	3/4/2022	261QM0850X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2418 SAN GABRIEL BLVD	None	ROSEMEAD	CA	91770	3674	19	06037	34.0558524	-118.0905163	Los Angeles County
147503	Fee-for-Service	1104872431	1104872431	1	1	KATRIS, FRANCES P MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
147524	Fee-for-Service	1265528673	1265528673	1	1	KEARNS, KATHLEEN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67245	08	Family Practice	0	In state provider	None	440 AIRPORT BLVD	STE A	SALINAS	CA	93905	3302	27	06053	36.66527366	-121.616758	Monterey County
147536	Fee-for-Service	1710961552	1710961552	1	1	KING, PHILLIP M MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6982	None	None	0	In state provider	None	909 BLANCO CIR	None	SALINAS	CA	93901	4401	27	06053	36.65354107	-121.6381985	Monterey County
147544	Fee-for-Service	1699788133	1699788133	1	1	KELLY, ERIC LMFT	11/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25 MITCHELL BLVD	SUITE 3	SAN RAFAEL	CA	94903	2007	21	06041	38.01713471	-122.5393512	Marin County
147564	Fee-for-Service	1205139268	1205139268	1	1	KIMURA, JEANNE D PSYD	10/5/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
147584	Fee-for-Service	1780763482	1780763482	1	3	KAMRAN MATIN, MD, INC	11/7/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4201 TORRANCE BLVD	SUITE 790	TORRANCE	CA	90503	4561	19	06037	33.8375955	-118.358748	Los Angeles County
147595	Fee-for-Service	1174527717	1174527717	1	1	KINDRACHUK, ROBERT W MD	9/23/1996	193400000X	NA	Other	026	PHYSICIANS	42539	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 S SHORE CTR W	None	ALAMEDA	CA	94501	5725	01	06001	37.75884896	-122.2528366	Alameda County
147598	Fee-for-Service	1104322239	1104322239	1	1	KURUVADI, NISHA MD	11/22/2024	207R00000X	NA	Other	026	PHYSICIANS	20100	41	Internal Medicine	0	In state provider	None	1890 W MAIN ST	110	BARSTOW	CA	92311	3725	36	06071	34.89321455	-117.0507578	San Bernardino County
147639	Fee-for-Service	1851768568	1851768568	1	1	K&S THERAPEUTIC SERVICES	2/19/2017	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	5601 W SLAUSON AVE	STE 178	CULVER CITY	CA	90230	6582	19	06037	33.98900447	-118.37979	Los Angeles County
147656	Fee-for-Service	1962439125	1962439125	1	1	KESSLER, WARREN O MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29578	34	Urology and Urological Surgery	0	In state provider	None	4060 4TH AVE	STE 310	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
147685	Fee-for-Service	1063035723	1063035723	1	1	KANE, ASHLEY M CRNA	11/28/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
147709	Fee-for-Service	1033145388	1033145388	1	1	KWONG, ERNA M MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40974	05	Anesthesiology	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
147820	Fee-for-Service	1770819740	1770819740	1	1	KRUSE, ANDRIA D CNM	5/27/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	27350 IRIS AVENUE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.897402	-117.1860255	Riverside County
147838	Fee-for-Service	1972868396	1972868396	1	1	KRISTINA MARIE KOCH NP	11/14/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
147847	Fee-for-Service	1225309164	1225309164	1	1	KARP, FELIX S MD	6/15/2015	207R00000X	NA	Other	026	PHYSICIANS	127329	41	Internal Medicine	0	In state provider	None	150 PIONEER LANE	None	BISHOP	CA	93514	2556	14	06027	37.36193834	-118.4073304	Inyo County
147860	Fee-for-Service	1710108261	1710108261	1	1	KALMANSOH & SCHIFF MED	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	852 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1601	19	06037	34.06139351	-118.3835652	Los Angeles County
147862	Fee-for-Service	1962454140	1962454140	1	2	KERN NEPHROLOGY MED GRP	8/15/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	443 W MORTON AVE	STE A	PORTERVILLE	CA	93257	3352	54	06107	36.07317626	-119.026942	Tulare County
147874	Fee-for-Service	1841753605	1841753605	1	1	KHATRI, SHREYA MD	10/20/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181047	None	None	0	In state provider	None	6600 LONE TREE WAY	None	BRENTWOOD	CA	94513	5256	07	06013	37.9617515	-121.730436	Contra Costa County
147876	Fee-for-Service	1013145267	1013145267	1	1	KOHAMA, MITSUYO MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149399	41	Internal Medicine	0	In state provider	None	23625 WR HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
147896	Fee-for-Service	1366516973	1366516973	1	1	KUPETZ, STEWART MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	28109	07	Dermatology	0	In state provider	None	120 LA CASA VIA	STE 101	WALNUT CREEK	CA	94598	3092	07	06013	37.91202407	-122.0419227	Contra Costa County
147923	Fee-for-Service	1073140059	1073140059	1	1	KAWASAKI, MEGAN K	7/1/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
147929	Fee-for-Service	1851768568	1851768568	1	1	K&S THERAPEUTIC SERVICES	2/19/2017	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	5601 W SLAUSON AVE	STE 178	CULVER CITY	CA	90230	6582	19	06037	33.98900447	-118.37979	Los Angeles County
147935	Fee-for-Service	1265490700	1265490700	1	1	KINGMAN K HO, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
147945	Fee-for-Service	1831179985	1831179985	1	1	KUMURA, DENNIS H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE RADIOLOGY GROUP INC	941 KAMEBAMEHA HWY	STE 208	PEARL CITY	HI	96782	0000	00	None	21.39429472	-157.97183	Honolulu County
148028	Fee-for-Service	1508155227	1508155227	1	1	KANNAN, SWATI V MD	11/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13729	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 450, 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
148045	Fee-for-Service	1306057989	1306057989	1	1	KRONLAND, RENE C MD	11/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85096	01	General Practice	0	In state provider	None	107 CATHERINE LN	None	GRASS VALLEY	CA	95945	5705	29	06057	39.22975754	-121.0475958	Nevada County
148147	Fee-for-Service	1710108261	1710108261	1	1	KALMANSOH & SCHIFF MED	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	852 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1601	19	06037	34.06139351	-118.3835652	Los Angeles County
148220	Fee-for-Service	1346367570	1346367570	1	2	KHALIQI, MUSA MD	5/1/2022	207R00000X	NA	Other	026	PHYSICIANS	127146	None	None	0	In state provider	None	520 W I ST	None	LOS BANOS	CA	93635	4211	20	06039	37.06346603	-120.8593647	Merced County
148277	Fee-for-Service	1659344430	1659344430	1	1	KARL HEILMAN	3/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	353 FAIRMONT BLVD	None	RAPID CITY	SD	57701	7375	00	None	44.05854729	-103.2246985	Pennington County
148297	Fee-for-Service	1801916119	1801916119	1	1	KERFOOT, LISA L F	8/31/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	980 ROOSEVELT	STE 100	IRVINE	CA	92620	3670	30	06059	33.69380208	-117.7653165	Orange County
148298	Fee-for-Service	1104409747	1104409747	1	1	KIM, JOSHUA H MD	10/9/2023	390200000X	NA	Other	026	PHYSICIANS	188072	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
148302	Fee-for-Service	1770947772	1770947772	1	1	KIN, KEVIN C MD	1/20/2020	207R00000X	NA	Other	026	PHYSICIANS	16968	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
148325	Fee-for-Service	1770592149	1770592149	1	1	KRAMER, JORDAN L MD	6/1/1996	207P00000X	NA	Other	026	PHYSICIANS	57619	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
148326	Fee-for-Service	1669554317	1669554317	1	1	KUMAR, NAVEEN N MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81673	30	Radiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
148327	Fee-for-Service	1265514129	1265514129	1	1	KUMAR, NUPUR DO	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	7896	08	Family Practice	0	In state provider	None	1414 S GRAND AVE	STE 456	LOS ANGELES	CA	90015	3071	19	06037	34.03661142	-118.2657227	Los Angeles County
148342	Fee-for-Service	1609238617	1609238617	1	1	KIET, TUYEN MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	167737	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
148359	Fee-for-Service	1598925208	1598925208	1	1	KLEINBERGER, ANDREW J MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129488	84	Surgery-Head and Neck	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
148379	Fee-for-Service	1528101193	1528101193	2	1	KOPEIKIN, BRIAN N MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73649	01	General Practice	0	In state provider	None	216 W PUEBLO ST	SUITE A	SANTA BARBARA	CA	93105	5806	42	06083	34.43124151	-119.7211927	Santa Barbara County
148404	Fee-for-Service	1497931208	1497931208	1	1	KID CARE EXPRESS III	4/28/2006	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
148410	Fee-for-Service	1518925692	1518925692	1	1	KAREN GOLD	6/10/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4444 E 41ST ST	None	TULSA	OK	74135	2527	00	None	36.101988	-95.925141	Tulsa County
148418	Fee-for-Service	1578726907	1578726907	1	1	KHULLAR, RESHMI B MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	102505	40	Pediatrics	0	In state provider	None	18102 IRVINE BLVD	STE 103 & 105	TUSTIN	CA	92780	3423	30	06059	33.74819092	-117.816792	Orange County
148423	Fee-for-Service	1659481125	1659481125	1	1	KONOW, AUDREY MD	2/5/2013	207R00000X	NA	Other	026	PHYSICIANS	32179	41	Internal Medicine	0	In state provider	None	16960 BASTANCHURY RD	STE G	YORBA LINDA	CA	92886	1711	30	06059	33.8992167	-117.838452	Orange County
148438	Fee-for-Service	1720469984	1720469984	1	1	KEESARA, SIRINA R MD	5/25/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162589	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
148464	Fee-for-Service	1063421592	1063421592	1	1	KASETTY, MEGHANA R MD	4/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177130	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
148469	Fee-for-Service	1467847202	1467847202	1	1	KERMAN DIALYSIS CENTER LLC	9/30/2016	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	14945 W WHITESBRIDGE AVE	None	KERMAN	CA	93630	1111	10	06019	36.7348737	-120.0589577	Fresno County
148489	Fee-for-Service	1982751210	1982751210	1	1	KAISER FOUNDATION HEALTH PLA	1/27/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMAN PHAR#241	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
148540	Fee-for-Service	1376589705	1376589705	2	1	KIM, ARMANDO	6/23/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 170	POMONA	CA	91767	3030	19	06037	34.07791925	-117.746146	Los Angeles County
148562	Fee-for-Service	1275659039	1275659039	1	1	KHERIATY, AARON D MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89144	36	Psychiatry	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
148655	Fee-for-Service	1376133322	1376133322	1	1	KING, ASHLEY A CNP	3/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	738 BANCROFT RD	None	WALNUT CREEK	CA	94598	1531	07	06013	37.92857256	-122.041705	Contra Costa County
148667	Fee-for-Service	1528101193	1528101193	2	1	KOPEIKIN, BRIAN N MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73649	05	Anesthesiology	0	In state provider	None	216 W PUEBLO ST	SUITE A	SANTA BARBARA	CA	93105	5806	42	06083	34.43124151	-119.7211927	Santa Barbara County
148713	Fee-for-Service	1487082749	1487082749	1	1	KIM, MELODY J OD	4/27/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44815 FIG AVE	None	LANCASTER	CA	93534	5501	19	06037	34.69630244	-118.1431105	Los Angeles County
148722	Fee-for-Service	1487041158	1487041158	1	1	KOPSTEIN, JEFFREY S DO	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15232	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA STREET	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
148732	Fee-for-Service	1922250323	1922250323	1	1	KELEKAR, GAURI D MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111323	46	Hand Surgery	0	In state provider	None	1001 POTRERO AVE	BLDG 80, WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
148759	Fee-for-Service	1053495069	1053495069	1	1	KLAMATH COUNTY FIRE DIST #4	2/23/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	None	4041 BALSAM DR	None	KLAMATH FALLS	OR	97601	5406	00	None	42.19185347	-121.8079395	Klamath County
148781	Fee-for-Service	1902311756	1902311756	1	1	KADOSH, LILY V PSYD	5/11/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
148782	Fee-for-Service	1871940940	1871940940	1	1	KRIGSTEIN, KELSEY L MD	9/27/2020	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	152092	47	Miscellaneous	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
148852	Fee-for-Service	1023166915	1023166915	1	1	KOHORN, RONALD S MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40792	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
148894	Fee-for-Service	1316987605	1316987605	1	1	KIM, SEONG I MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139331	68	Hematology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
148901	Fee-for-Service	1356429039	1356429039	1	1	KELLY-REIF, STEVEN M MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50423	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	STE C	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
148933	Fee-for-Service	1588663769	1588663769	1	7	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1443 W 7TH STREET	None	HANFORD	CA	93230	4937	16	06031	36.32550091	-119.6678789	Kings County
148952	Fee-for-Service	1871912519	1871912519	1	1	KOO, JAHOON J MD	11/6/2019	208600000X	NA	General Surgery	026	PHYSICIANS	140169	02	General Surgery	0	In state provider	None	1401 SPANOS COURT	SUITE 108	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
148969	Fee-for-Service	1508128117	1508128117	1	1	KIRKENDALL-AZER, ROSANNA R	2/2/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
148970	Fee-for-Service	1760724843	1760724843	1	1	KIM, ROY	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14097	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
148986	Fee-for-Service	1164502639	1164502639	1	1	KIM, JAMES C MD	7/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63306	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
149007	Fee-for-Service	1124476270	1124476270	1	4	KHADER, WASEEM M DO	9/20/2023	207QA0401X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	16567	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	None	EL CAJON	CA	92021	4994	37	06073	32.80773552	-116.9384985	San Diego County
149012	Fee-for-Service	1275588055	1275588055	1	1	KANAKAMEDALA, SANDHYA C MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51005	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 125	LOS ANGELES	CA	90033	2445	19	06037	34.05112725	-118.2173921	Los Angeles County
149021	Fee-for-Service	1437680261	1437680261	1	1	KAPA, NANDAKISHOR MD	7/15/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	157989	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
149022	Fee-for-Service	1922250323	1922250323	1	1	KELEKAR, GAURI D MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111323	78	Neoplastic Diseases/Oncology	0	In state provider	None	1001 POTRERO AVE	BLDG 80, WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
149028	Fee-for-Service	1891882379	1891882379	1	1	KAW, MARITA	12/20/1991	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	MEDI-COACH	3161 BUTLER AVE	None	LOS ANGELES	CA	90066	1301	19	06037	34.02262402	-118.432365	Los Angeles County
149029	Fee-for-Service	1699357525	1699357525	1	1	KARANDE, PRACHI PT	6/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	600 PALM AVE	126	IMPERIAL BEACH	CA	91932	1246	37	06073	32.5839813	-117.1207525	San Diego County
149050	Fee-for-Service	1194342246	1194342246	1	1	KHAN, WAQAS MD	9/7/2023	207R00000X	NA	Other	026	PHYSICIANS	184668	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
149053	Fee-for-Service	1922233394	1922233394	1	1	KHALEGHI, MAHYAR MD	4/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149610	41	Internal Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
149064	Fee-for-Service	1609923937	1609923937	1	1	KAISER FDN HLTH PLAN	8/9/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #431	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
149115	Fee-for-Service	1588663769	1588663769	1	21	KAWEAH DELTA HEALTH CARE	6/24/2024	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4945 W CYPRESS AVE	SUITE C	VISALIA	CA	93277	1592	54	06107	36.323226	-119.346048	Tulare County
149138	Fee-for-Service	1043327018	1043327018	1	1	KATHRYN A BUCKLEN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE CHILDRENS PLACE	CAMPUS BOX 8515	ST LOUIS	MO	63110	1002	00	None	38.63728519	-90.26492064	St. Louis city
149165	Fee-for-Service	1477729796	1477729796	1	1	KRZYZANIAK, SARA M MD	9/17/2020	207P00000X	NA	Other	026	PHYSICIANS	168349	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
149172	Fee-for-Service	1861488579	1861488579	1	1	KNAPP MEDICAL CENTER	5/18/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1401 E 8TH ST	None	WESLACO	TX	78596	6640	00	None	26.15197883	-97.97757776	Hidalgo County
149173	Fee-for-Service	1043638539	1043638539	1	1	KO,STEVE	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH STREET	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
149175	Fee-for-Service	1295230829	1295230829	1	1	KHAN, FARINAZ MD	2/13/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
149183	Fee-for-Service	1316987605	1316987605	1	1	KIM, SEONG I MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139331	78	Neoplastic Diseases/Oncology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
149268	Fee-for-Service	1538222096	1538222096	1	1	KNIGHT, BILLIE Z	2/28/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
149277	Fee-for-Service	1861703787	1861703787	1	1	KOSER, KAREN H MD	11/6/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162529	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
149285	Fee-for-Service	1588663769	1588663769	1	14	KAWEAH DELTA HEALTH CARE	12/15/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	325 SOUTH WILLIS STREET	None	VISALIA	CA	93329	6105	54	06107	36.327717	-119.2981005	Tulare County
149289	Fee-for-Service	1528260411	1528260411	1	1	KNOWLES, NEGAR G MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140762	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
149293	Fee-for-Service	1578874004	1578874004	1	1	KITTISARAPONG, NATWALEE DO	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
149317	Fee-for-Service	1861840316	1861840316	1	1	KUMAR, PREETHAM MD	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144423	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
149360	Fee-for-Service	1356581748	1356581748	1	1	KAMBHAM, KAVITHA R MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106444	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
149447	Fee-for-Service	1750470803	1750470803	1	1	KASIDI, EDDAH D	3/27/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1151 TORI DRIVE	None	HEMET	CA	92545	1230	33	06065	33.76625942	-117.0017698	Riverside County
149463	Fee-for-Service	1861488579	1861488579	1	1	KNAPP MEDICAL CENTER	2/16/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1401 E 8TH ST	None	WESLACO	TX	78596	6640	00	None	26.15197883	-97.97757776	Hidalgo County
149485	Fee-for-Service	1922020221	1922020221	1	1	KIM, DAVID HONG TAE MD	12/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79584	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
149528	Fee-for-Service	1295775641	1295775641	1	1	KHALID NAQI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1713 S KOFA AVE	STE J	PARKER	AZ	85344	6400	00	None	34.14225319	-114.2871917	La Paz County
149529	Fee-for-Service	1407920333	1407920333	1	1	KHAN, MUSHTAQ A MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51034	66	Emergency Medicine (Urgent Care)	0	In state provider	EMERGENCY DEPT	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
149530	Fee-for-Service	1689777872	1689777872	1	1	KUNG, GRACE C MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	54021	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
149536	Fee-for-Service	1922076223	1922076223	1	1	KAYE, WALTER H MD	1/29/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	24819	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
149540	Fee-for-Service	1699853358	1699853358	1	1	KEENE, KIRK D MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76032	34	Urology and Urological Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
149619	Fee-for-Service	1306840954	1306840954	1	1	KAROL, JAMES B MD	9/23/1996	193400000X	NA	Other	026	PHYSICIANS	26178	34	Urology and Urological Surgery	0	In state provider	None	501 S SHORE CTR W	None	ALAMEDA	CA	94501	5725	01	06001	37.75884896	-122.2528366	Alameda County
149622	Fee-for-Service	1114229101	1114229101	1	1	KEYES, SHARON LCSW	8/7/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1317 OAKDALE RD	SUITE 440	MODESTO	CA	95355	3364	50	06099	37.662489	-120.957588	Stanislaus County
149716	Fee-for-Service	1770714628	1770714628	1	1	KIM, BRYANT J MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120843	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
149723	Fee-for-Service	1205190774	1205190774	1	1	KATTAN, OMAR M MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134906	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
149735	Fee-for-Service	1750470803	1750470803	1	1	KASIDI, EDDAH D	3/27/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1151 TORI DRIVE	None	HEMET	CA	92545	1230	33	06065	33.76625942	-117.0017698	Riverside County
149741	Fee-for-Service	1396570461	1396570461	1	1	KIM, YEONG RI CNP	10/29/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	645 E PALOMAR ST	None	CHULA VISTA	CA	91911	6974	37	06073	32.61446195	-117.0260102	San Diego County
149798	Fee-for-Service	1720066848	1720066848	1	1	KANG EDITH H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST PAUL RADIOLOGY, PA	166 4TH ST E	None	ST PAUL	MN	55101	1421	00	None	44.94748068	-93.08830943	Ramsey County
149799	Fee-for-Service	1477598506	1477598506	1	1	KIM, ROBERT Y MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81211	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
149836	Fee-for-Service	1669471603	1669471603	1	1	KAMIEL, MICHAEL B	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24597	None	None	0	In state provider	None	3831 HUGHES AVE	STE 606	CULVER CITY	CA	90232	6849	19	06037	34.02243278	-118.3981492	Los Angeles County
149844	Fee-for-Service	1518015452	1518015452	1	1	KLAU, MARC H MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43233	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
149848	Fee-for-Service	1629006234	1629006234	1	1	KIM, LANCHI V AU	4/30/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
149850	Fee-for-Service	1235168568	1235168568	1	1	KRAMER, IAN MD	6/1/1983	207P00000X	NA	Other	026	PHYSICIANS	27540	01	General Practice	0	In state provider	HB-DUANE 8-1-83	1807 MANHATTAN BEACH BLV	None	MANHATTAN BEACH	CA	90266	6221	19	06037	33.88744553	-118.380276	Los Angeles County
149861	Fee-for-Service	1831225952	1831225952	1	1	KELISHADI, SHAHROOZ S MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127984	24	Plastic Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
149863	Fee-for-Service	1245388271	1245388271	1	1	KWON, DAVID S MD	9/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90101	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
149883	Fee-for-Service	1194993923	1194993923	1	1	KIM, KRISTINA J DO	5/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10311	08	Family Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
149916	Fee-for-Service	1780768853	1780768853	1	1	KWOK, GRACE C MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78551	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
149919	Fee-for-Service	1881859221	1881859221	1	1	KHORRAMI, SANAZ MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94024	41	Internal Medicine	0	In state provider	None	510 SUPERIOR AVE	None	NEWPORT BEACH	CA	92663	3664	30	06059	33.63019271	-117.9294795	Orange County
149929	Fee-for-Service	1588615181	1588615181	1	1	KUCH, ONICA A NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
149950	Fee-for-Service	1326545211	1326545211	1	1	KIRMIZ, SAMER W MD	6/16/2023	208800000X	NA	Other	026	PHYSICIANS	185294	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
149956	Fee-for-Service	1649400839	1649400839	1	1	KAMBHAMPATI, GANESH MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117811	45	Nephrology (Renal-Kidney)	0	In state provider	None	777 CAMPUS COMMONS RD	STE 120	SACRAMENTO	CA	95825	8343	34	06067	38.571021	-121.416786	Sacramento County
149983	Fee-for-Service	1730174004	1730174004	2	1	KURIAN, LEONARD S MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70489	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1331 W AVE J	STE 202	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
150029	Fee-for-Service	1881851574	1881851574	1	1	KOUDSI, NABIL MD INC	4/24/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33797	02	General Surgery	0	In state provider	None	811 E 11TH STREET	SUITE 207	UPLAND	CA	91786	4872	36	06071	34.1034335	-117.6398415	San Bernardino County
150035	Fee-for-Service	1396792552	1396792552	1	1	KAGRAMANOV, VADIM MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52994	41	Internal Medicine	0	In state provider	None	1309 SOUTH MARY AVE	SUITE 200	SUNNYVALE	CA	94087	3060	43	06085	37.34939241	-122.0505414	Santa Clara County
150085	Fee-for-Service	1548348352	1548348352	1	1	KLEINROCK, ROBERT A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30060	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
150106	Fee-for-Service	1073939815	1073939815	1	1	KIM, KISUNG MD	4/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141207	40	Pediatrics	0	In state provider	None	2450 SISTER MARY COLUMBA	DR	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
150110	Fee-for-Service	1215148630	1215148630	1	1	KATZ, BRENNAN B DO	7/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11212	05	Anesthesiology	0	In state provider	None	1404 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03682781	-118.2655363	Los Angeles County
150128	Fee-for-Service	1295197796	1295197796	1	1	KOESTERS, EMMA C MD	9/19/2023	2086S0122X	NA	General Surgery	026	PHYSICIANS	152518	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
150183	Fee-for-Service	1295922300	1295922300	1	1	KAYE, JOSHUA M DPM INC	4/2/1979	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 106	LOS ANGELES	CA	90045	3811	19	06037	33.96022076	-118.3961982	Los Angeles County
150193	Fee-for-Service	1467509794	1467509794	1	1	KAISER FND HLTH PLAN INC	3/1/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHAR #101	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
150196	Fee-for-Service	1598724577	1598724577	1	1	K.I.D.S. THERAPY ASSOCIATES,	5/23/2019	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC.	11838 BERNARDO PLAZA CT	SUITE 110	SAN DIEGO	CA	92128	2413	37	06073	33.02037119	-117.0760729	San Diego County
150205	Fee-for-Service	1417913518	1417913518	1	1	KIJNER, DANIEL M MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65581	None	None	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
150240	Fee-for-Service	1164607149	1164607149	1	1	KELLY, JENNIFER L MD	1/13/2009	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	101523	08	Family Practice	0	In state provider	None	1667 DOMINICAN WAY	SUITE 134	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
150252	Fee-for-Service	1083798607	1083798607	1	1	KYOO S RO MD INC	7/9/1974	207T00000X	NA	General Surgery	026	PHYSICIANS	26079	14	Neurological Surgery	0	In state provider	None	435 ARDEN AVE	STE 380	GLENDALE	CA	91203	1147	19	06037	34.15848148	-118.2628845	Los Angeles County
150325	Fee-for-Service	1538359179	1538359179	1	1	KALLUSCH, CHARLENE B PSYD	5/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94409	4364	41	06081	37.53039072	-122.2987772	San Mateo County
150326	Fee-for-Service	1881878023	1881878023	1	1	KLARISTENFIELD, TESS F MD	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101806	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 W ROUTE 66	None	GLENDORA	CA	91740	6207	19	06037	34.12866152	-117.86535	Los Angeles County
150333	Fee-for-Service	1063911006	1063911006	1	1	KWASNIUK, ASHLEY N OT	10/21/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR	SUITE 340	PALM DESERT	CA	92211	0450	33	06065	33.75833451	-116.3114325	Riverside County
150348	Fee-for-Service	1033102306	1033102306	1	1	KAMA, WILLIAM H MD	8/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	18144 SECO ST	None	JAMESTOWN	CA	95327	9737	55	06109	37.95208073	-120.4216785	Tuolumne County
150360	Fee-for-Service	1104956358	1104956358	1	1	KALEIDA HEALTH SYSTEM	12/30/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	445 TREMONT ST	None	N TONAWANDA	NY	14120	6150	00	None	43.026003	-78.8632425	Niagara County
150389	Fee-for-Service	1942663158	1942663158	1	1	KATSNELSON, MARCELLA	2/19/2023	208M00000X	NA	Other	026	PHYSICIANS	20600	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
150410	Fee-for-Service	1003117649	1003117649	1	1	KREIDEL, MARIT K MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116418	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
150446	Fee-for-Service	1417446550	1417446550	1	1	KANDA, CHRISTOPHER MD	10/6/2022	207L00000X	NA	Other	026	PHYSICIANS	173605	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
150485	Fee-for-Service	1508880659	1508880659	1	1	KALTHIA, ASHISH H MD	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78472	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
150536	Fee-for-Service	1366428310	1366428310	1	1	KAPLAN, STEVEN F DPM	6/7/1982	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	406 W BASELINE RD	None	GLENDORA	CA	91740	4801	19	06037	34.1212917	-117.8699341	Los Angeles County
150569	Fee-for-Service	1710171012	1710171012	1	1	KOPMAN, MARINA PSYD	5/2/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
150585	Fee-for-Service	1871866103	1871866103	1	1	KAPIL, RANJIT DO	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13875	30	Radiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
150619	Fee-for-Service	1679640510	1679640510	1	1	KRECKER, ELIZABETH A MD	2/28/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	50696	68	Hematology	0	In state provider	None	201 S ALVARADO ST	STE A	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
150623	Fee-for-Service	1346534989	1346534989	1	1	KRISPINSKY, MEGAN A MD	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124889	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
150648	Fee-for-Service	1104956358	1104956358	1	1	KALEIDA HEALTH SYSTEM	12/30/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	445 TREMONT ST	None	N TONAWANDA	NY	14120	6150	00	None	43.026003	-78.8632425	Niagara County
150659	Fee-for-Service	1285646802	1285646802	1	1	KAVY, STEVE MD	7/1/1987	207RP1001X	NA	Pulmonology	026	PHYSICIANS	61658	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
150679	Fee-for-Service	1518012301	1518012301	1	3	KAISER FOUNDATION	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
150699	Fee-for-Service	1275611949	1275611949	1	1	KATZ, DEBORAH L MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79689	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
150720	Fee-for-Service	1902108855	1902108855	1	3	KHANNA VISION INSTITUTE, A M	5/22/2024	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	15315 MAGNOLIA BLVD	100	SHERMAN OAKS	CA	91403	1173	19	06037	34.16488161	-118.4666419	Los Angeles County
150726	Fee-for-Service	1104996933	1104996933	1	1	KAISER FOUNDATION HOSP	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOME HEALTH SANTA ROSA	3550 ROUND BARN BLVD	SUITE 112	SANTA ROSA	CA	95403	1796	49	06097	38.476152	-122.7257685	Sonoma County
150773	Fee-for-Service	1932202371	1932202371	1	1	KIKKAWA, DON O MD	10/31/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	65447	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
150777	Fee-for-Service	1356551089	1356551089	1	1	KEVIN DAHL MD	6/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 25TH ST S	None	FARGO	ND	58103	6104	00	None	46.843677	-96.8207985	Cass County
150787	Fee-for-Service	1679775571	1679775571	1	1	KALYANI, PARTHO S MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109725	18	Ophthalmology	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
150809	Fee-for-Service	1053650275	1053650275	1	1	KURAEV, VADIM CRNA	5/17/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
150872	Fee-for-Service	1033356399	1033356399	1	1	KAUR, RUPINDER MD	4/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129518	None	None	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
150886	Fee-for-Service	1235336694	1235336694	1	1	KIM, WOOJAE MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105306	25	Physical Medicine and Rehabilitation	0	In state provider	None	647 W AVE Q	None	PALMDALE	CA	93551	3893	19	06037	34.58715647	-118.1417372	Los Angeles County
150907	Fee-for-Service	1679640510	1679640510	1	1	KRECKER, ELIZABETH A MD	2/28/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	50696	41	Internal Medicine	0	In state provider	None	201 S ALVARADO ST	STE A	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
150918	Fee-for-Service	1255402012	1255402012	1	1	KIM, JENNY M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80257	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
150921	Fee-for-Service	1548395122	1548395122	1	1	KANOW, STANLEY K MD	3/8/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	28617	40	Pediatrics	0	In state provider	None	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4235	30	06059	33.78029455	-117.864369	Orange County
150957	Fee-for-Service	1033138177	1033138177	1	1	KOLZ, MATTHEW L MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85806	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
151005	Fee-for-Service	1740255850	1740255850	1	1	KARADSHEH, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
151009	Fee-for-Service	1902108855	1902108855	1	3	KHANNA VISION INSTITUTE, A M	5/22/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15315 MAGNOLIA BLVD	100	SHERMAN OAKS	CA	91403	1173	19	06037	34.16488161	-118.4666419	Los Angeles County
151039	Fee-for-Service	1275700973	1275700973	1	1	KALMAZ, DENISE B MD	5/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87252	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
151105	Fee-for-Service	1972949469	1972949469	1	1	KIM, YOUNG I DO	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13755	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
151137	Fee-for-Service	1346672706	1346672706	1	1	KERDMAN, SAMANTHA LMFT	11/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
151141	Fee-for-Service	1952332991	1952332991	1	1	KONA COMMUNITY HOSPITAL	4/24/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	79-1019 HAUKAPILA ST	None	KEALAKEKUA	HI	96750	7920	00	None	19.519965	-155.918154	Hawaii County
151193	Fee-for-Service	1679640510	1679640510	1	1	KRECKER, ELIZABETH A MD	2/28/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	50696	78	Neoplastic Diseases/Oncology	0	In state provider	None	201 S ALVARADO ST	STE A	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
151207	Fee-for-Service	1255402012	1255402012	1	1	KIM, JENNY M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80257	78	Neoplastic Diseases/Oncology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
151209	Fee-for-Service	1982387395	1982387395	1	1	KAISER FOUNDATION HEALTH PLA	2/12/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	600	6600 BRUCEVILLE RD	ED BLDG FL 1 RM H2416	SACRAMENTO	CA	95823	0000	34	06067	38.470392	-121.4223975	Sacramento County
151253	Fee-for-Service	1497175798	1497175798	1	1	KEENAN, BRIDGET P MD	10/27/2020	207RX0202X	NA	Oncology	026	PHYSICIANS	145542	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
151319	Fee-for-Service	1245390566	1245390566	1	1	KHANJIAN, ELIZA PHD	8/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
151403	Fee-for-Service	1508863887	1508863887	1	1	KEINER, JENNIFER R MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73785	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
151426	Fee-for-Service	1861463390	1861463390	1	1	KATZ, MICHAEL E MD	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88982	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
151429	Fee-for-Service	1952332991	1952332991	1	1	KONA COMMUNITY HOSPITAL	4/24/2000	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	79-1019 HAUKAPILA ST	None	KEALAKEKUA	HI	96750	7920	00	None	19.519965	-155.918154	Hawaii County
151435	Fee-for-Service	1699851196	1699851196	1	1	KRISHINASWAMI, ASHOK MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72000	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
151497	Fee-for-Service	1255402012	1255402012	1	1	KIM, JENNY M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80257	68	Hematology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
151522	Fee-for-Service	1477789675	1477789675	1	1	KAFLE, MAHESHWOR MD	10/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
151533	Fee-for-Service	1366961112	1366961112	1	1	KHOURAKI, AIMEN PSYD	1/23/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23332 HAWTHORNE BLVD	STE 304	TORRANCE	CA	90505	3749	19	06037	33.813747	-118.3510045	Los Angeles County
151554	Fee-for-Service	1588663769	1588663769	1	3	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	840 S AKERS ROAD	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
151569	Fee-for-Service	1316200728	1316200728	1	1	KOLTOUGIAN, ARPI MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132616	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
151584	Fee-for-Service	1750605614	1750605614	1	1	KUKREJA, JANET E B MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	34	Urology and Urological Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
151603	Fee-for-Service	1750309365	1750309365	1	1	KIM, RHODORA E MD	10/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71519	40	Pediatrics	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
151702	Fee-for-Service	1083970776	1083970776	1	1	KAZEMI, FERDOUS F INC	2/2/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32367	40	Pediatrics	0	In state provider	None	1220 HEMLOCK WAY	SUITE 105-B	SANTA ANA	CA	92707	3600	30	06059	33.70975375	-117.8842792	Orange County
151730	Fee-for-Service	1225253883	1225253883	1	1	KEITH PERKINS MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	620 SKYLINE DR	None	JACKSON	TN	38301	3923	00	None	35.63721	-88.831359	Madison County
151736	Fee-for-Service	1508243338	1508243338	1	1	KIRUPANANTHAN, ANUJEETHA NP	5/31/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
151743	Fee-for-Service	1679671259	1679671259	1	1	KOKINOS, POLYXENE G MD	8/27/2020	174400000X	NA	Other	026	PHYSICIANS	66946	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
151778	Fee-for-Service	1346545241	1346545241	1	1	KETTELLE, CHRISTINA MD	4/2/2025	207L00000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
151782	Fee-for-Service	1124330303	1124330303	1	1	KOO, JULIE J MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135398	30	Radiology	0	In state provider	None	3161 L STREET	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
151808	Fee-for-Service	1568613016	1568613016	1	1	KANNAN, MURLIKRISHNA MD	2/28/2020	207L00000X	NA	Other	026	PHYSICIANS	148650	05	Anesthesiology	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
151861	Fee-for-Service	1063615110	1063615110	1	1	KURLAN, MATTHEW DO	5/14/2020	207P00000X	NA	Other	026	PHYSICIANS	9819	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
151879	Fee-for-Service	1730341728	1730341728	1	1	KOZMA, KURT L LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	514 CALIFORNIA AVE	STE 4	BEAUMONT	CA	92223	6833	33	06065	33.92824357	-116.9812965	Riverside County
151883	Fee-for-Service	1699195255	1699195255	1	1	KOLEV, JOHANN MD	9/23/2019	208M00000X	NA	Other	026	PHYSICIANS	139247	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
151894	Fee-for-Service	1427370444	1427370444	1	2	KIM, JAMES MD	12/8/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	123811	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
151930	Fee-for-Service	1508172578	1508172578	1	1	KHEDIA, SANJAY N MD INC	3/5/2012	207R00000X	NA	Other	026	PHYSICIANS	56166	41	Internal Medicine	0	In state provider	None	211 WEST BADILLO ST	None	COVINA	CA	91723	1907	19	06037	34.0863333	-117.8928692	Los Angeles County
151957	Fee-for-Service	1306044540	1306044540	1	1	KOLAVALA, JANARDHANA R MD	7/19/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38782	41	Internal Medicine	0	In state provider	APC	18523 CORWIN ROAD	SUITE E	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
151992	Fee-for-Service	1700841004	1700841004	1	1	KING, STEPHEN W MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	66265	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
152001	Fee-for-Service	1003040353	1003040353	1	1	KRAMPITZ, GEOFFREY W MD	3/27/2023	2086X0206X	NA	General Surgery	026	PHYSICIANS	115198	None	None	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
152030	Fee-for-Service	1821441551	1821441551	1	1	KIM, JOHN H NP	4/22/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
152035	Fee-for-Service	1861525602	1861525602	1	5	KOREAN COMMUNITY SERVICES	5/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	451 W LINCOLN AVE	STE 100	ANAHEIM	CA	98205	2912	30	06059	33.83445082	-117.9189372	Orange County
152072	Fee-for-Service	1750566154	1750566154	1	1	KUMMATI, DEEPA L MD	8/3/2022	207R00000X	NA	Other	026	PHYSICIANS	153084	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
152088	Fee-for-Service	1831543743	1831543743	1	1	KOLIBAS, KIMBERLY S DO	6/21/2019	207P00000X	NA	Other	026	PHYSICIANS	16785	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
152119	Fee-for-Service	1871502054	1871502054	1	1	KRAMER, FRANCOISE	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42678	41	Internal Medicine	0	In state provider	None	2726 LAKEWOOD AVE	None	LOS ANGELES	CA	90039	2619	19	06037	34.10609395	-118.2645768	Los Angeles County
152131	Fee-for-Service	1841618964	1841618964	1	1	KITICH, ALEKSANDAR MD	5/6/2019	390200000X	NA	Other	026	PHYSICIANS	142332	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
152169	Fee-for-Service	1588628507	1588628507	1	1	KENNEY, GREGORY J MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
152189	Fee-for-Service	1730319526	1730319526	1	1	KYLE, WILLIAM B MD	11/1/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
152192	Fee-for-Service	1356354823	1356354823	1	1	KELLER DERMATOPATHOLOGY	4/28/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP INC	401 29TH ST	STE 109	OAKLAND	CA	94609	3579	01	06001	37.81771119	-122.2648299	Alameda County
152222	Fee-for-Service	1689845588	1689845588	1	1	KHODADADI, OMID MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	101046	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
152227	Fee-for-Service	1487617163	1487617163	1	1	KLEINSCHMIDT, KURT C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
152236	Fee-for-Service	1043515067	1043515067	1	1	KHAZAL, SAJAD J MD	7/3/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	118755	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
152303	Fee-for-Service	1053591941	1053591941	1	1	KAZANJIAN, KEVORK K MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81738	28	Proctology (colon and rectal)	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
152320	Fee-for-Service	1861525602	1861525602	1	5	KOREAN COMMUNITY SERVICES	5/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	451 W LINCOLN AVE	STE 100	ANAHEIM	CA	98205	2912	30	06059	33.83445082	-117.9189372	Orange County
152328	Fee-for-Service	1447301965	1447301965	1	1	KOTOB, MARY J MD	8/21/1995	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	56757	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1140 W LA VETA AVE	STE 560	ORANGE	CA	92868	4214	30	06059	33.7802984	-117.8651669	Orange County
152368	Fee-for-Service	1316960396	1316960396	1	1	KITTUR, AJIT M MD	3/31/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	33045	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6801 COLDWATER CANYON AV	None	NORTH HOLLYWOOD	CA	91605	5162	19	06037	34.194447	-118.4138285	Los Angeles County
152403	Fee-for-Service	1871502054	1871502054	1	1	KRAMER, FRANCOISE	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42678	77	Infectious Disease	0	In state provider	None	2726 LAKEWOOD AVE	None	LOS ANGELES	CA	90039	2619	19	06037	34.10609395	-118.2645768	Los Angeles County
152427	Fee-for-Service	1497132062	1497132062	1	1	KASSAS, NURE B	1/22/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
152454	Fee-for-Service	1700017241	1700017241	1	1	KALANITHI, LUCY E G MD	11/16/2010	207R00000X	NA	Other	026	PHYSICIANS	106416	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
152458	Fee-for-Service	1588628507	1588628507	1	1	KENNEY, GREGORY J MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
152482	Fee-for-Service	1629004148	1629004148	1	1	KAMDAR, VIKRAM V MD	6/11/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	26508	None	None	0	In state provider	None	1801 WILSHIRE BLVD	STE 100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
152483	Fee-for-Service	1124297395	1124297395	1	1	KATSUMI, HIROSHI K MD	7/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93331	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
152486	Fee-for-Service	1558147058	1558147058	1	1	KANESHIGE, GISELLE A NP	2/5/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
152517	Fee-for-Service	1114311180	1114311180	1	1	KORENAGA, TRAVIS-RILEY K MD	4/8/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146275	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
152518	Fee-for-Service	1215903976	1215903976	1	1	KANSAS SURGICAL CONSULTANTS	5/21/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	2	Out of state provider	LLP	3243 E MURDOCK	STE 404	WICHITA	KS	67208	3007	00	None	37.6974125	-97.2972675	Sedgwick County
152533	Fee-for-Service	1730317850	1730317850	1	1	KASSIS, CHRISTINE MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130404	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
152556	Fee-for-Service	1700869914	1700869914	1	1	KAMP, SHEILA V	3/16/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	582 S SUNNYVALE AVE	None	SUNNYVALE	CA	94086	6125	43	06085	37.36886669	-122.0316101	Santa Clara County
152610	Fee-for-Service	1861525602	1861525602	1	5	KOREAN COMMUNITY SERVICES	10/17/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	451 W LINCOLN AVE	STE 100	ANAHEIM	CA	98205	2912	30	06059	33.83445082	-117.9189372	Orange County
152611	Fee-for-Service	1760713846	1760713846	1	1	KAWERE, MARY AGNES	5/5/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14563 ALDER DR	None	CORONA	CA	92880	9616	33	06065	33.94493649	-117.601047	Riverside County
152613	Fee-for-Service	1083685085	1083685085	1	1	KELLEY, LEON R MD	5/1/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	27643	40	Pediatrics	0	In state provider	None	286 EUCLID AVE	STE 207	SAN DIEGO	CA	92114	3612	37	06073	32.70706919	-117.0850896	San Diego County
152621	Fee-for-Service	1467447029	1467447029	1	1	KHATCHATRIAN, ANDRANIK V MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106143	20	Orthopedic Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
152633	Fee-for-Service	1487977195	1487977195	1	1	KEDO LLC	6/12/2013	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	4105 WESTCOR CT	STE 1	CORALVILLE	IA	52241	2874	00	None	41.702643	-91.6393725	Johnson County
152686	Fee-for-Service	1134300924	1134300924	1	1	KARSAN, SUNDIP S MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100884	10	Gastroenterology (M.D. only)	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
152692	Fee-for-Service	1871502054	1871502054	1	1	KRAMER, FRANCOISE	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42678	01	General Practice	0	In state provider	None	2726 LAKEWOOD AVE	None	LOS ANGELES	CA	90039	2619	19	06037	34.10609395	-118.2645768	Los Angeles County
152718	Fee-for-Service	1003062530	1003062530	1	1	KATO, ROBERTA M MD	6/2/2010	2080P0214X	NA	Pulmonology	026	PHYSICIANS	95174	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
152721	Fee-for-Service	1962990168	1962990168	1	1	KRIER, ROBERT J	7/9/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
152723	Fee-for-Service	1447321419	1447321419	1	1	KUIZON, BEATRIZ D MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53222	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
152724	Fee-for-Service	1174632095	1174632095	1	1	KRAUS, KAREN J MD	3/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	78485	36	Psychiatry	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
152747	Fee-for-Service	1083796379	1083796379	1	1	KAPLAN, JEFFREY H MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	65628	02	General Surgery	0	In state provider	None	2505 SAMARITAN DRIVE	SUITE 508	SAN JOSE	CA	95124	4014	43	06085	37.25111447	-121.9483395	Santa Clara County
152778	Fee-for-Service	1578726410	1578726410	1	1	KENNEDY, SCOTT MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125423	30	Radiology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
152782	Fee-for-Service	1942462411	1942462411	1	1	KINANE, WILLIAM P DO	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9379	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
152804	Fee-for-Service	1346439866	1346439866	1	1	KRUEGER RIEKE, SHELLEY M	9/30/2008	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	191 W BURTON MESA BLVD	STE B	LOMPOC	CA	93436	1400	42	06083	34.70401649	-120.4647615	Santa Barbara County
152808	Fee-for-Service	1639711625	1639711625	1	1	KELLY, EMILY K NP	11/14/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
152814	Fee-for-Service	1427175926	1427175926	1	1	KAUFMAN, MURRAY S LMFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	31444	-	NOT APPLICABLE	0	In state provider	None	11705 DEPUTY YAMAMOTO PL	STE A	LYNWOOD	CA	90262	4026	19	06037	33.92683343	-118.2284388	Los Angeles County
152833	Fee-for-Service	1861574352	1861574352	1	1	KIM, OWEN C MD	1/1/1998	2085R0203X	NA	Other	026	PHYSICIANS	48257	30	Radiology	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
152840	Fee-for-Service	1902861792	1902861792	1	1	KIM, SUIL MD	12/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84651	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
152848	Fee-for-Service	1437127032	1437127032	1	1	KRAMER, MARK J MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58077	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
152875	Fee-for-Service	1619320769	1619320769	1	1	KREPKIY, VIKTORIYA DPM	11/5/2019	211D00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
152876	Fee-for-Service	1649570268	1649570268	1	1	KAO, VINCENT W C DO	3/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11408	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
152899	Fee-for-Service	1760713846	1760713846	1	1	KAWERE, MARY AGNES	5/5/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14563 ALDER DR	None	CORONA	CA	92880	9616	33	06065	33.94493649	-117.601047	Riverside County
152943	Fee-for-Service	1104147834	1104147834	1	1	KIM, EUNJEONG MD	12/18/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161592	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
152961	Fee-for-Service	1720648074	1720648074	1	1	KHAN, MADIHA B MD	11/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180281	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
152962	Fee-for-Service	1164447249	1164447249	1	1	KANG, ALEXANDER E MD	7/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95914	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
152966	Fee-for-Service	1104963461	1104963461	1	1	KRAUSE, JULIA A	4/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24258 EL TORO RD	None	LAGUNA WOODS	CA	92637	3488	30	06059	33.61088364	-117.7236433	Orange County
152973	Fee-for-Service	1134300924	1134300924	1	1	KARSAN, SUNDIP S MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100884	41	Internal Medicine	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
152991	Fee-for-Service	1760554596	1760554596	1	1	KOLEVSKA, TATJANA MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79150	68	Hematology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
153010	Fee-for-Service	1174632095	1174632095	1	1	KRAUS, KAREN J MD	3/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	78485	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
153012	Fee-for-Service	1447321419	1447321419	1	1	KUIZON, BEATRIZ D MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53222	45	Nephrology (Renal-Kidney)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
153018	Fee-for-Service	1134111958	1134111958	1	1	KOUMAS, JOHN C DO	9/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	5515	None	None	0	In state provider	None	767 S SUNSET AVE	STE 4	WEST COVINA	CA	91790	3546	19	06037	34.0672602	-117.9400049	Los Angeles County
153095	Fee-for-Service	1669826046	1669826046	1	1	KHALID, FAKHRA MD	9/23/2024	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153594	15	Obstetrics (D.O. only)	0	In state provider	None	1135 S SUNSET AVENUE	SUITE 208	WEST COVINA	CA	91790	3938	19	06037	34.06215064	-117.9453997	Los Angeles County
153120	Fee-for-Service	1861574352	1861574352	1	1	KIM, OWEN C MD	1/1/1998	2085R0203X	NA	Other	026	PHYSICIANS	48257	78	Neoplastic Diseases/Oncology	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
153126	Fee-for-Service	1013440114	1013440114	1	1	KALKAT, PRANEET K MD	9/14/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169412	None	None	0	In state provider	None	950 S ARROYO PKWY FL 3	None	PASADENA	CA	91105	3932	19	06037	34.12942212	-118.1471619	Los Angeles County
153135	Fee-for-Service	1013096742	1013096742	1	1	KIM, JASON Y MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89881	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
153171	Fee-for-Service	1285800359	1285800359	1	1	KAMRAVA, DAVID S MD	3/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102042	None	None	0	In state provider	None	200 MISSION BLVD	None	JACKSON	CA	95642	2564	03	06005	38.35007723	-120.7659932	Amador County
153177	Fee-for-Service	1942303177	1942303177	1	1	KURAN, RASHA A MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79950	77	Infectious Disease	0	In state provider	None	2828 H ST	STE A	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
153178	Fee-for-Service	1811075492	1811075492	1	1	KHASAWINAH, TARIQ A MD	3/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95588	01	General Practice	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
153210	Fee-for-Service	1760092043	1760092043	1	1	KRACKE, KAHO S CCC-SLP	5/31/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
153234	Fee-for-Service	1104147834	1104147834	1	1	KIM, EUNJEONG MD	12/18/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161592	70	Clinic (mixed specialty)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
153259	Fee-for-Service	1114459948	1114459948	1	1	KATTAN, JAFFER M MD	4/30/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	158448	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
153266	Fee-for-Service	1235426255	1235426255	1	1	KIZZIA, LORI G LCSW	10/10/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2330 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2220	19	06037	34.0681396	-118.2738016	Los Angeles County
153279	Fee-for-Service	1760554596	1760554596	1	1	KOLEVSKA, TATJANA MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79150	78	Neoplastic Diseases/Oncology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
153288	Fee-for-Service	1437100898	1437100898	1	1	KRISHNA, ALOK MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55199	08	Family Practice	0	In state provider	None	726 FOURTH STREET	None	MARYSVILLE	CA	95901	5600	58	06115	39.13872267	-121.5944372	Yuba County
153299	Fee-for-Service	1295025005	1295025005	1	1	KOSTER, FELICITAS DO	11/21/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21102	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
153300	Fee-for-Service	1376512228	1376512228	1	1	KRUGLIK, GERALD D MD	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	34085	30	Radiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
153378	Fee-for-Service	1730162314	1730162314	1	1	KILEY, JULIE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
153384	Fee-for-Service	1356451553	1356451553	1	1	KATKOV, WILLIAM N MD INC	4/30/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54468	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	SUITE 390W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
153390	Fee-for-Service	1376641589	1376641589	1	1	KENDALL, BARRY R PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19543 MAYALL ST	None	NORTHRIDGE	CA	91324	1015	19	06037	34.25366574	-118.5594058	Los Angeles County
153397	Fee-for-Service	1235600669	1235600669	1	1	KOHL, ALYSON R LMFT	6/30/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1506 MARKET STREET	None	REDDING	CA	96001	1023	45	06089	40.58403672	-122.3908469	Shasta County
153423	Fee-for-Service	1730408774	1730408774	1	1	KAISER, SUNITHA V MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112239	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
153429	Fee-for-Service	1659798965	1659798965	1	1	KVAMME, ERIK MD	1/28/2019	207P00000X	NA	Other	026	PHYSICIANS	157689	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
153483	Fee-for-Service	1861406878	1861406878	1	1	KWONG, HA T OD	12/26/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9959 WALKER ST	None	CYPRESS	CA	90630	3827	30	06059	33.81768404	-118.0369005	Orange County
153484	Fee-for-Service	1326461286	1326461286	1	1	KARP, STEFANIE L CCC-SLP	4/28/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2625 TOWNSGATE RD	102	THOUSAND OAKS	CA	91361	5726	56	06111	34.15794856	-118.8297275	Ventura County
153496	Fee-for-Service	1285665224	1285665224	1	1	KATOUZIAN, ALIREZA MD	9/20/2007	207L00000X	NA	Other	026	PHYSICIANS	64500	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
153519	Fee-for-Service	1104147834	1104147834	1	1	KIM, EUNJEONG MD	12/18/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161592	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
153537	Fee-for-Service	1558758524	1558758524	1	1	KIM, HYUNSEOK MD	7/28/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	186926	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
153549	Fee-for-Service	1871941773	1871941773	1	1	KATCHERIAN, CHRISTOPHER MD	8/23/2016	174400000X	NA	Other	026	PHYSICIANS	108987	46	Hand Surgery	0	In state provider	INC	4902 IRVINE CENTER DR	STE 107	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
153558	Fee-for-Service	1104973494	1104973494	1	1	KENNEDY, REGINA L LMFT	1/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6840 INDIANA AVE	275	RIVERSIDE	CA	92506	4279	33	06065	33.94246965	-117.3926366	Riverside County
153597	Fee-for-Service	1114080918	1114080918	1	1	KNIGHT, SUSAN E LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
153610	Fee-for-Service	1124070677	1124070677	1	1	KARZOUN, NOUR A MD	1/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100596	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
153630	Fee-for-Service	1689818056	1689818056	1	1	KRIER, NICHOLAS J MD	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110983	05	Anesthesiology	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
153633	Fee-for-Service	1699186999	1699186999	1	1	KIM, DANIEL Y MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147893	01	General Practice	0	In state provider	None	7520 ARROYO CIRCLE	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
153642	Fee-for-Service	1629332473	1629332473	1	1	KHAN, ABRAR H DO	5/17/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18490	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
153649	Fee-for-Service	1568410827	1568410827	1	1	KIM, EUGENE J MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91919	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
153673	Fee-for-Service	1356451553	1356451553	1	1	KATKOV, WILLIAM N MD INC	4/30/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54468	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 SANTA MONICA BLVD	SUITE 390W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
153675	Fee-for-Service	1427548494	1427548494	1	1	KINNEY, JEREMY NP	1/26/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
153677	Fee-for-Service	1598788630	1598788630	1	1	KUNG, SOPHIA T MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54612	None	None	0	In state provider	None	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	01	06001	37.69212528	-121.8803442	Alameda County
153683	Fee-for-Service	1871880195	1871880195	1	1	KIM, HAINE MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123475	None	None	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
153687	Fee-for-Service	1912587403	1912587403	1	1	KIM, EILEEN J MD	7/3/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153699	Fee-for-Service	1952460156	1952460156	1	1	KORYO HEALTH FOUNDATION	2/1/1997	261QP2300X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2655 W. OLYMPIC BLVD	SUITE 101	LOS ANGELES	CA	90006	2800	19	06037	34.05243121	-118.289956	Los Angeles County
153722	Fee-for-Service	1063541761	1063541761	1	1	KIM, NANCY M MD	1/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	82341	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
153746	Fee-for-Service	1063667830	1063667830	1	1	KAZI, BEENA A MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132259	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8762	20	06039	36.88437894	-119.8003484	Madera County
153753	Fee-for-Service	1568496743	1568496743	1	1	KOBE, KAY E DC	6/1/1995	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4221 SHASTA DAM BLVD	None	SHASTA LAKE	CA	96019	9423	45	06089	40.68073292	-122.3702587	Shasta County
153775	Fee-for-Service	1376623538	1376623538	2	3	KERN COUNTY HOSPITAL	9/8/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1111 COLUMBUS ST	SUITE 2000	BAKERSFIELD	CA	93305	1938	15	06029	35.39744148	-118.9822815	Kern County
153778	Fee-for-Service	1699166355	1699166355	1	1	KULKARNI, CHIRAAG MD	5/15/2024	207R00000X	NA	Other	026	PHYSICIANS	163620	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
153826	Fee-for-Service	1184072696	1184072696	1	1	KINDCARE HOME HEALTH INC	5/22/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3200 WILSHERE BLVD	STE 308	LOS ANGELES	CA	90010	1347	19	06037	34.06176518	-118.2920553	Los Angeles County
153837	Fee-for-Service	1871941773	1871941773	1	1	KATCHERIAN, CHRISTOPHER MD	8/23/2016	174400000X	NA	Other	026	PHYSICIANS	108987	02	General Surgery	0	In state provider	INC	4902 IRVINE CENTER DR	STE 107	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
153864	Fee-for-Service	1689406068	1689406068	1	1	KAZZAZI, LAWRENCE OD	9/6/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3451 S DOGWOOD AVE	SUITE 1334	EL CENTRO	CA	92243	7906	13	06025	32.762997	-115.530678	Imperial County
153909	Fee-for-Service	1679020374	1679020374	1	1	KEEHNER, STEPHANIE F LCSW	7/29/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
153913	Fee-for-Service	1073500948	1073500948	1	1	KADDIS, IRIS MD	12/29/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	96282	40	Pediatrics	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
153927	Fee-for-Service	1548337405	1548337405	1	1	KOGUT, NEIL M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43234	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
153935	Fee-for-Service	1487636114	1487636114	1	1	KOST, GERALD MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40878	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
153966	Fee-for-Service	1144631524	1144631524	1	1	KIM, JANE O PSYD	5/25/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
153992	Fee-for-Service	1073596862	1073596862	1	1	KUNZ, LIZA H MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86562	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
153996	Fee-for-Service	1639499718	1639499718	1	1	KOUCHOUK, AMR M MD	1/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137407	18	Ophthalmology	0	In state provider	None	22525 MAPLE AVENUE	SUITE 100	TORRANCE	CA	90505	2700	19	06037	33.82264238	-118.3401719	Los Angeles County
154016	Fee-for-Service	1841406394	1841406394	1	1	KIKUNAGA, HENRY E OD	8/16/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	180 OTAY LAKES RD	SUITE 201	BONITA	CA	91902	2400	37	06073	32.65928608	-117.0304661	San Diego County
154062	Fee-for-Service	1710914932	1710914932	1	1	KENOYER, RAY M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 N HUSER	None	SYRACUSE	KS	67878	7000	00	None	37.98468271	-101.7416434	Hamilton County
154077	Fee-for-Service	1306487012	1306487012	1	1	KARDINA, LENNY	12/12/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1135 E ROUTE 66	STE 111	GLENDORA	CA	91740	3778	19	06037	34.12888853	-117.845127	Los Angeles County
154101	Fee-for-Service	1588663769	1588663769	1	8	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1014B SAN JUAN AVE	None	EXETER	CA	93221	1312	54	06107	36.29884959	-119.1319278	Tulare County
154122	Fee-for-Service	1417623240	1417623240	1	1	KONDAPALLY, APOORVA MD	10/31/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
154180	Fee-for-Service	1104226570	1104226570	1	1	KRAUSS, LILY A PHD	3/25/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
154186	Fee-for-Service	1235217969	1235217969	1	1	KYO, KATHY S MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63760	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
154195	Fee-for-Service	1104239078	1104239078	1	1	KNAJIAN, RAZMIG OD FAAO	10/18/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
154227	Fee-for-Service	1528176955	1528176955	1	1	KAREN KAY SWISHER, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	230 N MIDWEST BLVD	None	MIDWEST CITY	OK	73110	4321	00	None	35.466735	-97.3885212	Oklahoma County
154237	Fee-for-Service	1235199340	1235199340	1	1	KLEIN, LIVIU MD	10/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54894	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154242	Fee-for-Service	1033475702	1033475702	1	1	KADAPAKKAM, MEENA MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135049	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
154264	Fee-for-Service	1609973478	1609973478	1	1	KOHATSU, WENDY MD	6/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55843	08	Family Practice	0	In state provider	None	3325 CHANATE ROAD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
154266	Fee-for-Service	1831345354	1831345354	1	1	KEAYS, CHRISTINE E DO	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10409	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
154268	Fee-for-Service	1679839005	1679839005	1	1	KEATING, KATHLEEN L DO	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	12905	01	General Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
154282	Fee-for-Service	1780867119	1780867119	2	1	KHAFAJA, MOHAMAD H MD	7/26/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	115892	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
154291	Fee-for-Service	1922767367	1922767367	1	1	KORPONTINOS, NICOLE LMFT	7/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
154331	Fee-for-Service	1700388915	1700388915	1	1	KANBAR-AGHA, FAISAL A	10/21/2024	207R00000X	NA	Other	026	PHYSICIANS	172454	41	Internal Medicine	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
154353	Fee-for-Service	1710037346	1710037346	1	1	KHAN,H JOSEPH MD INC	4/1/2001	207VH0002X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PARAMOUNT CARE MED GRP	12881 CHAPMAN AVE	None	GARDEN GROVE	CA	92840	4100	30	06059	33.78896063	-117.9071725	Orange County
154445	Fee-for-Service	1972097863	1972097863	1	1	KONG, MIN MD	6/8/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183976	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154450	Fee-for-Service	1891255048	1891255048	1	1	KARIMI, RAMIN MD	1/16/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	192387	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
154452	Fee-for-Service	1801277447	1801277447	1	1	KHAN, AMIR	1/16/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	152335	None	None	0	In state provider	None	101 BEVERLY BLVD	STE 406	MONTEBELLO	CA	90640	4300	19	06037	34.01556395	-118.0983878	Los Angeles County
154468	Fee-for-Service	1790884526	1790884526	1	1	KUMAR,MITHILESH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.812245	-96.841584	Dallas County
154490	Fee-for-Service	1841227477	1841227477	1	1	KLINE, LANNING B MD	7/8/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	31557	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
154515	Fee-for-Service	1932166519	1932166519	1	1	KLEIN, PHYLLIS H MD	1/6/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	23172	68	Hematology	0	In state provider	None	315 N 3RD AVE	STE 307	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
154516	Fee-for-Service	1396337309	1396337309	1	1	KENNEDY, BRIANA LMFT	8/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
154517	Fee-for-Service	1023084035	1023084035	1	1	KAESBERG, PAUL R MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88099	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
154519	Fee-for-Service	1831714294	1831714294	1	1	KEENAN, KAITLIN E MD	7/8/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154524	Fee-for-Service	1235199340	1235199340	1	1	KLEIN, LIVIU MD	10/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54894	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154530	Fee-for-Service	1033475702	1033475702	1	1	KADAPAKKAM, MEENA MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135049	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
154542	Fee-for-Service	1629005566	1629005566	1	1	KRUPNICK, MATHEW E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	369 W BLACKWELL ST	None	DOVER	NJ	07801	2560	00	None	40.88619616	-74.57447839	Morris County
154552	Fee-for-Service	1639142417	1639142417	1	1	KRUGER, DAVID H. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 W 16TH AVE	None	DENVER	CO	80204	1335	00	None	39.74280302	-105.0412741	City and County of Denver
154572	Fee-for-Service	1548762263	1548762263	1	1	KAISER FOUNDATION HEALTH	7/2/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	1ST FL MOB 6	SANTA ROSA	CA	95407	0000	49	06097	38.421135	-122.752008	Sonoma County
154580	Fee-for-Service	1346701570	1346701570	1	1	KHINE, AYE H MD	4/21/2025	207R00000X	NA	Other	026	PHYSICIANS	179180	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154601	Fee-for-Service	1326063801	1326063801	1	2	KHEDIA, SANJAY N MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	56166	None	None	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
154644	Fee-for-Service	1699783167	1699783167	1	1	KAUL,SANJIV MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2314 NW KINGS BLVD	STE A	CORVALLI	OR	97330	3925	00	None	44.59018248	-123.2774548	Benton County
154646	Fee-for-Service	1861755092	1861755092	1	1	KEYHAN, SANAZ MD	8/31/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	113856	67	Endocrinology	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
154658	Fee-for-Service	1861417446	1861417446	1	1	KALLENBERG, GENE A MD	10/3/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	32821	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
154762	Fee-for-Service	1114649589	1114649589	1	1	KATHERINE HEALTHCARE LLC	6/30/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	315 ALAMEDA AVE	None	SALINAS	CA	93901	4120	27	06053	36.66224654	-121.6481968	Monterey County
154802	Fee-for-Service	1932166519	1932166519	1	1	KLEIN, PHYLLIS H MD	1/6/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	23172	78	Neoplastic Diseases/Oncology	0	In state provider	None	315 N 3RD AVE	STE 307	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
154813	Fee-for-Service	1629173299	1629173299	1	1	KOCKEN,PAULA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDREN'S HEALTH CARE	2525 CHICAGO AVE #5	None	MINNEAPOLIS	MN	55404	0000	00	None	44.95666589	-93.26255996	Hennepin County
154864	Fee-for-Service	1245675438	1245675438	1	1	KETT, STACEY D LAC	12/28/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	735 12TH ST	None	ARCATA	CA	95521	5865	12	06023	40.8713849	-124.0857261	Humboldt County
154869	Fee-for-Service	1346701570	1346701570	1	1	KHINE, AYE H MD	4/21/2025	207R00000X	NA	Other	026	PHYSICIANS	179180	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154887	Fee-for-Service	1205052032	1205052032	1	1	KWAN, DAMON M MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81592	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
154890	Fee-for-Service	1508851957	1508851957	1	1	KIRCHNER, ROBERT M MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112584	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
154926	Fee-for-Service	1538405881	1538405881	1	1	KNEDEL, JEREMY W	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5061 SHASTA DAM BLVD	None	SHASTA LAKE	CA	96019	9405	45	06089	40.68027851	-122.3557875	Shasta County
154932	Fee-for-Service	1861755092	1861755092	1	1	KEYHAN, SANAZ MD	8/31/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	113856	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
154937	Fee-for-Service	1972182640	1972182640	1	1	KIM, MI SONG MD	10/10/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
154945	Fee-for-Service	1861417446	1861417446	1	1	KALLENBERG, GENE A MD	10/3/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	32821	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
154950	Fee-for-Service	1881187474	1881187474	1	1	KWON, SOONSI OPTOMETRY INC	6/25/2018	152WP0200X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	731 NORTH EUCLID ST	None	ANAHEIM	CA	92801	4116	30	06059	33.842385	-117.9416385	Orange County
155014	Fee-for-Service	1982036729	1982036729	1	1	KNITTEL, PAUL MD INC	3/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72047	None	None	0	In state provider	None	1812 ARTESIA BLVD	None	REDONDO BEACH	CA	90278	2906	19	06037	33.8727117	-118.379344	Los Angeles County
155058	Fee-for-Service	1063590776	1063590776	1	1	KLONECKE, ANDREW S MD	6/29/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	34237	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5105 VISTA DEL ORO WAY	None	FAIR OAKS	CA	95628	4146	34	06067	38.658006	-121.214268	Sacramento County
155063	Fee-for-Service	1164699203	1164699203	1	1	KERBEL, RUSSELL B MD	6/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128689	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
155083	Fee-for-Service	1427017284	1427017284	1	1	KOSAREK, FRANK MD	12/11/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
155088	Fee-for-Service	1710243530	1710243530	1	1	KOH, CYNTHIA H MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136406	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
155104	Fee-for-Service	1225770670	1225770670	1	1	KETCHUM, NEAL CRNA	2/26/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
155150	Fee-for-Service	1275738445	1275738445	1	1	KUMARI, RADHIKA MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117307	01	General Practice	0	In state provider	None	25865 BARTON RD	STE 101	LOMA LINDA	CA	92354	3128	36	06071	34.04824853	-117.2403225	San Bernardino County
155157	Fee-for-Service	1043390206	1043390206	1	1	KABAKIBI, AHMAD MD	4/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94768	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
155167	Fee-for-Service	1588663769	1588663769	1	20	KAWEAH DELTA HEALTH CARE	10/5/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	325 S WILLIS STREET	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
155177	Fee-for-Service	1508851957	1508851957	1	1	KIRCHNER, ROBERT M MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112584	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
155179	Fee-for-Service	1225650534	1225650534	1	1	KROLICZEK, ARLENA A PSYD	5/18/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
155200	Fee-for-Service	1912297284	1912297284	1	1	KATZMAN, LEE R MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135673	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO STREET	SUITE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
155214	Fee-for-Service	1518987668	1518987668	1	1	KENDALL STRAND M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
155218	Fee-for-Service	1437266269	1437266269	1	1	KUO, ERWIN MD	5/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74718	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	RM 1002	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
155219	Fee-for-Service	1134360159	1134360159	1	1	KHAN, ASIYA A MD	11/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109466	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
155222	Fee-for-Service	1174009062	1174009062	1	1	KORNFELD, HANNAH W MD	4/10/2023	208600000X	NA	General Surgery	026	PHYSICIANS	165042	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
155229	Fee-for-Service	1346292836	1346292836	1	1	KAMAL, SYED S MD	1/31/1995	2080P0210X	NA	Nephrology	026	PHYSICIANS	52973	40	Pediatrics	0	In state provider	None	1311 WHITLEY AVE	None	CORCORAN	CA	93212	2329	16	06031	36.09800884	-119.5641738	Kings County
155296	Fee-for-Service	1639637648	1639637648	1	1	KRISTA CARE LLC	4/22/2019	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	32 DIAMOND ST	SUITE A	ARCADIA	CA	91006	3893	19	06037	34.13562508	-118.0297987	Los Angeles County
155341	Fee-for-Service	1972655918	1972655918	1	1	KWON, JEONG A CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ACUPUNCTURE CLINIC	4016 GEARY BLVD	STE 2B	SAN FRANCISCO	CA	94118	3108	38	06075	37.78120008	-122.4625124	San Francisco County
155382	Fee-for-Service	1902112048	1902112048	1	1	KIRBY, JENNIFER K PSYD	8/14/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BOULEVARD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
155387	Fee-for-Service	1699275925	1699275925	1	1	KLEIN, OLGA MD	4/7/2025	208600000X	NA	General Surgery	026	PHYSICIANS	189643	02	General Surgery	0	In state provider	None	205 RIVER PARK CIR	None	FRESNO	CA	93720	1571	10	06019	36.85456375	-119.7863981	Fresno County
155411	Fee-for-Service	1538299433	1538299433	1	1	KOLDHEKAR, SATISH M	10/10/2007	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	INVESTMENTS INC	8450 S SEPULVEDA BLVD	STE 708	LOS ANGELES	CA	90045	3807	19	06037	33.96129457	-118.3961484	Los Angeles County
155422	Fee-for-Service	1750343760	1750343760	1	1	KHALID, SHAFI MD	2/1/2018	208VP0014X	NA	Other	026	PHYSICIANS	51093	41	Internal Medicine	0	In state provider	None	5850 OBERLIN DRIVE	SUITE 100	SAN DIEGO	CA	92121	4710	37	06073	32.894677	-117.1928626	San Diego County
155439	Fee-for-Service	1588640197	1588640197	1	1	KRISHNAN, RAVI G MD	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	901 RANCHO LN	STE 255	LAS VEGAS	NV	89106	3838	00	None	36.16025414	-115.1711566	Clark County
155462	Fee-for-Service	1770785073	1770785073	1	1	KOSAR, EROL M MD INC	1/10/2006	193400000X	NA	Other	026	PHYSICIANS	75877	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4201 TORRANCE BLVD	STE 560	TORRANCE	CA	90503	4853	19	06037	33.8375955	-118.358748	Los Angeles County
155478	Fee-for-Service	1770787558	1770787558	1	1	KIM, CHRISTINE Y MD	5/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10669	08	Family Practice	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3014	37	06073	32.781195	-117.0070695	San Diego County
155498	Fee-for-Service	1568833259	1568833259	1	1	KADENCE HEALTHCARE, INC	6/24/2021	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	29400 KOHOUTEK WAY	170	UNION CITY	CA	94587	1251	01	06001	37.60871585	-122.0813952	Alameda County
155559	Fee-for-Service	1154409951	1154409951	1	1	KIRCHEBERG, JAMES S MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	71940	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
155624	Fee-for-Service	1750745105	1750745105	1	1	KING, MOLLY D OD FAAO	8/21/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
155640	Fee-for-Service	1306824495	1306824495	1	1	KWONG, PETER O. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 INDEPENDENCE BLVD	None	VIRGINIA BCH	VA	23455	6005	00	None	36.86771335	-76.13267801	Virginia Beach city
155642	Fee-for-Service	1063604288	1063604288	1	1	KINNUCAN, ELSPETH R MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117397	20	Orthopedic Surgery	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
155647	Fee-for-Service	1194935858	1194935858	1	1	KUBICKY, CHARLOTTE D MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	85664	78	Neoplastic Diseases/Oncology	0	In state provider	None	2 MEDICAL PLAZA DR	STE 180	ROSEVILLE	CA	95661	3049	31	06061	38.76507948	-121.2477476	Placer County
155652	Fee-for-Service	1447512413	1447512413	1	1	KALIN, DANIEL J MD	11/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	EMILE @ 42ND	None	OMAHA	NE	68198	0001	00	None	41.254236	-95.97573	Douglas County
155655	Fee-for-Service	1205450418	1205450418	1	1	KARMA DOCTORS & ASSOCIATES,	10/3/2023	2084P0800X	NA	Psychiatry	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	P.C.	560 S PASEO DOROTEA	SUITE 4A	PALM SPRINGS	CA	92264	1434	33	06065	33.8146094	-116.5017737	Riverside County
155709	Fee-for-Service	1316007230	1316007230	2	1	KHWARG, STEVEN G MD	1/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	47726	18	Ophthalmology	0	In state provider	None	201 S ALVARADO ST	STE 325	LOS ANGELES	CA	90057	2354	19	06037	34.06417777	-118.2719543	Los Angeles County
155734	Fee-for-Service	1295709533	1295709533	1	1	KULIK, KENNETH J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	44199 DEQUINDRE RD	STE 503	TROY	MI	48085	1128	00	None	42.61849536	-83.09121784	Oakland County
155809	Fee-for-Service	1104246016	1104246016	1	1	KOSITSAWAT, JUTHAMAS MD	7/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139735	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	SUITE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
155834	Fee-for-Service	1851479497	1851479497	1	1	KREITZER, LORIN M MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8855	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
155835	Fee-for-Service	1073657698	1073657698	1	1	KARVELAS, BRIAN R MD	8/1/2000	208VP0000X	NA	Other	026	PHYSICIANS	63301	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155836	Fee-for-Service	1033110861	1033110861	2	1	KYAZZE, FRED B MD	8/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51997	08	Family Practice	0	In state provider	None	1410 W. ALONDRA BLVD.	SUITE C	COMPTON	CA	90220	3533	19	06037	33.88839148	-118.2446201	Los Angeles County
155901	Fee-for-Service	1093718785	1093718785	1	1	KANE, BRENT L MD	3/31/1994	174400000X	NA	Other	026	PHYSICIANS	75272	42	Nuclear Medicine	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
155915	Fee-for-Service	1881664555	1881664555	1	1	KRAMER, JOHN O CRNA	6/18/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	5200 FAIRVIEW BLVD	None	WYOMING	MN	55092	8013	00	None	45.32172586	-92.99989785	Chisago County
155934	Fee-for-Service	1700171717	1700171717	1	1	KNOWLTON, DANIELLE MD	4/1/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2169 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7059	09	06017	38.91235146	-119.9974905	El Dorado County
155944	Fee-for-Service	1205450418	1205450418	1	1	KARMA DOCTORS & ASSOCIATES,	3/1/2020	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	P.C.	560 S PASEO DOROTEA	SUITE 4A	PALM SPRINGS	CA	92264	1434	33	06065	33.8146094	-116.5017737	Riverside County
155946	Fee-for-Service	1043496458	1043496458	1	1	KAISER, BETTE M LMFT	7/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	820 BAY AVE	STE 205	CAPITOLA	CA	95010	2102	44	06087	36.98166021	-121.9560152	Santa Cruz County
155961	Fee-for-Service	1033153960	1033153960	1	1	KOZLOWSKI, CHRISTOPHER M MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	1500 EAST 2ND STREET	SUITE 400	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
155988	Fee-for-Service	1114216132	1114216132	1	1	KERK, MICHELLE P C MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126948	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
155993	Fee-for-Service	1093874612	1093874612	1	1	KOPECKY, JOSEPH S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32237	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
156021	Fee-for-Service	1720362999	1720362999	1	1	KNIGHT, SAMUEL B CRNA	2/26/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
156034	Fee-for-Service	1376684522	1376684522	1	1	KALOOGIAN, HAROLD H DPM	2/8/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6260 EL CAMINO REAL	None	CARLSBAD	CA	92009	1609	37	06073	33.12215813	-117.266659	San Diego County
156048	Fee-for-Service	1760088546	1760088546	1	1	KERSHAW, KIMBERLEY	8/29/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
156092	Fee-for-Service	1629343348	1629343348	1	1	KEUSKAMP, JANINE MD DO	6/21/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	126515	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
156103	Fee-for-Service	1457432726	1457432726	1	1	KAPOOR, DEVENDRA S MD	7/14/1986	174400000X	NA	Other	026	PHYSICIANS	42875	05	Anesthesiology	0	In state provider	PIONEER HOSPITAL	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
156188	Fee-for-Service	1093718785	1093718785	1	1	KANE, BRENT L MD	3/31/1994	174400000X	NA	Other	026	PHYSICIANS	75272	78	Neoplastic Diseases/Oncology	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
156218	Fee-for-Service	1992881650	1992881650	1	1	KAY, SUSIE S K MD APC	7/31/1983	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	35778	25	Physical Medicine and Rehabilitation	0	In state provider	None	1240 S SAN GABRIEL BLVD	None	SAN GABRIEL	CA	91776	3117	19	06037	34.084701	-118.0907845	Los Angeles County
156231	Fee-for-Service	1205450418	1205450418	1	1	KARMA DOCTORS & ASSOCIATES,	4/2/2024	2084P0800X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P.C.	560 S PASEO DOROTEA	SUITE 4A	PALM SPRINGS	CA	92264	1434	33	06065	33.8146094	-116.5017737	Riverside County
156240	Fee-for-Service	1881658151	1881658151	1	1	KUANG, AUDREY MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80708	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
156245	Fee-for-Service	1598928988	1598928988	1	1	KHALEEL, MASEEHA S MD	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132316	05	Anesthesiology	0	In state provider	None	2185 WEST CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
156253	Fee-for-Service	1184250417	1184250417	1	1	KARAPETIAN, ELENA L OD	8/30/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2619 E COLORADO BLVD	SUITE 150	PASADENA	CA	91107	3747	19	06037	34.14616014	-118.0964013	Los Angeles County
156258	Fee-for-Service	1518153733	1518153733	1	1	KHAN, ABID H MD APC	5/1/1999	193400000X	NA	Other	026	PHYSICIANS	53806	41	Internal Medicine	0	In state provider	None	1001 W SIXTH ST	STE A	ONTARIO	CA	91762	1218	36	06071	34.084872	-117.668295	San Bernardino County
156260	Fee-for-Service	1669903621	1669903621	1	1	KARANJA, ANNIE WAIRIMU	8/1/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14908 NORFOLK CIRCLE	None	MORENO VALLEY	CA	92555	7064	33	06065	33.90466503	-117.1614426	Riverside County
156268	Fee-for-Service	1497782239	1497782239	1	1	KOSAKOWSKI, CHRIS A MD	1/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	49499	01	General Practice	0	In state provider	None	1111 SONOMA AVE	STE 112	SANTA ROSA	CA	95405	4813	49	06097	38.442042	-122.700033	Sonoma County
156286	Fee-for-Service	1972893907	1972893907	1	1	KENO HOME HEALTH AGENCY	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	9360 SANTA ANITA AVE	SUITE 101	RANCHO CUCAMONGA	CA	91730	6151	36	06071	34.0839	-117.539257	San Bernardino County
156289	Fee-for-Service	1417391368	1417391368	1	1	KOUSHIK, SARANG S MD	9/1/2020	207L00000X	NA	Other	026	PHYSICIANS	168304	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
156295	Fee-for-Service	1932216702	1932216702	1	1	KUMAR, ANAND MD	6/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50627	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
156312	Fee-for-Service	1114636040	1114636040	1	1	KINSEY, DEANO S	5/31/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	744 EMPIRE ST STE 210	None	FAIRFIELD	CA	94533	5562	48	06095	38.2503715	-122.0429115	Solano County
156335	Fee-for-Service	1609378652	1609378652	1	1	KIRIAKU, MARY W	11/28/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	34138 CAMELINA ST	None	LAKE ELSINORE	CA	92532	2946	33	06065	33.66010126	-117.2375392	Riverside County
156337	Fee-for-Service	1023022795	1023022795	1	1	KUHN, MARCIA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
156384	Fee-for-Service	1134445547	1134445547	1	1	KILBOURNE, SAMANTHA PSYD	4/24/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
156387	Fee-for-Service	1659758746	1659758746	1	1	KAUFFMAN, SARAH M MD	11/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167662	36	Psychiatry	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
156388	Fee-for-Service	1396125761	1396125761	1	1	KHAN, SARAH OT	3/5/2025	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	14623 HAWTHORNE BLVD	103	LAWNDALE	CA	90260	1581	19	06037	33.898572	-118.3527775	Los Angeles County
156407	Fee-for-Service	1588663769	1588663769	1	12	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	100 WILLOW PLAZA	SUITE 301	VISALIA	CA	93291	6215	54	06107	36.33012504	-119.2922477	Tulare County
156455	Fee-for-Service	1447821954	1447821954	1	1	KOBREN, CLAIRE LCSW	12/12/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	127450	-	NOT APPLICABLE	0	In state provider	None	2120 W WILLIAMS STREET	BLDG 1, 2 AND 3	LONG BEACH	CA	90810	3636	19	06037	33.7929977	-118.2210007	Los Angeles County
156464	Fee-for-Service	1326306622	1326306622	1	1	KEHNER, CHERYL L LMFT	6/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
156478	Fee-for-Service	1093718785	1093718785	1	1	KANE, BRENT L MD	3/31/1994	174400000X	NA	Other	026	PHYSICIANS	75272	30	Radiology	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
156481	Fee-for-Service	1104433937	1104433937	1	1	KAUR, JASMINE LMFT	10/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
156496	Fee-for-Service	1568624948	1568624948	1	1	KAUR, JASBIR MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116734	01	General Practice	0	In state provider	None	23512 MADERO ROAD	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
156501	Fee-for-Service	1699948265	1699948265	1	1	KIM, WONHA MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127117	40	Pediatrics	0	In state provider	None	25845 BARTON ROAD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
156506	Fee-for-Service	1992881650	1992881650	1	1	KAY, SUSIE S K MD APC	7/31/1983	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	35778	13	Neurology (M.D. only)	0	In state provider	None	1240 S SAN GABRIEL BLVD	None	SAN GABRIEL	CA	91776	3117	19	06037	34.084701	-118.0907845	Los Angeles County
156544	Fee-for-Service	1194195305	1194195305	1	1	KNOWLTON, ALICE LCSW	10/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94218	-	NOT APPLICABLE	0	In state provider	None	1563 MISSION ST	1ST & 3RD FL	SAN FRANCISCO	CA	94103	2543	38	06075	37.77327874	-122.4183559	San Francisco County
156545	Fee-for-Service	1518153733	1518153733	1	1	KHAN, ABID H MD APC	5/1/1999	193400000X	NA	Other	026	PHYSICIANS	53806	45	Nephrology (Renal-Kidney)	0	In state provider	None	1001 W SIXTH ST	STE A	ONTARIO	CA	91762	1218	36	06071	34.084872	-117.668295	San Bernardino County
156547	Fee-for-Service	1669903621	1669903621	1	1	KARANJA, ANNIE WAIRIMU	8/1/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14908 NORFOLK CIRCLE	None	MORENO VALLEY	CA	92555	7064	33	06065	33.90466503	-117.1614426	Riverside County
156558	Fee-for-Service	1558314625	1558314625	1	1	KUNELIS,THOMAS DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 200 B	PHOENIX	AZ	85020	0000	00	None	33.57054	-112.0692465	Maricopa County
156606	Fee-for-Service	1851442131	1851442131	1	1	KADO, RANDOLPH PHD	9/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5330 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2952	36	06071	34.0776965	-117.688707	San Bernardino County
156610	Fee-for-Service	1598933541	1598933541	1	1	KIELY, JACQUELINE N	12/13/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
156624	Fee-for-Service	1609378652	1609378652	1	1	KIRIAKU, MARY W	11/28/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	34138 CAMELINA ST	None	LAKE ELSINORE	CA	92532	2946	33	06065	33.66010126	-117.2375392	Riverside County
156638	Fee-for-Service	1780673483	1780673483	1	1	KWAI, ANDREW H MD	6/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	45581	None	None	0	In state provider	None	2201 WALNUT AVE	STE 150	FREMONT	CA	94538	2334	01	06001	37.55521283	-121.975405	Alameda County
156642	Fee-for-Service	1386856839	1386856839	1	1	KHAN, TANVEER A MD	8/27/2007	2086S0129X	NA	General Surgery	026	PHYSICIANS	77333	33	Thoracic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
156655	Fee-for-Service	1366871808	1366871808	1	1	KIDS CONNECTIONS DEVELOPMENT	1/20/2022	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	AL THERAPY CENTER	2665 PARK CENTER DRIVE	SUITE D	SIMI VALLEY	CA	93065	6215	56	06111	34.28449244	-118.7968424	Ventura County
156674	Fee-for-Service	1407904477	1407904477	1	1	KALVE, ELISABETH MD	12/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80548	01	General Practice	0	In state provider	None	5601 DE SOTO AVEQ	None	WOODLAND HILLS	CA	91365	0000	19	06037	34.17030266	-118.5881699	Los Angeles County
156689	Fee-for-Service	1881865350	1881865350	1	1	KANG, TIM J LAC	12/8/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
156694	Fee-for-Service	1457391773	1457391773	1	1	KIM, KYUNG N MD	1/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91016	78	Neoplastic Diseases/Oncology	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
156701	Fee-for-Service	1912014341	1912014341	1	1	KIM. RICHARD	3/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	59256	08	Family Practice	0	In state provider	None	25455 BARTON RD	# 106	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
156706	Fee-for-Service	1114970076	1114970076	1	1	KRISHNAN, BRINDA S MD	2/23/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	141951	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
156718	Fee-for-Service	1649669094	1649669094	1	1	KHALEGHI, FARHAD MD	11/11/2020	207R00000X	NA	Other	026	PHYSICIANS	149798	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
156754	Fee-for-Service	1306994371	1306994371	1	1	KERTZNER, RICHARD I MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42328	08	Family Practice	0	In state provider	None	3788 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1408	15	06029	35.39420177	-119.0081678	Kern County
156769	Fee-for-Service	1942630207	1942630207	1	1	KAISER FOUNDATION HEALTH	7/23/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	2521 MICHELLE DR	FL 1	TUSTIN	CA	92780	7014	30	06059	33.72230884	-117.8031495	Orange County
156789	Fee-for-Service	1538650544	1538650544	1	1	KORDIC MARRIAGE & FAMILY	7/20/2018	261Q00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING PROF CORP	537 G ST	STE 200	EUREKA	CA	95501	1043	12	06023	40.80153993	-124.1647136	Humboldt County
156810	Fee-for-Service	1568521136	1568521136	1	1	KHALILI-BORNA, DENNIS MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81485	47	Miscellaneous	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
156825	Fee-for-Service	1518051408	1518051408	1	1	KERR, REBECCA MD	5/31/1991	207LP2900X	NA	Other	026	PHYSICIANS	51583	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
156839	Fee-for-Service	1235458530	1235458530	1	1	KYRIACOU, CHARALAMBOS A PSYD	7/22/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	540 W BASELINE RD	SUITE 3	CLAREMONT	CA	91711	1612	19	06037	34.12158153	-117.723276	Los Angeles County
156870	Fee-for-Service	1568635399	1568635399	1	1	KINNEY-HAM, LISA J MD	8/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109355	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	# A108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
156876	Fee-for-Service	1841430758	1841430758	1	1	KANURI, SANTHI MD	4/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105401	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
156894	Fee-for-Service	1497929517	1497929517	1	1	KOBAYASHI, KAREN N MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10831	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	655 EUCLID AVENUE	# 409	NATIONAL CITY	CA	91950	2981	37	06073	32.68353398	-117.082625	San Diego County
156900	Fee-for-Service	1346569779	1346569779	1	1	KHOSRAVIANI, ARDESHIR MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122319	45	Nephrology (Renal-Kidney)	0	In state provider	None	1011 E DEVONSHIRE	SUITE 201	HEMET	CA	92543	3033	33	06065	33.75118151	-116.9615025	Riverside County
156912	Fee-for-Service	1275097131	1275097131	1	1	KOMAK, SPIEN G MD	8/19/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183531	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
156938	Fee-for-Service	1083800890	1083800890	1	1	KMB RESIDENTIAL CARE INC	3/22/2003	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CANTLAY HOUSE	14160 CANTLAY ST	None	VAN NUYS	CA	91405	2431	19	06037	34.20232463	-118.4421256	Los Angeles County
156943	Fee-for-Service	1366871808	1366871808	1	1	KIDS CONNECTIONS DEVELOPMENT	11/28/2018	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	AL THERAPY CENTER	2665 PARK CENTER DRIVE	SUITE D	SIMI VALLEY	CA	93065	6215	56	06111	34.28449244	-118.7968424	Ventura County
156961	Fee-for-Service	1407904477	1407904477	1	1	KALVE, ELISABETH MD	12/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80548	08	Family Practice	0	In state provider	None	5601 DE SOTO AVEQ	None	WOODLAND HILLS	CA	91365	0000	19	06037	34.17030266	-118.5881699	Los Angeles County
156981	Fee-for-Service	1457391773	1457391773	1	1	KIM, KYUNG N MD	1/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91016	68	Hematology	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
156984	Fee-for-Service	1588964456	1588964456	1	1	KHAN, KHADEER NP	9/20/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
156985	Fee-for-Service	1447546205	1447546205	1	1	KLAR, AMARITA S MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156696	02	General Surgery	0	In state provider	None	205 E RIVER PARK CIR	STE 460	FRESNO	CA	93720	1585	10	06019	36.85456375	-119.7863981	Fresno County
157013	Fee-for-Service	1619515830	1619515830	1	1	KURZ, HEATHER M NP	4/22/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
157038	Fee-for-Service	1063916575	1063916575	1	1	KAUSHIK, CHARISMA MD	7/26/2022	390200000X	NA	Other	026	PHYSICIANS	166762	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
157042	Fee-for-Service	1306994371	1306994371	1	1	KERTZNER, RICHARD I MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42328	20	Orthopedic Surgery	0	In state provider	None	3788 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1408	15	06029	35.39420177	-119.0081678	Kern County
157078	Fee-for-Service	1144840786	1144840786	1	1	KEELER, NICHOLAS F NP	6/9/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
157080	Fee-for-Service	1992760763	1992760763	1	1	KRISHNAMSHETTY, PRASANNA	4/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	63379	40	Pediatrics	0	In state provider	None	135 N JACKSON AVE	STE 101	SAN JOSE	CA	95116	1917	43	06085	37.36164758	-121.8466827	Santa Clara County
157097	Fee-for-Service	1568521136	1568521136	1	1	KHALILI-BORNA, DENNIS MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81485	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
157112	Fee-for-Service	1699036046	1699036046	1	1	KARIMPOOR, LEILA K DO	11/4/2022	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
157147	Fee-for-Service	1255302238	1255302238	1	1	KNOLL, CARRIE E MD	10/11/2006	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77415	01	General Practice	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
157172	Fee-for-Service	1780655464	1780655464	1	1	KIM, LILY H OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2344 EL CAMINO REAL	STE 118	SANTA CLARA	CA	95050	4072	43	06085	37.35228155	-121.966758	Santa Clara County
157182	Fee-for-Service	1295838746	1295838746	1	1	KUMAR, PRADEEP MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62416	41	Internal Medicine	0	In state provider	None	2147 MOWRY AVE	STE D4	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
157186	Fee-for-Service	1346569779	1346569779	1	1	KHOSRAVIANI, ARDESHIR MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122319	41	Internal Medicine	0	In state provider	None	1011 E DEVONSHIRE	SUITE 201	HEMET	CA	92543	3033	33	06065	33.75118151	-116.9615025	Riverside County
157210	Fee-for-Service	1518263029	1518263029	1	1	KAWANA, MASATAKA MD	5/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114281	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157230	Fee-for-Service	1750852752	1750852752	1	1	KAHM, CARA N PT	12/18/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
157240	Fee-for-Service	1881741106	1881741106	1	1	KAISER FOUNDATION HEALTH	10/4/1990	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY	1955 COWELL BLVD	None	DAVIS	CA	95616	6325	57	06113	38.5399459	-121.7284328	Yolo County
157244	Fee-for-Service	1609187004	1609187004	1	1	KUNKEL, SCOTT A DO	7/13/2022	207P00000X	NA	Other	026	PHYSICIANS	19505	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
157246	Fee-for-Service	1861071318	1861071318	1	1	KEECHILOT, CINZIA S	10/7/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
157255	Fee-for-Service	1467511048	1467511048	1	1	KORR, SHARON MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	42330	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
157258	Fee-for-Service	1649698481	1649698481	1	1	KIM, JAMES T MD	6/27/2020	207LP2900X	NA	Other	026	PHYSICIANS	159619	70	Clinic (mixed specialty)	0	In state provider	None	236 W COLLEGE ST	None	COVINA	CA	91723	1902	19	06037	34.08746822	-117.8933488	Los Angeles County
157268	Fee-for-Service	1457391773	1457391773	1	1	KIM, KYUNG N MD	1/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91016	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
157276	Fee-for-Service	1013072016	1013072016	1	1	KAMBOJ, AMIT P MD	8/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96818	10	Gastroenterology (M.D. only)	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
157307	Fee-for-Service	1700881661	1700881661	1	1	KUTZSCHER, ETHAN M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71949	18	Ophthalmology	0	In state provider	None	1850 SULLIVAN AVE	STE 540	DALY CITY	CA	94015	2215	41	06081	37.68085904	-122.4728842	San Mateo County
157318	Fee-for-Service	1861679441	1861679441	1	1	KHAN, MOHAMMAD A MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108716	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
157359	Fee-for-Service	1134307713	1134307713	1	1	KELLY, ROBERT B MD	2/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91532	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BUILDING 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
157371	Fee-for-Service	1669499216	1669499216	2	1	KLP,LLC	2/4/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9580 GARDEN GROVE BLVD	108	GARDEN GROVE	CA	92844	1589	30	06059	33.7739485	-117.9654615	Orange County
157383	Fee-for-Service	1730561994	1730561994	1	1	KARAMANUKYAN, TIGRAN MD	8/29/2022	390200000X	NA	Other	026	PHYSICIANS	151086	None	None	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
157384	Fee-for-Service	1770011223	1770011223	1	1	KIM, JEFFREY MD	9/14/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172006	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
157394	Fee-for-Service	1326351446	1326351446	1	1	KE, MICHAEL C MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118293	13	Neurology (M.D. only)	0	In state provider	None	2100 WEBSTER STREET	SUITE 404	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
157435	Fee-for-Service	1255302238	1255302238	1	1	KNOLL, CARRIE E MD	10/11/2006	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77415	40	Pediatrics	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
157453	Fee-for-Service	1467077933	1467077933	1	1	KIET A.T. TON, MD, CORP.	8/26/2020	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	14082 MAGNOLIA STREET	UNIT 109	WESTMINSTER	CA	92683	4786	30	06059	33.75832207	-117.9723348	Orange County
157455	Fee-for-Service	1114929924	1114929924	1	1	KEVIN SCOTT SMITH M.D.	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10628 PARK RD	None	CHARLOTTE	NC	28210	8407	00	None	35.091657	-80.8716195	Mecklenburg County
157469	Fee-for-Service	1295838746	1295838746	1	1	KUMAR, PRADEEP MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62416	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2147 MOWRY AVE	STE D4	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
157522	Fee-for-Service	1467401513	1467401513	1	1	KOSS, JAMES MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32294	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
157534	Fee-for-Service	1710621123	1710621123	1	1	KAMAU, LUCY W	5/26/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	640 NEW WELL CT	None	LATHROP	CA	95330	8974	39	06077	37.81181805	-121.3060904	San Joaquin County
157567	Fee-for-Service	1821303769	1821303769	1	1	KUMAR, DEVINDER M D INC	7/25/2011	193400000X	NA	Other	026	PHYSICIANS	42788	05	Anesthesiology	0	In state provider	None	25327 AVENUE STANFORD	STE 104	VALENCIA	CA	91355	4755	19	06037	34.43406299	-118.5791967	Los Angeles County
157572	Fee-for-Service	1568756229	1568756229	1	1	KIM, JEONG M CRNA	1/23/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.85429451	-117.8446551	Orange County
157587	Fee-for-Service	1962573949	1962573949	1	1	KO, JUDY H MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74281	22	Pathology (M.D. only)	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
157589	Fee-for-Service	1255760609	1255760609	1	1	KABATT, SARAH E NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
157617	Fee-for-Service	1073548764	1073548764	1	1	KNULL, GEORGE R MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	34669	08	Family Practice	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
157618	Fee-for-Service	1992866545	1992866545	1	1	KATHRYN WAGE, SPEECH-LANGUAG	12/21/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	TER	2505 W SHAW AVE	STE. 101	FRESNO	CA	93711	3334	10	06019	36.80619423	-119.8359004	Fresno County
157640	Fee-for-Service	1427277169	1427277169	1	1	KWON, PAUL S MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65584	07	Dermatology	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
157647	Fee-for-Service	1891971404	1891971404	1	1	KORN, ERROL MEDICAL CORPORAT	4/28/2009	193400000X	NA	Other	026	PHYSICIANS	15481	10	Gastroenterology (M.D. only)	0	In state provider	None	752 MEDICAL CENTER COURT	#200	CHULA VISTA	CA	91911	6659	37	06073	32.61800405	-117.0232585	San Diego County
157717	Fee-for-Service	1154616324	1154616324	1	1	KANABAR, MITIKA MD	3/26/2019	207RA0401X	NA	Other	026	PHYSICIANS	132664	08	Family Practice	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
157765	Fee-for-Service	1770089419	1770089419	1	1	KAMEL, TONY H MD	7/27/2021	208M00000X	NA	Other	026	PHYSICIANS	174040	None	None	0	In state provider	None	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
157808	Fee-for-Service	1467401513	1467401513	1	1	KOSS, JAMES MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32294	01	General Practice	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
157821	Fee-for-Service	1710621123	1710621123	1	1	KAMAU, LUCY W	5/26/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	640 NEW WELL CT	None	LATHROP	CA	95330	8974	39	06077	37.81181805	-121.3060904	San Joaquin County
157830	Fee-for-Service	1336671536	1336671536	1	1	KHAN, ELLEXIS E MD	3/30/2021	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	170410	None	None	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
157855	Fee-for-Service	1780763482	1780763482	1	2	KAMRAN MATIN, MD, INC	8/7/2006	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	66711	41	Internal Medicine	0	In state provider	None	8631 W 3RD ST	STE 1140E	LOS ANGELES	CA	90048	0000	19	06037	34.07361928	-118.3803143	Los Angeles County
157866	Fee-for-Service	1285821850	1285821850	1	1	KHURANA, MOHAN MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25580	41	Internal Medicine	0	In state provider	None	3655 LOMITA BLVD	STE 301	TORRANCE	CA	90505	3968	19	06037	33.81497113	-118.3489779	Los Angeles County
157869	Fee-for-Service	1588663769	1588663769	1	11	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	316 WEST WILLOW AVE	None	VISALIA	CA	93291	6208	54	06107	36.32837042	-119.295349	Tulare County
157883	Fee-for-Service	1326218272	1326218272	1	1	KUROHARA, JONATHAN MD INC	3/2/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55913	08	Family Practice	0	In state provider	None	2876 SYCAMORE DR	#101	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
157884	Fee-for-Service	1457545832	1457545832	1	1	KADAM, BRIJESH H MD	9/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109208	40	Pediatrics	0	In state provider	None	311 WEST I STREET	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
157899	Fee-for-Service	1538492582	1538492582	1	1	KELLY, SHEILA LMFT	9/1/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	90494	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
157904	Fee-for-Service	1073691853	1073691853	1	1	KINOSHITA, LISA L MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64670	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
157905	Fee-for-Service	1073548764	1073548764	1	1	KNULL, GEORGE R MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	34669	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
157927	Fee-for-Service	1215032305	1215032305	1	1	KHOSHNEVIS, MATT R MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84904	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
157934	Fee-for-Service	1891807863	1891807863	1	1	KRISHNANANTHAN, RUBEN	9/19/2024	207U00000X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
157963	Fee-for-Service	1114122470	1114122470	1	1	KHAN, MUSSARAT Z PHD	8/17/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
157980	Fee-for-Service	1194013797	1194013797	1	1	KEELEY, JESSICA A MD	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122318	02	General Surgery	0	In state provider	None	6041 CADILLAC ACE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
157989	Fee-for-Service	1760552616	1760552616	1	1	KAO, YI-LING MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90033	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVENUE	None	HAYWARD	CA	94545	4383	01	06001	37.63347961	-122.0897735	Alameda County
158042	Fee-for-Service	1235153511	1235153511	1	1	KLEIN, MICHAEL R JR MD	1/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	31935	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6403 COYLE AVE	STE 170	CARMICHAEL	CA	95608	0363	34	06067	38.668347	-121.3148745	Sacramento County
158052	Fee-for-Service	1851468904	1851468904	1	1	KIM, SEONG-CHEON P MD	10/1/2000	2085B0100X	NA	MRI Provider	026	PHYSICIANS	84708	30	Radiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
158058	Fee-for-Service	1548657240	1548657240	1	1	KHANG, TONY MD	8/19/2019	207R00000X	NA	Other	026	PHYSICIANS	144185	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
158065	Fee-for-Service	1225708217	1225708217	1	1	KARASKIEWICZ COX, ANETA LMF	11/29/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HERAPY	5855 NAPLES PLAZA	217	LONG BEACH	CA	90803	5060	19	06037	33.75591002	-118.119711	Los Angeles County
158097	Fee-for-Service	1043873920	1043873920	1	1	KENDLE, ANDREW P MD	7/23/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
158114	Fee-for-Service	1285893990	1285893990	1	1	KONING, MICHAEL MD	11/14/2024	207L00000X	NA	Other	026	PHYSICIANS	66757	05	Anesthesiology	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
158129	Fee-for-Service	1922179951	1922179951	1	1	KOTLEWSKI, ADAM MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39644	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
158137	Fee-for-Service	1780763482	1780763482	1	2	KAMRAN MATIN, MD, INC	8/7/2006	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	66711	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8631 W 3RD ST	STE 1140E	LOS ANGELES	CA	90048	0000	19	06037	34.07361928	-118.3803143	Los Angeles County
158211	Fee-for-Service	1689853095	1689853095	1	1	KEVITHAN CORPORATION	2/27/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THE MEDICINE SHOPPE	2173 PICKWICK DR	None	CAMARILLO	CA	93010	6426	56	06111	34.22230976	-119.0404526	Ventura County
158215	Fee-for-Service	1215032305	1215032305	1	1	KHOSHNEVIS, MATT R MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84904	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
158290	Fee-for-Service	1124107149	1124107149	2	1	KRUGLYAKOV, SVETLANA MD FAA	8/11/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	93438	None	None	0	In state provider	None	5901 W OLYMPIC BLVD	503 B	LOS ANGELES	CA	90036	4679	19	06037	34.05764121	-118.3603115	Los Angeles County
158299	Fee-for-Service	1497797492	1497797492	1	1	KIM, YOUNG H MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50831	30	Radiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
158306	Fee-for-Service	1134153653	1134153653	1	1	KIM, SEUNG HYUN MD	8/15/1995	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	50035	41	Internal Medicine	0	In state provider	None	338 S WESTERN AVE	STE 100	LOS ANGELES	CA	90020	3842	19	06037	34.067826	-118.309083	Los Angeles County
158315	Fee-for-Service	1376698043	1376698043	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
158330	Fee-for-Service	1235153511	1235153511	1	1	KLEIN, MICHAEL R JR MD	1/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	31935	20	Orthopedic Surgery	0	In state provider	None	6403 COYLE AVE	STE 170	CARMICHAEL	CA	95608	0363	34	06067	38.668347	-121.3148745	Sacramento County
158336	Fee-for-Service	1013624972	1013624972	1	1	KIM, JUHO LMFT	1/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
158345	Fee-for-Service	1689714248	1689714248	1	1	KAO, JENNIFER C MD	2/28/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50265	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158390	Fee-for-Service	1700993599	1700993599	1	1	KARANES, CHATCHADA MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51816	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
158400	Fee-for-Service	1902842354	1902842354	1	2	KHAIRA, RAVINDER S MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56390	None	None	0	In state provider	None	4617 FREEPORT BLVD	SUITE B	SACRAMENTO	CA	95822	2015	34	06067	38.533311	-121.4939295	Sacramento County
158474	Fee-for-Service	1154434728	1154434728	1	1	KIM, ILKYOON MD	1/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34081	41	Internal Medicine	0	In state provider	None	660 SANITARIUM RD	# 306	DEER PARK	CA	94576	9710	28	06055	38.54206023	-122.47561	Napa County
158488	Fee-for-Service	1841373594	1841373594	1	1	KIM, HYE K MD	7/31/1986	207ZP0105X	NA	Other	026	PHYSICIANS	30584	22	Pathology (M.D. only)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
158493	Fee-for-Service	1215370846	1215370846	1	1	KIRK, MATTHEW E MD	12/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174580	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
158502	Fee-for-Service	1619430386	1619430386	1	1	KAHLON, NAVNEET K MD	10/7/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178747	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
158503	Fee-for-Service	1629439179	1629439179	1	1	KAUR, AMANDEEP DO	8/30/2020	207R00000X	NA	Other	026	PHYSICIANS	16136	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
158518	Fee-for-Service	1609267905	1609267905	1	1	KHANNA, RYAN MD	9/19/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	183424	14	Neurological Surgery	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
158537	Fee-for-Service	1780662635	1780662635	1	1	KEROLLE,HAROLD	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	451 CLARKSON AVENUE	None	BROOKLYN	NY	11203	2054	00	None	40.656258	-73.9446165	Kings County
158589	Fee-for-Service	1497797492	1497797492	1	1	KIM, YOUNG H MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50831	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
158620	Fee-for-Service	1205893476	1205893476	1	1	KRAVETZ, DAVID MD	3/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50036	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158658	Fee-for-Service	1073776555	1073776555	1	1	KAMDAR, TORAL A MD	2/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	151621	03	Allergy	0	In state provider	None	1761 BROADWAY ST	STE 203	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
158697	Fee-for-Service	1285193011	1285193011	1	1	KHAN, MALIHA MD	3/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176368	None	None	0	In state provider	None	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
158706	Fee-for-Service	1831300714	1831300714	1	1	KUNDIDZORA, NGONIDZASHE E	4/21/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
158709	Fee-for-Service	1184159428	1184159428	1	1	KIM, GRACE MD	1/10/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176289	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
158735	Fee-for-Service	1295718328	1295718328	1	1	KAMMIRE,LESLIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	MEDICAL CENTER BLVD	None	WINSTON SALEM	NC	27157	0001	00	None	36.08955228	-80.27134643	Forsyth County
158737	Fee-for-Service	1124180518	1124180518	1	1	KAYE, DAVID BRETT MD	6/21/1991	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32581	18	Ophthalmology	0	In state provider	None	6767 N FRESNO ST	None	FRESNO	CA	93710	3709	10	06019	36.83686637	-119.7813437	Fresno County
158772	Fee-for-Service	1669507851	1669507851	1	1	KIM, GRACE PSYD	6/26/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	26795	-	NOT APPLICABLE	0	In state provider	None	3600 WILSHIRE BLVD	2200	LOS ANGELES	CA	90010	2632	19	06037	34.0617065	-118.3036455	Los Angeles County
158796	Fee-for-Service	1861525602	1861525602	1	8	KOREAN COMMUNITY SERVICES	3/2/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6494 CABALLERO BLVD	None	BUENA PARK	CA	90620	1128	30	06059	33.86583584	-118.0197647	Orange County
158826	Fee-for-Service	1922032283	1922032283	1	1	KHANNA, SANDEEP K MD	7/1/1998	207L00000X	NA	Other	026	PHYSICIANS	54249	40	Pediatrics	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
158852	Fee-for-Service	1710634126	1710634126	1	1	KIREEVA, OXANA LMFT	2/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
158857	Fee-for-Service	1497869648	1497869648	1	1	KNAPP, ANDREW L DO PC	3/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	6460	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
158864	Fee-for-Service	1477994549	1477994549	1	1	KWON, PAUL SOO HAN OD	2/16/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	28505 HESPERIAN BLVD	None	HAYWARD	CA	94545	5008	01	06001	37.61653109	-122.0880046	Alameda County
158875	Fee-for-Service	1447220124	1447220124	1	1	KREMP, ALLAN N MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135385	22	Pathology (M.D. only)	0	In state provider	None	7592 METROPOLITAN DR	STE 405	SAN DIEGO	CA	92108	4428	37	06073	32.77772014	-117.1575637	San Diego County
158900	Fee-for-Service	1881798056	1881798056	1	1	KONG, THOMAS Q JR MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83838	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	147 BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
158906	Fee-for-Service	1205893476	1205893476	1	1	KRAVETZ, DAVID MD	3/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50036	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158928	Fee-for-Service	1942541768	1942541768	1	1	KEHOE, KATRINA S F CRNA	6/5/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158964	Fee-for-Service	1215245675	1215245675	1	1	KAISER, BENTE MD INC	6/16/2011	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1300 N. VERMONT AVENUE,	SUITE 501	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
158999	Fee-for-Service	1275789299	1275789299	1	1	KHAZAI, BAHRAM MD	4/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109212	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
159056	Fee-for-Service	1851057392	1851057392	1	1	KENDAL, JOSEPH K MD	12/21/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	174866	None	None	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
159085	Fee-for-Service	1861525602	1861525602	1	8	KOREAN COMMUNITY SERVICES	3/2/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6494 CABALLERO BLVD	None	BUENA PARK	CA	90620	1128	30	06059	33.86583584	-118.0197647	Orange County
159110	Fee-for-Service	1922032283	1922032283	1	1	KHANNA, SANDEEP K MD	7/1/1998	207L00000X	NA	Other	026	PHYSICIANS	54249	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
159126	Fee-for-Service	1548317860	1548317860	1	1	KAISER PERMANENTE	6/12/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #157	14011 PARK AVE	None	VICTORVILLE	CA	92392	2413	36	06071	34.505647	-117.3265457	San Bernardino County
159143	Fee-for-Service	1306094925	1306094925	1	1	KHERADYAR, DAVID MD	3/10/2009	193400000X	NA	Other	026	PHYSICIANS	74610	13	Neurology (M.D. only)	0	In state provider	None	323 N PRAIRIE AVE	STE 200	INGLEWOOD	CA	90301	4504	19	06037	33.966333	-118.3439975	Los Angeles County
159173	Fee-for-Service	1013139732	1013139732	1	1	KASRAVI, ARJANG MD	2/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92944	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
159210	Fee-for-Service	1093809568	1093809568	1	1	KENNEDY, DANIEL J MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	59571	41	Internal Medicine	0	In state provider	None	2031 ANDERSON RD	STE B	DAVIS	CA	95616	0621	57	06113	38.56133924	-121.7586174	Yolo County
159259	Fee-for-Service	1396849345	1396849345	3	1	KLA HEALTHCARE INC	12/17/2024	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9828 GARDEN GROVE BLVD	STE 101	GARDEN GROVE	CA	92844	1639	30	06059	33.77397547	-117.960813	Orange County
159303	Fee-for-Service	1881782688	1881782688	1	1	KUNIHIRO, AMY B MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69525	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
159305	Fee-for-Service	1396031803	1396031803	1	1	KALLIANOS, KIMBERLY G MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123808	30	Radiology	0	In state provider	None	400 PARNASSUS	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
159319	Fee-for-Service	1922250240	1922250240	1	1	KALANITHI, SUMAN A MD	12/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94995	None	None	0	In state provider	None	300 MEDICAL PLAZA	SUITE B 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
159334	Fee-for-Service	1144515693	1144515693	1	1	KUKRETI, SHWAYTA MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124764	None	None	0	In state provider	None	10833 LE CONTE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
159353	Fee-for-Service	1235219031	1235219031	1	1	KEENE, DAVID H MD	2/21/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	51024	40	Pediatrics	0	In state provider	None	6330 SAN VICENTE BLVD	STE 305	LOS ANGELES	CA	90048	5425	19	06037	34.06129173	-118.3678359	Los Angeles County
159362	Fee-for-Service	1851458723	1851458723	1	1	KREIT, SAMIR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	203 N COLLEGE AVE	None	CLEVELAND	TX	77327	4000	00	None	30.34341655	-95.0865869	Liberty County
159372	Fee-for-Service	1861525602	1861525602	1	8	KOREAN COMMUNITY SERVICES	10/17/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6494 CABALLERO BLVD	None	BUENA PARK	CA	90620	1128	30	06059	33.86583584	-118.0197647	Orange County
159391	Fee-for-Service	1790280774	1790280774	1	1	KOSLOV, KATRINA R MD	10/7/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165575	None	None	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
159478	Fee-for-Service	1659445245	1659445245	1	1	KOTZBAUER, STEVEN M MD	12/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96220	30	Radiology	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
159502	Fee-for-Service	1093809568	1093809568	1	1	KENNEDY, DANIEL J MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	59571	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2031 ANDERSON RD	STE B	DAVIS	CA	95616	0621	57	06113	38.56133924	-121.7586174	Yolo County
159507	Fee-for-Service	1871856567	1871856567	1	1	KONG, STEVEN E MD	6/17/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	123944	None	None	0	In state provider	None	1690 BARTON RD	107 & 108	REDLANDS	CA	92373	4229	36	06071	34.04836346	-117.2125293	San Bernardino County
159512	Fee-for-Service	1154514677	1154514677	1	1	KUMARAVELU, PRIYA G MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100993	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
159577	Fee-for-Service	1043387293	1043387293	1	1	KEARNEY, AMY J PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
159612	Fee-for-Service	1093101453	1093101453	1	1	KIM, JENNIFER	7/23/2019	207L00000X	NA	Other	026	PHYSICIANS	158845	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
159613	Fee-for-Service	1336255660	1336255660	1	1	KAGAN, RISA MD	5/31/1981	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	41604	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	# 1490M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
159618	Fee-for-Service	1003106014	1003106014	1	1	KANE, SINAE A MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142792	07	Dermatology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
159624	Fee-for-Service	1235147638	1235147638	1	1	KRASNY,ROBERT M MD	9/24/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	69870	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
159648	Fee-for-Service	1306012364	1306012364	1	1	KHOCHE, SWAPNIL MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129487	05	Anesthesiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
159679	Fee-for-Service	1932143963	1932143963	1	1	KO, DAVID Y MD	12/31/1994	2084N0400X	NA	Neurology	026	PHYSICIANS	81872	13	Neurology (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	STE 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
159698	Fee-for-Service	1750550059	1750550059	1	1	KHAN, NAUREEN MD	3/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133926	01	General Practice	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
159713	Fee-for-Service	1841695459	1841695459	1	1	KING, MARESA	11/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 BRISTOL ST	STE E203	COSTA MESA	CA	92626	7908	30	06059	33.67689875	-117.8872016	Orange County
159720	Fee-for-Service	1407845886	1407845886	1	2	KRAMER, DAVID S MD	3/3/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49359	41	Internal Medicine	0	In state provider	None	6575 CHURCHILL DR	None	HUNTINGTON BEACH	CA	92648	1513	30	06059	33.68963452	-118.013562	Orange County
159725	Fee-for-Service	1093736639	1093736639	1	1	KENNETH M LOUIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3000 E FLETCHER AVE #300	None	TAMPA	FL	33613	0000	00	None	28.0692763	-82.42528678	Hillsborough County
159726	Fee-for-Service	1376032235	1376032235	1	1	KLEIN, JUSTIN C DPM	10/28/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	883 SNEATH LANE	SUITE 160	SAN BRUNO	CA	94066	2409	41	06081	37.63591781	-122.4231037	San Mateo County
159747	Fee-for-Service	1124418652	1124418652	1	1	KWON, ESTHER Y MD	6/11/2018	207R00000X	NA	Other	026	PHYSICIANS	139834	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
159755	Fee-for-Service	1982648259	1982648259	1	1	KAADE, SAMER AL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3635 VISTA AVE	None	SAINT LOUIS	MO	63110	2539	00	None	38.62249413	-90.23900688	St. Louis city
159762	Fee-for-Service	1295136406	1295136406	1	1	KIM, MICHAEL G MD	9/30/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	169905	None	None	0	In state provider	None	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
159813	Fee-for-Service	1134570864	1134570864	1	1	KAUR, RAVINDAR NP	4/2/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
159830	Fee-for-Service	1134166887	1134166887	1	1	KARAKASHIAN, ARAM B MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38391	08	Family Practice	0	In state provider	None	1510 S CENTRAL AVE	STE 130	GLENDALE	CA	91204	2568	19	06037	34.12709764	-118.2577911	Los Angeles County
159849	Fee-for-Service	1417036187	1417036187	1	1	KASSAM, DIAMOND MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31963	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
159877	Fee-for-Service	1649273004	1649273004	1	1	KEIZER FIRE DI AMBULANCE	12/29/2003	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	661 CHEMAWA RD N	None	KEIZER	OR	97303	5334	00	None	44.99702353	-123.0348758	Marion County
159892	Fee-for-Service	1659765071	1659765071	1	1	KIM, SUSAN Y MD	7/12/2019	207L00000X	NA	Other	026	PHYSICIANS	145968	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
159895	Fee-for-Service	1194363770	1194363770	1	1	KECKLEY, CORTNEY CNP	2/3/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1792 GARNET AVE	None	SAN DIEGO	CA	92109	3350	37	06073	32.80054833	-117.2374979	San Diego County
159896	Fee-for-Service	1922428952	1922428952	1	1	KIM, KEVIN D MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138163	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
159924	Fee-for-Service	1457523177	1457523177	1	1	KIM, MICHAEL M MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99275	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
159964	Fee-for-Service	1023404837	1023404837	1	1	KADAKIA, RISHI V MD	7/15/2021	207LP3000X	NA	Other	026	PHYSICIANS	169609	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
159973	Fee-for-Service	1134784051	1134784051	1	1	KULASHEKAR, MALAVVIKA	5/1/2023	390200000X	NA	Other	026	PHYSICIANS	20491	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
160006	Fee-for-Service	1407845886	1407845886	1	2	KRAMER, DAVID S MD	3/3/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49359	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6575 CHURCHILL DR	None	HUNTINGTON BEACH	CA	92648	1513	30	06059	33.68963452	-118.013562	Orange County
160011	Fee-for-Service	1164736708	1164736708	1	1	KAUR, SUKHDEEP MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137149	01	General Practice	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
160015	Fee-for-Service	1154403186	1154403186	1	1	KABACK, KEITH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5301 E GRANT RD	None	TUCSON	AZ	85712	2805	00	None	32.252391	-110.8790055	Pima County
160025	Fee-for-Service	1952813016	1952813016	1	1	KINCAID SENIOR LIVING, INC	2/20/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	641 S BEACH BLVD	None	ANAHEIM	CA	92804	3102	30	06059	33.82338944	-117.9934518	Orange County
160034	Fee-for-Service	1073859930	1073859930	1	2	KAN-DI-KI LLC	9/2/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	1	Border provider	None	7355 PRAIRIE FALCON RD	None	LAS VEGAS	NV	89128	0801	00	None	36.20668776	-115.2540899	Clark County
160041	Fee-for-Service	1356400956	1356400956	1	1	KEOGH, LOUISE MD	12/23/1982	207RR0500X	NA	Other	026	PHYSICIANS	36535	83	Rheumatology	0	In state provider	U C SAN DIEGO	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
160073	Fee-for-Service	1487853743	1487853743	1	1	KIMBERLY, MULSON MD	1/6/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
160087	Fee-for-Service	1154685121	1154685121	1	1	KURSS, JONATHAN M MD	9/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142087	15	Obstetrics (D.O. only)	0	In state provider	None	500 DOYLE PARK DR	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
160088	Fee-for-Service	1710177522	1710177522	1	1	KIM, HANNAH H MD	3/12/2008	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	85544	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
160092	Fee-for-Service	1609826718	1609826718	1	1	KEHL, THOMAS A MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	23842	41	Internal Medicine	0	In state provider	None	23845 HOLMAN HWY	STE 220	MONTEREY	CA	93940	5901	27	06053	36.57594044	-121.9132944	Monterey County
160093	Fee-for-Service	1578661997	1578661997	1	1	KAPOOR, SIMI MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115671	03	Allergy	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
160094	Fee-for-Service	1003392309	1003392309	1	1	KIM, HAEIN MD	9/30/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173404	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
160143	Fee-for-Service	1780884395	1780884395	1	1	KHODABAKHSH, DANIEL B MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106419	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
160154	Fee-for-Service	1871527416	1871527416	1	1	KAUFMAN, ALAN M LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
160160	Fee-for-Service	1144419482	1144419482	1	1	KATZ, DANIEL E LCSW	10/30/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
160174	Fee-for-Service	1386917177	1386917177	1	1	KAHLON, ANMOL MD	2/15/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	143285	41	Internal Medicine	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	4645	57	06113	38.56101005	-121.7821776	Yolo County
160179	Fee-for-Service	1780763482	1780763482	1	1	KAMRAN MATIN, MD, INC	8/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66711	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3392 MOTOR AVE	None	LOS ANGELES	CA	90034	3712	19	06037	34.02780514	-118.4095758	Los Angeles County
160182	Fee-for-Service	1063461747	1063461747	1	1	KANSARA, RASIK T MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35977	10	Gastroenterology (M.D. only)	0	In state provider	None	200 JOSE FIGUERES AVE	#395	SAN JOSE	CA	95116	1593	43	06085	37.36122014	-121.8505998	Santa Clara County
160229	Fee-for-Service	1689175192	1689175192	1	1	KAISER FOUNDATION HEALTH	7/13/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	4949 MARKET ST	1ST FL	VENTURA	CA	93003	0000	56	06111	34.25762033	-119.2239863	Ventura County
160266	Fee-for-Service	1588838643	1588838643	2	1	KWIATKOWSKI, DAVID M MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130273	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
160267	Fee-for-Service	1831486679	1831486679	1	1	KOSMALSKA, AGATA K MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124419	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
160269	Fee-for-Service	1578724951	1578724951	1	1	KAMERKAR, ASAVARI U DO	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12189	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
160299	Fee-for-Service	1841855962	1841855962	1	1	KILBAS, TIFFANY L DO	4/29/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1601 N MONTE VISTA AVE	#100	CLAREMONT	CA	91711	6601	19	06037	34.112259	-117.698539	Los Angeles County
160305	Fee-for-Service	1104402270	1104402270	1	1	KIM, JOYCE Y MD	1/24/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	180578	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
160316	Fee-for-Service	1669792107	1669792107	1	1	KELLY, SHANNON MD	6/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100334	68	Hematology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
160354	Fee-for-Service	1669691200	1669691200	1	2	KNOLL, MICHAEL R DDS MD	2/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128233	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
160380	Fee-for-Service	1609826718	1609826718	1	1	KEHL, THOMAS A MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	23842	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23845 HOLMAN HWY	STE 220	MONTEREY	CA	93940	5901	27	06053	36.57594044	-121.9132944	Monterey County
160396	Fee-for-Service	1245423011	1245423011	1	1	KEITH, STEPHEN N MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37534	40	Pediatrics	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
160416	Fee-for-Service	1366572216	1366572216	1	1	KIM, JANE J MD	5/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90399	None	None	0	In state provider	None	400 PARNASSUS AVE	0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160423	Fee-for-Service	1336595727	1336595727	1	1	KELLEY, WILLIAM P DO	7/19/2019	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
160435	Fee-for-Service	1497913206	1497913206	1	1	KAUR, JASPREET MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103375	41	Internal Medicine	0	In state provider	None	999 S FAIRMONT AVENUE	None	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
160459	Fee-for-Service	1447446190	1447446190	1	1	KIRILCUK, NATALIE N MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96821	02	General Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
160466	Fee-for-Service	1780763482	1780763482	1	1	KAMRAN MATIN, MD, INC	8/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66711	41	Internal Medicine	0	In state provider	None	3392 MOTOR AVE	None	LOS ANGELES	CA	90034	3712	19	06037	34.02780514	-118.4095758	Los Angeles County
160467	Fee-for-Service	1518371194	1518371194	1	1	KHOSLA, MANRAJ S MD	7/1/2017	208M00000X	NA	Other	026	PHYSICIANS	148854	41	Internal Medicine	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
160518	Fee-for-Service	1982004032	1982004032	1	1	KELAVA, LUCA J NP	4/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
160536	Fee-for-Service	1861633083	1861633083	1	1	KOVACS, DAVID B MD	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106958	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2815	30	06059	33.84718298	-117.933758	Orange County
160547	Fee-for-Service	1013458868	1013458868	1	1	KIM, ANGELIQUE MD	7/8/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182001	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
160552	Fee-for-Service	1942074356	1942074356	1	1	KUPKA, LEAH CRNA	12/19/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
160553	Fee-for-Service	1588838643	1588838643	2	1	KWIATKOWSKI, DAVID M MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130273	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
160557	Fee-for-Service	1275166381	1275166381	1	1	KAMAU, VERONICA	4/24/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8627 CAMARGUE CT	None	SACRAMENTO	CA	95828	5947	34	06067	38.472921	-121.383252	Sacramento County
160574	Fee-for-Service	1972685121	1972685121	1	1	KRUEGER, JOHN M LCSW	8/21/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	SUITE 3	LONG BEACH	CA	90815	3020	19	06037	33.79388819	-118.1261825	Los Angeles County
160581	Fee-for-Service	1235440991	1235440991	1	1	KLEIN, ALEXANDER S PSYD	4/30/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
160587	Fee-for-Service	1023472297	1023472297	1	1	KOPPINGER, LINDSAY MD	10/24/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150424	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
160596	Fee-for-Service	1225370059	1225370059	1	1	KEENAN, KEVIN J MD	4/24/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	136005	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
160629	Fee-for-Service	1922094309	1922094309	1	1	KARLA PUENTE-SHULTZ MD	11/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
160643	Fee-for-Service	1134234024	1134234024	1	1	KAUFMAN, DAVID I MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	46736	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
160650	Fee-for-Service	1124562939	1124562939	1	1	KIRUUTA, PAUL T NP	10/14/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	12 RITTER ST	None	SAN RAFAEL	CA	94901	3323	21	06041	37.97154858	-122.5251877	Marin County
160724	Fee-for-Service	1063822237	1063822237	1	1	KORTA, DOROTA Z MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138403	07	Dermatology	0	In state provider	None	2720 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
160744	Fee-for-Service	1366829269	1366829269	1	1	KASINPILA, PATPILAI MD	8/16/2023	390200000X	NA	Other	026	PHYSICIANS	144885	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
160755	Fee-for-Service	1083894844	1083894844	1	1	KIM, SUN HEE MD	6/21/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75251	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
160769	Fee-for-Service	1851687008	1851687008	1	1	KATRIVESIS, JAMES MD	7/6/2017	2085R0204X	NA	Other	026	PHYSICIANS	122890	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
160794	Fee-for-Service	1053483800	1053483800	1	1	KAMRAVA, KAMRAN K MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43281	01	General Practice	0	In state provider	None	6915 RESEDA BLVD	UNIT 1	RESEDA	CA	91335	4244	19	06037	34.196211	-118.536078	Los Angeles County
160809	Fee-for-Service	1770751174	1770751174	1	1	KUBRICAN, TOMAS MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129895	01	General Practice	0	In state provider	None	75 ROWLAND WAY	STE 100	NOVATO	CA	94945	5054	21	06041	38.09501878	-122.5589434	Marin County
160833	Fee-for-Service	1992716450	1992716450	1	1	KRAUT ERIC J MEDICAL	5/1/2002	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	NORTH BAY MED GROUP INC	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
160845	Fee-for-Service	1275166381	1275166381	1	1	KAMAU, VERONICA	4/24/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8627 CAMARGUE CT	None	SACRAMENTO	CA	95828	5947	34	06067	38.472921	-121.383252	Sacramento County
160852	Fee-for-Service	1932141215	1932141215	1	1	KILLEFER,PETER JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST	None	SALEM	OR	97301	0000	00	None	44.933211	-123.0355125	Marion County
160859	Fee-for-Service	1235187055	1235187055	1	1	KORN, WOLFGANG M MD	11/9/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77069	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160883	Fee-for-Service	1467509778	1467509778	1	1	KAISER PERM PHCY #214	7/12/1985	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3250 FORDHAM ST	None	SAN DIEGO	CA	92110	5339	37	06073	32.75023731	-117.2141701	San Diego County
160891	Fee-for-Service	1356607121	1356607121	1	1	KIM, CHRISTOPHER J Y MD	6/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131506	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
160913	Fee-for-Service	1205260379	1205260379	1	1	KEANY, JENNIFER E MFT	4/3/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8936 S SEPULVEDA BLVD	SUITE 200	LOS ANGELES	CA	90045	3628	19	06037	33.954957	-118.3961925	Los Angeles County
160919	Fee-for-Service	1699022111	1699022111	1	1	KIM, BRIAN T	3/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6 WILLARD	None	IRVINE	CA	92604	4694	30	06059	33.67534801	-117.7900415	Orange County
160928	Fee-for-Service	1962054981	1962054981	1	1	KING, ALEXIS LMFT	12/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
160967	Fee-for-Service	1538666029	1538666029	1	1	KONICKE, KATHRYN A MD	7/29/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	179498	07	Dermatology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
160973	Fee-for-Service	1013012046	1013012046	1	1	KIM, GORDON L MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81107	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
160977	Fee-for-Service	1558483255	1558483255	1	1	KECK, DARRYL L LCSW	9/10/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6765 GREEN VALLEY RD	None	PLACERVILLE	CA	95667	0543	09	06017	38.72039732	-120.8664353	El Dorado County
160995	Fee-for-Service	1144677675	1144677675	1	1	KEBIR, HAKIM N MD	6/28/2019	390200000X	NA	Other	026	PHYSICIANS	158125	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
161022	Fee-for-Service	1639373798	1639373798	1	1	KABRA, ASHISH N MD	9/3/2020	207UN0901X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122620	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2067 W VISTA WAY	SUITE 225	VISTA	CA	92083	5523	37	06073	33.18505594	-117.285958	San Diego County
161032	Fee-for-Service	1306880596	1306880596	1	1	KURAISHI, AQDAS MD	4/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	31370	None	None	0	In state provider	None	3333 SKYPARK DRIVE	SUITE 160	TORRANCE	CA	90505	5042	19	06037	33.81036565	-118.3466218	Los Angeles County
161075	Fee-for-Service	1144325952	1144325952	1	1	KARTHA, KRISHNAN MD	7/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	150077	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
161097	Fee-for-Service	1073577441	1073577441	1	1	KEISARI, RAMI MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50424	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
161115	Fee-for-Service	1790929966	1790929966	1	1	KOMARI, VISHNU V R MD	4/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147294	41	Internal Medicine	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
161123	Fee-for-Service	1992716450	1992716450	1	1	KRAUT ERIC J MEDICAL	5/1/2002	193200000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	NORTH BAY MED GROUP INC	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
161170	Fee-for-Service	1689056954	1689056954	1	1	KENNEDY, LOUIS MD	5/7/2019	208M00000X	NA	Other	026	PHYSICIANS	150399	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
161223	Fee-for-Service	1841399847	1841399847	1	1	KWON, STEVE O MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85597	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
161263	Fee-for-Service	1013012046	1013012046	1	1	KIM, GORDON L MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81107	70	Clinic (mixed specialty)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
161281	Fee-for-Service	1154680981	1154680981	1	1	KOTOYAN, RAFFI A MD	1/28/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	163268	33	Thoracic Surgery	0	In state provider	None	18350 ROSCOE BLVD	STE 201	NORTHRIDGE	CA	91325	4148	19	06037	34.22071855	-118.5341175	Los Angeles County
161287	Fee-for-Service	1528033701	1528033701	1	1	KASHIWABARA, YUKI MD	1/10/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79688	None	None	0	In state provider	None	16100 SAND CANYON AVE	STE 240	IRVINE	CA	92618	3724	30	06059	33.6632187	-117.7721984	Orange County
161312	Fee-for-Service	1689826141	1689826141	1	1	KRISTEN E DAY, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
161314	Fee-for-Service	1306935564	1306935564	1	1	KOOPER, KAREL W MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71166	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
161320	Fee-for-Service	1538175112	1538175112	1	1	KU, IVY A MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98604	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 O'FARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
161321	Fee-for-Service	1326191602	1326191602	1	1	KEVIN TRAN & ASSOCIATES	12/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORPORATION	7509 CARSON BLVD	None	LONG BEACH	CA	90808	2365	19	06037	33.83129015	-118.0874526	Los Angeles County
161335	Fee-for-Service	1225144835	1225144835	1	1	KIM, ELEANORE S MD	4/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72756	15	Obstetrics (D.O. only)	0	In state provider	None	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
161360	Fee-for-Service	1073618112	1073618112	1	1	KENNEDY, PHILLIP W MD	9/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80030	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
161396	Fee-for-Service	1588282024	1588282024	1	1	KREUTZER, ADAM J DO	12/29/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	19924	20	Orthopedic Surgery	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
161411	Fee-for-Service	1992716450	1992716450	1	1	KRAUT ERIC J MEDICAL	5/1/2002	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	NORTH BAY MED GROUP INC	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
161424	Fee-for-Service	1396715314	1396715314	1	1	KOENIG, LAWRENCE A MD	10/21/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35926	08	Family Practice	0	In state provider	A MEDICAL CORP	1335 CAMINO DEL MAR	None	DEL MAR	CA	92014	2507	37	06073	32.95822287	-117.2647474	San Diego County
161446	Fee-for-Service	1154579969	1154579969	1	1	KAMAL, FAHMEEDAH S MD	2/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134411	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161544	Fee-for-Service	1891028098	1891028098	1	1	KAMAL, BINDU M MD INC	9/29/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	68308	45	Nephrology (Renal-Kidney)	0	In state provider	None	2420 CASTILLO STREET	SUITE 100	SANTA BARBARA	CA	93105	5307	42	06083	34.431079	-119.7249253	Santa Barbara County
161580	Fee-for-Service	1073146643	1073146643	1	1	KLEIN, THOMAS A CO	11/16/2020	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 CASS STREET	112	MONTEREY	CA	93940	4518	27	06053	36.59201772	-121.8966282	Monterey County
161609	Fee-for-Service	1427296110	1427296110	1	1	KHALIL, BEEMEN N MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108578	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
161625	Fee-for-Service	1205149200	1205149200	1	1	KOH, WONSHILL	3/25/2024	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
161632	Fee-for-Service	1851478895	1851478895	1	1	KRISTIN M DETTMER CPNP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDRENS HEALTH CARE	345 N SMITH AVE	None	ST PAUL	MN	55102	0000	00	None	44.94251219	-93.1074995	Ramsey County
161640	Fee-for-Service	1285732636	1285732636	1	1	KAZAK, MICHAEL K MD	1/8/1992	207R00000X	NA	Other	026	PHYSICIANS	43888	41	Internal Medicine	0	In state provider	None	1040 W MAIN ST	None	SANTA MARIA	CA	93458	4238	42	06083	34.95325767	-120.4511645	Santa Barbara County
161644	Fee-for-Service	1306870258	1306870258	1	1	KAHWAJI, IMAN Y MD	3/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86244	None	None	0	In state provider	None	5301 F ST	STE 316	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
161645	Fee-for-Service	1942239892	1942239892	1	1	KAPOOR, VISHWA M MD	10/24/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	41870	None	None	0	In state provider	None	1560 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.779782	-115.569736	Imperial County
161660	Fee-for-Service	1821415324	1821415324	1	1	KELLER, MARK A CRNA	8/17/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
161689	Fee-for-Service	1255414629	1255414629	1	1	KIM, CHIWAN MD	12/5/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	88369	None	None	0	In state provider	None	5301 F STREET	#313	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
161733	Fee-for-Service	1154579969	1154579969	1	1	KAMAL, FAHMEEDAH S MD	2/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134411	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161738	Fee-for-Service	1134684657	1134684657	1	1	KAHN, OLIVIA L NP	3/29/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7130 MILLBROOK AVE	SUITE 112	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
161760	Fee-for-Service	1730258401	1730258401	1	1	KAFRI, HASSAN	12/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96002	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
161803	Fee-for-Service	1821229972	1821229972	1	1	KIM, MICHAEL M MD	3/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111652	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
161832	Fee-for-Service	1891028098	1891028098	1	1	KAMAL, BINDU M MD INC	9/29/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	68308	41	Internal Medicine	0	In state provider	None	2420 CASTILLO STREET	SUITE 100	SANTA BARBARA	CA	93105	5307	42	06083	34.431079	-119.7249253	Santa Barbara County
161849	Fee-for-Service	1700313285	1700313285	1	1	KRAGIE, ALEXANDRIA C MD	9/14/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173988	None	None	0	In state provider	None	20642 JOHN DR	None	CASTRO VALLEY	CA	94546	5103	01	06001	37.69270814	-122.090934	Alameda County
161903	Fee-for-Service	1689839722	1689839722	1	1	KHEMLINA, GALINA L MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	104599	38	Geriatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
161905	Fee-for-Service	1144738956	1144738956	1	1	KOO, ELLIE S PT	2/22/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
161911	Fee-for-Service	1205149200	1205149200	1	1	KOH, WONSHILL	3/25/2024	2080P0203X	NA	Other	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
161913	Fee-for-Service	1912056276	1912056276	1	1	KIM, MARVIN H MD	5/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85950	05	Anesthesiology	0	In state provider	MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
161919	Fee-for-Service	1093342461	1093342461	1	1	KAHKEJIAN, JENNICA MD	9/15/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179740	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
161985	Fee-for-Service	1346424785	1346424785	1	1	KERTSER, ANNA MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103236	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162008	Fee-for-Service	1871518167	1871518167	1	1	KERRY ANN MCDONALD MD	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
162011	Fee-for-Service	1083655252	1083655252	1	1	KLEIN, ROGER ALLEN	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58706	20	Orthopedic Surgery	0	In state provider	None	1111 SONOMA AVE	STE 106	SANTA ROSA	CA	95405	4813	49	06097	38.442042	-122.700033	Sonoma County
162044	Fee-for-Service	1720309735	1720309735	1	1	KIM, EUN MIN MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131733	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
162058	Fee-for-Service	1386138279	1386138279	1	1	KENNEDY, KANAK MD	7/23/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
162059	Fee-for-Service	1386721231	1386721231	1	1	KAUR, RUPINDER MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64709	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
162086	Fee-for-Service	1487901930	1487901930	1	1	KUMAR, KETKI	5/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
162106	Fee-for-Service	1205057544	1205057544	1	1	KESSLER, DAVID L MD	9/26/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	4829	01	General Practice	0	In state provider	None	204 PROVIDENCE MINE RD	STE 211	NEVADA CITY	CA	95959	2954	29	06057	39.25014736	-121.0297624	Nevada County
162119	Fee-for-Service	1003058546	1003058546	1	1	KIELEY, SAMUEL B MD	3/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130815	34	Urology and Urological Surgery	0	In state provider	None	116 S PALISADE DRIVE	SUITE 110	SANTA MARIA	CA	93454	5906	42	06083	34.9523869	-120.4120717	Santa Barbara County
162130	Fee-for-Service	1427375369	1427375369	1	1	KIM, PHYLLIS S MD	5/24/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	119289	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
162166	Fee-for-Service	1942659594	1942659594	1	1	KHAN, RAFIA R MD	5/29/2020	207R00000X	NA	Other	026	PHYSICIANS	161761	41	Internal Medicine	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
162198	Fee-for-Service	1467684795	1467684795	1	1	KAFELE, DAJENYA S	5/25/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 HILLTOP MALL ROAD	SUITE 41	RICHMOND	CA	94806	1921	07	06013	37.9802423	-122.3244075	Contra Costa County
162209	Fee-for-Service	1053467720	1053467720	1	1	KARIMKHANI, VALEH DO	1/29/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	10183	36	Psychiatry	0	In state provider	None	2510 DOUGLAS BLVD	#300	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
162238	Fee-for-Service	1346311545	1346311545	1	1	KRAFT, DANIEL L MD	2/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82985	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
162252	Fee-for-Service	1427493444	1427493444	1	1	KAMBESTAD, KRISTI M MD	8/1/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	133828	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
162290	Fee-for-Service	1598295925	1598295925	1	1	KUTZ, CRAIG J MD	9/7/2020	207P00000X	NA	Other	026	PHYSICIANS	158043	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
162334	Fee-for-Service	1235471962	1235471962	1	1	KORNBAU, ANDREA M MD	8/1/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	131472	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
162380	Fee-for-Service	1528594108	1528594108	1	1	KAMATH, AKSHAY R MD	7/8/2024	390200000X	NA	Other	026	PHYSICIANS	170184	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
162397	Fee-for-Service	1336320928	1336320928	1	1	KLUFAS, MARTHA T OD	4/20/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 VALENCIA ST	None	SAN FRANCISCO	CA	94110	2406	38	06075	37.75670558	-122.4211139	San Francisco County
162427	Fee-for-Service	1093104242	1093104242	1	1	KAWANKAR, REKHA PT	2/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2623 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2309	19	06037	34.02103446	-118.1316423	Los Angeles County
162454	Fee-for-Service	1356837496	1356837496	1	1	KIM, JAY NP	7/31/2020	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
162487	Fee-for-Service	1811052368	1811052368	1	1	KAPLAN, JESSICA	5/31/1993	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	51657	40	Pediatrics	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
162492	Fee-for-Service	1891735742	1891735742	1	1	KREEGEL, PAIGE V MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
162541	Fee-for-Service	1770875353	1770875353	1	1	KURTZ, DAVID M MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114549	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
162555	Fee-for-Service	1700933025	1700933025	1	1	KAISER FOUNDATION HEALTH	10/10/1989	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#603	3501 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2150	15	06029	35.35408422	-119.0424307	Kern County
162564	Fee-for-Service	1437654340	1437654340	1	1	KWONG, NATHAN T MD	7/15/2021	207R00000X	NA	Other	026	PHYSICIANS	173450	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
162608	Fee-for-Service	1285601310	1285601310	1	1	KURUMA, PAVANI MD	8/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89249	08	Family Practice	0	In state provider	None	3000 COLBY ST	STE 304	BERKELEY	CA	94705	2058	01	06001	37.85473248	-122.2575793	Alameda County
162620	Fee-for-Service	1174517296	1174517296	1	1	KOE, STEVEN R MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	45900	41	Internal Medicine	0	In state provider	None	1000 NEWBURY RD	STE 115	NEWBURY PARK	CA	91320	6436	56	06111	34.18353384	-118.9044556	Ventura County
162624	Fee-for-Service	1467612580	1467612580	1	1	KATZER, ROBERT J MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116544	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
162651	Fee-for-Service	1427082882	1427082882	1	1	KRISHNAN, RAJAGOPAL MD	7/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48568	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
162675	Fee-for-Service	1255515490	1255515490	1	1	KINSELLA, KATHRYN L MD	7/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101539	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
162714	Fee-for-Service	1245228766	1245228766	1	1	KALRA, RUBEN MD	7/1/2008	207LP2900X	NA	Other	026	PHYSICIANS	102041	05	Anesthesiology	0	In state provider	None	2420 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	4319	07	06013	37.77229042	-121.9634581	Contra Costa County
162733	Fee-for-Service	1649276296	1649276296	1	1	KINGSFORD, RALPH P MD	11/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49592	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6037	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
162735	Fee-for-Service	1407333214	1407333214	1	1	KIM, DIANA	2/22/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
162768	Fee-for-Service	1649438706	1649438706	1	1	KAPLAN, BONNIE L MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
162779	Fee-for-Service	1780775742	1780775742	1	1	KHATCHIKIAN, AUDREY PHD	12/27/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
162840	Fee-for-Service	1164008918	1164008918	1	1	KIM, ELEANOR MD	2/4/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
162862	Fee-for-Service	1992009955	1992009955	1	1	KRAMER, KATHERINE J MD	6/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	117460	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
162884	Fee-for-Service	1699125450	1699125450	1	1	KONDILI, DHIMITER MD	7/13/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172716	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
162924	Fee-for-Service	1619377793	1619377793	1	1	KLEINBERG, ARTHUR	10/4/2022	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
162925	Fee-for-Service	1336239011	1336239011	2	1	KOSMISKI, LISA A MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
162938	Fee-for-Service	1427082882	1427082882	1	1	KRISHNAN, RAJAGOPAL MD	7/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48568	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
162945	Fee-for-Service	1437710555	1437710555	1	1	KIRANE, MARK DO	3/21/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23742	30	Radiology	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
162958	Fee-for-Service	1720668312	1720668312	1	1	KOENIG, JENNY B	5/16/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
162980	Fee-for-Service	1073790408	1073790408	1	1	K & Z INC	4/6/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4250 BARRANCA PKWY	SUITE F	IRVINE	CA	92604	1731	30	06059	33.68149363	-117.8045855	Orange County
162992	Fee-for-Service	1104092477	1104092477	1	1	KEEYAPAJ, WORASAK MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133317	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
163002	Fee-for-Service	1790281947	1790281947	1	1	KOEPPEN, ERICA S NP	4/25/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
163006	Fee-for-Service	1043604606	1043604606	1	1	KJELLAND, JACOB MD	10/12/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	145633	None	None	0	In state provider	None	1020 NUT TREE RD	STE 390	VACAVILLE	CA	95687	4100	48	06095	38.35512	-121.94973	Solano County
163009	Fee-for-Service	1952807067	1952807067	1	1	KAHLON, AVNEET S DO	12/1/2021	208M00000X	NA	Other	026	PHYSICIANS	17905	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
163026	Fee-for-Service	1588663769	1588663769	1	9	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4945 W CYPRESS AVE	SUITE A	VISALIA	CA	93277	1592	54	06107	36.323226	-119.346048	Tulare County
163038	Fee-for-Service	1326013319	1326013319	1	1	KAO, YANG-EN S MD	9/25/2020	171000000X	NA	Other	026	PHYSICIANS	110899	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
163079	Fee-for-Service	1649338914	1649338914	1	1	KOHANZADEH, SHAHLA MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	47964	None	None	0	In state provider	CLINICA MEDICA SANTA MAR	803 S ALVARADO ST	None	LOS ANGELES	CA	90057	4009	19	06037	34.05457879	-118.2780627	Los Angeles County
163124	Fee-for-Service	1063429777	1063429777	1	1	KOULIBALI,LAZENI DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST	None	SALEM	OR	97301	0000	00	None	44.933211	-123.0355125	Marion County
163132	Fee-for-Service	1649480468	1649480468	1	1	KRISHNAN, JYOTHI MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55866	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
163165	Fee-for-Service	1104382506	1104382506	1	1	KAMOTHO, ELIJAH K	8/12/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	30362 BLUE CEDAR DRIVE	None	MENIFEE	CA	92584	2744	33	06065	33.68038367	-117.1984828	Riverside County
163195	Fee-for-Service	1215011945	1215011945	1	1	KAPLAN, DAVID W MD	2/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
163210	Fee-for-Service	1336239011	1336239011	2	1	KOSMISKI, LISA A MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	67	Endocrinology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
163231	Fee-for-Service	1881785624	1881785624	1	1	KEVIN YOO, M.D. APC	7/24/2024	174400000X	NA	Other	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	4150 REGENTS PARK ROW	STE 325	LA JOLLA	CA	92037	9102	37	06073	32.87272099	-117.2175656	San Diego County
163239	Fee-for-Service	1508899758	1508899758	1	2	KAMRA, DHEERAJ MD APMC	4/18/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6608 MERCY COURT	SUITE C	FAIR OAKS	CA	95628	3171	34	06067	38.665917	-121.3106895	Sacramento County
163240	Fee-for-Service	1902084635	1902084635	1	1	KYLE ARNOLD	4/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
163291	Fee-for-Service	1710093182	1710093182	1	1	KIM, HANS H MD	5/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100556	18	Ophthalmology	0	In state provider	None	4201 TORRANCE BLVD	STE 220	TORRANCE	CA	90503	4537	19	06037	33.8375955	-118.358748	Los Angeles County
163344	Fee-for-Service	1477663565	1477663565	1	1	KOELER, THU T OD	6/26/2007	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3705 E SOUTH ST	None	LONG BEACH	CA	90805	4521	19	06037	33.86026343	-118.1478013	Los Angeles County
163346	Fee-for-Service	1437189230	1437189230	1	1	KRIENGPRARTHANA, ROSA MD	12/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70576	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
163363	Fee-for-Service	1639240492	1639240492	1	1	KNIGHT, GAIL R MD	6/21/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71285	40	Pediatrics	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
163386	Fee-for-Service	1548254089	1548254089	1	1	KOWALCZYK, JOHN J DO	7/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	6818	34	Urology and Urological Surgery	0	In state provider	INC	1127 WILSHIRE BLVD	STE 1001	LOS ANGELES	CA	90017	4001	19	06037	34.05270508	-118.2641005	Los Angeles County
163424	Fee-for-Service	1295897700	1295897700	1	1	KLEIN, JOSEPH R MD	1/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11669	05	Anesthesiology	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
163431	Fee-for-Service	1891818738	1891818738	1	1	KELAVA, MIRJANA PHD	8/21/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
163454	Fee-for-Service	1104382506	1104382506	1	1	KAMOTHO, ELIJAH K	8/12/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	30362 BLUE CEDAR DRIVE	None	MENIFEE	CA	92584	2744	33	06065	33.68038367	-117.1984828	Riverside County
163464	Fee-for-Service	1770780959	1770780959	1	1	KANDULA, LEENA MD	6/12/2018	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	144233	10	Gastroenterology (M.D. only)	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
163488	Fee-for-Service	1770124166	1770124166	1	1	KANDA, MICHELLE M OT	8/21/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
163506	Fee-for-Service	1306827944	1306827944	1	1	KUTZ, DAVID L MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80373	26	Psychiatry (child)	0	In state provider	None	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
163522	Fee-for-Service	1881785624	1881785624	1	1	KEVIN YOO, M.D. APC	8/14/2024	174400000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4150 REGENTS PARK ROW	STE 325	LA JOLLA	CA	92037	9102	37	06073	32.87272099	-117.2175656	San Diego County
163539	Fee-for-Service	1508051459	1508051459	1	1	KRIL, MERVIN P MD	8/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31299	02	General Surgery	0	In state provider	None	6325 TOPANGA CANYON BLVD	STE 513	WOODLAND HILLS	CA	91367	2053	19	06037	34.184934	-118.6059175	Los Angeles County
163551	Fee-for-Service	1124431374	1124431374	1	1	KARM, DEBORAH L MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3828 SCHAUFELE AVE	STE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
163554	Fee-for-Service	1427123132	1427123132	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	OAKLAND/RICHMOND	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
163567	Fee-for-Service	1568660439	1568660439	1	1	KAUR, AMRITA DO	1/4/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	18941	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
163572	Fee-for-Service	1831341155	1831341155	1	1	KHAKPOUR, HOUMAN MD	4/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110480	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
163582	Fee-for-Service	1366760027	1366760027	1	1	KAHLON, TALWINDERDEEP S MD	3/4/2017	390200000X	NA	Other	026	PHYSICIANS	132538	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1540 FLORIDA AVE	STE 100	MODESTO	CA	95350	4430	50	06099	37.667115	-120.9962205	Stanislaus County
163598	Fee-for-Service	1437100898	1437100898	1	2	KRISHNA, ALOK MD	8/5/2024	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	55199	-	NOT APPLICABLE	0	In state provider	None	1103 SIBLEY ST	None	FOLSOM	CA	95630	3274	34	06067	38.665224	-121.172931	Sacramento County
163602	Fee-for-Service	1932595493	1932595493	1	1	KRATTER, IAN H MD	6/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	160540	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
163612	Fee-for-Service	1689181885	1689181885	1	1	KAUR, PRABPREET MD	10/18/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	168290	36	Psychiatry	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
163647	Fee-for-Service	1528004470	1528004470	2	1	KAUFFMAN, JANE Y MD	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51293	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8733 BEVERLY BLVD	SUITE 312	WEST HOLLYWOOD	CA	90048	1843	19	06037	34.07688048	-118.3815765	Los Angeles County
163649	Fee-for-Service	1538247317	1538247317	1	1	KIM, EILEEN Y MD	6/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83305	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
163651	Fee-for-Service	1780603183	1780603183	1	1	KORENMAN, STANLEY G MD	1/1/1995	207RE0101X	NA	Endocrinology	026	PHYSICIANS	12064	None	None	0	In state provider	UCLA CTR FOR THE HLTH SC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
163676	Fee-for-Service	1730271040	1730271040	1	1	KAYE, DAVID H DO	2/5/2024	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	6458	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
163725	Fee-for-Service	1053548446	1053548446	1	1	KIM, JANICE H MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114653	40	Pediatrics	0	In state provider	None	1141 PEAR TREE LN	None	NAPA	CA	94558	6485	28	06055	38.32125908	-122.2921523	Napa County
163752	Fee-for-Service	1770780959	1770780959	1	1	KANDULA, LEENA MD	6/12/2018	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	144233	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
163758	Fee-for-Service	1912927419	1912927419	1	1	KOOK, EMILY Y OD	12/4/2007	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3200 N SEPULVEDA BLVD	STE E4	MANHATTAN BEACH	CA	90266	2469	19	06037	33.898797	-118.393713	Los Angeles County
163791	Fee-for-Service	1912069550	1912069550	1	1	KERENDI, FARNAZ S PHD	2/1/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6360 WILSHIRE BLVD	STE 414	LOS ANGELES	CA	90048	5601	19	06037	34.06363617	-118.3676811	Los Angeles County
163809	Fee-for-Service	1922118884	1922118884	1	1	KINTER, CHRISTOPHER R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73863	02	General Surgery	0	In state provider	INC	1247 E ALLUVIAL AVE	STE 101	FRESNO	CA	93720	2686	10	06019	36.84470048	-119.7606195	Fresno County
163817	Fee-for-Service	1962600692	1962600692	1	1	KRESHA,TERRI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	35713	6204	00	None	32.175801	-110.9306925	Pima County
163833	Fee-for-Service	1245551647	1245551647	1	1	KURTYKA, JAMEN G MD	10/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137287	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91107	3010	19	06037	34.133598	-118.1534895	Los Angeles County
163865	Fee-for-Service	1699077065	1699077065	1	1	KANIARU, JAMES	7/14/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	664 DAPHNE LN	None	LEMOORE	CA	93245	4244	16	06031	36.30496479	-119.7677959	Kings County
163875	Fee-for-Service	1467911495	1467911495	1	1	KARIHE, DIANA MUTHONI	4/24/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	961 E PHILLIPS BLVD	UNIT 10	POMONA	CA	91766	7553	19	06037	34.04452949	-117.737649	Los Angeles County
163927	Fee-for-Service	1457662553	1457662553	1	1	KOPYLOV, ANDREI V MD	6/11/2021	207L00000X	NA	Other	026	PHYSICIANS	134654	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
163934	Fee-for-Service	1639220213	1639220213	1	1	KENECHUKWU OFORDEME, M.D.	9/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6750 WEST LOOP S	STE 950	BELLAIRE	TX	77401	4124	00	None	29.70663367	-95.46002735	Harris County
163935	Fee-for-Service	1558474262	1558474262	1	1	KIM, CLEMENT C MD	1/1/1999	207R00000X	NA	Other	026	PHYSICIANS	64821	40	Pediatrics	0	In state provider	None	23838 VALENCIA BLVD	None	VALENCIA	CA	91355	5319	19	06037	34.41337791	-118.5520369	Los Angeles County
163956	Fee-for-Service	1598743700	1598743700	1	1	KUSSKE, AMY M MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	78872	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
163961	Fee-for-Service	1285893602	1285893602	1	1	KRISTO, CAROLINE Z LMFT	5/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29995 TECHNOLOGY DR	STE 304	MURRIETA	CA	92563	7230	33	06065	33.56041691	-117.1370428	Riverside County
163992	Fee-for-Service	1295787646	1295787646	1	1	KAYE, TODD B MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	60893	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
164034	Fee-for-Service	1245546639	1245546639	1	1	KANN, GREGORY S MD	8/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122214	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
164038	Fee-for-Service	1588103725	1588103725	1	1	KWAN, PATRICK MD INC	10/20/2017	207L00000X	NA	Other	026	PHYSICIANS	71487	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
164059	Fee-for-Service	1104873603	1104873603	1	1	KELTS, DREW G MD	8/27/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	40720	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
164087	Fee-for-Service	1942252911	1942252911	1	1	KAHL, NATASHA A MD	10/1/2000	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62156	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3317 CHANATE RD	None	SANTA ROSA	CA	95404	1737	49	06097	38.470896	-122.708889	Sonoma County
164108	Fee-for-Service	1497230767	1497230767	1	1	KHAFAJIZADEH, BEHNOUSH	5/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
164121	Fee-for-Service	1194148171	1194148171	1	1	KAISER FOUNDATION HEALTH	8/13/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	1302 ROCKY POINT DR	FL 1	OCEANSIDE	CA	92056	5864	37	06073	33.21492434	-117.2906436	San Diego County
164129	Fee-for-Service	1811373962	1811373962	1	1	KHANDELWAL, SACHIL DO	8/13/2018	207R00000X	NA	Other	026	PHYSICIANS	15118	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
164151	Fee-for-Service	1922218338	1922218338	1	1	KHOKHAR, SAMINA MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115334	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
164154	Fee-for-Service	1699077065	1699077065	1	1	KANIARU, JAMES	7/14/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	664 DAPHNE LN	None	LEMOORE	CA	93245	4244	16	06031	36.30496479	-119.7677959	Kings County
164161	Fee-for-Service	1467911495	1467911495	1	1	KARIHE, DIANA MUTHONI	4/24/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	961 E PHILLIPS BLVD	UNIT 10	POMONA	CA	91766	7553	19	06037	34.04452949	-117.737649	Los Angeles County
164175	Fee-for-Service	1720428048	1720428048	1	1	KOOKOOTSEDES, GAYLE M	2/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	62644	None	None	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
164212	Fee-for-Service	1366790602	1366790602	1	1	KAUR, RESHAM MD	7/30/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154644	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
164222	Fee-for-Service	1558474262	1558474262	1	1	KIM, CLEMENT C MD	1/1/1999	207R00000X	NA	Other	026	PHYSICIANS	64821	41	Internal Medicine	0	In state provider	None	23838 VALENCIA BLVD	None	VALENCIA	CA	91355	5319	19	06037	34.41337791	-118.5520369	Los Angeles County
164232	Fee-for-Service	1780720151	1780720151	1	1	KUCHAKULLA, RAGHUNATH R MD	11/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100558	05	Anesthesiology	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
164233	Fee-for-Service	1336177484	1336177484	1	1	KAN, BRIAN D MD	11/30/1990	174400000X	NA	Other	026	PHYSICIANS	65744	08	Family Practice	0	In state provider	None	5800 HANNUM AVE	None	CULVER CITY	CA	90230	6502	19	06037	33.98724995	-118.3858338	Los Angeles County
164251	Fee-for-Service	1811393309	1811393309	1	1	KOMONDOR, KATHERINE D NP	4/18/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
164282	Fee-for-Service	1295787646	1295787646	1	1	KAYE, TODD B MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	60893	67	Endocrinology	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
164285	Fee-for-Service	1942483375	1942483375	1	1	KERRI S PARKS MD A PROF	3/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL CORPORATION	1808 VERDUGO BLVD	STE 208	GLENDALE	CA	91208	1415	19	06037	34.2056211	-118.2154553	Los Angeles County
164293	Fee-for-Service	1417109117	1417109117	1	1	KAO, ANNE R MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	97820	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
164295	Fee-for-Service	1518499763	1518499763	1	1	KINET, MAXIME J MD	6/23/2021	207RR0500X	NA	Other	026	PHYSICIANS	159747	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
164323	Fee-for-Service	1598276446	1598276446	1	1	KHAN, SADIA M NP	8/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
164334	Fee-for-Service	1427123132	1427123132	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
164345	Fee-for-Service	1104873603	1104873603	1	1	KELTS, DREW G MD	8/27/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	40720	10	Gastroenterology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
164360	Fee-for-Service	1487968541	1487968541	1	1	KULKARNI, RISHIKESH P MD	5/16/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	157619	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
164393	Fee-for-Service	1689657496	1689657496	2	1	KUMAR, VASANTH K MD	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	32885	41	Internal Medicine	0	In state provider	None	2105 BEVERLY BLVD	SUITE 205	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
164467	Fee-for-Service	1477651222	1477651222	1	1	KELLY, KAREN L MD	12/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88845	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
164481	Fee-for-Service	1821158775	1821158775	1	1	KUNDI, MUKHTAIR S MD	12/31/1985	2084N0400X	NA	Neurology	026	PHYSICIANS	41283	13	Neurology (M.D. only)	0	In state provider	None	412 W CARROLL AVE	STE 105	GLENDORA	CA	91741	4705	19	06037	34.13415622	-117.8702547	Los Angeles County
164555	Fee-for-Service	1073033239	1073033239	1	1	KROM, ABBY D LMFT	10/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2676	19	06037	34.17245599	-118.5633517	Los Angeles County
164588	Fee-for-Service	1083666564	1083666564	1	1	KIM, VIVIAN T MD	4/28/1997	207L00000X	NA	Other	026	PHYSICIANS	78573	05	Anesthesiology	0	In state provider	None	4643 QUAIL LAKES DR	STE 204	STOCKTON	CA	95207	5269	39	06077	37.987092	-121.343391	San Joaquin County
164627	Fee-for-Service	1770747305	1770747305	1	1	KAWASAKI, MIZIN MD	3/31/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	63471	40	Pediatrics	0	In state provider	None	425 HAALAND DRIVE	104	THOUSAND OAKS	CA	91361	0000	19	06037	34.17512608	-118.8697623	Ventura County
164647	Fee-for-Service	1720374671	1720374671	1	1	KEEN, JORDAN MD	10/28/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
164695	Fee-for-Service	1578902573	1578902573	1	1	KAMBEYANDA, ROHAN MD	12/16/2024	2086S0122X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	555 HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
164696	Fee-for-Service	1568804235	1568804235	1	1	KAUR, NINA PSYD	4/27/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3443 W SHAW AVE	None	FRESNO	CA	93711	3249	10	06019	36.805356	-119.854413	Fresno County
164735	Fee-for-Service	1962724948	1962724948	1	1	KNIGHT, RONEESHA S MD	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107935	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT ROAD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
164736	Fee-for-Service	1043273295	1043273295	1	1	KRAMER, SCOTT L. MD	1/22/1996	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	59337	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2299 MOWRY AVE	STE 3C	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
164755	Fee-for-Service	1477651222	1477651222	1	1	KELLY, KAREN L MD	12/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88845	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
164757	Fee-for-Service	1518745181	1518745181	1	1	KANGIRI, SAMSON KIARIE	2/14/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33098 CANOPY LN	None	LAKE ELSINORE	CA	92532	2540	33	06065	33.65746924	-117.2454503	Riverside County
164767	Fee-for-Service	1801003959	1801003959	1	1	KIRK, CARISSA N MD	3/29/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	20576	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
164864	Fee-for-Service	1316083926	1316083926	1	1	KAISER FHP, INC	3/1/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #516	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
164865	Fee-for-Service	1548376783	1548376783	1	1	KUMAR, SARASA MD INC	4/7/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49540	None	None	0	In state provider	None	13768 ROSWELL AVE	STE 205	CHINO	CA	91710	1405	36	06071	34.0038	-117.7218555	San Bernardino County
164873	Fee-for-Service	1265474225	1265474225	1	1	KANG, JUNKU MD	4/30/1993	207R00000X	NA	Other	026	PHYSICIANS	76252	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
164882	Fee-for-Service	1205992310	1205992310	1	1	KNOX, FRANCES M MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104775	30	Radiology	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
164983	Fee-for-Service	1003120452	1003120452	1	2	KIMBERLY PETERSON, O.D., INC	1/16/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 N RIVERSIDE AVE	SUITE 100	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
164988	Fee-for-Service	1487701702	1487701702	1	1	KAISER PHARMACY #030	10/27/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	444 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2917	19	06037	34.1598361	-118.2632528	Los Angeles County
165044	Fee-for-Service	1518745181	1518745181	1	1	KANGIRI, SAMSON KIARIE	2/14/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33098 CANOPY LN	None	LAKE ELSINORE	CA	92532	2540	33	06065	33.65746924	-117.2454503	Riverside County
165064	Fee-for-Service	1366922924	1366922924	1	1	KALTENBACH, AMY D LMFT	9/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1985 YOSEMITE AVE.	#230	SIMI VALLEY	CA	93063	5200	56	06111	34.27096005	-118.6784091	Ventura County
165116	Fee-for-Service	1952796062	1952796062	1	1	KHAN, ANEE Z MD	6/5/2020	207P00000X	NA	Other	026	PHYSICIANS	162508	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
165179	Fee-for-Service	1669844650	1669844650	2	1	KERN MEDICAL SUPPLY LLC	1/18/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2520 PEGASUS DRIVE	None	BAKERSFIELD	CA	93308	6807	15	06029	35.42875536	-119.0642444	Kern County
165187	Fee-for-Service	1992908123	1992908123	1	1	KHAN, IMRAN A MD	9/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97975	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
165247	Fee-for-Service	1275738445	1275738445	1	2	KUMARI, RADHIKA MD	5/1/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	117307	None	None	0	In state provider	None	1551 BISHOP	STE 230	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
165271	Fee-for-Service	1992118616	1992118616	1	1	KAKU, SHAWN K MD INC	10/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
165378	Fee-for-Service	1922014273	1922014273	1	1	KERRY ALAN BLACKHAM, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	131 E MAIN ST	STE 3	SALINA	UT	84654	1335	00	None	38.95759313	-111.8577843	Sevier County
165402	Fee-for-Service	1255643201	1255643201	1	1	KIM, SUSAN A MD	7/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113035	41	Internal Medicine	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
165430	Fee-for-Service	1225099286	1225099286	1	1	KAO, ALBERT C MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75956	None	None	0	In state provider	None	1498 SOUTHGATE AVE	STE 102	DALY CITY	CA	94015	4015	41	06081	37.67558947	-122.4761175	San Mateo County
165448	Fee-for-Service	1225116072	1225116072	1	1	KODURI, ARUNA MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	44559	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
165485	Fee-for-Service	1699193649	1699193649	1	1	KAHN, EUGENE T MD	6/23/2022	208600000X	NA	General Surgery	026	PHYSICIANS	149600	None	None	0	In state provider	None	2617 E CHAPMAN AVE	103	ORANGE	CA	92869	3226	30	06059	33.7878445	-117.8254845	Orange County
165504	Fee-for-Service	1063688851	1063688851	1	1	KHEMANI, ROBINDER G MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91014	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
165528	Fee-for-Service	1992169940	1992169940	1	1	KEYSTONE PEDIATRIC BEHAVIORA	6/25/2019	103TM1800X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	L HEALTH, INC.	12062 VALLEY VIEW STREET	SUITE 220	GARDEN GROVE	CA	92845	1001	30	06059	33.78720885	-118.028413	Orange County
165534	Fee-for-Service	1285077255	1285077255	1	1	KHAN, JAMEEL J MD	9/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143447	25	Physical Medicine and Rehabilitation	0	In state provider	None	3421 VILLA LN	STE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
165544	Fee-for-Service	1285907147	1285907147	1	1	KARODY, ATULA R PT	3/19/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
165552	Fee-for-Service	1679623706	1679623706	1	1	KATTENHORN, DAVID L	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	50 E FOOTHILL BLVD	STE 204	ARCADIA	CA	91006	2314	19	06037	34.15096965	-118.0295442	Los Angeles County
165596	Fee-for-Service	1578854170	1578854170	1	1	KUNDI, MUKHTAIR S MD INC	2/9/2015	302F00000X	NA	Other	026	PHYSICIANS	41283	13	Neurology (M.D. only)	0	In state provider	A MEDICAL CORPORATION	415 W CARROLL AVE	SUITE 203	GLENDORA	CA	91741	4208	19	06037	34.13420945	-117.870876	Los Angeles County
165611	Fee-for-Service	1437448917	1437448917	1	1	KO, KIMBERLY J MD	4/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77120	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
165670	Fee-for-Service	1790741734	1790741734	1	1	KRISHNA, VASANTHI MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119222	13	Neurology (M.D. only)	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
165676	Fee-for-Service	1790727139	1790727139	1	1	KOCHARIAN, EDWARD MD	11/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52852	None	None	0	In state provider	None	435 ARDEN AVENUE	SUITE 450	GLENDALE	CA	91203	4024	19	06037	34.15848148	-118.2628845	Los Angeles County
165682	Fee-for-Service	1174731095	1174731095	1	1	KHAN, FAHD R MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114240	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
165710	Fee-for-Service	1740243286	1740243286	2	1	KLYSTRA, TRIENEKE A MD	10/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65110	08	Family Practice	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
165727	Fee-for-Service	1962845602	1962845602	1	1	KIDD, STEPHANIE C MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134765	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
165733	Fee-for-Service	1780844290	1780844290	1	1	KRISHAN, RACHNA MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120344	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
165740	Fee-for-Service	1982073615	1982073615	1	1	KIKANI, SWETA D LMFT	8/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1940 W ORANGEWOOD AVE	STE 202	ORANGE	CA	92868	1206	30	06059	33.79574869	-117.8734735	Orange County
165742	Fee-for-Service	1760197420	1760197420	1	1	KIIRU, CATHERINE WAMBUI	7/5/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11601 FIRESTONE BLVD	APT 101	NORWALK	CA	90650	8824	19	06037	33.91461427	-118.0851629	Los Angeles County
165766	Fee-for-Service	1265847461	1265847461	1	1	KEATS, ARIELE CRNA	12/28/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
165773	Fee-for-Service	1215998737	1215998737	1	1	KEUM, JACOB S S DO	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13246	66	Emergency Medicine (Urgent Care)	0	In state provider	None	240 SPRUCE STREET	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
165817	Fee-for-Service	1912074857	1912074857	1	1	KU, SIN SONG MD	9/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64824	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
165818	Fee-for-Service	1073955191	1073955191	1	1	KATTAN, ALIA S MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133092	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
165827	Fee-for-Service	1386796050	1386796050	1	1	KARALAKULASINGAM, CHRISHANT	8/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121652	None	None	0	In state provider	HIE J MD	500 UNIVERSITY AVENUE	SUITE 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
165829	Fee-for-Service	1306827324	1306827324	1	1	KIM, CHRISTINE C MD	5/3/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	100588	07	Dermatology	0	In state provider	None	713 N DOUGLAS ST.	None	EL SEGUNDO	CA	90245	2830	19	06037	33.92546537	-118.3832318	Los Angeles County
165834	Fee-for-Service	1114154861	1114154861	1	1	KRUSE, JENNIFER L MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113860	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90074	0001	19	06037	34.07067	-118.4432445	Los Angeles County
165842	Fee-for-Service	1437453891	1437453891	1	1	KIM, BO KYUN LAC	11/12/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	13560 SAN ANTONIO DR	# C	NORWALK	CA	90650	4045	19	06037	33.90780423	-118.0766887	Los Angeles County
165862	Fee-for-Service	1629158894	1629158894	1	1	KAWAS, CLAUDIA H MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50534	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
165884	Fee-for-Service	1942576384	1942576384	1	1	KUNG, DAVID CHIEN-YUAN OD	9/16/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
165896	Fee-for-Service	1861656977	1861656977	1	1	KEEGAN, CATHERINE N MD	6/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	134082	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
165961	Fee-for-Service	1891925640	1891925640	1	1	KUAN, JENNY Y C OD	9/5/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
166031	Fee-for-Service	1760197420	1760197420	1	1	KIIRU, CATHERINE WAMBUI	7/5/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11601 FIRESTONE BLVD	APT 101	NORWALK	CA	90650	8824	19	06037	33.91461427	-118.0851629	Los Angeles County
166036	Fee-for-Service	1518100445	1518100445	1	1	KATHERINE ELISA WILLIAMS	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
166061	Fee-for-Service	1457513863	1457513863	1	1	KAMAU, DORIS WANJIKU	6/7/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1352 WALDEN DRIVE	None	FOLSOM	CA	95630	8467	33	06065	38.649069	-121.130424	Sacramento County
166070	Fee-for-Service	1740226919	1740226919	1	1	KAMRATH, RICHARD O MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	34661	67	Endocrinology	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
166074	Fee-for-Service	1942778675	1942778675	1	1	KFK CORP	5/24/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	720 S. RAMONA AVE	102	CORONA	CA	92879	2153	33	06065	33.87364876	-117.5654939	Riverside County
166080	Fee-for-Service	1497849343	1497849343	1	1	KAPOOR, NEENA MD	2/9/1994	2080P0207X	NA	Hematology	026	PHYSICIANS	43167	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
166085	Fee-for-Service	1386843035	1386843035	1	1	KAHENZADEH, SHIRLEY M LCSW	8/2/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	11980 SAN VICENTE BLVD	SUITE 102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
166127	Fee-for-Service	1306910617	1306910617	1	1	KHEMANI, SARITA MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54965	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
166131	Fee-for-Service	1386651115	1386651115	1	1	KORNBLUM, HARLEY I MD	11/30/1992	2080P0008X	NA	Neurology	026	PHYSICIANS	70261	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	STE 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
166154	Fee-for-Service	1962445569	1962445569	1	1	KHANDELWAL, GAUTAM MD	8/14/2023	207P00000X	NA	Other	026	PHYSICIANS	178081	None	None	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
166157	Fee-for-Service	1134634603	1134634603	1	1	KANG, KWANGYO PT	1/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23401 EL TORO RD	SUITE 200	LAKE FOREST	CA	92630	6923	30	06059	33.62343549	-117.6971029	Orange County
166165	Fee-for-Service	1093941221	1093941221	1	1	KINDERMANN, DANA R MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125040	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
166222	Fee-for-Service	1215224761	1215224761	1	1	KELLERT, BRIAN A DO	9/13/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	110 TAMPICO DR	100	WALNUT CREEK	CA	94598	2961	07	06013	37.91113845	-122.0458263	Contra Costa County
166223	Fee-for-Service	1447606819	1447606819	1	1	KAISER FOUNDATION HEALTH	3/28/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	401 BICENTENNIAL WAY	HOSP BLDG FL-1	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
166232	Fee-for-Service	1053370825	1053370825	1	1	KAJIOKA, KEITH DAVID	2/28/1990	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	809 SYLVAN AVE	STE 103	MODESTO	CA	95350	1500	50	06099	37.68900616	-120.9836976	Stanislaus County
166242	Fee-for-Service	1235440330	1235440330	1	1	KIPP, ALEX J MD	9/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170078	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
166244	Fee-for-Service	1043233885	1043233885	1	1	KHAN, FAISAL A MD	4/30/1983	208600000X	NA	General Surgery	026	PHYSICIANS	45343	01	General Practice	0	In state provider	None	10414 VACCO ST	None	SOUTH EL MONTE	CA	91733	3350	19	06037	34.04731781	-118.0443923	Los Angeles County
166296	Fee-for-Service	1033616008	1033616008	1	1	KEITH, HEATHER L NP	3/19/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
166297	Fee-for-Service	1821156027	1821156027	1	1	KOURAJIAN, PETER MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65107	05	Anesthesiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
166306	Fee-for-Service	1164460358	1164460358	1	1	KOENIG, MARC G MD	11/1/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183995	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
166308	Fee-for-Service	1104130160	1104130160	1	1	KERTESZ-BRIEST, HEATHER A PS	3/10/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	YD	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
166331	Fee-for-Service	1588640999	1588640999	1	1	KLEIN, NORMA J MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56215	40	Pediatrics	0	In state provider	ST MARY'S MED CENTER	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
166332	Fee-for-Service	1942425434	1942425434	1	1	KATRINA A LUND	5/30/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7200 STATE HIGHWAY 161	STE 220	IRVING	TX	75039	3830	00	None	32.90456562	-96.95756966	Dallas County
166341	Fee-for-Service	1427240563	1427240563	1	1	KROUSE, DONALD E MD INC	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	42613	01	General Practice	0	In state provider	None	560 MAIN ST	None	WEAVERVILLE	CA	96093	2460	53	06105	40.73286682	-122.9405831	Trinity County
166347	Fee-for-Service	1538399134	1538399134	1	1	KIM, CYNTHIA H MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142112	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
166350	Fee-for-Service	1457513863	1457513863	1	1	KAMAU, DORIS WANJIKU	6/7/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1352 WALDEN DRIVE	None	FOLSOM	CA	95630	8467	33	06065	38.649069	-121.130424	Sacramento County
166360	Fee-for-Service	1740226919	1740226919	1	1	KAMRATH, RICHARD O MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	34661	41	Internal Medicine	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
166363	Fee-for-Service	1104985597	1104985597	1	1	KAWAGOE, DIANE D PHD	8/20/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
166383	Fee-for-Service	1841378924	1841378924	1	1	KERSHNER, PAMELA	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64310	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
166386	Fee-for-Service	1235525684	1235525684	1	1	KATNENI, RATNAJA MD INC	2/16/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	134129	45	Nephrology (Renal-Kidney)	0	In state provider	None	801 N TUSTIN AVE	STE 202	SANTA ANA	CA	92705	3600	30	06059	33.752286	-117.8341735	Orange County
166388	Fee-for-Service	1942408919	1942408919	1	1	KLETS, DIANA OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
166402	Fee-for-Service	1144210626	1144210626	1	1	KAUVAR, DAVID MD	8/1/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	188080	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
166418	Fee-for-Service	1386651115	1386651115	1	1	KORNBLUM, HARLEY I MD	11/30/1992	2080P0008X	NA	Neurology	026	PHYSICIANS	70261	13	Neurology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	STE 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
166449	Fee-for-Service	1437692142	1437692142	1	1	KHATIBIJAH, LADAN PSYD	4/5/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
166454	Fee-for-Service	1962136523	1962136523	1	1	KADENCE HEALTHCARE, INC	2/17/2023	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9351 NARNIA DR	None	RIVERSIDE	CA	92503	5634	33	06065	33.91461556	-117.4386111	Riverside County
166457	Fee-for-Service	1689840415	1689840415	1	1	KWONG, NORRA MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110578	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
166477	Fee-for-Service	1881899144	1881899144	1	1	KAPPAZ, GEORGE C LCSW	12/1/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
166548	Fee-for-Service	1093917254	1093917254	1	1	KOO, CAROLINE	5/17/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	188315	25	Physical Medicine and Rehabilitation	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
166605	Fee-for-Service	1679026363	1679026363	1	1	KIM, HEEYOON MD	8/1/2023	207R00000X	NA	Other	026	PHYSICIANS	183558	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
166613	Fee-for-Service	1407199417	1407199417	1	1	KHOO, CYNTHIA MD	4/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131767	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
166627	Fee-for-Service	1134878655	1134878655	1	1	KLINE, BETHANY CCC-SLP	11/29/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6965 SAN LUIS AVE	None	ATASCADERO	CA	93422	5201	40	06079	35.48021573	-120.6597811	San Luis Obispo County
166638	Fee-for-Service	1770039703	1770039703	1	1	KAWEAH REHAB GROUP INC	11/3/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	840 S AKERS ST	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
166639	Fee-for-Service	1558656132	1558656132	1	1	KIRCHER, JACQUELINE MD	8/25/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
166640	Fee-for-Service	1538399134	1538399134	1	1	KIM, CYNTHIA H MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142112	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
166645	Fee-for-Service	1477717585	1477717585	1	1	KHAN, ADNAN A MD	6/25/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	122069	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
166656	Fee-for-Service	1922155241	1922155241	1	1	KAISER FHP, INC	3/1/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #394	3401 S HARBOR BLVD	FL 1	SANTA ANA	CA	92704	7933	30	06059	33.701166	-117.9194305	Orange County
166661	Fee-for-Service	1982108981	1982108981	1	1	KHACHATRYAN, TIGRAN MD	6/26/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	174703	None	None	0	In state provider	None	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
166668	Fee-for-Service	1124065917	1124065917	1	1	KUBAN, ALAN L MD	5/1/1984	207P00000X	NA	Other	026	PHYSICIANS	51932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
166672	Fee-for-Service	1235525684	1235525684	1	1	KATNENI, RATNAJA MD INC	2/16/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	134129	41	Internal Medicine	0	In state provider	None	801 N TUSTIN AVE	STE 202	SANTA ANA	CA	92705	3600	30	06059	33.752286	-117.8341735	Orange County
166691	Fee-for-Service	1396746046	1396746046	1	1	KERCHBERGER, VERN H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 E CENTRAL RD	None	ARLINGTON HTS	IL	60005	2857	00	None	42.06647051	-87.966846	Cook County
166719	Fee-for-Service	1578116976	1578116976	1	1	KINDRED HEART HOSPICE INC	3/19/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 207F	CANOGA PARK	CA	91303	2366	19	06037	34.1994564	-118.5884133	Los Angeles County
166745	Fee-for-Service	1689840415	1689840415	1	1	KWONG, NORRA MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110578	67	Endocrinology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
166756	Fee-for-Service	1780749549	1780749549	1	1	KWAN, WINNIE Y MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97228	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
166766	Fee-for-Service	1588663769	1588663769	1	17	KAWEAH DELTA HEALTH CARE	3/14/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	202 W WILLOW ST	SUITE 202	VISALIA	CA	93291	6238	54	06107	36.3283683	-119.29356	Tulare County
166778	Fee-for-Service	1770362998	1770362998	1	1	KIM, ALICE K NP	1/11/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	421 N BROOKHURST ST	STE 119	ANAHEIM	CA	92801	5618	30	06059	33.83743497	-117.9590498	Orange County
166785	Fee-for-Service	1295295764	1295295764	1	1	KUSARI, AYAN MD	5/15/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	181659	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166834	Fee-for-Service	1356379473	1356379473	1	1	KIMBELL, ARMAGHAN N DO	11/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	12906	08	Family Practice	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
166848	Fee-for-Service	1316030224	1316030224	1	1	KAHN, JAMES R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58941	01	General Practice	0	In state provider	None	5144 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10419823	-122.9089591	Lake County
166867	Fee-for-Service	1528055456	1528055456	1	1	KIM, YANG S MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146105	40	Pediatrics	0	In state provider	None	500 S VIRGIL AVE	SUITE 204	LOS ANGELES	CA	90020	1446	19	06037	34.064964	-118.2870335	Los Angeles County
166871	Fee-for-Service	1578060976	1578060976	1	1	KIM, STAECY MD	11/7/2022	390200000X	NA	Other	026	PHYSICIANS	173674	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
166888	Fee-for-Service	1215039094	1215039094	1	1	KINZIE, WESLEY E MD	5/31/1986	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	48580	20	Orthopedic Surgery	0	In state provider	None	1401 SPANOS CT	STE 101	MODESTO	CA	95355	2811	50	06099	37.66975543	-120.9724048	Stanislaus County
166899	Fee-for-Service	1205134665	1205134665	1	1	KHAN, SADIA DO	12/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11449	02	General Surgery	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
166917	Fee-for-Service	1932528684	1932528684	1	1	KUCERA, WALTER B MD	6/13/2024	208600000X	NA	General Surgery	026	PHYSICIANS	183863	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
166919	Fee-for-Service	1881801835	1881801835	1	3	KIDS-CARE PEDIATRIC	11/1/1998	2080H0002X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	1164 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849621	-117.941612	Orange County
166926	Fee-for-Service	1770039703	1770039703	1	1	KAWEAH REHAB GROUP INC	11/3/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	840 S AKERS ST	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
166947	Fee-for-Service	1588959688	1588959688	1	1	KIM, EUGENE S MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130824	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	SUITE B 100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
166958	Fee-for-Service	1386703726	1386703726	1	1	KARON, JEFFREY R MD	6/1/2018	207R00000X	NA	Other	026	PHYSICIANS	43218	41	Internal Medicine	0	In state provider	None	500 SAN PABLO AVE	None	ALBANY	CA	94706	1127	01	06001	37.89781848	-122.3014067	Alameda County
166959	Fee-for-Service	1093103681	1093103681	1	1	KOTAKONDA, HARI PRASAD V AU	1/13/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
167008	Fee-for-Service	1578116976	1578116976	1	1	KINDRED HEART HOSPICE INC	3/19/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 207F	CANOGA PARK	CA	91303	2366	19	06037	34.1994564	-118.5884133	Los Angeles County
167097	Fee-for-Service	1043272172	1043272172	1	1	KAWEAH DELTA HEALTH CARE	8/8/1998	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1014 SAN JUAN AVE	None	EXETER	CA	93221	1312	54	06107	36.29887348	-119.1316702	Tulare County
167105	Fee-for-Service	1144617002	1144617002	1	1	KHORFAN, RHAMI MD	10/1/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	175807	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
167139	Fee-for-Service	1063490464	1063490464	1	1	KIKER, DALE G MD	12/30/1988	174400000X	NA	Other	026	PHYSICIANS	43889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15151 JANINE DR	None	WHITTIER	CA	90605	1803	19	06037	33.94969305	-118.0035917	Los Angeles County
167156	Fee-for-Service	1710567573	1710567573	1	1	KIND HOME HEALTH CARE INC	1/20/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19634 VENTURA BLVD	SUITE 222	TARZANA	CA	91356	7145	19	06037	34.17264197	-118.5613482	Los Angeles County
167157	Fee-for-Service	1699970947	1699970947	1	1	KHAN, MICHELLE J MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117395	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
167182	Fee-for-Service	1235663857	1235663857	1	1	KURNIK, CHRISTOPHER MD	10/11/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	191395	None	None	0	In state provider	None	4300 GOLDEN CENTER DRIVE	SUITE C	PLACERVILLE	CA	95667	6278	09	06017	38.70657265	-120.82856	El Dorado County
167217	Fee-for-Service	1417502022	1417502022	1	1	KNITTEL, MICHAEL CRNA	3/22/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
167253	Fee-for-Service	1235347477	1235347477	1	1	KIM, KENNETH H MD	8/10/2020	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169111	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
167274	Fee-for-Service	1295121721	1295121721	1	1	KELLEHER, DIANNEJOY PT	2/17/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
167288	Fee-for-Service	1114212370	1114212370	1	1	KUNCHAKARRA, SIRI MD	11/1/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162615	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2335 E KASHIAN LANE	STE 240	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
167291	Fee-for-Service	1497706816	1497706816	1	1	KIRCHMANN, TIN TIN T MD	8/31/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	75074	07	Dermatology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
167294	Fee-for-Service	1548276777	1548276777	1	1	KIM, JERRY B MD	7/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
167307	Fee-for-Service	1194830521	1194830521	1	1	KUSHEL, MARGOT B MD	11/1/2000	207R00000X	NA	Other	026	PHYSICIANS	61564	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
167314	Fee-for-Service	1902830623	1902830623	2	1	KOBALTER, AMY S MD	12/1/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	78305	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
167316	Fee-for-Service	1750450615	1750450615	1	1	KAY, MARTIN H MD	2/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	60115	07	Dermatology	0	In state provider	None	14857 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4617	19	06037	34.22150352	-118.4571405	Los Angeles County
167359	Fee-for-Service	1265427595	1265427595	1	1	KOO, CHOON S MD	8/2/2005	207ZP0102X	NA	Other	026	PHYSICIANS	31561	22	Pathology (M.D. only)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
167375	Fee-for-Service	1891750212	1891750212	1	1	KLEYNBERG, LEONID M MD	8/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76900	41	Internal Medicine	0	In state provider	None	6221 WILSHIRE BLVD	STE 504	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
167384	Fee-for-Service	1043272172	1043272172	1	1	KAWEAH DELTA HEALTH CARE	10/21/2024	261QR1300X	NA	Rural Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1014 SAN JUAN AVE	None	EXETER	CA	93221	1312	54	06107	36.29887348	-119.1316702	Tulare County
167388	Fee-for-Service	1972243038	1972243038	1	1	KIM, JUNG M CNM	7/14/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
167402	Fee-for-Service	1811285232	1811285232	1	1	KHAIRA, RAJNI MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141157	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
167422	Fee-for-Service	1780400283	1780400283	1	1	KELKELYAN, KOHAR LCSW	1/16/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
167476	Fee-for-Service	1265444145	1265444145	2	1	KALE, ASHAY A MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	65772	20	Orthopedic Surgery	0	In state provider	None	686 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
167501	Fee-for-Service	1013168921	1013168921	1	1	KLINE, KRIS F MD	3/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105567	05	Anesthesiology	0	In state provider	None	514 WEST PUEBLO STREET	2ND FLOOR	SANTA BARBARA	CA	93105	4294	42	06083	34.4279775	-119.7247284	Santa Barbara County
167528	Fee-for-Service	1386790053	1386790053	1	1	KLIGERMAN, SETH J MD	6/16/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147649	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
167545	Fee-for-Service	1699934125	1699934125	1	1	KAPPEN, MATTHEW S MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103989	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
167557	Fee-for-Service	1083813315	1083813315	1	1	KIM, EUGENE C OD	7/23/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6377 RIVERSIDE AVE	STE 101	RIVERSIDE	CA	92506	3155	33	06065	33.9516	-117.387977	Riverside County
167572	Fee-for-Service	1205091170	1205091170	1	1	KLEKER, BRIAN M MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125914	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
167580	Fee-for-Service	1003086182	1003086182	1	1	KANAKADANDI, UDAY B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
167634	Fee-for-Service	1598749848	1598749848	1	1	KIRK, JAMES D MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	66207	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
167664	Fee-for-Service	1891750212	1891750212	1	1	KLEYNBERG, LEONID M MD	8/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76900	78	Neoplastic Diseases/Oncology	0	In state provider	None	6221 WILSHIRE BLVD	STE 504	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
167673	Fee-for-Service	1043272172	1043272172	1	1	KAWEAH DELTA HEALTH CARE	2/15/2000	261QR1300X	NA	Rural Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1014 SAN JUAN AVE	None	EXETER	CA	93221	1312	54	06107	36.29887348	-119.1316702	Tulare County
167693	Fee-for-Service	1902813173	1902813173	2	1	KING, RENEE A MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
167700	Fee-for-Service	1033541248	1033541248	1	1	KOHNER, MELISSA S PSYD	8/8/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2931 SHATTUCK AVE	STE 101D	BERKELEY	CA	94705	1986	01	06001	37.85574785	-122.2665517	Alameda County
167713	Fee-for-Service	1821251570	1821251570	1	1	KROENING, EMILY A MD	5/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110577	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
167755	Fee-for-Service	1356983670	1356983670	1	1	KANG, SOO	2/10/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
167801	Fee-for-Service	1730279035	1730279035	1	1	KAVALERCHIK, EDWARD MD	5/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87968	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
167811	Fee-for-Service	1285955880	1285955880	1	1	KIM, RICHARD E MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129743	05	Anesthesiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
167863	Fee-for-Service	1932632338	1932632338	1	1	KUO, TIFFANY MD	1/1/2021	207R00000X	NA	Other	026	PHYSICIANS	169912	None	None	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
167908	Fee-for-Service	1073019279	1073019279	1	1	KATIBIAN, DAVID J MD	9/1/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	174362	10	Gastroenterology (M.D. only)	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
167916	Fee-for-Service	1669080925	1669080925	1	1	KREITLOW, AMBER LMFT	12/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4909 MURPHY CANYON RD	300	SAN DIEGO	CA	92123	4349	37	06073	32.8287682	-117.1197549	San Diego County
167923	Fee-for-Service	1194120279	1194120279	1	1	KP ANESTHESIA NURSING INC	11/25/2014	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1337 S LOVERS LANE	None	VISALIA	CA	93292	5249	54	06107	36.31828465	-119.2607893	Tulare County
167927	Fee-for-Service	1861616716	1861616716	1	1	KUZMINSKI, SUZANNE M	10/7/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
167943	Fee-for-Service	1699193888	1699193888	1	1	KWAN, CHRISTINA MD	10/29/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	144637	67	Endocrinology	0	In state provider	None	2850 TELEGRAPH AVE	110	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
167951	Fee-for-Service	1891750212	1891750212	1	1	KLEYNBERG, LEONID M MD	8/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76900	68	Hematology	0	In state provider	None	6221 WILSHIRE BLVD	STE 504	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
167960	Fee-for-Service	1043272172	1043272172	1	1	KAWEAH DELTA HEALTH CARE	8/8/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1014 SAN JUAN AVE	None	EXETER	CA	93221	1312	54	06107	36.29887348	-119.1316702	Tulare County
167990	Fee-for-Service	1770061087	1770061087	1	1	KIM, HAI V CRNA	11/17/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
168097	Fee-for-Service	1609415140	1609415140	1	1	KNESEK, SHANG CNP	9/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7096 N WEST AVE	None	FRESNO	CA	93711	0462	10	06019	36.83875103	-119.8262343	Fresno County
168139	Fee-for-Service	1023080033	1023080033	1	1	KILL, MATHIAS J MD	8/5/2010	208600000X	NA	General Surgery	026	PHYSICIANS	75769	02	General Surgery	0	In state provider	None	7910 FROST ST	STE 450	SAN DIEGO	CA	92123	2765	37	06073	32.80027449	-117.153846	San Diego County
168145	Fee-for-Service	1386654010	1386654010	2	1	KAISEY, MUSHRIK MD	4/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	72963	41	Internal Medicine	0	In state provider	None	480 4TH AVE	SUITE 206	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
168147	Fee-for-Service	1144254764	1144254764	1	1	KEARNEY, JOHN P MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	26058	02	General Surgery	0	In state provider	None	401 E 21ST ST	None	SAN BERNARDINO	CA	92404	4845	36	06071	34.13403253	-117.2762685	San Bernardino County
168171	Fee-for-Service	1538778261	1538778261	1	1	KARIMI AFSHAR, ARASH DO	4/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21301	None	None	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
168193	Fee-for-Service	1104336361	1104336361	1	1	KONDAPALLY, YAMUNA R MD	9/22/2020	207R00000X	NA	Other	026	PHYSICIANS	166735	41	Internal Medicine	0	In state provider	None	1701 E FLORIDA AVE	None	HEMET	CA	92544	4632	33	06065	33.74755247	-116.9539875	Riverside County
168200	Fee-for-Service	1073019279	1073019279	1	1	KATIBIAN, DAVID J MD	9/1/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	174362	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
168252	Fee-for-Service	1871757252	1871757252	1	1	KANG, LISA H MD	7/15/2019	2085R0204X	NA	Other	026	PHYSICIANS	159802	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
168258	Fee-for-Service	1710147061	1710147061	1	1	KOMLOS, FABIO MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105861	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
168271	Fee-for-Service	1952764458	1952764458	1	1	KIM, JAEHWAN MD	2/16/2022	207R00000X	NA	Other	026	PHYSICIANS	175700	None	None	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
168288	Fee-for-Service	1376005306	1376005306	1	1	KIM, NAOMI M MD	3/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176418	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
168293	Fee-for-Service	1801819321	1801819321	1	1	KIM, LAUREN S MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79083	41	Internal Medicine	0	In state provider	None	931 BUENA VISTA ST	None	DUARTE	CA	91010	1712	19	06037	34.141635	-117.9775755	Los Angeles County
168328	Fee-for-Service	1285887406	1285887406	2	1	KADENCE HEALTHCARE, INC.	6/25/2021	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7554 TRADE ST	None	SAN DIEGO	CA	92111	2013	37	06073	32.88935194	-117.160079	San Diego County
168332	Fee-for-Service	1457996951	1457996951	1	1	KOVAIAN, SIONEH CRNA	2/27/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8110 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21850103	-118.4310944	Los Angeles County
168344	Fee-for-Service	1073876900	1073876900	1	1	KREVITZ, SHARI M MD INC	3/19/2013	207R00000X	NA	Other	026	PHYSICIANS	103546	41	Internal Medicine	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
168429	Fee-for-Service	1376623538	1376623538	2	2	KERN COUNTY HOSPITAL	9/20/2018	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1111 COLUMBUS ST	SUITE 1000	BAKERSFIELD	CA	93305	1937	15	06029	35.39744148	-118.9822815	Kern County
168431	Fee-for-Service	1497770457	1497770457	1	1	KHOO, LARRY T MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62896	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	# 200	LOS ANGELES	CA	90024	7002	19	06037	34.06473399	-118.445865	Los Angeles County
168435	Fee-for-Service	1316698772	1316698772	1	1	KANG, GYUNGSUNG LAC	4/29/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5471 LA PALMA AVE	# 203-A	LA PALMA	CA	90623	1795	30	06059	33.84643649	-118.0377675	Orange County
168480	Fee-for-Service	1043216856	1043216856	1	1	KLEIS, JEFFREY C DPM	11/18/1999	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	518 16TH ST	APT A	HUNTINGTON BEACH	CA	92648	4080	30	06059	33.66812839	-118.0075454	Orange County
168481	Fee-for-Service	1427723055	1427723055	1	1	KNAGGS, ERIK	11/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300 & 230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
168497	Fee-for-Service	1396829370	1396829370	1	1	KURTZ, KENNETH M MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85564	03	Allergy	0	In state provider	None	1100 PEAR TREE LN	None	NAPA	CA	94558	6446	28	06055	38.32087983	-122.2946228	Napa County
168502	Fee-for-Service	1780975730	1780975730	1	1	KIM, MICHELLE E MD	7/12/2020	207L00000X	NA	Other	026	PHYSICIANS	164382	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
168569	Fee-for-Service	1326417841	1326417841	1	1	KISCH, STEPHANIE M LMFT	2/2/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97585	-	NOT APPLICABLE	0	In state provider	None	11643 GLENOAKS BLVD	None	PACOIMA	CA	91331	1050	19	06037	34.28133474	-118.4198166	Los Angeles County
168572	Fee-for-Service	1093275786	1093275786	1	1	KND REAL ESTATE 4O LLC	5/2/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	16453 COLORADO AVE	None	PARAMOUNT	CA	90723	5011	19	06037	33.8848803	-118.1614216	Los Angeles County
168585	Fee-for-Service	1568501682	1568501682	1	1	KILCOYNE, KELLY M LMFT	7/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 CABRILLO HWY S	209C	HALF MOON BAY	CA	94019	8200	41	06081	37.46542425	-122.4337617	San Mateo County
168598	Fee-for-Service	1922051846	1922051846	1	1	KOLADE, AKINDELE E MD	2/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84300	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
168613	Fee-for-Service	1710951363	1710951363	1	1	KAMRANI,FARZAD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2116 CRAIG ROAD	None	EAU CLAIRE	WI	54701	0000	00	None	44.79642	-91.5191165	Eau Claire County
168706	Fee-for-Service	1386896264	1386896264	1	1	KNOX, JENNIFER L MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98912	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	8589	30	06059	33.62421676	-117.9309656	Orange County
168723	Fee-for-Service	1669041901	1669041901	1	1	KWON, RACHEL DO	6/28/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	22685	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
168742	Fee-for-Service	1841246063	1841246063	1	1	KHOURY, SAMI MD INC	3/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35083	08	Family Practice	0	In state provider	None	9818 PARAMOUNT BLVD	STE D	DOWNEY	CA	90240	3865	19	06037	33.95622445	-118.127923	Los Angeles County
168765	Fee-for-Service	1053534354	1053534354	1	1	KIDD, SABRINA A MD FACS	9/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111326	None	None	0	In state provider	None	5 BON AIR RD	STE 101	LARKSPUR	CA	94939	1134	21	06041	37.9438204	-122.5395357	Marin County
168773	Fee-for-Service	1588663769	1588663769	1	1	KAWEAH DELTA HEALTH CARE	2/1/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
168783	Fee-for-Service	1760583041	1760583041	1	1	KONO, DANTON T MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78727	40	Pediatrics	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
168821	Fee-for-Service	1972608677	1972608677	1	1	KOUROS, PHILIP D MD	5/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	69428	01	General Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
168837	Fee-for-Service	1487937710	1487937710	1	1	KING, CHRISTY M DPM	9/5/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
168843	Fee-for-Service	1700056140	1700056140	1	1	KOKOROWSKI, PAUL J MD	6/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88654	34	Urology and Urological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
168852	Fee-for-Service	1396299020	1396299020	1	1	KANKE, NICOLE LMFT	5/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR	SUITE #230	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
168859	Fee-for-Service	1093275786	1093275786	1	1	KND REAL ESTATE 4O LLC	5/2/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	16453 COLORADO AVE	None	PARAMOUNT	CA	90723	5011	19	06037	33.8848803	-118.1614216	Los Angeles County
168865	Fee-for-Service	1558379891	1558379891	1	1	KENNETH SIRINEK, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
168866	Fee-for-Service	1396812152	1396812152	1	1	KIRCHOFFNER, MARK T CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
168870	Fee-for-Service	1386142164	1386142164	1	1	KIMBERLY CLAPP MARRIAGE AND	7/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ENTER	3301 OCEAN PARK BLVD	104	SANTA MONICA	CA	90405	3270	19	06037	34.02188451	-118.4507675	Los Angeles County
168885	Fee-for-Service	1326484635	1326484635	1	1	KAUL, BHAVIKA MD	5/25/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	148907	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
168890	Fee-for-Service	1366753659	1366753659	1	1	KAY, DIANA C DOULA	12/8/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
168910	Fee-for-Service	1225407950	1225407950	1	1	KEARNS, CAROLE	9/24/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3736 CALIFORNIA AVENUE	None	CARMICHAEL	CA	95608	6444	34	06067	38.632527	-121.320873	Sacramento County
168913	Fee-for-Service	1437814431	1437814431	1	1	KAUR, MANBIR	1/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
168916	Fee-for-Service	1205097474	1205097474	1	1	KWAN, MATTHEW D MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104349	24	Plastic Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
168953	Fee-for-Service	1659329209	1659329209	1	1	KHOYNEZHAD, ALI MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92674	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
168987	Fee-for-Service	1003112830	1003112830	1	1	KEATY, KATHRYN E MD	7/10/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166315	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
169001	Fee-for-Service	1861525602	1861525602	1	6	KOREAN COMMUNITY SERVICES	1/28/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	19742 MACARTHUR BLVD	SUITE 250	IRVINE	CA	92612	2488	30	06059	33.65738766	-117.8625556	Orange County
169032	Fee-for-Service	1841246063	1841246063	1	1	KHOURY, SAMI MD INC	3/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35083	01	General Practice	0	In state provider	None	9818 PARAMOUNT BLVD	STE D	DOWNEY	CA	90240	3865	19	06037	33.95622445	-118.127923	Los Angeles County
169055	Fee-for-Service	1861497968	1861497968	1	1	KLAUSNER, SHELDON N MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	10015	04	Otology, Laryngology, Rhinology	0	In state provider	None	2001 SANTA MONICA BLVD	STE 870W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
169063	Fee-for-Service	1588663769	1588663769	1	1	KAWEAH DELTA HEALTH CARE	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
169074	Fee-for-Service	1053838987	1053838987	1	1	KATIBAH, IBRAHIM MD	7/1/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	170300	None	None	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
169082	Fee-for-Service	1316917883	1316917883	1	1	KANG, HYUN MD	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54908	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 DOYLE PARK DR	SUITE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
169092	Fee-for-Service	1225121932	1225121932	1	1	KUNZ, PAMELA MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79887	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169102	Fee-for-Service	1528350014	1528350014	1	1	KYAZZE, FRED B MD INC	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51997	None	None	0	In state provider	None	1410 W. ALONDRA BLVD.	SUITE C	COMPTON	CA	90220	3533	19	06037	33.88839148	-118.2446201	Los Angeles County
169110	Fee-for-Service	1972608677	1972608677	1	1	KOUROS, PHILIP D MD	5/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	69428	08	Family Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
169115	Fee-for-Service	1912555848	1912555848	1	1	KINGREY, JOSHUA PT	5/17/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
169131	Fee-for-Service	1013362417	1013362417	1	1	KAPADIA, SONAM G MD	7/12/2022	390200000X	NA	Other	026	PHYSICIANS	150681	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
169132	Fee-for-Service	1124119235	1124119235	1	1	KWOK, MICHAEL K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69555	41	Internal Medicine	0	In state provider	None	165 ROWLAND WAY	STE 201	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
169134	Fee-for-Service	1235314873	1235314873	1	1	KIM, HUBERT D MD	5/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93509	85	Surgery-Pediatric	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
169170	Fee-for-Service	1164924247	1164924247	1	1	KOH, LAURA CRNA	8/27/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
169197	Fee-for-Service	1225407950	1225407950	1	1	KEARNS, CAROLE	9/24/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3736 CALIFORNIA AVENUE	None	CARMICHAEL	CA	95608	6444	34	06067	38.632527	-121.320873	Sacramento County
169215	Fee-for-Service	1417214503	1417214503	1	1	KIM, JULIE N MD	7/28/2020	2086S0122X	NA	General Surgery	026	PHYSICIANS	166360	24	Plastic Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
169231	Fee-for-Service	1730312729	1730312729	1	1	KHAN, ALYA MD	3/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112039	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
169232	Fee-for-Service	1417051749	1417051749	1	1	KHALIL-KELADA, HAYNE Y	9/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38374	08	Family Practice	0	In state provider	None	1000 CAMERADO DR	None	CAMERON PARK	CA	95682	8864	09	06017	38.68733262	-120.9874054	El Dorado County
169263	Fee-for-Service	1982232211	1982232211	1	1	KURTZ, BRIAN MD	8/14/2024	207L00000X	NA	Other	026	PHYSICIANS	179167	05	Anesthesiology	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
169287	Fee-for-Service	1861525602	1861525602	1	6	KOREAN COMMUNITY SERVICES	1/28/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	19742 MACARTHUR BLVD	SUITE 250	IRVINE	CA	92612	2488	30	06059	33.65738766	-117.8625556	Orange County
169337	Fee-for-Service	1821529413	1821529413	1	1	KHOR, CHAI H LAC	1/22/2019	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	210 N GARFIELD AVE	STE 203	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
169349	Fee-for-Service	1588663769	1588663769	1	1	KAWEAH DELTA HEALTH CARE	6/1/1976	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
169361	Fee-for-Service	1679599575	1679599575	1	1	KAREN KILIAN	5/17/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
169408	Fee-for-Service	1851568943	1851568943	1	1	KLEIN, CAROLINA A MD	1/14/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148969	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
169412	Fee-for-Service	1437241809	1437241809	1	1	KUMAR, SURINDER MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32024	41	Internal Medicine	0	In state provider	None	40 PENNY LN	None	WATSONVILLE	CA	95076	6008	44	06087	36.93000773	-121.7782644	Santa Cruz County
169417	Fee-for-Service	1457746885	1457746885	1	1	KARIM, ADNAN MD	11/14/2020	207L00000X	NA	Other	026	PHYSICIANS	168701	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
169453	Fee-for-Service	1891730636	1891730636	1	1	KULCZYCKI, JAMES MD	8/31/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37009	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
169459	Fee-for-Service	1619521549	1619521549	1	1	KUJORE, RUBY CNM	10/22/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
169473	Fee-for-Service	1609859586	1609859586	1	1	KARLAN, BETH Y MD	10/25/1991	174400000X	NA	Other	026	PHYSICIANS	57519	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
169479	Fee-for-Service	1538708136	1538708136	1	1	KWAK, DANNYLYN JOY G PT	4/19/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
169489	Fee-for-Service	1376960005	1376960005	1	1	KERN COUNTY HOSPITAL AUTHORI	11/14/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	9330 STOCKDALE HWY	400	BAKERSFIELD	CA	93311	3614	15	06029	35.35452946	-119.106351	Kern County
169495	Fee-for-Service	1699858225	1699858225	1	1	KATHERIN, HOEKSTRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HEALTHONE CLINIC SERVICE	9191 GRANT ST	None	THORNTON	CO	80229	0000	00	None	39.86420881	-104.9846155	Adams County
169504	Fee-for-Service	1831384148	1831384148	1	2	KURWA, BADRUDIN R MD INC	4/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	36590	18	Ophthalmology	0	In state provider	B KURWA, MD INC	210 S GRAND AVE	STE 115	GLENDORA	CA	91741	4263	19	06037	34.133859	-117.872523	Los Angeles County
169507	Fee-for-Service	1992732671	1992732671	1	1	KINNEY, THOMAS B MD	2/28/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	64176	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
169509	Fee-for-Service	1619497005	1619497005	1	1	KHALILI, SHIVA MD	4/28/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182793	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
169561	Fee-for-Service	1568028009	1568028009	1	1	KIELMEYER, RORY K CRNA	9/5/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
169576	Fee-for-Service	1861525602	1861525602	1	6	KOREAN COMMUNITY SERVICES	10/17/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	19742 MACARTHUR BLVD	SUITE 250	IRVINE	CA	92612	2488	30	06059	33.65738766	-117.8625556	Orange County
169586	Fee-for-Service	1811938541	1811938541	1	1	KAMEL, KAMEL L	1/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42118	None	None	0	In state provider	NOBLE GEROPSYC MED GRP	4199 CAMPUS DR	STE 550	IRVINE	CA	92612	4694	30	06059	33.650775	-117.838296	Orange County
169612	Fee-for-Service	1811902372	1811902372	1	1	KENDALL PAUL CROOKSTON MD	4/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
169647	Fee-for-Service	1588842488	1588842488	1	1	KATZMAN, BARRY MD INC	10/31/1991	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	WEST COAST EYE CARE ASSC	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
169664	Fee-for-Service	1689682908	1689682908	1	1	KIM, JONATHAN W MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55765	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
169702	Fee-for-Service	1124026620	1124026620	1	1	KREIMAN, HADASSAH R MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130544	25	Physical Medicine and Rehabilitation	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
169703	Fee-for-Service	1164970026	1164970026	1	1	KUZNI, KATHY D	7/2/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
169704	Fee-for-Service	1265965339	1265965339	1	1	KIM, YOHANAN MD	7/17/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	157124	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
169706	Fee-for-Service	1871868059	1871868059	1	1	KARLIN, DANIEL M MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126762	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	365,240,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
169719	Fee-for-Service	1760830830	1760830830	1	1	KOCH, CHRISTOPHER	6/1/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	200 IRONSTONE CT	None	ROSEVILLE	CA	95747	5840	31	06061	38.76884866	-121.3258181	Placer County
169741	Fee-for-Service	1891730636	1891730636	1	1	KULCZYCKI, JAMES MD	8/31/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37009	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
169754	Fee-for-Service	1578553772	1578553772	1	2	KEARNS, HERSCHEL F LCSW	2/12/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1201 PLACER STREET	None	REDDING	CA	96001	0605	45	06089	40.58291759	-122.3877927	Shasta County
169762	Fee-for-Service	1700964285	1700964285	1	1	KNEE, ALICIA A DPM	9/23/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	100 HOSPITAL DR	#303	VALLEJO	CA	94589	2583	48	06095	38.13100118	-122.2403008	Solano County
169778	Fee-for-Service	1376960005	1376960005	1	1	KERN COUNTY HOSPITAL AUTHORI	11/14/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	9330 STOCKDALE HWY	400	BAKERSFIELD	CA	93311	3614	15	06029	35.35452946	-119.106351	Kern County
169825	Fee-for-Service	1932220324	1932220324	1	1	K J KOPECKO OD CHRISTINE	4/13/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	L MAYER OD OPTOMETRY	2581 NUT TREE RD	STE C	VACAVILLE	CA	95687	6915	48	06095	38.33447259	-121.9532847	Solano County
169860	Fee-for-Service	1013340447	1013340447	1	1	KIM, ARTHUR	4/5/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
169885	Fee-for-Service	1306371059	1306371059	1	1	KASSAM, HAFIZ F MD	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157457	20	Orthopedic Surgery	0	In state provider	None	470 PLUMAS BLVD	STE 200	YUBA CITY	CA	95991	5007	51	06101	39.13270038	-121.6141985	Sutter County
169888	Fee-for-Service	1720072473	1720072473	1	1	KON, DAVID V MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	12344	22	Pathology (M.D. only)	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
169905	Fee-for-Service	1194276923	1194276923	1	1	KAUR, SUKHJOT NP	9/30/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3850 RIVERLAKES DRIVE	SUITE B	BAKERSFIELD	CA	93312	6662	15	06029	35.39426565	-119.0936823	Kern County
169927	Fee-for-Service	1922014174	1922014174	1	1	KUNG, CHARLES K MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78550	41	Internal Medicine	0	In state provider	None	10251 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6719	19	06037	33.87290452	-118.1154735	Los Angeles County
169953	Fee-for-Service	1568913820	1568913820	1	1	KIM, JOHNNY LCSW	8/26/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
169955	Fee-for-Service	1699858993	1699858993	1	1	KIM, ANDREW J MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49072	41	Internal Medicine	0	In state provider	None	3663 W 6TH ST	STE 309	LOS ANGELES	CA	90020	3050	19	06037	34.06360557	-118.30199	Los Angeles County
169973	Fee-for-Service	1639602618	1639602618	1	1	KIM, JAEHYUN MD	6/23/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	170731	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
169988	Fee-for-Service	1386105203	1386105203	1	1	KIM, ROBERT MD	5/9/2022	207P00000X	NA	Other	026	PHYSICIANS	176974	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
169992	Fee-for-Service	1124026620	1124026620	1	1	KREIMAN, HADASSAH R MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130544	01	General Practice	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
170006	Fee-for-Service	1760830830	1760830830	1	1	KOCH, CHRISTOPHER	6/1/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	200 IRONSTONE CT	None	ROSEVILLE	CA	95747	5840	31	06061	38.76884866	-121.3258181	Placer County
170013	Fee-for-Service	1821259516	1821259516	1	1	KOLTA, SOHA W MD	9/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124956	08	Family Practice	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
170023	Fee-for-Service	1124170295	1124170295	1	1	KAPLAN, DEBORAH PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
170039	Fee-for-Service	1518344548	1518344548	1	1	KAPADIA, BHAVEEN MD	6/28/2024	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	160222	01	General Practice	0	In state provider	None	13542 2ND ST	None	YUCAIPA	CA	92399	0001	36	06071	34.007832	-117.0432455	San Bernardino County
170057	Fee-for-Service	1386843035	1386843035	1	2	KAHENZADEH, SHIRLEY M LCSW	8/2/2013	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
170066	Fee-for-Service	1376960005	1376960005	1	1	KERN COUNTY HOSPITAL AUTHORI	11/14/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	9330 STOCKDALE HWY	400	BAKERSFIELD	CA	93311	3614	15	06029	35.35452946	-119.106351	Kern County
170077	Fee-for-Service	1326579442	1326579442	1	1	KHADGE, SHRADHA MD	8/10/2021	207L00000X	NA	Other	026	PHYSICIANS	173662	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
170104	Fee-for-Service	1467474544	1467474544	1	1	KATZ, DANIEL MD	7/1/1994	207L00000X	NA	Other	026	PHYSICIANS	50549	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
170118	Fee-for-Service	1972777225	1972777225	1	1	KALIN, KELLEY M DO	10/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14277	05	Anesthesiology	0	In state provider	None	726 FOURTH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
170120	Fee-for-Service	1437446366	1437446366	2	1	KMD HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11631 VICTORY BLVD	SUITE 201	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
170132	Fee-for-Service	1336651967	1336651967	1	1	KLUG, DANIEL G NP	3/30/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
170144	Fee-for-Service	1972751675	1972751675	1	1	KR PARUNGAO INC	10/6/2008	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	252 ARDENDALE DR	None	DALY CITY	CA	94014	1409	41	06081	37.70564391	-122.4353073	San Mateo County
170158	Fee-for-Service	1659533982	1659533982	1	1	KHYNE, AYE T MD	4/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	99556	41	Internal Medicine	0	In state provider	None	400 TAYLOR BLVD	SUITE 201	PLEASANT HILL	CA	94523	2163	07	06013	37.96132631	-122.0740275	Contra Costa County
170160	Fee-for-Service	1295814994	1295814994	1	1	KIM, TED T MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70853	84	Surgery-Head and Neck	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
170184	Fee-for-Service	1275610552	1275610552	1	1	KHANJAN, MARJAN K PSYD	8/15/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
170229	Fee-for-Service	1528292026	1528292026	1	1	KESSIDES, MARIA C MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126080	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
170230	Fee-for-Service	1952476665	1952476665	1	1	KAISER FOUNDATION HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SACRAMENTO/ROSEVILLE	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
170233	Fee-for-Service	1760871974	1760871974	1	1	KOCH OHYE, ERICA N LCSW	10/30/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
170250	Fee-for-Service	1063610590	1063610590	1	2	KELLY, SUKESHINI P	1/17/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2033 E COLUNGA ST	None	COLTON	CA	92324	7510	36	06071	34.05520144	-117.2918855	San Bernardino County
170298	Fee-for-Service	1134790447	1134790447	1	1	KHALSA, HARIMANDIR K	5/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
170304	Fee-for-Service	1487157269	1487157269	1	1	KORETZ, ZACHARY A MD	7/21/2022	390200000X	NA	Other	026	PHYSICIANS	180519	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
170310	Fee-for-Service	1750988390	1750988390	1	1	KHANNA, NICOLE S LMFT	12/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
170410	Fee-for-Service	1437446366	1437446366	2	1	KMD HOSPICE INC	8/18/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11631 VICTORY BLVD	SUITE 201	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
170426	Fee-for-Service	1063823136	1063823136	1	1	KARHADE, KAVERI MD	11/18/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	163628	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
170443	Fee-for-Service	1659533982	1659533982	1	1	KHYNE, AYE T MD	4/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	99556	77	Infectious Disease	0	In state provider	None	400 TAYLOR BLVD	SUITE 201	PLEASANT HILL	CA	94523	2163	07	06013	37.96132631	-122.0740275	Contra Costa County
170452	Fee-for-Service	1114514114	1114514114	1	1	KRISHNAN, VIMAL MD	4/11/2023	207ZC0500X	NA	Other	026	PHYSICIANS	167729	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
170472	Fee-for-Service	1215394036	1215394036	1	3	KC TAN, M.D. MEDICAL CORPORA	7/1/2020	2085N0700X	NA	MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TION	438 LAS TUNAS	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
170482	Fee-for-Service	1447279864	1447279864	1	1	KORETZ, BRANDON K MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65670	38	Geriatrics	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
170490	Fee-for-Service	1740336411	1740336411	1	1	KESHAVARZI, AMID MD	11/26/2007	390200000X	NA	Other	026	PHYSICIANS	101694	02	General Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
170545	Fee-for-Service	1093906109	1093906109	1	1	KARANAM, DEEPTHI MD	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143662	41	Internal Medicine	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.41257644	-118.5597683	Los Angeles County
170579	Fee-for-Service	1386207454	1386207454	1	1	KARNOSKI, RYAN	12/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
170596	Fee-for-Service	1821399551	1821399551	1	1	KIM, JAMES S MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111651	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
170620	Fee-for-Service	1881939445	1881939445	1	1	KIRALLA, LEO S	4/1/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1495 VICTOR AVE	SUITE D	REDDING	CA	96003	4093	45	06089	40.586022	-122.338834	Shasta County
170639	Fee-for-Service	1932348141	1932348141	1	1	KILLIAN, DOROTHY P	4/26/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
170655	Fee-for-Service	1043590748	1043590748	1	1	KAUSHIK, MOHITA CCC-SP	5/16/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
170657	Fee-for-Service	1548648868	1548648868	1	1	KIM, DANIEL MD	6/15/2018	390200000X	NA	Other	026	PHYSICIANS	146674	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
170700	Fee-for-Service	1891771382	1891771382	1	1	KEDLAYA, INDIRA MD	9/25/2023	207R00000X	NA	Other	026	PHYSICIANS	67008	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
170715	Fee-for-Service	1053487793	1053487793	1	1	KAISER FOUNDATION HOSPITAL	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
170725	Fee-for-Service	1376031195	1376031195	1	1	KIM, KELVIN Y MD	9/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	14642 NEWPORT AVE	SUITE 105	TUSTIN	CA	92780	6058	30	06059	33.73082212	-117.8293987	Orange County
170750	Fee-for-Service	1295274660	1295274660	1	1	KOE MEDICAL CONSULTING, INC.	4/12/2020	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3040 IMPERIAL AVE	None	SAN DIEGO	CA	92102	4128	37	06073	32.70643926	-117.1285458	San Diego County
170758	Fee-for-Service	1881738987	1881738987	1	1	KAMPURYAN, GAREGIN	12/3/1998	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	FAMILY HLTH CARE MED	3820 SLAUSON AVE	None	MAYWOOD	CA	90270	2792	19	06037	33.98814879	-118.195755	Los Angeles County
170763	Fee-for-Service	1265653448	1265653448	1	1	KHAN, AZRA P LMFT	11/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	815 FIRST STREET	2	BRENTWOOD	CA	94513	5304	07	06013	37.93394493	-121.6960606	Contra Costa County
170771	Fee-for-Service	1952552333	1952552333	1	1	KOPACZ, SHARON M MD	11/24/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	105590	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7050 N RECREATION AVENUE	SUITE 102	FRESNO	CA	93720	8001	10	06019	36.83835219	-119.7404373	Fresno County
170804	Fee-for-Service	1598302697	1598302697	1	1	KARA TIFFANY-ROBERTS, MA, MF	3/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T INDIVIDUAL, COUPLES, A	32605 TEMECULA PKWY	STE 207	TEMECULA	CA	92592	6839	33	06065	33.48367403	-117.088031	Riverside County
170807	Fee-for-Service	1497949440	1497949440	1	1	KIRANE, HARSHAL D MD	3/14/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	175744	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
170859	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	7/5/2016	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
170935	Fee-for-Service	1235639519	1235639519	1	1	KHOSA, PANTHJIT PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
170959	Fee-for-Service	1861807794	1861807794	1	1	KAKOL, MONIKA K MD	10/25/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168766	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
171004	Fee-for-Service	1053487793	1053487793	1	1	KAISER FOUNDATION HOSPITAL	11/18/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
171006	Fee-for-Service	1346346020	1346346020	1	1	KUMAR, MAYA C MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52977	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
171050	Fee-for-Service	1881011054	1881011054	1	1	KELLY, ASHLEIGH M MD	12/19/2023	207L00000X	NA	Other	026	PHYSICIANS	191565	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
171051	Fee-for-Service	1750608774	1750608774	1	1	KANG, EVERETT K MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119364	01	General Practice	0	In state provider	None	5500 UNIVERSITY PARKWAY	None	SAN BERNARDINO	CA	92407	2397	36	06071	34.17917599	-117.3266088	San Bernardino County
171053	Fee-for-Service	1073817326	1073817326	1	1	KANEN, TODD A M D MEDICAL	9/4/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66159	02	General Surgery	0	In state provider	CORPORATION	5333 HOLLISTER AVE	SUITE 210	SANTA BARBARA	CA	93111	3331	42	06083	34.43491982	-119.8105484	Santa Barbara County
171087	Fee-for-Service	1780806711	1780806711	1	1	KAR, ERICA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	STE 3950	PITTSBURGH	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
171143	Fee-for-Service	1942796834	1942796834	1	1	KESSELL, BARBARA	4/9/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
171147	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	7/5/2016	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
171157	Fee-for-Service	1477144798	1477144798	1	1	KELLER, JUSTIN NP	5/10/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	37	06073	32.7481088	-117.0743149	San Diego County
171219	Fee-for-Service	1801095187	1801095187	1	1	KYLENE ANN KENT, MD	5/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
171249	Fee-for-Service	1588774707	1588774707	1	1	KANGARLU, SOPHIA S MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74483	None	None	0	In state provider	None	490 S FARRELL DR	STE C108	PALM SPRINGS	CA	92262	7962	33	06065	33.81651	-116.5180015	Riverside County
171267	Fee-for-Service	1801273370	1801273370	1	1	KLEINMAN, RONALD P OD APC	4/19/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14449 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	3012	19	06037	34.22156491	-118.4483229	Los Angeles County
171275	Fee-for-Service	1093718165	1093718165	1	1	KLEIN, MARK J MD	1/1/1979	207RP1001X	NA	Pulmonology	026	PHYSICIANS	22851	None	None	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
171277	Fee-for-Service	1093972382	1093972382	1	1	KURUPATH, VINOD K MD	4/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116636	41	Internal Medicine	0	In state provider	None	2165 S BASCOM AVE	SUITE B	CAMPBELL	CA	95008	3280	43	06085	37.284048	-121.9317865	Santa Clara County
171278	Fee-for-Service	1942284419	1942284419	1	1	KENTON H FISH, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4450 SUNSET DR	None	SAN ANGELO	TX	76901	5611	00	None	31.43603188	-100.501883	Tom Green County
171288	Fee-for-Service	1538579107	1538579107	1	1	KAPLAN, JESSE MD	7/3/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	132815	20	Orthopedic Surgery	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
171318	Fee-for-Service	1366652216	1366652216	1	1	KAPLAN & WIDELITZ MDS IN	10/9/1981	174400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	10861 CHERRY ST	STE 305	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
171325	Fee-for-Service	1386181865	1386181865	1	1	KOCHKARIAN, VAN OD	5/10/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND ST	SUITE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
171347	Fee-for-Service	1154523553	1154523553	1	1	KIM, ALICE S MD	1/14/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	99201	18	Ophthalmology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
171412	Fee-for-Service	1932424231	1932424231	1	1	KULKARNI, DEEPA D MD	8/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119116	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	SUITE 265	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
171424	Fee-for-Service	1497785810	1497785810	1	1	KIM, JANE K DO	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9078	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
171427	Fee-for-Service	1871227959	1871227959	1	1	KURIA, ROY G	10/6/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	27730 SAND DOLLAR WAY	None	MORENO VALLEY	CA	92555	5766	33	06065	33.91302127	-117.1788763	Riverside County
171435	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	7/1/2016	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
171479	Fee-for-Service	1912295510	1912295510	1	1	KIM, JERRY J MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124130	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
171493	Fee-for-Service	1538801469	1538801469	1	1	KUUSKVERE, KEVIN DO	9/25/2024	207P00000X	NA	Other	026	PHYSICIANS	22261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
171556	Fee-for-Service	1043203763	1043203763	1	1	KAYEKJIAN, GARABED MD	11/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54072	40	Pediatrics	0	In state provider	INC	18250 ROSCOE BLVD	STE 130	NORTHRIDGE	CA	91325	4264	19	06037	34.22076142	-118.5313223	Los Angeles County
171563	Fee-for-Service	1093972382	1093972382	1	1	KURUPATH, VINOD K MD	4/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116636	10	Gastroenterology (M.D. only)	0	In state provider	None	2165 S BASCOM AVE	SUITE B	CAMPBELL	CA	95008	3280	43	06085	37.284048	-121.9317865	Santa Clara County
171600	Fee-for-Service	1275092470	1275092470	1	1	KHIL, JACLYN C MD	6/5/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	178192	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
171602	Fee-for-Service	1225650054	1225650054	1	1	KAPLOW, TANYA F LMFT	7/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
171608	Fee-for-Service	1184184269	1184184269	1	1	KILPATRICK, JENAE D MD	9/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1755 COURT STREET	None	REDDING	CA	96001	1721	45	06089	40.58041248	-122.3945221	Shasta County
171649	Fee-for-Service	1376537928	1376537928	1	1	KARAS, STEPHEN JR MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	25539	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
171660	Fee-for-Service	1245375393	1245375393	1	1	KAYLER, KIRA S LMFT	2/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2 PADRE PARKWAY	STE 302A	ROHNERT PARK	CA	94928	2114	49	06097	38.34982429	-122.7083127	Sonoma County
171716	Fee-for-Service	1871227959	1871227959	1	1	KURIA, ROY G	10/6/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	27730 SAND DOLLAR WAY	None	MORENO VALLEY	CA	92555	5766	33	06065	33.91302127	-117.1788763	Riverside County
171725	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	12/5/2023	282N00000X	NA	Hospitals	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
171726	Fee-for-Service	1457459877	1457459877	1	1	KERR, RANDALL L LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
171755	Fee-for-Service	1578519963	1578519963	1	1	KOPLOVSKY, AMY F MD	12/27/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55455	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
171800	Fee-for-Service	1386869113	1386869113	1	1	KOUROUYAN, HRATCH D MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70536	18	Ophthalmology	0	In state provider	KOUROUYAN MD THE EYE &	5106 HOLLYWOOD BLVD	STE 103	LOS ANGELES	CA	90027	6134	19	06037	34.1017205	-118.300968	Los Angeles County
171806	Fee-for-Service	1902954837	1902954837	1	1	KHALIFA, AHMAD S MD	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79995	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
171846	Fee-for-Service	1821073727	1821073727	1	1	KURZROCK, ERIC A MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	75484	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
171884	Fee-for-Service	1629335146	1629335146	1	1	KWAN, DANIEL K MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128256	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
171905	Fee-for-Service	1497391932	1497391932	1	1	KHACHATOOR SARKISSIAN, TALIN	7/30/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2619 E COLORADO BLVD	SUITE 150	PASADENA	CA	91107	3747	19	06037	34.14616014	-118.0964013	Los Angeles County
171917	Fee-for-Service	1588091383	1588091383	1	1	KNOLLS WEST POST ACUTE LLC	12/20/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16890 GREEN TREE BLVD	None	VICTORVILLE	CA	92395	5618	36	06071	34.50005646	-117.2959065	San Bernardino County
171926	Fee-for-Service	1891936753	1891936753	1	1	KIM, PAUL JINSUP MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61765	08	Family Practice	0	In state provider	None	911 E TUOLUMNE RD	None	TURLOCK	CA	95382	1543	50	06099	37.51464851	-120.837933	Stanislaus County
171943	Fee-for-Service	1376593970	1376593970	1	1	KLUESS, BRIAN E MD	6/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52664	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
171977	Fee-for-Service	1083169908	1083169908	1	1	KHOSHSEFAT, JOSHUA R NP	3/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
172003	Fee-for-Service	1013145200	1013145200	1	1	KAZI, FARSHID M MD	4/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116956	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
172010	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	5/31/2017	282N00000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
172013	Fee-for-Service	1407163280	1407163280	1	1	KHATTAR, SMITHA MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148292	40	Pediatrics	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
172027	Fee-for-Service	1477760593	1477760593	1	1	KUMAR, REETIKA K MD	10/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84091	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
172063	Fee-for-Service	1578767182	1578767182	1	1	KIM, CARL I MD	7/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99670	30	Radiology	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
172071	Fee-for-Service	1881920247	1881920247	1	1	KUNDI, ANITA DO INC	11/1/1995	261Q00000X	NA	Other	026	PHYSICIANS	6725	08	Family Practice	0	In state provider	None	8221 ROCHESTER AVENUE	STE 120	RANCHO CUCAMONGA	CA	91730	0721	36	06071	34.104249	-117.5430105	San Bernardino County
172072	Fee-for-Service	1336292721	1336292721	1	1	KIM, JULIE L OD	9/30/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7100 VAN NUYS BLVD	STE 208	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
172090	Fee-for-Service	1306039425	1306039425	1	1	KWAK, ROY C MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	87176	30	Radiology	0	In state provider	None	100 SOUTH RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
172104	Fee-for-Service	1144377938	1144377938	1	1	KOSKI, MICHELLE E MD	11/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125665	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
172131	Fee-for-Service	1508811175	1508811175	1	1	KISTLER, MICHAEL W MD	6/29/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	17434	49	Unknown	0	In state provider	None	6386 ALVARADO CT	STE 107	SAN DIEGO	CA	92120	4906	37	06073	32.77666838	-117.0614255	San Diego County
172141	Fee-for-Service	1023665841	1023665841	1	1	KANG, ESTHER H MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
172155	Fee-for-Service	1972998789	1972998789	1	1	KAGAN, AMANDA B	7/21/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	186088	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
172181	Fee-for-Service	1104048131	1104048131	1	1	KWON, HANNAH S MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99350	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
172185	Fee-for-Service	1689815763	1689815763	1	1	KASHANI, HOUMAN M MD APC	2/13/2009	261QP2300X	NA	Other	026	PHYSICIANS	84361	08	Family Practice	0	In state provider	None	18355 SHERMAN WAY	None	RESEDA	CA	91335	4435	19	06037	34.20121151	-118.533726	Los Angeles County
172197	Fee-for-Service	1215158829	1215158829	1	1	KIM, STEPHEN MD	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114677	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	5655	19	06037	34.06527974	-118.4462792	Los Angeles County
172215	Fee-for-Service	1558871160	1558871160	1	1	KOURIS, KRISTINA F	5/23/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
172223	Fee-for-Service	1407239700	1407239700	1	1	KOFF, ALAN MD	7/13/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169164	77	Infectious Disease	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
172265	Fee-for-Service	1548318413	1548318413	1	1	KIM, JU Y MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71257	04	Otology, Laryngology, Rhinology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
172275	Fee-for-Service	1457375750	1457375750	1	1	KAPLAN, JEROLD Z MD INC	5/31/1979	174400000X	NA	Other	026	PHYSICIANS	37413	47	Miscellaneous	0	In state provider	None	184 CANYON VISTA PL	None	ALAMO	CA	94507	2730	07	06013	37.8479165	-121.9807672	Contra Costa County
172290	Fee-for-Service	1821445727	1821445727	1	1	KAISER FOUNDATION HEALTH	4/30/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	845 E WILLOW ST	1ST FLR	SIGNAL HILL	CA	90755	0000	19	06037	33.80441546	-118.1823032	Los Angeles County
172298	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	7/5/2016	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
172309	Fee-for-Service	1477049005	1477049005	1	1	KOTTE, MANASA MD	1/12/2022	207R00000X	NA	Other	026	PHYSICIANS	174658	None	None	0	In state provider	None	400 OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
172444	Fee-for-Service	1376960260	1376960260	1	1	KASTNER, DAVID MD	8/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	137580	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
172469	Fee-for-Service	1578553772	1578553772	1	1	KEARNS, HERSCHEL F JR LCSW	4/1/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	36977 PARK AVENUE	None	BURNEY	CA	96013	4374	45	06089	40.87640189	-121.6730441	Shasta County
172513	Fee-for-Service	1407239700	1407239700	1	1	KOFF, ALAN MD	7/13/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169164	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
172519	Fee-for-Service	1295217784	1295217784	1	1	KATUS, SYLVIA A LMFT	10/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	128336	-	NOT APPLICABLE	0	In state provider	None	2414 HOOVER AVE	SUITES A,B,C	NATIONAL CITY	CA	91950	8581	37	06073	32.66033086	-117.1043552	San Diego County
172520	Fee-for-Service	1770937690	1770937690	1	1	KRIEGER, BRANDON E DO	4/13/2020	207P00000X	NA	Other	026	PHYSICIANS	17472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
172540	Fee-for-Service	1376650218	1376650218	1	1	KARL HAPCIC MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
172543	Fee-for-Service	1659425601	1659425601	1	1	KASHANI, AMIR H MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101878	18	Ophthalmology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
172544	Fee-for-Service	1346240520	1346240520	1	1	KRIWANEK RAPPLEYE, KELLY L	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91018	40	Pediatrics	0	In state provider	MD	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
172551	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	1/15/2021	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
172552	Fee-for-Service	1548318413	1548318413	1	1	KIM, JU Y MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71257	84	Surgery-Head and Neck	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
172564	Fee-for-Service	1053751552	1053751552	1	1	KAGHAZWALA, RASHEEDA S MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145404	36	Psychiatry	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94535	2310	01	06001	37.55102172	-121.9759026	Alameda County
172571	Fee-for-Service	1598783862	1598783862	1	1	KHOURY, GEORGE M MD	8/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	44041	None	None	0	In state provider	None	2800 N CALIFORNIA ST	#4 & #6	STOCKTON	CA	95204	3758	39	06077	37.97782434	-121.2919633	San Joaquin County
172575	Fee-for-Service	1003154030	1003154030	1	1	KAUMAYA, SANDRA K MFT	1/16/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17215 S STUDEBAKER RD	STE 180	CERRITOS	CA	90703	2523	19	06037	33.874686	-118.0998595	Los Angeles County
172586	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	6/5/2019	282N00000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
172611	Fee-for-Service	1366652430	1366652430	1	1	KOREATOWN YOUTH AND COMMUNIT	1/27/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	Y CENTER, INC.	3727 W 6TH ST	STE 411	LOS ANGELES	CA	90020	5108	19	06037	34.06358655	-118.3037656	Los Angeles County
172616	Fee-for-Service	1124130901	1124130901	1	1	KIDOKORO, YASUKO MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	32727	22	Pathology (M.D. only)	0	In state provider	None	4282 GENESEE AVE	STE 202	SAN DIEGO	CA	92117	4989	37	06073	32.82092667	-117.1828683	San Diego County
172621	Fee-for-Service	1952476665	1952476665	1	3	KAISER FOUNDATION HOSPITAL	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
172625	Fee-for-Service	1760884597	1760884597	1	1	KUMAR, SHIKHA P	9/24/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
172634	Fee-for-Service	1114956570	1114956570	1	1	KIPPER, STUART B MD	2/28/1987	207R00000X	NA	Other	026	PHYSICIANS	61129	01	General Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
172673	Fee-for-Service	1972523793	1972523793	1	1	KANG,JOANNE S MD	5/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73622	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
172712	Fee-for-Service	1356924831	1356924831	1	1	KINSEL, BLAKE DO	11/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23045	08	Family Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
172713	Fee-for-Service	1982157814	1982157814	1	1	KARIMPOUR, GHAZAL	12/5/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
172738	Fee-for-Service	1831384148	1831384148	1	1	KURWA, BADRUDIN R MD INC	4/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	36590	18	Ophthalmology	0	In state provider	None	301 W HUNTINGTON DR	STE 107	ARCADIA	CA	91007	3400	19	06037	34.13481053	-118.0425638	Los Angeles County
172777	Fee-for-Service	1295976371	1295976371	1	1	KEMPE-MEHL, SARAH MD	10/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109842	13	Neurology (M.D. only)	0	In state provider	None	317 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42967671	-119.7228362	Santa Barbara County
172792	Fee-for-Service	1073688891	1073688891	1	1	KOREAN COMMUNITY SERVICES IN	9/21/2015	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	19742 MACARTHUR BLVD	245	IRVINE	CA	92612	2488	30	06059	33.65738766	-117.8625556	Orange County
172812	Fee-for-Service	1427432681	1427432681	1	1	KAUR, RAJPREET OD	7/8/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1144 NORMAN DRIVE	None	MANTECA	CA	95366	5959	39	06077	37.79425166	-121.1998524	San Joaquin County
172824	Fee-for-Service	1861588543	1861588543	1	1	KELLY,KATRINA L MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84243	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
172839	Fee-for-Service	1306231501	1306231501	1	1	KIMURA, MICHAEL T MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
172841	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	12/28/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
172846	Fee-for-Service	1629209291	1629209291	1	1	KAZMIERSKI, BRITTANY J MD	5/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114495	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
172849	Fee-for-Service	1801815808	1801815808	1	1	KUMMERFELD, KEVIN R MD	5/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50420	18	Ophthalmology	0	In state provider	None	1680 E HERNDON AVE	None	FRESNO	CA	93720	3305	10	06019	36.83756052	-119.7571005	Fresno County
172850	Fee-for-Service	1366618290	1366618290	1	1	KAUR, KIRANDEEP MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109727	18	Ophthalmology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
172859	Fee-for-Service	1669418182	1669418182	1	2	KHALSA, SIRI SAT MD	5/8/2024	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	75010	-	NOT APPLICABLE	0	In state provider	None	21540 WEST PLUMMER ST	SUITE A	CHATSWORTH	CA	91311	4143	19	06037	34.24270353	-118.6001685	Los Angeles County
172873	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	1/15/2020	282N00000X	NA	Hospitals	031	PSYCHOLOGISTS	-	None	None	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
172886	Fee-for-Service	1962728246	1962728246	1	2	KF COMMUNITY CARE LLC	2/9/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2335 S MOUNTAIN AVE	None	DUARTE	CA	91010	3559	19	06037	34.12268096	-117.9903597	Los Angeles County
172891	Fee-for-Service	1366977233	1366977233	1	1	KAUR, SHARANPREET DO	1/16/2023	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	17309	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
172906	Fee-for-Service	1306336367	1306336367	1	1	KAISER, JACOB A MD	11/5/2021	208M00000X	NA	Other	026	PHYSICIANS	164060	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
172907	Fee-for-Service	1912516113	1912516113	1	1	KAMUYU, JOYCE MUTHONI	11/8/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2010 SOUTH EUCLID ST	APT 35	ANAHEIM	CA	92802	3124	30	06059	33.79855152	-117.940158	Orange County
172983	Fee-for-Service	1518248442	1518248442	1	1	KEENAN, JESSICA E DO	8/22/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	14197	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
172985	Fee-for-Service	1649322009	1649322009	1	1	KIM, KYUNG H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	39955	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
173025	Fee-for-Service	1619219102	1619219102	1	1	KORN, MICHELLE L DO	9/1/2021	2080P0203X	NA	Other	026	PHYSICIANS	14755	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
173028	Fee-for-Service	1689930034	1689930034	1	1	KAMINS, JOSHUA L MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130917	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
173038	Fee-for-Service	1831481225	1831481225	1	1	KASTING, GREGG A MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	86287	01	General Practice	0	In state provider	None	4934 VERDUGO WAY	None	CAMARILLO	CA	93012	8631	56	06111	34.21594032	-119.0048014	Ventura County
173039	Fee-for-Service	1215394036	1215394036	1	6	KC TAN, M.D. MEDICAL CORPORA	8/3/2021	2085N0700X	NA	MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TION	1900 SULLIVAN	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
173057	Fee-for-Service	1598916587	1598916587	1	1	KONTNY, EWA MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116169	41	Internal Medicine	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
173103	Fee-for-Service	1538247390	1538247390	1	1	KRAETZER, BRADFORD B MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63041	20	Orthopedic Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
173110	Fee-for-Service	1467102012	1467102012	1	1	KLAHR, MAX K MD	7/17/2024	207P00000X	NA	Other	026	PHYSICIANS	190802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
173112	Fee-for-Service	1861588543	1861588543	1	1	KELLY,KATRINA L MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84243	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
173127	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
173135	Fee-for-Service	1841602596	1841602596	1	2	KHATRI, PYAR LPCC	5/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	687 UPLAND ROAD	None	REDWOOD CITY	CA	94062	2828	41	06081	37.47213818	-122.2520257	San Mateo County
173162	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	5/11/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
173186	Fee-for-Service	1821181918	1821181918	1	1	KELFER, HOWARD M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
173193	Fee-for-Service	1912516113	1912516113	1	1	KAMUYU, JOYCE MUTHONI	11/8/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2010 SOUTH EUCLID ST	APT 35	ANAHEIM	CA	92802	3124	30	06059	33.79855152	-117.940158	Orange County
173262	Fee-for-Service	1861508038	1861508038	1	1	KIM, JAMES S MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77334	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
173263	Fee-for-Service	1851851596	1851851596	1	1	KORDBACHEH, HAMED MD	6/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173272	Fee-for-Service	1245307115	1245307115	1	1	KESLER, MATTHEW G MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67593	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
173274	Fee-for-Service	1467844647	1467844647	1	1	KANGETHE, ANTHONY M	10/30/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	24259 GAZANIA WAY	None	LAKE ELSINORE	CA	92532	2736	33	06065	33.66665532	-117.2679858	Riverside County
173281	Fee-for-Service	1811073430	1811073430	2	1	KING, DON FRIDAY MD	12/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	34207	22	Pathology (M.D. only)	0	In state provider	None	7947 PAINTER AVE	None	WHITTIER	CA	90602	2414	19	06037	33.96860447	-118.0327317	Los Angeles County
173291	Fee-for-Service	1538728126	1538728126	1	1	KASHKOUSH, JASMINE MD	5/14/2024	208800000X	NA	Other	026	PHYSICIANS	192484	34	Urology and Urological Surgery	0	In state provider	None	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	30	06059	33.65251244	-117.7317885	Orange County
173303	Fee-for-Service	1457939647	1457939647	1	1	KALA, MANPREET SINGH	11/15/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
173412	Fee-for-Service	1326079765	1326079765	1	1	KARAM, AMIR M MD	8/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82484	None	None	0	In state provider	None	101 THE CITY DR	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
173417	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	11/24/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
173429	Fee-for-Service	1912926379	1912926379	1	1	KOVACS, THOMAS O MD	7/3/1997	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	49595	10	Gastroenterology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
173451	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	12/6/2016	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
173457	Fee-for-Service	1710119003	1710119003	1	1	KAMIREDDY, SWAPNA MD	9/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117393	None	None	0	In state provider	None	525 WEST ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
173462	Fee-for-Service	1184821407	1184821407	1	1	KASHANI, SAMUEL MD	11/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87624	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
173463	Fee-for-Service	1750988770	1750988770	1	1	KECK MEDICAL CENTER OF USC	1/1/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
173490	Fee-for-Service	1619243805	1619243805	1	1	KISRA, SOOD S MD	10/19/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	135006	None	None	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
173514	Fee-for-Service	1093824633	1093824633	1	1	KUO, HELEN F DPM INC	4/30/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25316 CRENSHAW BLVD	None	TORRANCE	CA	90505	6121	19	06037	33.79422403	-118.3298339	Los Angeles County
173519	Fee-for-Service	1578093597	1578093597	1	1	KEBASO, LENAH BOYANI	7/7/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	40 NEWBURN CT	None	BEAUMONT	CA	92223	3130	33	06065	33.92056495	-116.9597161	Riverside County
173538	Fee-for-Service	1528479516	1528479516	1	1	KELLY, CHRISTINE NP	7/27/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
173548	Fee-for-Service	1134505316	1134505316	1	1	KWON, EDWARD MD INC	11/16/2015	2086S0127X	NA	General Surgery	026	PHYSICIANS	120642	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
173551	Fee-for-Service	1619991023	1619991023	1	1	KARIM, SYED A MD	2/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55006	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
173564	Fee-for-Service	1467844647	1467844647	1	1	KANGETHE, ANTHONY M	10/30/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	24259 GAZANIA WAY	None	LAKE ELSINORE	CA	92532	2736	33	06065	33.66665532	-117.2679858	Riverside County
173568	Fee-for-Service	1811073430	1811073430	2	1	KING, DON FRIDAY MD	12/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	34207	07	Dermatology	0	In state provider	None	7947 PAINTER AVE	None	WHITTIER	CA	90602	2414	19	06037	33.96860447	-118.0327317	Los Angeles County
173592	Fee-for-Service	1497995500	1497995500	1	1	KAISER FOUNDATION HEALTH	4/10/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #269	11001 SEPULVEDA BLVD	FLR 2	MISSION HILLS	CA	91345	1413	19	06037	34.26991066	-118.4671653	Los Angeles County
173656	Fee-for-Service	1023420601	1023420601	1	1	KIMMEL, CHRISTINE PHD	12/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
173662	Fee-for-Service	1679100721	1679100721	1	1	KRIS J. STORKERSEN M.D. INC.	6/4/2020	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
173692	Fee-for-Service	1518945435	1518945435	1	1	KHALPARI, MOJGAN DO	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6564	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
173705	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	10/26/1984	282NC0060X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
173715	Fee-for-Service	1558419382	1558419382	1	1	KAISER PERMANENTE POINT	9/29/1997	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	WEST MAIN PHARMACY #626	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
173738	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	7/5/2016	282N00000X	NA	Hospitals	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
173807	Fee-for-Service	1578093597	1578093597	1	1	KEBASO, LENAH BOYANI	7/7/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	40 NEWBURN CT	None	BEAUMONT	CA	92223	3130	33	06065	33.92056495	-116.9597161	Riverside County
173828	Fee-for-Service	1588826192	1588826192	1	1	KABRA, SATISH MD	6/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133857	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	94505	4801	49	06097	38.443806	-122.701374	Sonoma County
173840	Fee-for-Service	1013962885	1013962885	1	2	KHOSLA, DEVEN MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52516	14	Neurological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
173855	Fee-for-Service	1184988057	1184988057	1	1	KAUR, JASPREET DO	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14066	01	General Practice	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
173867	Fee-for-Service	1700835196	1700835196	1	1	KAZI, WASEEMUDDIN MD	6/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	49554	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	SUITE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
173872	Fee-for-Service	1265118590	1265118590	1	1	KENNEY, DEBRA LCSW	8/22/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5743 CORSA AVE	207	WESTLAKE VILLAGE	CA	91362	6464	56	06111	34.156863	-118.7994295	Los Angeles County
173888	Fee-for-Service	1619685633	1619685633	1	1	KALAYDJIAN, AZADUHI CNM	3/22/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
173946	Fee-for-Service	1336380872	1336380872	1	1	KHODABANDELOO, ELHAM LAC	2/14/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1411 MARSH STREET	SUITE 106	SAN LUIS OBISPO	CA	93401	2967	40	06079	35.28418203	-120.6540933	San Luis Obispo County
173992	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	12/1/1977	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
174021	Fee-for-Service	1225187388	1225187388	1	1	KIM, JAIME E MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	83581	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	DOCTORS OF OB GYN MED CO	8700 WARNER AVE	STE 160	FOUNTAIN VALLEY	CA	92708	3209	30	06059	33.71568247	-117.977193	Orange County
174026	Fee-for-Service	1376623538	1376623538	2	1	KERN COUNTY HOSPITAL	1/10/2018	282N00000X	NA	Hospitals	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
174029	Fee-for-Service	1851822084	1851822084	1	1	KAHN, JAMES A MD	8/17/2021	390200000X	NA	Other	026	PHYSICIANS	170437	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
174142	Fee-for-Service	1689889594	1689889594	1	1	KAREN RAMPTON MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
174144	Fee-for-Service	1851841068	1851841068	1	1	KO, HEA JIN LMFT	11/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
174164	Fee-for-Service	1194850230	1194850230	1	1	KHACHATRYAN, SUNNY N	3/30/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	SUITE 210	SAN DIEGO	CA	92108	3104	37	06073	32.76632791	-117.1616245	San Diego County
174177	Fee-for-Service	1104875830	1104875830	1	1	KWAN, CHRIS W PT	3/6/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1300 E MAIN ST	STE. 210	ALHAMBRA	CA	91801	4150	19	06037	34.10150419	-118.1134548	Los Angeles County
174184	Fee-for-Service	1821735895	1821735895	1	1	KAISER FOUNDATION HEALTH PLA	8/19/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	642	1931 MAIN ST	FL 1 RM 1R150	WATSONVILLE	CA	95076	0000	44	06087	36.91820233	-121.7818664	Santa Cruz County
174247	Fee-for-Service	1083242689	1083242689	1	1	KIRSHNER, SARAH G MD	8/1/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
174249	Fee-for-Service	1881834505	1881834505	1	1	KODAMA, GRACE C LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
174271	Fee-for-Service	1710325139	1710325139	1	1	KALAMDJIAN, LUSINE OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
174280	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	9/1/2002	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
174298	Fee-for-Service	1912517780	1912517780	1	1	KIRISHIAN, ALISON M LMFT	2/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
174311	Fee-for-Service	1225204043	1225204043	1	1	KONCZAL, DAVID J MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113391	36	Psychiatry	0	In state provider	None	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
174318	Fee-for-Service	1497722797	1497722797	1	1	KEBEBEW, POSITRON MD	11/1/1998	207R00000X	NA	Other	026	PHYSICIANS	77512	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
174325	Fee-for-Service	1922035203	1922035203	1	1	KERN PHYSICIANS MEDICAL	8/23/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, INC	606 34TH ST	None	BAKERSFIELD	CA	93301	2208	15	06029	35.39051746	-119.008611	Kern County
174330	Fee-for-Service	1023208493	1023208493	1	1	KONECNY, TOMAS MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134853	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
174359	Fee-for-Service	1073660304	1073660304	1	1	KAISER FOUNDATION HEALTH PLA	1/27/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMAN PHAR#301	9201 BIG HORN BLVD	FL 1	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
174364	Fee-for-Service	1225432263	1225432263	1	1	KATEBIAN, ROIA MD	2/18/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	168718	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
174428	Fee-for-Service	1699725325	1699725325	1	1	KAJDOS, ADRIENA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41257	10	Gastroenterology (M.D. only)	0	In state provider	None	414 G ST	STE 140	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
174450	Fee-for-Service	1417586165	1417586165	1	1	KERR, JEFFREY DO	9/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21476	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
174479	Fee-for-Service	1912170788	1912170788	1	1	KHANDHAR, TEJAL M DO	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9635	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
174535	Fee-for-Service	1083242689	1083242689	1	1	KIRSHNER, SARAH G MD	8/1/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
174542	Fee-for-Service	1578024964	1578024964	1	1	KUMAR, ANKIT DO	2/8/2024	207R00000X	NA	Other	026	PHYSICIANS	21673	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
174550	Fee-for-Service	1376960203	1376960203	1	1	KUHAREVIC, SERGEY MD	6/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
174567	Fee-for-Service	1427121037	1427121037	1	1	KHADEMI, ALI MD	2/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	7421	10	Gastroenterology (M.D. only)	0	In state provider	BAYVIEW GASTROENTEROLOGY	7492 SOQUEL DR	None	APTOS	CA	95003	3820	44	06087	36.98218665	-121.9108589	Santa Cruz County
174568	Fee-for-Service	1427049964	1427049964	1	1	KERN VALLEY HEALTHCARE	12/1/1977	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	PO BOX 1628	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
174596	Fee-for-Service	1669033692	1669033692	1	1	KAIDA-YIP, FLYN MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	182529	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
174609	Fee-for-Service	1134160666	1134160666	1	1	KINMAN, RENEE A MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92381	67	Endocrinology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
174615	Fee-for-Service	1922035203	1922035203	1	1	KERN PHYSICIANS MEDICAL	8/23/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	GROUP, INC	606 34TH ST	None	BAKERSFIELD	CA	93301	2208	15	06029	35.39051746	-119.008611	Kern County
174673	Fee-for-Service	1881837748	1881837748	1	1	KROL, JOHN J MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137852	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
174712	Fee-for-Service	1962763516	1962763516	1	1	KALAUOKALANI, DONNA A K MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	86774	05	Anesthesiology	0	In state provider	INC	1650 CREEKSIDE DRIVE	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
174714	Fee-for-Service	1699725325	1699725325	1	1	KAJDOS, ADRIENA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41257	41	Internal Medicine	0	In state provider	None	414 G ST	STE 140	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
174723	Fee-for-Service	1346246162	1346246162	1	1	KONSTANTINOU, CHRIS	1/17/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	148555	None	None	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
174729	Fee-for-Service	1114257227	1114257227	1	1	KOPPENBRINK, KIMBERLY D MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116634	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
174816	Fee-for-Service	1205934312	1205934312	1	1	KAO, GRACE W MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	44855	13	Neurology (M.D. only)	0	In state provider	None	4950 BARRANA PKWY	#208	IRVINE	CA	92604	0000	30	06059	33.67620851	-117.7948348	Orange County
174891	Fee-for-Service	1134160666	1134160666	1	1	KINMAN, RENEE A MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92381	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
174900	Fee-for-Service	1780142380	1780142380	1	1	KIM, SEJUNG NP	1/7/2025	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
174958	Fee-for-Service	1487858270	1487858270	1	1	KRAUSE, BRIAN R MD	4/10/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175154	None	None	0	In state provider	None	8933 ACTIVITY RD	None	SAN DIEGO	CA	92126	4427	37	06073	32.89637448	-117.133497	San Diego County
174960	Fee-for-Service	1609876754	1609876754	1	1	KAY, SELWYN MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51249	02	General Surgery	0	In state provider	None	2521 G ST	None	BAKERSFIELD	CA	93301	2811	15	06029	35.382393	-119.0223575	Kern County
174997	Fee-for-Service	1205915394	1205915394	1	1	KEIR-GARZA, JENNIFER L MD	12/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53688	04	Otology, Laryngology, Rhinology	0	In state provider	None	2 UPPER RAGSDALE	STE B230	MONTEREY	CA	93940	7821	27	06053	36.57940327	-121.8142876	Monterey County
175052	Fee-for-Service	1629638606	1629638606	1	1	KING, JOSHUA D MD	11/20/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	182492	None	None	0	In state provider	None	11585 POPLAR ST	None	LOMA LINDA	CA	92563	2415	36	06071	34.04331864	-117.255106	San Bernardino County
175089	Fee-for-Service	1598152159	1598152159	1	1	KAUR, AMANDEEP DO	2/20/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15322	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
175121	Fee-for-Service	1972688844	1972688844	1	1	KAKITA, MELIA N	11/17/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	9999	30	06059	33.85429451	-117.8446551	Orange County
175138	Fee-for-Service	1508238619	1508238619	1	1	KWAN, TRACY M NP	9/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175237	Fee-for-Service	1902074453	1902074453	1	1	KHOUKAZ, RANIA MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118756	41	Internal Medicine	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
175246	Fee-for-Service	1801981485	1801981485	1	1	KNORR, PHILIP ANDREW MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56315	34	Urology and Urological Surgery	0	In state provider	None	160 GREEN VALLEY RD	STE 203	FREEDOM	CA	95019	3160	44	06087	36.93732602	-121.7715374	Santa Cruz County
175274	Fee-for-Service	1447751342	1447751342	1	1	KOSHIMIZU, CAROL G LMFT	9/28/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
175348	Fee-for-Service	1740400217	1740400217	1	1	KACHRU, AMITA MD	10/9/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	94667	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DR	STE 103	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
175372	Fee-for-Service	1669598827	1669598827	1	1	KOLODJI, ALICE J NP	1/24/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
175377	Fee-for-Service	1881626687	1881626687	1	1	KNOPF, KEVIN B MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87800	None	None	0	In state provider	None	2100 WEBSTER ST	STE 220	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
175415	Fee-for-Service	1184101511	1184101511	1	1	KIDS 1ST PEDIATRICS, INC.	8/6/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	18002 WIKA RD	None	APPLE VALLEY	CA	92307	2125	36	06071	34.54046469	-117.2712424	San Bernardino County
175425	Fee-for-Service	1134302771	1134302771	1	1	KIM, DAVID H MD	2/27/2008	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	5380 S RAINBOW BLVD	SUITE 310	LAS VEGAS	NV	89118	1880	00	None	36.09117	-115.242894	Clark County
175446	Fee-for-Service	1134412489	1134412489	1	1	KATZ, ALEXANDER Z MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135543	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
175459	Fee-for-Service	1811317191	1811317191	1	1	KIM, SARAH S MD	11/27/2017	390200000X	NA	Other	026	PHYSICIANS	139854	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
175464	Fee-for-Service	1851541684	1851541684	1	1	KONISHI, YOSHIYUKI PHD	6/7/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVENUE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
175465	Fee-for-Service	1447330915	1447330915	1	1	KALE, RAHUL M MD	2/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86820	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
175480	Fee-for-Service	1346333655	1346333655	1	1	KORNDORFFER, JAMES R JR MD	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151411	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175489	Fee-for-Service	1295784304	1295784304	1	1	KASPER, CAROL K MD	12/1/1995	207RH0000X	NA	Hematology	026	PHYSICIANS	19355	41	Internal Medicine	0	In state provider	None	2300 S FLOWER ST	None	LOS ANGELES	CA	90007	2660	19	06037	34.0294397	-118.2734132	Los Angeles County
175491	Fee-for-Service	1508983982	1508983982	1	1	KINDIG, BRANDI M	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
175500	Fee-for-Service	1306985114	1306985114	1	1	KRAL, FELIX MD	5/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159543	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
175556	Fee-for-Service	1356662928	1356662928	1	1	KIM, EUNICE R MD	6/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118412	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
175563	Fee-for-Service	1457708661	1457708661	1	1	KELLER, TAYLOR LCSW	9/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7530 WOODMAN PL	None	VAN NUYS	CA	91405	1544	19	06037	34.20710514	-118.4301398	Los Angeles County
175570	Fee-for-Service	1083661649	1083661649	1	1	KRISTI SOBOTA MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4000 WELLNESS DR	None	MIDLAND	MI	48670	2000	00	None	43.635141	-84.2581665	Midland County
175697	Fee-for-Service	1992948806	1992948806	1	1	KHO, JENNIEFER Y MD	9/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133827	20	Orthopedic Surgery	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
175757	Fee-for-Service	1225077035	1225077035	1	1	KAY COUNTY OKLAHOMA	7/22/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL COMPANY LLC	1900 N 14TH ST	None	PONCA CITY	OK	74601	2035	00	None	36.724716	-97.06724797	Kay County
175768	Fee-for-Service	1750462040	1750462040	1	1	KELLER, CHRISTINA L LCSW	9/21/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1203 N CHERRY ST	None	TULARE	CA	93274	2233	54	06107	36.224964	-119.336946	Tulare County
175774	Fee-for-Service	1538181110	1538181110	2	1	KASS, FREDERIC C MD	7/31/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	68274	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4311	42	06083	34.42946302	-119.7231388	Santa Barbara County
175808	Fee-for-Service	1972079903	1972079903	1	1	KIM MEDICAL CORPORATION	12/9/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	None	1950 SUNNY CREST DR	2700	FULLERTON	CA	92835	3645	30	06059	33.89240507	-117.9313904	Orange County
175874	Fee-for-Service	1316253024	1316253024	1	1	KEHL, DEVIN W MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118294	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
175885	Fee-for-Service	1023189909	1023189909	1	1	KING, DONALD I MD	7/1/1984	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	46948	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
175904	Fee-for-Service	1548359839	1548359839	1	1	KILLU, CLAUDE F MD	9/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63409	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
175908	Fee-for-Service	1275568388	1275568388	1	1	KARIN, MARDI R MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	68578	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175920	Fee-for-Service	1124384706	1124384706	1	1	KIM, JOHN MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137561	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
175989	Fee-for-Service	1144537606	1144537606	1	1	KOO, JAMIN MD	5/6/2021	2085R0204X	NA	Other	026	PHYSICIANS	164186	None	None	0	In state provider	None	5330 CARROLL CANYON RD	140	SAN DIEGO	CA	92121	3758	37	06073	32.8917216	-117.1927751	San Diego County
176038	Fee-for-Service	1386691830	1386691830	1	1	KIM, HOWARD H MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109058	34	Urology and Urological Surgery	0	In state provider	None	3791 KATELLA AVE	SUITE 200	LOS ALAMITOS	CA	90720	2016	30	06059	33.80318449	-118.0672965	Orange County
176045	Fee-for-Service	1225077035	1225077035	1	1	KAY COUNTY OKLAHOMA	7/22/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL COMPANY LLC	1900 N 14TH ST	None	PONCA CITY	OK	74601	2035	00	None	36.724716	-97.06724797	Kay County
176056	Fee-for-Service	1821035122	1821035122	1	1	KRAMER, MIRANDA J NP	1/19/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
176062	Fee-for-Service	1538181110	1538181110	2	1	KASS, FREDERIC C MD	7/31/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	68274	68	Hematology	0	In state provider	None	300 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4311	42	06083	34.42946302	-119.7231388	Santa Barbara County
176066	Fee-for-Service	1841226073	1841226073	1	1	KING, DANIEL M MD	1/1/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	39123	18	Ophthalmology	0	In state provider	None	411 CEDAR ST	None	RED BLUFF	CA	96080	2709	52	06103	40.17948981	-122.2385079	Tehama County
176080	Fee-for-Service	1992816532	1992816532	1	1	KOCHARIAN, NAIRA MD	10/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93881	13	Neurology (M.D. only)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
176084	Fee-for-Service	1720448749	1720448749	1	1	KAUR, NAVNEET MD	7/27/2023	207R00000X	NA	Other	026	PHYSICIANS	173744	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
176086	Fee-for-Service	1679767842	1679767842	1	1	KRISHNAMURTHY, CHAYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE + C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.779063	-111.8805548	Salt Lake County
176139	Fee-for-Service	1730316175	1730316175	1	1	KOMATSU, RYU MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127277	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
176160	Fee-for-Service	1083893838	1083893838	1	1	KAKUMANU, NAVEEN MD	9/12/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	163037	41	Internal Medicine	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
176217	Fee-for-Service	1427476464	1427476464	1	1	KARLIN, JUSTIN N MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152656	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
176233	Fee-for-Service	1952459919	1952459919	1	1	KHANH, BUI T MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30618	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
176240	Fee-for-Service	1336480284	1336480284	1	1	KOSAL, BRITTANY E S NP	1/25/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
176272	Fee-for-Service	1245784370	1245784370	1	1	KWAN, KAYLA N OT	1/23/2019	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
176286	Fee-for-Service	1982670667	1982670667	1	1	KLINGMAN, ROBERT R MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76329	33	Thoracic Surgery	0	In state provider	None	1860 PENNSYLVANIA AVENUE	STE 110	FAIRFIELD	CA	94533	3550	48	06095	38.261952	-122.0498745	Solano County
176326	Fee-for-Service	1104471598	1104471598	1	1	KLEM, JOSHUA J PT	3/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
176341	Fee-for-Service	1841221645	1841221645	1	1	KILLEEN, JAMES P MD	11/1/1999	207P00000X	NA	Other	026	PHYSICIANS	68035	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
176365	Fee-for-Service	1295827657	1295827657	1	1	KENDALL, JOAN A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
176379	Fee-for-Service	1891785960	1891785960	1	1	KESARI, SANTOSH MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53829	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
176449	Fee-for-Service	1083893838	1083893838	1	1	KAKUMANU, NAVEEN MD	9/12/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	163037	67	Endocrinology	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
176451	Fee-for-Service	1629264825	1629264825	1	1	KANDI, SUNANDA H MD	3/9/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	160574	40	Pediatrics	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
176469	Fee-for-Service	1528171667	1528171667	1	1	KUO, TONY YU-HONG MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67011	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
176508	Fee-for-Service	1548382203	1548382203	1	1	KANDALAFT, NAJI MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46044	41	Internal Medicine	0	In state provider	None	412 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4711	19	06037	34.13415622	-117.8702547	Los Angeles County
176542	Fee-for-Service	1023389566	1023389566	1	1	KELEKAR, DILIP R MD INC	8/21/2012	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	37290	20	Orthopedic Surgery	0	In state provider	None	18523 CORWIN RD	STE D	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
176562	Fee-for-Service	1366533846	1366533846	1	1	KANDAVEL, GANESHA R MD	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81089	18	Ophthalmology	0	In state provider	None	5363 BALBOA BLVD	STE 545	ENCINO	CA	91316	2854	19	06037	34.169058	-118.5011265	Los Angeles County
176645	Fee-for-Service	1861518003	1861518003	1	1	KRAUSE, EDMUND M OD	6/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3501 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2150	15	06029	35.35408422	-119.0424307	Kern County
176656	Fee-for-Service	1285702738	1285702738	1	1	KILLU, KEITH F MD	6/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55459	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
176660	Fee-for-Service	1376824524	1376824524	1	1	KHALID, YASMEEN MD INC	12/5/2014	207RR0500X	NA	Other	026	PHYSICIANS	62895	83	Rheumatology	0	In state provider	None	1260 E ALMOND AVE	None	MADERA	CA	93637	6500	20	06039	36.9453747	-120.0454403	Madera County
176666	Fee-for-Service	1861643058	1861643058	1	1	KONIK, ZITA I MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108895	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
176676	Fee-for-Service	1093205239	1093205239	1	1	KANG, LINDA MD	10/1/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179552	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
176705	Fee-for-Service	1225423619	1225423619	1	1	KHATTAR, RAMNI DO	5/25/2021	207RC0200X	NA	Other	026	PHYSICIANS	15323	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
176708	Fee-for-Service	1275539637	1275539637	1	1	KAZENELSON, KENNETH A MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	86358	08	Family Practice	0	In state provider	None	29472 AVE DE LAS BANDERA	None	RANCHO SANTA MARG	CA	92688	2651	30	06059	33.620238	-117.610578	Orange County
176726	Fee-for-Service	1679574701	1679574701	1	1	KHOSLA, DEEPAK MD	1/11/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49818	None	None	0	In state provider	None	2780 EUREKA WAY	None	REDDING	CA	96001	0223	45	06089	40.58585835	-122.4124086	Shasta County
176747	Fee-for-Service	1154473650	1154473650	1	1	KEENEY, TAMARA LMFT	10/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
176758	Fee-for-Service	1528171667	1528171667	1	1	KUO, TONY YU-HONG MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67011	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
176793	Fee-for-Service	1548382203	1548382203	1	1	KANDALAFT, NAJI MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46044	60	UNKNOWN	0	In state provider	None	412 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4711	19	06037	34.13415622	-117.8702547	Los Angeles County
176825	Fee-for-Service	1487713129	1487713129	1	1	KAO, KEVIN MD	12/26/2007	207R00000X	NA	Other	026	PHYSICIANS	95232	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
176971	Fee-for-Service	1205898020	1205898020	1	1	KISHINEFF, STEPHEN E MD	12/31/1989	207P00000X	NA	Other	026	PHYSICIANS	66208	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
176993	Fee-for-Service	1033147913	1033147913	1	1	KOOS, BRIAN J MD	3/31/1982	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	44129	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11234 ANDERSON ST	BLDG 3401	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
177007	Fee-for-Service	1164450714	1164450714	1	1	KATKHOUDA, NAMIR MD	5/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54640	None	None	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
177035	Fee-for-Service	1427158294	1427158294	1	1	KARING PEDIATRICS MEDICAL GR	10/7/1998	174400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	OUP	936 PINE AVE	None	LONG BEACH	CA	90813	4326	19	06037	33.77836937	-118.1923253	Los Angeles County
177083	Fee-for-Service	1548382203	1548382203	1	1	KANDALAFT, NAJI MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46044	42	Nuclear Medicine	0	In state provider	None	412 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4711	19	06037	34.13415622	-117.8702547	Los Angeles County
177125	Fee-for-Service	1194467076	1194467076	1	1	KRAUTHAMMER, CHRISTIAN P DO	5/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21991	66	Emergency Medicine (Urgent Care)	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
177130	Fee-for-Service	1538150594	1538150594	1	1	KIM, DONG UK MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	84214	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
177134	Fee-for-Service	1578862892	1578862892	1	1	KANTER, MARVIN MD	9/19/2023	332900000X	NA	Other	086	MEDICAL DIRECTORS	9009	-	NOT APPLICABLE	0	In state provider	None	5985 TOPANGA CANYON BLVD	None	WOODLAND HILLS	CA	91367	3623	19	06037	34.17887145	-118.60526	Los Angeles County
177191	Fee-for-Service	1093127235	1093127235	1	1	KELLEHER, KEVIN	8/9/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
177210	Fee-for-Service	1194752188	1194752188	1	1	KISTLER, JAMES W MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42689	02	General Surgery	0	In state provider	None	2281 PEREZ ST	APT 332	SALINAS	CA	93906	1793	27	06053	36.72853656	-121.6537433	Monterey County
177222	Fee-for-Service	1285610683	1285610683	1	1	KOZLOWSKI, MARK J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	None	AURORA	CO	80014	2910	00	None	39.6612	-104.8603095	Arapahoe County
177223	Fee-for-Service	1447771282	1447771282	1	1	KNIGHTLY, THOMAS J MD	11/2/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171719	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177275	Fee-for-Service	1730471699	1730471699	1	1	KATSNELSON, ILANA G	11/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	56327	None	None	0	In state provider	None	901 CAMPUS DRIVE	SUITE 210	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
177279	Fee-for-Service	1225353022	1225353022	1	1	KIM, SONYA Y MD	12/20/2019	207PS0010X	NA	Other	026	PHYSICIANS	79002	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1197 E ARQUES AVE	None	SUNNYVALE	CA	94085	3904	43	06085	37.38051652	-121.9964175	Santa Clara County
177314	Fee-for-Service	1689692717	1689692717	1	1	KANG, BOMAE MD	1/23/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	94769	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
177328	Fee-for-Service	1316010325	1316010325	1	1	KWAST, JENNIFER S	2/5/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2438 PONDEROSA DR	None	CAMARILLO	CA	93010	2369	56	06111	34.24219545	-119.0227012	Ventura County
177346	Fee-for-Service	1720635675	1720635675	1	1	KRISHAN K VASHISTHA, MD INC.	8/27/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	27141 HIDAWAY AVE	105	CANYON COUNTRY	CA	91351	4137	19	06037	34.41483	-118.469039	Los Angeles County
177356	Fee-for-Service	1124043765	1124043765	1	1	KIM, CHOLL W MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64323	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177398	Fee-for-Service	1750791091	1750791091	1	1	KIANI, SARAH Z MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
177406	Fee-for-Service	1275194524	1275194524	1	1	KELLER, CHRISTOPHER L MD	11/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181437	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
177437	Fee-for-Service	1568453637	1568453637	1	1	KHAW, BRANDON B. MD	1/31/1994	207R00000X	NA	Other	026	PHYSICIANS	44393	41	Internal Medicine	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
177524	Fee-for-Service	1790979698	1790979698	1	1	KALDAS, MARIAN MD	3/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107630	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
177543	Fee-for-Service	1376704999	1376704999	1	1	KHOURY, FARJALLAH N MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112452	25	Physical Medicine and Rehabilitation	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
177663	Fee-for-Service	1467617159	1467617159	1	1	KHAN, AYAZ O DO	3/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9417	18	Ophthalmology	0	In state provider	None	1425 W H STREET	SUITE 340	OAKDALE	CA	95671	3591	50	06099	37.75771796	-120.8627767	Stanislaus County
177665	Fee-for-Service	1750813747	1750813747	1	1	KOTA, RAJITHA MD	8/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169279	08	Family Practice	0	In state provider	None	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
177683	Fee-for-Service	1770826786	1770826786	1	1	KARRAM, SOUHAIL M MD	3/5/2024	207LP3000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
177691	Fee-for-Service	1578950531	1578950531	1	1	KITA, ASHLEY E MD	5/27/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	145574	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
177705	Fee-for-Service	1548622293	1548622293	1	1	KURUVILLA, ANEESH DO	11/12/2019	208M00000X	NA	Other	026	PHYSICIANS	17473	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177716	Fee-for-Service	1376623538	1376623538	2	5	KERN COUNTY HOSPITAL	9/14/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1111 COLUMBUS ST	SUITE 5000	BAKERSFIELD	CA	93305	4018	15	06029	35.39744148	-118.9822815	Kern County
177717	Fee-for-Service	1124106224	1124106224	1	1	KARMARKAR, SUSHIL V MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55612	02	General Surgery	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
177794	Fee-for-Service	1215908199	1215908199	1	1	KOCH, RICHARD A MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112972	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
177795	Fee-for-Service	1316479942	1316479942	1	1	KHAN, MUSTAFA A MD	7/13/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	157182	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
177797	Fee-for-Service	1669558367	1669558367	1	1	KIM, BRIAN J MD	7/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74367	30	Radiology	0	In state provider	None	624 S CENTRAL AVE	None	GLENDALE	CA	91204	2009	19	06037	34.13847846	-118.2578377	Los Angeles County
177799	Fee-for-Service	1891195525	1891195525	1	1	KENDALL, JOY	5/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1622 4TH ST	None	SANTA ROSA	CA	95404	4020	49	06097	38.448162	-122.6995335	Sonoma County
177802	Fee-for-Service	1881852432	1881852432	1	1	KIM, YOUNG W NP	10/1/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 206	LOS ANGELES	CA	90006	6506	19	06037	34.05260995	-118.3015825	Los Angeles County
177829	Fee-for-Service	1134423155	1134423155	1	1	KING, LEAH M	7/8/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
177858	Fee-for-Service	1750559100	1750559100	1	1	KIM, JOON W MD	1/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	95534	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
177871	Fee-for-Service	1538217476	1538217476	1	1	KURSHENBAUM, HOWARD MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	54396	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
177941	Fee-for-Service	1356367163	1356367163	1	1	KUMAR, SARVADAMAN J MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53239	08	Family Practice	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
177957	Fee-for-Service	1053469890	1053469890	1	1	KAISER FDN HLTH PLAN	1/18/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #215	975 SERENO DR	RM 2281	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
177966	Fee-for-Service	1316090939	1316090939	1	1	KRAMER, PHYLIS C PHD	9/9/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
178074	Fee-for-Service	1588928378	1588928378	1	1	KHALSA, BHAVRAJ MD	5/20/2019	2085R0204X	NA	Other	026	PHYSICIANS	130823	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
178112	Fee-for-Service	1649572652	1649572652	1	1	KHOYLYAN, GAGIK MD INC	1/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100597	40	Pediatrics	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
178114	Fee-for-Service	1124075056	1124075056	1	1	KIRK A. MILLER MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 N ROBBINS RD	STE 401	BOISE	ID	83702	4566	00	None	43.61662721	-116.1919114	Ada County
178117	Fee-for-Service	1215394036	1215394036	1	5	KC TAN, M.D. MEDICAL CORPORA	7/1/2020	2085N0700X	NA	MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TION	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
178167	Fee-for-Service	1326084682	1326084682	1	1	KUMAR, MOHAN VIJAY MD	12/1/1994	207P00000X	NA	Other	026	PHYSICIANS	37164	08	Family Practice	0	In state provider	None	150 W ALOSTA AVE	None	GLENDORA	CA	91740	6207	19	06037	34.1286357	-117.8661313	Los Angeles County
178188	Fee-for-Service	1669507000	1669507000	1	1	KNOX, JOHN R DO	5/3/2022	2084P0802X	NA	Psychiatry	026	PHYSICIANS	19267	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
178197	Fee-for-Service	1851658942	1851658942	1	1	KONDRASHOV, NADYA MD	10/19/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139730	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MILVIA ST	None	BERKELEY	CA	94704	2636	01	06001	37.86338897	-122.2698455	Alameda County
178199	Fee-for-Service	1184106536	1184106536	1	1	KONDLE, SABITA LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	945 SHASTA RD	STE 100	YUBA CITY	CA	95991	9705	51	06101	39.14392271	-121.6160328	Sutter County
178241	Fee-for-Service	1366708414	1366708414	1	1	KURCHE, JONATHAN S MD	12/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
178274	Fee-for-Service	1881031656	1881031656	1	1	KIM, STEPHANIE S DO	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14492	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
178318	Fee-for-Service	1750438073	1750438073	1	1	KAISER FOUNDATION HEALTH PLA	5/20/1985	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	OB PHY 371	1190 VETERANS BLVD	FL 1 RM 1132	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
178327	Fee-for-Service	1326186131	1326186131	1	1	KENNEDY, SARAH L DO	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12945	08	Family Practice	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
178344	Fee-for-Service	1639375959	1639375959	1	1	KAYKHA, AMIR MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95626	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2141 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51231802	-120.8353115	Stanislaus County
178346	Fee-for-Service	1134362676	1134362676	1	1	KUMAR, SANTHOSH B MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120087	None	None	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
178371	Fee-for-Service	1891094652	1891094652	1	1	KUO, IRIS MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114874	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
178400	Fee-for-Service	1568757441	1568757441	1	1	KATZ, SETH K MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129970	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
178407	Fee-for-Service	1336699933	1336699933	1	1	KO, SARAH C NP	11/18/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
178417	Fee-for-Service	1376968552	1376968552	1	1	KANG, EUGENE MD	8/8/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
178445	Fee-for-Service	1508832007	1508832007	1	1	KAMDAR, VIJAY V MD INC	2/28/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39486	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11411 BROOKSHIRE AVE	SUITE 501	DOWNEY	CA	90241	5007	19	06037	33.93667091	-118.1309273	Los Angeles County
178449	Fee-for-Service	1922150747	1922150747	1	1	KOVARS, PATRICIA A LMFT	2/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
178454	Fee-for-Service	1326084682	1326084682	1	1	KUMAR, MOHAN VIJAY MD	12/1/1994	207P00000X	NA	Other	026	PHYSICIANS	37164	01	General Practice	0	In state provider	None	150 W ALOSTA AVE	None	GLENDORA	CA	91740	6207	19	06037	34.1286357	-117.8661313	Los Angeles County
178496	Fee-for-Service	1851528509	1851528509	2	3	KUMAR, ASHWANI MD	3/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117524	None	None	0	In state provider	None	3550 CHURN CREEK ROAD	None	REDDING	CA	96002	2718	45	06089	40.55569803	-122.3530101	Shasta County
178509	Fee-for-Service	1770723645	1770723645	1	1	KAISER FOUNDATION HEALTH	5/4/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #102	3701 BROADWAY	FL 1	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
178530	Fee-for-Service	1366708414	1366708414	1	1	KURCHE, JONATHAN S MD	12/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
178545	Fee-for-Service	1659483584	1659483584	1	1	KEYES, KATHRYN A	7/31/1989	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY CARE PHARMACY	4440 BROCKTON AVE	STE 400	RIVERSIDE	CA	92501	4026	33	06065	33.97764104	-117.3838896	Riverside County
178571	Fee-for-Service	1730953704	1730953704	1	1	KINYUA, DANIELLA CNP	8/6/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	127 HOSPITAL DR	204	VALLEJO	CA	94589	2562	48	06095	38.13103371	-122.2387342	Solano County
178573	Fee-for-Service	1770253957	1770253957	1	1	KEAST, RACHAEL L PT	9/26/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4270 RIVERWALK PKWY	112,114,116	RIVERSIDE	CA	92505	8506	33	06065	33.90480341	-117.4935674	Riverside County
178582	Fee-for-Service	1497460117	1497460117	1	1	KETCHUM, SELENE DOULA	5/11/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
178614	Fee-for-Service	1326186131	1326186131	1	1	KENNEDY, SARAH L DO	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12945	01	General Practice	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
178622	Fee-for-Service	1124566963	1124566963	1	1	KAMADA, KIMBERLY M	5/10/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
178651	Fee-for-Service	1679547962	1679547962	1	1	KAPOOR,WISHWA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3459 FIFTH AVE SOUTH	None	PITTSBURGH	PA	15213	0000	00	None	40.43997277	-79.96097737	Allegheny County
178659	Fee-for-Service	1982801254	1982801254	1	1	KIM, LILY H OD APC	3/19/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2366 EL CAMINO REAL	STE 5	SANTA CLARA	CA	95050	4070	43	06085	37.35228252	-121.9674105	Santa Clara County
178686	Fee-for-Service	1336683747	1336683747	1	1	KRASUCKI, DAVID J CRNA	5/7/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
178694	Fee-for-Service	1316437445	1316437445	1	1	KRENEK, KATHERINE M MD	7/31/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	186097	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
178702	Fee-for-Service	1326059387	1326059387	1	1	KAWJI, SHAHEM MD	11/14/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	93120	None	None	0	In state provider	None	222 W EULALIA ST	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
178715	Fee-for-Service	1902457260	1902457260	1	1	KATHRIN WINKLER THERAPY	9/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 BRISTOL ST	J206	COSTA MESA	CA	92626	7921	30	06059	33.67689875	-117.8872016	Orange County
178719	Fee-for-Service	1114914405	1114914405	1	1	KAROUNA, CHANCHAI OD	8/1/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	170 TOWN CENTER PARKWAY	None	SANTEE	CA	92071	5801	37	06073	32.84159782	-116.9885467	San Diego County
178730	Fee-for-Service	1669531323	1669531323	1	1	KELMAN, GREGORY MD	11/1/1995	207R00000X	NA	Other	026	PHYSICIANS	55675	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
178732	Fee-for-Service	1508832007	1508832007	1	1	KAMDAR, VIJAY V MD INC	2/28/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39486	41	Internal Medicine	0	In state provider	None	11411 BROOKSHIRE AVE	SUITE 501	DOWNEY	CA	90241	5007	19	06037	33.93667091	-118.1309273	Los Angeles County
178739	Fee-for-Service	1700874260	1700874260	1	1	KENNEDY-FUNTILA, BARBARA	6/30/1995	207R00000X	NA	Other	026	PHYSICIANS	56471	41	Internal Medicine	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
178744	Fee-for-Service	1326084682	1326084682	1	1	KUMAR, MOHAN VIJAY MD	12/1/1994	207P00000X	NA	Other	026	PHYSICIANS	37164	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 W ALOSTA AVE	None	GLENDORA	CA	91740	6207	19	06037	34.1286357	-117.8661313	Los Angeles County
178800	Fee-for-Service	1043263080	1043263080	1	1	KAPIOLANI MEDICAL CENTER FOR	8/27/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WOMEN & CHILDREN	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
178817	Fee-for-Service	1366708414	1366708414	1	1	KURCHE, JONATHAN S MD	12/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
178860	Fee-for-Service	1932503554	1932503554	1	1	KITTELSON, JANELLE CNP	3/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14735 VENTURA BLVD	None	SHERMAN OAKS	CA	91403	3679	19	06037	34.15187275	-118.4543653	Los Angeles County
178877	Fee-for-Service	1700080173	1700080173	1	1	KATHLEEN ANN DOYLE	1/7/2007	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	24431 LANTERN HILL DR	UNIT F	DANA POINT	CA	92629	3710	30	06059	33.475725	-117.7041285	Orange County
178888	Fee-for-Service	1134125586	1134125586	1	1	KRUGMAN, MARK E MD	6/22/1976	208200000X	NA	General Surgery	026	PHYSICIANS	11635	24	Plastic Surgery	0	In state provider	None	720 N TUSTIN AVE	STE 202	SANTA ANA	CA	92705	3606	30	06059	33.75168221	-117.8342151	Orange County
178934	Fee-for-Service	1699209163	1699209163	1	1	KAZEMI, NASRIN MD	10/13/2020	390200000X	NA	Other	026	PHYSICIANS	163712	41	Internal Medicine	0	In state provider	None	3200 INLAND EMPIRE	STE 100	ONTARIO	CA	91764	5513	36	06071	34.070841	-117.580734	San Bernardino County
179033	Fee-for-Service	1063440840	1063440840	1	1	KHAN, KHALID B MD	2/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62486	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3350 W BALL RD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
179041	Fee-for-Service	1609871920	1609871920	1	1	KANDEL, ELENA F MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78040	07	Dermatology	0	In state provider	None	301 W HUNTINGTON DR	None	ARCADIA	CA	91007	3462	19	06037	34.13481053	-118.0425638	Los Angeles County
179068	Fee-for-Service	1467623322	1467623322	1	1	KIM, CHRISTINE J MD	8/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126447	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
179071	Fee-for-Service	1659735132	1659735132	1	1	KAWEAH DELTA HEALTH CARE	8/4/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y	202 W WILLOW AVE	SUITE 102	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
179082	Fee-for-Service	1700018868	1700018868	1	1	KUO, WEN EN MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126333	07	Dermatology	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
179089	Fee-for-Service	1043263080	1043263080	1	1	KAPIOLANI MEDICAL CENTER FOR	8/27/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WOMEN & CHILDREN	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
179103	Fee-for-Service	1275732455	1275732455	1	1	KUYLEN DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	30 7TH ST W	None	DICKINSON	ND	58601	4335	00	None	46.88595477	-102.7859042	Stark County
179106	Fee-for-Service	1124008313	1124008313	1	1	KIM, DANIEL C MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74715	03	Allergy	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
179107	Fee-for-Service	1134407703	1134407703	1	1	KHAJAVI, HENGAMEH M LMFT	9/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2102 BUSINESS CENTER DR	None	IRVINE	CA	92612	1001	30	06059	33.68027087	-117.855546	Orange County
179124	Fee-for-Service	1073753844	1073753844	1	1	KENIA, SWATI M	12/21/2016	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 N MAIN ST	STE 340	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
179129	Fee-for-Service	1629269014	1629269014	1	1	KAMINSKY, IRINA G MD	10/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96933	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
179132	Fee-for-Service	1417303363	1417303363	1	1	KLIETHERMES, MATTHEW	3/2/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	162309	None	None	0	In state provider	None	112 N AKERS ST	STE A	VISALIA	CA	93291	5121	54	06107	36.330156	-119.3483475	Tulare County
179143	Fee-for-Service	1013982529	1013982529	1	1	KING, JEREMY A MD	2/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	76036	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	222 N PACIFIC COAST HWY	2175	EL SEGUNDO	CA	90245	5639	19	06037	33.91868885	-118.3958904	Los Angeles County
179154	Fee-for-Service	1013146794	1013146794	1	1	KAUR, LAKHVIR MD	12/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158270	41	Internal Medicine	0	In state provider	None	2 MEDICAL PLAZA	STE 200	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
179158	Fee-for-Service	1689796674	1689796674	1	1	KELMENSON-CHAU, SARAH M	2/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98209	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
179170	Fee-for-Service	1992243877	1992243877	1	1	KASSASEYA, GABRIEL G LMFT	4/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
179175	Fee-for-Service	1134125586	1134125586	1	1	KRUGMAN, MARK E MD	6/22/1976	208200000X	NA	General Surgery	026	PHYSICIANS	11635	04	Otology, Laryngology, Rhinology	0	In state provider	None	720 N TUSTIN AVE	STE 202	SANTA ANA	CA	92705	3606	30	06059	33.75168221	-117.8342151	Orange County
179213	Fee-for-Service	1366512923	1366512923	1	1	KALLEN, SUZANNE L PHD	11/27/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
179248	Fee-for-Service	1033418249	1033418249	1	1	KEDIA, ROHIT R MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14161	67	Endocrinology	0	In state provider	None	11333 N SEPULVEDA BLVD	None	LOS ANGELES	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
179272	Fee-for-Service	1770583197	1770583197	1	1	KARIMI, MISAGH MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63851	68	Hematology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
179302	Fee-for-Service	1265883128	1265883128	1	1	KOLLEE, AMANDA OT	3/5/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
179358	Fee-for-Service	1215518105	1215518105	1	1	KORRAPATI, AKHIL DPM	6/14/2024	390200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
179359	Fee-for-Service	1821052176	1821052176	1	1	KUDIJA, KAREN ROBERSON	1/1/1996	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1112 VINE ST	None	PASO ROBLES	CA	93446	5505	40	06079	35.62602516	-120.6938682	San Luis Obispo County
179364	Fee-for-Service	1255177622	1255177622	1	1	KESLIN, ALLYSON NP	8/30/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
179381	Fee-for-Service	1821025537	1821025537	1	1	KUDIRKA, JOHN MD	4/30/1991	207P00000X	NA	Other	026	PHYSICIANS	55914	66	Emergency Medicine (Urgent Care)	0	In state provider	WESTLAKE EMERGENCY PHYSI	4415 LAKEVIEW CANYON RD	None	WESTLAKE VILLAGE	CA	91361	3603	19	06037	34.14720238	-118.8195228	Los Angeles County
179382	Fee-for-Service	1801007802	1801007802	1	1	KING OF KINGS COMMUNITY	12/13/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	2302 MARTIN L KING JR BL	None	FRESNO	CA	93706	4135	10	06019	36.717624	-119.7998695	Fresno County
179407	Fee-for-Service	1538220934	1538220934	1	1	KAMIL, BARRY PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
179409	Fee-for-Service	1790406882	1790406882	1	1	KSENDZ, PAVEL NP	1/10/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
179427	Fee-for-Service	1548588684	1548588684	1	1	KIM, ESTHER CRNA	12/27/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
179458	Fee-for-Service	1417226234	1417226234	1	1	KAHEN DAN M DO	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11814	08	Family Practice	0	In state provider	None	1030 W GARDENA BLVD	None	GARDENA	CA	90247	4956	19	06037	33.88154027	-118.2925662	Los Angeles County
179468	Fee-for-Service	1295991354	1295991354	1	1	KAMATH, BHOOMIKA R MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109209	None	None	0	In state provider	None	401 PARADISE ROAD	SUITE E	MODESTO	CA	95351	3163	50	06099	37.62692973	-121.0131742	Stanislaus County
179491	Fee-for-Service	1235591900	1235591900	1	1	KRAMER, SAGE P MD	6/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153570	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
179496	Fee-for-Service	1063928422	1063928422	1	1	KOMAL, BUSHRA	2/2/2021	207R00000X	NA	Other	026	PHYSICIANS	170439	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
179512	Fee-for-Service	1316946130	1316946130	1	1	KORVER, KEITH F	6/30/1992	208G00000X	NA	General Surgery	026	PHYSICIANS	52235	01	General Practice	0	In state provider	None	770 WELCH RD	STE 201	PALO ALTO	CA	94304	1513	43	06085	37.43748087	-122.1759625	Santa Clara County
179515	Fee-for-Service	1447238365	1447238365	1	1	KILLIAN, SAMUEL J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
179518	Fee-for-Service	1669635132	1669635132	1	1	KRAD, OMAR MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116832	18	Ophthalmology	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 120	MISSION VIEJO	CA	92691	6405	30	06059	33.558534	-117.6641255	Orange County
179528	Fee-for-Service	1962411447	1962411447	1	1	KFIR, MENASHE MD	11/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91290	47	Miscellaneous	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
179535	Fee-for-Service	1952424079	1952424079	1	2	KARIMOV, CATHERINE B MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138997	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
179553	Fee-for-Service	1043466626	1043466626	1	1	KONDO, SANAYO S	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
179557	Fee-for-Service	1770583197	1770583197	1	1	KARIMI, MISAGH MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63851	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
179589	Fee-for-Service	1497808620	1497808620	1	1	KAMATH, SANDYA M OD	1/30/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
179599	Fee-for-Service	1497833115	1497833115	1	1	KNIERIEM, KAREN M MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43118	05	Anesthesiology	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
179622	Fee-for-Service	1588738314	1588738314	2	1	KIM, HYO H MD	9/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	40291	41	Internal Medicine	0	In state provider	None	2136 SUTTER STREET	None	SAN FRANCISCO	CA	94115	3120	38	06075	37.78583216	-122.4355525	San Francisco County
179654	Fee-for-Service	1396979175	1396979175	1	1	KEKULAWELA, STEPHANIE P MD	7/13/2019	208600000X	NA	General Surgery	026	PHYSICIANS	153448	02	General Surgery	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
179686	Fee-for-Service	1427175926	1427175926	1	2	KAUFMAN, MURRAY S LMFT	12/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
179700	Fee-for-Service	1669867032	1669867032	1	1	KAYALOGLOU, ANNA MARIA MD	1/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156326	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
179710	Fee-for-Service	1477137040	1477137040	1	1	KAHLON, RAJPREET NP	12/9/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
179774	Fee-for-Service	1073699583	1073699583	1	1	KABAHIT, JOHN T	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6979	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
179803	Fee-for-Service	1316946130	1316946130	1	1	KORVER, KEITH F	6/30/1992	208G00000X	NA	General Surgery	026	PHYSICIANS	52235	02	General Surgery	0	In state provider	None	770 WELCH RD	STE 201	PALO ALTO	CA	94304	1513	43	06085	37.43748087	-122.1759625	Santa Clara County
179821	Fee-for-Service	1891993150	1891993150	1	1	KRUSE, DAVID W MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92859	08	Family Practice	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
179832	Fee-for-Service	1659803674	1659803674	1	1	KIM, JANI M MD	1/8/2019	207R00000X	NA	Other	026	PHYSICIANS	157180	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
179840	Fee-for-Service	1730869744	1730869744	1	1	KWOBA, MARION PSYD	3/6/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
179847	Fee-for-Service	1790852614	1790852614	1	1	KIM, EUN YEONG MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77457	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
179848	Fee-for-Service	1770583197	1770583197	1	1	KARIMI, MISAGH MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63851	78	Neoplastic Diseases/Oncology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
179860	Fee-for-Service	1972990885	1972990885	1	1	KIM, PETER L MD	11/8/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	177841	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
179874	Fee-for-Service	1750395828	1750395828	1	1	KODAMA, KEVIN T MD	3/1/2000	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	78832	10	Gastroenterology (M.D. only)	0	In state provider	None	1187 E HERNDON AVE	STE 106	FRESNO	CA	93720	3166	10	06019	36.83640179	-119.7674647	Fresno County
179892	Fee-for-Service	1821174343	1821174343	1	1	KENY, HEMANT V MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62579	02	General Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
179896	Fee-for-Service	1316940109	1316940109	1	1	KANSARA, DEVANSHU V MD	1/6/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	169386	None	None	0	In state provider	None	5555 GROSSMONT CENTER	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
179936	Fee-for-Service	1043896988	1043896988	1	1	KAVIANPOUR, BEHDAD MD	6/13/2024	390200000X	NA	Other	026	PHYSICIANS	181771	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
179940	Fee-for-Service	1396979175	1396979175	1	1	KEKULAWELA, STEPHANIE P MD	7/13/2019	208600000X	NA	General Surgery	026	PHYSICIANS	153448	89	Surgery-Traumatic	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
179979	Fee-for-Service	1962553263	1962553263	1	1	KU, KAREN MD	5/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81908	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
179990	Fee-for-Service	1093150054	1093150054	1	1	KIM, REBEKAH J DO	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14536	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
180037	Fee-for-Service	1710923677	1710923677	1	1	KIDNEY CENTER OF SHERMAN	5/14/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OAKS INC	4955 VAN NUYS BLVD	STE 111	SHERMAN OAKS	CA	91403	1850	19	06037	34.160805	-118.4487295	Los Angeles County
180043	Fee-for-Service	1285786400	1285786400	1	1	KOTTON, MICHAEL MD	6/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69650	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
180049	Fee-for-Service	1295869733	1295869733	3	1	KBC PHARMACY INC	2/27/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	580 FOREST SHADE RD	STE 7	CRESTLINE	CA	92325	2220	36	06071	34.24265206	-117.2780226	San Bernardino County
180062	Fee-for-Service	1831177757	1831177757	1	1	KWILMAN,ALLEN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
180068	Fee-for-Service	1205993474	1205993474	1	1	KOFMAN CHIROPRACTIC CORP	9/6/2011	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	11685 MAGNOLIA BLVD	None	VALLEY VILLAGE	CA	91601	3065	19	06037	34.16491446	-118.3872735	Los Angeles County
180069	Fee-for-Service	1023023587	1023023587	1	1	KATZMAN, JOANNA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
180159	Fee-for-Service	1558908194	1558908194	1	1	KLINE, VANESSA MSW LCSW	7/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 W JASON ST	None	ENCINITAS	CA	92009	9013	37	06073	33.07055539	-117.3052165	San Diego County
180267	Fee-for-Service	1710091749	1710091749	2	1	KITT, SEE-RUERN	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41262	None	None	0	In state provider	None	2222 19TH STREET	None	BAKERSFIELD	CA	93301	3609	15	06029	35.37628343	-119.0278229	Kern County
180290	Fee-for-Service	1427100924	1427100924	1	1	KIM, EILEEN H OD	5/6/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
180315	Fee-for-Service	1518974583	1518974583	1	1	KAZEMI, SEPIDEH MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94770	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3080 BRISTOL STREET	STE 600	COSTA MESA	CA	92626	7341	30	06059	33.68480996	-117.8854767	Orange County
180320	Fee-for-Service	1457309783	1457309783	1	1	KARNANI, JAYA MD INC	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89868	None	None	0	In state provider	None	2382 MARITIME DR	# 100	ELK GROVE	CA	95758	4669	34	06067	38.41173	-121.4831925	Sacramento County
180349	Fee-for-Service	1447338926	1447338926	1	2	KAN, LEO H DO	11/13/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	9163	None	None	0	In state provider	None	9289 BRANSTETTER PL	None	STOCKTON	CA	95209	1700	39	06077	38.03464815	-121.3463638	San Joaquin County
180381	Fee-for-Service	1023027695	1023027695	1	1	KERMANSHAHI, ARASH Y MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117210	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
180382	Fee-for-Service	1881909885	1881909885	1	1	KARIMI, ALEXANDER LMFT	7/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
180388	Fee-for-Service	1467516062	1467516062	1	1	KHAN, NOMAN Q MD	6/30/1991	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	73553	20	Orthopedic Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
180415	Fee-for-Service	1952752263	1952752263	1	1	KATONA, LINDSAY DO	10/15/2019	208M00000X	NA	Other	026	PHYSICIANS	15853	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
180444	Fee-for-Service	1629842448	1629842448	1	1	KNAPPE, BARRY PT	3/1/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	680 E ROMIE LN	A	SALINAS	CA	93901	4206	27	06053	36.65922321	-121.6430933	Monterey County
180454	Fee-for-Service	1477641686	1477641686	1	1	KIMBRO, TAMAKI A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66863	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
180467	Fee-for-Service	1134389653	1134389653	1	1	KWONG, WILSON T MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114763	10	Gastroenterology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
180527	Fee-for-Service	1356577977	1356577977	1	1	KAREN DUNCAN	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
180574	Fee-for-Service	1376500447	1376500447	1	1	KELLY KLEIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3601 4TH STREET	None	LUBBOCK	TX	79430	0002	00	None	33.58953	-101.891907	Lubbock County
180589	Fee-for-Service	1144764820	1144764820	1	1	KAPLAN, CHRISTOPHER C PT	12/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	521 E ELDER ST	SUITE 106/107	FALLBROOK	CA	92028	3081	37	06073	33.38015149	-117.246267	San Diego County
180598	Fee-for-Service	1679682652	1679682652	1	1	KHALEDY, ABDULRAHMAN MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62946	38	Geriatrics	0	In state provider	None	1025 W OLYMPIC	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
180602	Fee-for-Service	1083651038	1083651038	1	1	KIM, TAE HYUN DPM INC	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	903 CRENSHAW BLVD	STE 204	LOS ANGELES	CA	90019	1964	19	06037	34.05617593	-118.3221956	Los Angeles County
180641	Fee-for-Service	1700966686	1700966686	1	1	KLEBANOV, MARK MD CORP	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54480	41	Internal Medicine	0	In state provider	None	120 LA CASA VIA	STE 102	WALNUT CREEK	CA	94598	3092	07	06013	37.91202407	-122.0419227	Contra Costa County
180648	Fee-for-Service	1265783039	1265783039	1	1	KREIMER BARRON, SARA REGINA	5/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122929	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
180701	Fee-for-Service	1770659740	1770659740	1	1	KIRYAS JOEL COMMUNITY AMBULA	2/14/2013	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	48 BAKERTOWN RD	STE 407	MONROE	NY	10950	8434	00	None	41.333922	-74.1611745	Orange County
180740	Fee-for-Service	1215419460	1215419460	1	1	KWAN, ERIC PT	5/20/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
180752	Fee-for-Service	1134389653	1134389653	1	1	KWONG, WILSON T MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114763	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
180768	Fee-for-Service	1689751398	1689751398	1	1	KALANTA, WILLIAM DPM	10/31/1985	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1941 MITCHELL RD	STE R	CERES	CA	95307	2434	50	06099	37.600713	-120.9387265	Stanislaus County
180803	Fee-for-Service	1023546009	1023546009	1	1	KARAN, ABRAAR MD	1/30/2024	207R00000X	NA	Other	026	PHYSICIANS	172199	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
180810	Fee-for-Service	1295116432	1295116432	1	1	KIM, DMITRIY DO	10/19/2020	208600000X	NA	General Surgery	026	PHYSICIANS	18244	02	General Surgery	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
180811	Fee-for-Service	1114362670	1114362670	1	1	KUSILKA, ROBIN L LMFT	7/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 PACIFIC COAST HIGHW	SUITE 324	HERMOSA BEACH	CA	90254	2227	19	06037	33.87364527	-118.3960248	Los Angeles County
180850	Fee-for-Service	1346565587	1346565587	1	1	KHATIBI, MAXIMILIAM MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113259	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
180861	Fee-for-Service	1801090519	1801090519	1	1	KOEHLER, MATTHEW M DO	12/1/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	10685	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
180884	Fee-for-Service	1669695979	1669695979	1	1	KEPPEN, DENA L	3/7/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	1	Border provider	KEPPEN PEDIATRIC PHYSICA	306 S 6TH ST	None	KLAMATH FALLS	OR	97601	6114	00	None	42.22359012	-121.7807584	Klamath County
180885	Fee-for-Service	1679682652	1679682652	1	1	KHALEDY, ABDULRAHMAN MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62946	41	Internal Medicine	0	In state provider	None	1025 W OLYMPIC	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
180888	Fee-for-Service	1376701607	1376701607	1	1	KUNGYS, GUDRUN MD	12/17/2008	207L00000X	NA	Other	026	PHYSICIANS	99560	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
180926	Fee-for-Service	1396823431	1396823431	1	1	KANTOR, JEFFREY A MD	6/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	69250	20	Orthopedic Surgery	0	In state provider	None	23206 LYONS AVE	SUITE 110	SANTA CLARITA	CA	91321	2667	19	06037	34.37981956	-118.5384385	Los Angeles County
180929	Fee-for-Service	1700966686	1700966686	1	1	KLEBANOV, MARK MD CORP	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54480	67	Endocrinology	0	In state provider	None	120 LA CASA VIA	STE 102	WALNUT CREEK	CA	94598	3092	07	06013	37.91202407	-122.0419227	Contra Costa County
180943	Fee-for-Service	1700106564	1700106564	1	1	KILLEEN, TIMOTHY J MD INC	1/8/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55364	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	29645 RANCHO CALIFORNIA	SUITE 226	TEMECULA	CA	92591	5211	33	06065	33.50627123	-117.1431728	Riverside County
180956	Fee-for-Service	1548581853	1548581853	1	1	KAY, TERRY MD	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132032	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
180959	Fee-for-Service	1376698043	1376698043	1	1	KAISER FOUNDATION HOSP	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
180966	Fee-for-Service	1730312877	1730312877	1	1	KOLAVALA, RAHUL R MD	11/12/2018	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	152856	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
180998	Fee-for-Service	1942712971	1942712971	1	1	KOSARAJU, MONISHA MD	5/17/2022	207R00000X	NA	Other	026	PHYSICIANS	167337	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
181007	Fee-for-Service	1174754493	1174754493	1	1	KENNINGTON, SHANE LCSW	6/16/2014	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	10436 SANTA MONICA BLVD	STE 3005 OFFICE NUMBER 3	LOS ANGELES	CA	90025	6934	19	06037	34.05657141	-118.4249266	Los Angeles County
181010	Fee-for-Service	1609958180	1609958180	1	1	KHAN-HUDSON, ALIA MD	1/22/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	89051	41	Internal Medicine	0	In state provider	None	2699 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
181017	Fee-for-Service	1205015468	1205015468	1	2	KALRA, KUNAL	4/4/2024	207L00000X	NA	Other	026	PHYSICIANS	162071	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
181021	Fee-for-Service	1265975148	1265975148	1	1	KLITH, DAISY NP	2/16/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95005493	-	NOT APPLICABLE	0	In state provider	None	145 BOST AVE	None	NEVADA CITY	CA	95959	3249	29	06057	39.25027262	-121.0215808	Nevada County
181026	Fee-for-Service	1558325654	1558325654	1	1	KEENAN, ROBERT N	7/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79742	None	None	0	In state provider	None	521 E ELDER ST	STE 205	FALLBROOK	CA	92028	3083	37	06073	33.38015149	-117.246267	San Diego County
181066	Fee-for-Service	1578669370	1578669370	1	1	KUPELIAN, ANNIE MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69748	40	Pediatrics	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
181081	Fee-for-Service	1215314281	1215314281	1	1	KURIN, TESA A	12/27/2017	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	1505 WEST AVE J	SUITE 203	LANCASTER	CA	93534	0001	19	06037	34.68945168	-118.1571066	Los Angeles County
181091	Fee-for-Service	1417392663	1417392663	1	1	KWONG, MIMMIE MD	9/18/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	140004	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
181104	Fee-for-Service	1043652522	1043652522	1	1	KAUR, NAVDEEP MD	7/8/2022	207R00000X	NA	Other	026	PHYSICIANS	176695	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
181113	Fee-for-Service	1659345940	1659345940	2	1	KHAMLY, JASON Y	12/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	43000	01	General Practice	0	In state provider	None	1314 S EUCLID ST	STE 104	ORANGE	CA	92802	2079	30	06059	33.815502	-117.9413935	Orange
181118	Fee-for-Service	1013946565	1013946565	1	1	KRIEGER, DAVID E MD	4/1/1998	174400000X	NA	Other	026	PHYSICIANS	42146	10	Gastroenterology (M.D. only)	0	In state provider	None	25775 MCBEAN PKWY	STE 115	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
181143	Fee-for-Service	1639256928	1639256928	1	1	KHER, KANWAL K MD	4/22/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	148058	40	Pediatrics	0	In state provider	None	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	07	06013	37.90582392	-122.0613697	Contra Costa County
181155	Fee-for-Service	1841829306	1841829306	1	1	KUSAKA, GEOFFREY K MD	7/5/2023	208M00000X	NA	Other	026	PHYSICIANS	180729	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
181188	Fee-for-Service	1386792265	1386792265	1	1	KANSAGARA, DIPUL MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64480	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
181210	Fee-for-Service	1821368127	1821368127	1	1	KLEIN, CHRISTINA L LMFT	9/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
181216	Fee-for-Service	1528139581	1528139581	1	1	KHAN, SHAHID H MD	7/31/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49077	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
181243	Fee-for-Service	1679007934	1679007934	1	1	KUMAR, RAJENDRA	2/7/2017	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	415 E. HARDING WAY	SUITE J.	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
181274	Fee-for-Service	1508180761	1508180761	1	1	KHAITAN, ANISHA MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142920	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
181297	Fee-for-Service	1194144170	1194144170	1	1	KELLEY, SEAN M MD	6/27/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	141999	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
181308	Fee-for-Service	1205015468	1205015468	1	2	KALRA, KUNAL	4/4/2024	207L00000X	NA	Other	026	PHYSICIANS	162071	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
181351	Fee-for-Service	1083921050	1083921050	1	1	KEYSER, JESSICA D PHD	9/12/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
181355	Fee-for-Service	1578669370	1578669370	1	1	KUPELIAN, ANNIE MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69748	41	Internal Medicine	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
181396	Fee-for-Service	1922031467	1922031467	1	1	KOWNACKI, JOHN MD INC	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84672	18	Ophthalmology	0	In state provider	None	680 FLETCHER PKWY	STE 202	EL CAJON	CA	92020	2500	37	06073	32.80780847	-116.970687	San Diego County
181397	Fee-for-Service	1225146293	1225146293	1	1	KANDASWAMY, CHITRADEVI	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92981	41	Internal Medicine	0	In state provider	MD	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
181399	Fee-for-Service	1659345940	1659345940	2	1	KHAMLY, JASON Y	12/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	43000	40	Pediatrics	0	In state provider	None	1314 S EUCLID ST	STE 104	ORANGE	CA	92802	2079	30	06059	33.815502	-117.9413935	Orange
181409	Fee-for-Service	1477757359	1477757359	1	1	KINGERY, JULIE D MD	2/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90698	22	Pathology (M.D. only)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
181506	Fee-for-Service	1528139581	1528139581	1	1	KHAN, SHAHID H MD	7/31/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49077	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
181520	Fee-for-Service	1407871866	1407871866	1	1	KANG, GAIL A MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72690	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA #B200	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
181526	Fee-for-Service	1376157446	1376157446	1	1	KENAI RIVER HOLDINGS LLC	9/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	790 HOLMES STREET	None	LIVERMORE	CA	94550	4229	01	06001	37.672782	-121.7803766	Alameda County
181569	Fee-for-Service	1528377694	1528377694	1	1	KAZAZIAN, SHANT MD INC	5/2/2011	207R00000X	NA	Other	026	PHYSICIANS	94612	41	Internal Medicine	0	In state provider	None	2585 E WASHINGTON BLVD	None	PASADENA	CA	91107	1446	19	06037	34.1691963	-118.0972255	Los Angeles County
181589	Fee-for-Service	1356398861	1356398861	1	1	KIM, SUNG H MD	12/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	31842	05	Anesthesiology	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
181608	Fee-for-Service	1417378597	1417378597	1	1	KEDREN COMMUNITY HEALTH	3/7/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	4211 SOUTH AVALON BLVD	SUITE A	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
181628	Fee-for-Service	1437394160	1437394160	1	1	KIRAKOSIAN, ARMAN A DPM	7/20/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	883 SNEATH LANE	STE 160	SAN BRUNO	CA	94066	2401	41	06081	37.63591781	-122.4231037	San Mateo County
181693	Fee-for-Service	1710097191	1710097191	1	1	KWAN, WILLIAM H DPM	8/1/1983	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1687 ERRINGER RD	STE 108	SIMI VALLEY	CA	93065	6509	56	06111	34.268886	-118.761426	Ventura County
181720	Fee-for-Service	1376811380	1376811380	1	1	KIM, CHAE Y MD	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124484	41	Internal Medicine	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
181732	Fee-for-Service	1588659759	1588659759	1	1	KUEI, JOSEPH MD	9/30/1987	207RP1001X	NA	Pulmonology	026	PHYSICIANS	42833	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
181742	Fee-for-Service	1972541829	1972541829	1	1	KUMAR, PAWAN MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106658	67	Endocrinology	0	In state provider	None	590 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3257	54	06107	36.06962449	-119.030337	Tulare County
181774	Fee-for-Service	1568651594	1568651594	1	1	KALRA, RAJESH MD	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107363	25	Physical Medicine and Rehabilitation	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
181793	Fee-for-Service	1528139581	1528139581	1	1	KHAN, SHAHID H MD	7/31/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49077	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
181808	Fee-for-Service	1063800316	1063800316	1	1	KUKULJ, ANA T NP	5/6/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
181828	Fee-for-Service	1174650626	1174650626	1	1	KHA, MY N MD	5/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89765	08	Family Practice	0	In state provider	None	9001 STOCKDALE HWY	28 HC	BAKERSFIELD	CA	93311	1022	15	06029	35.350344	-119.1050775	Kern County
181870	Fee-for-Service	1093778219	1093778219	1	1	KHAN, FARAH MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81188	36	Psychiatry	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
181880	Fee-for-Service	1912078817	1912078817	1	1	KHOURY, MARGARET MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49137	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
181895	Fee-for-Service	1417378597	1417378597	1	1	KEDREN COMMUNITY HEALTH	3/7/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	4211 SOUTH AVALON BLVD	SUITE A	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
182006	Fee-for-Service	1376986794	1376986794	1	1	KARINA WALKER MD	11/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVENUE SW	None	MINOT	ND	58702	5010	00	None	48.23336909	-101.2951165	Ward County
182039	Fee-for-Service	1740461821	1740461821	1	1	KENNETH R HANCOCK	5/11/1988	No Taxonomy Provided	NA	None	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	NORTH VLLY PORTABLE XRAY	2095 RENZ RD	None	DURHAM	CA	95938	9627	04	06007	39.650202	-121.786657	Butte County
182053	Fee-for-Service	1659552008	1659552008	1	1	KAUR, SARBJOT MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101693	08	Family Practice	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94553	6901	48	06095	38.2629133	-122.0560176	Solano County
182098	Fee-for-Service	1356335277	1356335277	1	1	KHANLOU, HOMAYOON MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66631	None	None	0	In state provider	None	12100 VALLEY BLVD	SUITE 109A	EL MONTE	CA	91732	3161	19	06037	34.06130355	-118.0164048	Los Angeles County
182117	Fee-for-Service	1639330301	1639330301	1	1	KAUR, DILPREET MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114239	13	Neurology (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
182143	Fee-for-Service	1205465085	1205465085	1	1	KUO, JESSICA MD	3/4/2024	207L00000X	NA	Other	026	PHYSICIANS	187533	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
182168	Fee-for-Service	1114952488	1114952488	1	1	KANDAVEL, MONICA P MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84903	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
182171	Fee-for-Service	1558600064	1558600064	1	1	KWONG, AVON W OD INC	10/15/2013	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 BROADWAY	None	SAN FRANCISCO	CA	94133	4405	38	06075	37.79779175	-122.4073064	San Francisco County
182178	Fee-for-Service	1386662807	1386662807	1	1	KIM, AIRIE MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99799	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
182212	Fee-for-Service	1568430718	1568430718	1	1	KEDDISSI,JEAN I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 NE 13TH STREET	None	OKLAHOMA CITY	OK	73104	0000	00	None	35.480961	-97.5013965	Oklahoma County
182225	Fee-for-Service	1447556154	1447556154	1	1	KATHERINE JAHNES	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
182235	Fee-for-Service	1457453128	1457453128	1	1	KIMBALL, JENNIFER C PT	5/2/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
182286	Fee-for-Service	1225141963	1225141963	1	1	KHWAJA, SAMINA O MD	2/8/2015	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	55947	41	Internal Medicine	0	In state provider	None	1150 E 4TH STREET	SUITE 111	LONG BEACH	CA	90802	1735	19	06037	33.77170247	-118.1769615	Los Angeles County
182295	Fee-for-Service	1386674976	1386674976	1	1	KENDALL, ERIC MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
182377	Fee-for-Service	1326165770	1326165770	1	1	KARN, VALERIE A LMFT	1/4/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1608 SUNRISE AVE	SUITE 5	MODESTO	CA	95350	4678	50	06099	37.66782938	-120.9848364	Stanislaus County
182392	Fee-for-Service	1295963395	1295963395	1	1	KNAUFF, SARAH E	8/22/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
182393	Fee-for-Service	1508893421	1508893421	1	1	KANNANGARA, SAMAN MD	10/29/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	163234	77	Infectious Disease	0	In state provider	None	2250 HAYES ST	STE 302	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
182401	Fee-for-Service	1316961964	1316961964	1	1	KAUL, PARITOSH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
182421	Fee-for-Service	1639124803	1639124803	1	1	KILCHESKI, THOMAS S MD	11/1/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	44954	None	None	0	In state provider	None	5565 GROSSMONT CENTER DR	BLDG 21	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
182438	Fee-for-Service	1346569944	1346569944	1	1	KALAMKARIAN, NAREG MD	4/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139478	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
182445	Fee-for-Service	1609403682	1609403682	1	1	KHALIL, MARIO MD	10/4/2024	207L00000X	NA	Other	026	PHYSICIANS	190759	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
182466	Fee-for-Service	1386662807	1386662807	1	1	KIM, AIRIE MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99799	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
182473	Fee-for-Service	1356675573	1356675573	1	1	KURIAN, THOMAS M MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130877	13	Neurology (M.D. only)	0	In state provider	None	23928 LYONS AVE	102	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
182491	Fee-for-Service	1417076605	1417076605	1	1	KAN, WEN-TING PHD	12/3/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
182497	Fee-for-Service	1023308947	1023308947	1	1	KOO, JA HYUN LAC	3/6/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	645 W 9TH STREET	None	SAN PEDRO	CA	90731	3107	19	06037	33.73602055	-118.291077	Los Angeles County
182554	Fee-for-Service	1841768694	1841768694	1	1	KUEHL, AMY	6/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5266 HOLLISTER AVE	STE 205	SANTA BARBARA	CA	93111	2037	42	06083	34.43497016	-119.8071895	Santa Barbara County
182567	Fee-for-Service	1386637528	1386637528	2	1	KENYON, KEITH E JR MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	30715	18	Ophthalmology	0	In state provider	None	201 S ALVARADO STREET	SUITE 406	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
182573	Fee-for-Service	1225141963	1225141963	1	1	KHWAJA, SAMINA O MD	2/8/2015	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	55947	38	Geriatrics	0	In state provider	None	1150 E 4TH STREET	SUITE 111	LONG BEACH	CA	90802	1735	19	06037	33.77170247	-118.1769615	Los Angeles County
182580	Fee-for-Service	1073558383	1073558383	1	1	KURAPATI, SURENDER MD	2/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138487	30	Radiology	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
182604	Fee-for-Service	1578963021	1578963021	1	1	KIM, GRACE S MD	5/8/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	144946	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
182637	Fee-for-Service	1871670828	1871670828	1	1	KUSHNER, PAMELA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53239	08	Family Practice	0	In state provider	None	2865 ATLANTIC AVE	STE 207	LONG BEACH	CA	90806	1730	19	06037	33.809418	-118.185058	Los Angeles County
182655	Fee-for-Service	1679100721	1679100721	1	2	KRIS J. STORKERSEN M.D. INC.	6/4/2020	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	400 N PEPPER AVE	SECOND FLOOR, OPC	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
182711	Fee-for-Service	1457425407	1457425407	1	1	KEY, FOLLIN A	7/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
182712	Fee-for-Service	1568858199	1568858199	1	1	KOKHANOV, ARTEMIY MD	3/22/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	155154	None	None	0	In state provider	None	300 HILLMONT AVENUE	None	VENTURA	CA	93003	1651	56	06111	34.27771547	-119.2540344	Ventura County
182713	Fee-for-Service	1427383108	1427383108	1	1	KIM, YUNIE MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110979	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
182728	Fee-for-Service	1861531485	1861531485	1	1	KERR, DEREK MD	6/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49031	01	General Practice	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
182752	Fee-for-Service	1053471318	1053471318	1	1	KOURA DIVYA T MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125774	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
182775	Fee-for-Service	1902984495	1902984495	1	1	KOO, DERRICK MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86734	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
182808	Fee-for-Service	1609978618	1609978618	1	1	KIM, ANDREW C MD	2/14/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	45641	None	None	0	In state provider	None	3800 JANES ROAD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
183007	Fee-for-Service	1619943313	1619943313	1	1	KAILATH, JOHN M MD	2/28/1984	207RH0003X	NA	Oncology	026	PHYSICIANS	38389	68	Hematology	0	In state provider	None	406 SUNRISE AVE	None	ROSEVILLE	CA	95661	4106	31	06061	38.73944898	-121.2720559	Placer County
183013	Fee-for-Service	1568556173	1568556173	1	1	KING, HENRY T-H MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56087	05	Anesthesiology	0	In state provider	None	1801 HANOVER DR	STE F	DAVIS	CA	95616	1067	57	06113	38.55895232	-121.7567316	Yolo County
183017	Fee-for-Service	1497757512	1497757512	1	1	KHAN, SAYEED AHMED MD	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83414	41	Internal Medicine	0	In state provider	None	12660 RIVERSIDE DR	STE 310&320	NORTH HOLLYWOOD	CA	91607	3429	19	06037	34.1575795	-118.409499	Los Angeles County
183035	Fee-for-Service	1952355547	1952355547	1	1	KAUR, NIRMALJIT MD	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79804	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
183040	Fee-for-Service	1053471318	1053471318	1	1	KOURA DIVYA T MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125774	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
183060	Fee-for-Service	1891894531	1891894531	1	1	KRANSON, BLAIR S MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40294	None	None	0	In state provider	None	7320 WOODLAKE AVE	STE 395	WEST HILLS	CA	91307	1496	19	06037	34.20245266	-118.6321273	Los Angeles County
183069	Fee-for-Service	1871054346	1871054346	1	1	KHOURY, ANTOINE DO	2/26/2024	207L00000X	NA	Other	026	PHYSICIANS	20942	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
183070	Fee-for-Service	1528379708	1528379708	1	1	KUHL, KRISTOPHER V DO	5/1/2018	207L00000X	NA	Other	026	PHYSICIANS	15310	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
183087	Fee-for-Service	1437562568	1437562568	1	1	KARANJA, ROSEMARY	5/17/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	21622 MARGUERITE PKWY	APT 554	MISSION VIEJO	CA	92692	4434	30	06059	33.649893	-117.64179	Orange County
183103	Fee-for-Service	1902162217	1902162217	1	1	KWON, JULIE Y MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142879	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
183142	Fee-for-Service	1437220704	1437220704	1	1	KUNNAPPILLY, CHESTER MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70314	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
183169	Fee-for-Service	1730752650	1730752650	1	1	KAVOUSSI, KIYANA OD	11/22/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
183176	Fee-for-Service	1851433882	1851433882	1	1	KIM, KI H	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4055 WILSHIRE BLVD	SUITE 345	LOS ANGELES	CA	90010	3403	19	06037	34.06172406	-118.3162982	Los Angeles County
183204	Fee-for-Service	1720075906	1720075906	2	1	KCI USA INC	12/5/2011	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	606 S GLENWOOD PL	None	BURBANK	CA	91506	2820	19	06037	34.16653986	-118.3142784	Los Angeles County
183286	Fee-for-Service	1417361726	1417361726	1	1	KUSLER, MELISSA B LCSW	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	78090	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
183289	Fee-for-Service	1255317806	1255317806	1	1	KUZMICH, CATHERINE A NP	12/27/2004	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
183318	Fee-for-Service	1154572477	1154572477	1	1	KALIRA, DIMPI MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99199	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4383	01	06001	37.63347961	-122.0897735	Alameda County
183319	Fee-for-Service	1487185740	1487185740	1	1	KIM, JEFFREY K MD	3/9/2021	207L00000X	NA	Other	026	PHYSICIANS	159612	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
183327	Fee-for-Service	1598850984	1598850984	1	1	KOPPLIN,MATTHEW A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
183328	Fee-for-Service	1265973424	1265973424	1	1	KUSHNER, LAUREN E MD	2/9/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	157064	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
183329	Fee-for-Service	1053471318	1053471318	1	1	KOURA DIVYA T MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125774	68	Hematology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
183354	Fee-for-Service	1831271428	1831271428	1	1	KUNTZ, SHAWNA E OD	12/1/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 4TH ST	None	LIVERMORE	CA	94550	4454	01	06001	37.67808567	-121.7724653	Alameda County
183361	Fee-for-Service	1821258922	1821258922	1	1	KYI, SANDAR MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96661	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
183369	Fee-for-Service	1639443120	1639443120	1	1	KASPIAN, SUSAN OD	10/15/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1735 PACIFIC COAST HWY	None	LOMITA	CA	90717	2719	19	06037	33.78948452	-118.309149	Los Angeles County
183375	Fee-for-Service	1437562568	1437562568	1	1	KARANJA, ROSEMARY	5/17/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	21622 MARGUERITE PKWY	APT 554	MISSION VIEJO	CA	92692	4434	30	06059	33.649893	-117.64179	Orange County
183377	Fee-for-Service	1013922665	1013922665	1	1	KUMABE, CARRIE W OD	11/25/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3756 SANTA ROSALIA DR	STE 100	LOS ANGELES	CA	90740	5748	19	06037	34.00888336	-118.3389334	Los Angeles County
183414	Fee-for-Service	1649436379	1649436379	1	1	KENT, SALLY K LMFT	6/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	278 MAIN ST	STE A	CHESTER	CA	96020	0000	32	06063	40.30755872	-121.2310731	Plumas County
183489	Fee-for-Service	1003235441	1003235441	1	1	KINGSLEY, JENNY MD	8/24/2020	2080P0203X	NA	Other	026	PHYSICIANS	168803	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
183506	Fee-for-Service	1124430574	1124430574	1	1	KHURSHID, MADIHA DO	2/7/2019	207P00000X	NA	Other	026	PHYSICIANS	16841	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
183536	Fee-for-Service	1740741370	1740741370	1	1	KANZARIA, BHAVIK R DO	7/12/2022	207P00000X	NA	Other	026	PHYSICIANS	19639	None	None	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
183542	Fee-for-Service	1427006113	1427006113	1	1	KHAN, HAMEED A MD INC	5/24/1980	174400000X	NA	Other	026	PHYSICIANS	31453	08	Family Practice	0	In state provider	None	3655 W LOMITA BLVD	SUITE 421	TORRANCE	CA	90505	1934	19	06037	33.81497113	-118.3489779	Los Angeles County
183549	Fee-for-Service	1538236344	1538236344	1	1	KWUNYEUN, SUCHADA MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7928	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
183582	Fee-for-Service	1013398866	1013398866	1	1	KIM, ROBERT MD	5/18/2020	207L00000X	NA	Other	026	PHYSICIANS	146880	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
183621	Fee-for-Service	1154734606	1154734606	1	1	KASHYAP, SAMIR DO	8/21/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	15599	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
183628	Fee-for-Service	1720538283	1720538283	1	2	KACI, KAHINA LCSW	1/23/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	60749	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
183648	Fee-for-Service	1932559002	1932559002	1	1	KHANDELWAL, PUNEET DO	7/22/2019	390200000X	NA	Other	026	PHYSICIANS	15994	41	Internal Medicine	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
183675	Fee-for-Service	1528029063	1528029063	1	1	KENT LOWELL ANDERSON, M.D.,	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
183697	Fee-for-Service	1235296559	1235296559	1	1	KASSEL, STEPHEN H MD	2/28/1988	207ZP0213X	NA	Other	026	PHYSICIANS	18364	22	Pathology (M.D. only)	0	In state provider	None	3151 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	10	06019	36.77841	-119.7635455	Fresno County
183725	Fee-for-Service	1063806057	1063806057	1	1	KUMARESAN, JANANI MD	10/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PKWY	None	CARSON CITY	NV	98703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
183740	Fee-for-Service	1255937363	1255937363	1	1	KIM, JEFFREY CNP	7/20/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
183775	Fee-for-Service	1265463970	1265463970	3	1	KINI, VIJAY MD INC	4/24/2014	193400000X	NA	Other	026	PHYSICIANS	84739	78	Neoplastic Diseases/Oncology	0	In state provider	None	2895 EDINGER AVE	None	TUSTIN	CA	92780	7257	30	06059	33.70859781	-117.8080464	Orange County
183809	Fee-for-Service	1154319754	1154319754	1	1	KALATZIS, CHRISTOS A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40074	05	Anesthesiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
183818	Fee-for-Service	1710202999	1710202999	1	1	KHAN, ALI M MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130449	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
183823	Fee-for-Service	1275616393	1275616393	1	1	KWONG, KRISTIN NP	9/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	911 E SAN ANTONIO DR	STE 4	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
183830	Fee-for-Service	1427006113	1427006113	1	1	KHAN, HAMEED A MD INC	5/24/1980	174400000X	NA	Other	026	PHYSICIANS	31453	01	General Practice	0	In state provider	None	3655 W LOMITA BLVD	SUITE 421	TORRANCE	CA	90505	1934	19	06037	33.81497113	-118.3489779	Los Angeles County
183852	Fee-for-Service	1194925933	1194925933	1	1	KARAMATSU, MIA L MD	6/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93314	40	Pediatrics	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
183865	Fee-for-Service	1639323553	1639323553	1	1	KIM, JINSUN MD	10/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127700	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
183915	Fee-for-Service	1255486072	1255486072	1	1	KAKEHASHI, ROBERT K MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51494	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
183921	Fee-for-Service	1164468286	1164468286	1	1	KWAN,PATRICK H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71487	05	Anesthesiology	0	In state provider	None	5176 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
183938	Fee-for-Service	1053575142	1053575142	1	1	KAZMI, SYED MD	5/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
183952	Fee-for-Service	1215025549	1215025549	1	1	KARATEPE, MELTEM MD	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113806	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
183956	Fee-for-Service	1336247717	1336247717	1	1	KADES, WAGDY W MD INC	1/12/2005	207RR0500X	NA	Other	026	PHYSICIANS	56293	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 775	LOS ANGELES	CA	90017	4881	19	06037	34.05362775	-118.2661889	Los Angeles County
183959	Fee-for-Service	1699180703	1699180703	1	1	KULKARNI, ABHISHEK MD	6/3/2019	207P00000X	NA	Other	026	PHYSICIANS	150957	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
183970	Fee-for-Service	1356360721	1356360721	1	1	KIMBALL, CAROL M MD	6/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76903	08	Family Practice	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
184047	Fee-for-Service	1629162136	1629162136	1	1	KOOPERSMITH, TINA B MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	69869	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
184050	Fee-for-Service	1063970390	1063970390	1	1	KANAKE, ROSEMARY W CRNA	9/11/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
184055	Fee-for-Service	1558850503	1558850503	1	1	KUMAR, JAY I MD	2/24/2025	207T00000X	NA	General Surgery	026	PHYSICIANS	176453	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184061	Fee-for-Service	1275889198	1275889198	1	1	KRISHNA MYLAVARAPU	3/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
184069	Fee-for-Service	1861811010	1861811010	1	1	KADDEN, MICAH B MD	5/28/2021	2080P0203X	NA	Other	026	PHYSICIANS	172649	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
184076	Fee-for-Service	1639953532	1639953532	1	1	KLAS, PAUL G MD	9/11/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	189816	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184083	Fee-for-Service	1457742934	1457742934	1	1	KAISI, MUSTAFA MD	4/1/2021	207R00000X	NA	Other	026	PHYSICIANS	143215	None	None	0	In state provider	None	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
184098	Fee-for-Service	1538446455	1538446455	1	1	KOLLER, REGINA L LPCC	11/21/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
184099	Fee-for-Service	1518777101	1518777101	1	1	KADAM, ASHNA OT	4/18/2025	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
184135	Fee-for-Service	1235210766	1235210766	1	1	KHOSHROU, DARYOUSH MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49539	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
184169	Fee-for-Service	1144377607	1144377607	1	1	KOVALEVSKY, MARINA MD APC	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63485	41	Internal Medicine	0	In state provider	None	7737 SANTA MONICA BLVD	None	LOS ANGELES	CA	90046	6269	19	06037	34.09087352	-118.3577406	Los Angeles County
184213	Fee-for-Service	1417271388	1417271388	1	1	KAHN, JAMIE L MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124413	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD.	EM DEPT.	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
184222	Fee-for-Service	1194787275	1194787275	1	1	KADAKIA, NIMISH R MD INC	3/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79590	20	Orthopedic Surgery	0	In state provider	None	16300 SAND CANYON AVE	STE 511	IRVINE	CA	92618	3705	30	06059	33.66115075	-117.7742405	Orange County
184232	Fee-for-Service	1942319918	1942319918	1	2	KAN, DAVID Y MD	5/15/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	73621	-	NOT APPLICABLE	0	In state provider	None	2603 CAMINO RAMON	STE 200	SAN RAMON	CA	94583	9137	07	06013	37.76856551	-121.9609999	Contra Costa County
184244	Fee-for-Service	1336247717	1336247717	1	1	KADES, WAGDY W MD INC	1/12/2005	207RR0500X	NA	Other	026	PHYSICIANS	56293	83	Rheumatology	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 775	LOS ANGELES	CA	90017	4881	19	06037	34.05362775	-118.2661889	Los Angeles County
184275	Fee-for-Service	1003472291	1003472291	1	1	KANG, SARAH MD	10/30/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	184626	13	Neurology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
184295	Fee-for-Service	1710059894	1710059894	1	1	KOZINA, JOSEPH A MD	5/8/1986	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	57161	01	General Practice	0	In state provider	None	4141 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1705	37	06073	32.814594	-117.141219	San Diego County
184319	Fee-for-Service	1700945383	1700945383	1	1	KARG, DIANA L MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48843	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
184334	Fee-for-Service	1104873413	1104873413	1	1	KONIA, NADINE MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65582	None	None	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
184342	Fee-for-Service	1649257874	1649257874	1	1	KONG, ROBERTO M MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55778	05	Anesthesiology	0	In state provider	None	75 NEILSON STREET	None	WATSONVILLE	CA	95076	2468	44	06087	36.92823955	-121.792905	Santa Cruz County
184348	Fee-for-Service	1922058437	1922058437	1	1	KOOSTRA, JOHN M MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75276	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
184350	Fee-for-Service	1184010795	1184010795	1	1	KARUNAKARAN, PALLAVI MD	5/17/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	172973	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
184377	Fee-for-Service	1417186453	1417186453	1	1	KING, ALICE MD	10/1/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
184422	Fee-for-Service	1649473513	1649473513	1	1	KROWN, LYNN LMFT	6/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 213	ENCINO	CA	91436	2978	19	06037	34.15524484	-118.4756687	Los Angeles County
184425	Fee-for-Service	1184791063	1184791063	1	1	KAPLAN, MICHAEL S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	17879	03	Allergy	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
184450	Fee-for-Service	1609638303	1609638303	1	1	KARIUKI, NANCY WANJIKU	4/24/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2831 MORNING STAR DRIVE	None	CORONA	CA	92881	8634	33	06065	33.83861362	-117.5444824	Riverside County
184451	Fee-for-Service	1770702417	1770702417	1	1	KOVACS, GEORGE D MD	1/1/1987	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	42880	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13865 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	7011	19	06037	33.905367	-118.3527865	Los Angeles County
184540	Fee-for-Service	1952536625	1952536625	1	1	KARTAWIDJAJA, LUSIANA MD	1/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105710	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
184580	Fee-for-Service	1033552401	1033552401	1	1	KANTHARAJ, TARA MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142495	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
184609	Fee-for-Service	1841602596	1841602596	1	3	KHATRI, PYAR LPCC	8/9/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	687 UPLAND ROAD	None	REDWOOD CITY	CA	95816	5712	41	06081	37.47213818	-122.2520257	San Mateo County
184614	Fee-for-Service	1992860621	1992860621	1	1	KRANE, ELLIOT J MD	5/31/1993	207L00000X	NA	Other	026	PHYSICIANS	79586	05	Anesthesiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
184638	Fee-for-Service	1598224727	1598224727	1	1	KIM, ESTHER MD	1/3/2023	207P00000X	NA	Other	026	PHYSICIANS	176417	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
184639	Fee-for-Service	1922058437	1922058437	1	1	KOOSTRA, JOHN M MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75276	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
184644	Fee-for-Service	1073928750	1073928750	1	1	KLOCHKOV, ANTON DO	2/1/2020	207P00000X	NA	Other	026	PHYSICIANS	17622	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
184649	Fee-for-Service	1033370788	1033370788	1	1	KAPOOR, ASHWANI MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150005	10	Gastroenterology (M.D. only)	0	In state provider	None	870 SHASTA ST	STE 200	YUBA CITY	CA	95991	4117	51	06101	39.14204	-121.6161711	Sutter County
184658	Fee-for-Service	1962716035	1962716035	1	1	KELLEY, ALYN E MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129263	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
184661	Fee-for-Service	1669762233	1669762233	1	1	KAO, JULIA A MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124759	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
184673	Fee-for-Service	1538240494	1538240494	1	1	KAMENA, MARSHALL H OD	2/21/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1171 MURRIETA BLVD	STE 100	LIVERMORE	CA	94550	4143	01	06001	37.67592941	-121.7802007	Alameda County
184674	Fee-for-Service	1821041906	1821041906	1	1	KWON, EDWARD S MD	4/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94775	05	Anesthesiology	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
184690	Fee-for-Service	1255333035	1255333035	1	1	KELADA, MERVAT G MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48353	08	Family Practice	0	In state provider	None	1001 BLAIR AVE	None	CALEXICO	CA	92231	2308	13	06025	32.678172	-115.4907771	Imperial County
184691	Fee-for-Service	1750452660	1750452660	1	1	KOSCO, ANNE E MD	4/30/1992	2085B0100X	NA	MRI Provider	026	PHYSICIANS	72385	30	Radiology	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
184717	Fee-for-Service	1033593744	1033593744	1	1	KUO, MICHAEL MD	8/28/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	144320	67	Endocrinology	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
184719	Fee-for-Service	1366718546	1366718546	1	1	KIM, WILLIAM H MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147920	25	Physical Medicine and Rehabilitation	0	In state provider	None	5601 DE SOTO	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
184726	Fee-for-Service	1053802843	1053802843	1	1	KURLAND, SIENNA C MD	9/28/2022	207R00000X	NA	Other	026	PHYSICIANS	181162	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184738	Fee-for-Service	1609638303	1609638303	1	1	KARIUKI, NANCY WANJIKU	4/24/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2831 MORNING STAR DRIVE	None	CORONA	CA	92881	8634	33	06065	33.83861362	-117.5444824	Riverside County
184811	Fee-for-Service	1477059491	1477059491	1	1	KOUR, HARDEEP MD	4/7/2022	207R00000X	NA	Other	026	PHYSICIANS	174408	None	None	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
184827	Fee-for-Service	1972605541	1972605541	1	1	KO, JOHN Y MD	6/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99005	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
184843	Fee-for-Service	1811910672	1811910672	1	1	KAUR, AMANPREET MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9144	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
184869	Fee-for-Service	1457556292	1457556292	1	1	KNOLL,JULIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN	None	PORTLAND	OR	97208	3777	00	None	45.54387841	-122.6696022	Multnomah County
184871	Fee-for-Service	1144216284	1144216284	1	1	KINGSBURY, A GRANT MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64822	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4060 FOURTH AVE	# 500	SAN DIEGO	CA	92103	2138	37	06073	32.75053673	-117.1616539	San Diego County
184873	Fee-for-Service	1811674237	1811674237	1	1	KIMBLEY Y LAU PC	5/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	10802 COLLEGE PL	None	CERRITOS	CA	90703	1505	19	06037	33.88484554	-118.102932	Los Angeles County
184895	Fee-for-Service	1831400043	1831400043	1	1	KNOWLIN, LAQUANDA T MD	1/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	135170	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
184927	Fee-for-Service	1922058437	1922058437	1	1	KOOSTRA, JOHN M MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75276	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
184978	Fee-for-Service	1255333035	1255333035	1	1	KELADA, MERVAT G MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48353	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 BLAIR AVE	None	CALEXICO	CA	92231	2308	13	06025	32.678172	-115.4907771	Imperial County
185024	Fee-for-Service	1891821542	1891821542	1	1	KHAWAJA, OMAR M MD	7/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103992	05	Anesthesiology	0	In state provider	None	332 S JUNIPER	#108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
185036	Fee-for-Service	1588856538	1588856538	1	1	KIM, CAROLINE A MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104943	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
185081	Fee-for-Service	1730683541	1730683541	1	1	KAPOOR, ASHIE MD	6/8/2023	207L00000X	NA	Other	026	PHYSICIANS	177477	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
185146	Fee-for-Service	1205098225	1205098225	1	1	KENNEDY, SARA L MD	7/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107766	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
185155	Fee-for-Service	1144216284	1144216284	1	1	KINGSBURY, A GRANT MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64822	41	Internal Medicine	0	In state provider	None	4060 FOURTH AVE	# 500	SAN DIEGO	CA	92103	2138	37	06073	32.75053673	-117.1616539	San Diego County
185161	Fee-for-Service	1588842488	1588842488	1	2	KATZMAN, BARRY MD INC	7/6/1992	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4344 CONVOY ST	STE C2	SAN DIEGO	CA	92111	3737	37	06073	32.81949721	-117.1550284	San Diego County
185162	Fee-for-Service	1700946332	1700946332	1	1	KADAKIA, RINA A MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94910	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
185200	Fee-for-Service	1427136324	1427136324	1	1	KING, WILLIAM J MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	44394	41	Internal Medicine	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
185208	Fee-for-Service	1447883442	1447883442	1	1	KAUTZ, JUDITH M LCSW	11/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	900 E MAIN ST	STE 106	GRASS VALLEY	CA	95945	5853	29	06057	39.22827201	-121.0517684	Nevada County
185242	Fee-for-Service	1639315708	1639315708	1	1	KOHM, ALISHA D MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108495	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
185245	Fee-for-Service	1720264047	1720264047	1	1	KNOCHE, AMBER J CNM	7/24/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
185254	Fee-for-Service	1710297536	1710297536	1	1	KISER, STEPHEN	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
185263	Fee-for-Service	1114607652	1114607652	1	1	KEANE, JENNIFER E LMFT	2/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	231 N EUCLID AVE	None	UPLAND	CA	91786	4359	36	06071	34.096779	-117.6513275	San Bernardino County
185322	Fee-for-Service	1124073309	1124073309	1	1	KANG, DONG KYOO R MD	9/11/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	56927	04	Otology, Laryngology, Rhinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
185324	Fee-for-Service	1588856538	1588856538	1	1	KIM, CAROLINE A MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104943	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
185344	Fee-for-Service	1639280076	1639280076	1	1	KRAEMER, JANET E PSYD	1/29/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
185348	Fee-for-Service	1720538283	1720538283	1	1	KACI, KAHINA LCSW	5/24/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 E. LINCOLN AVE	STE 230	ANAHEIM	CA	92805	4747	30	06059	33.8368447	-117.9138391	Orange County
185351	Fee-for-Service	1013079649	1013079649	1	1	KIM, CHARLOTTE YOH MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80158	30	Radiology	0	In state provider	None	1069 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65855557	-121.6450018	Monterey County
185365	Fee-for-Service	1063726933	1063726933	1	1	KIHARA, LYNN N MD	7/18/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	119426	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
185389	Fee-for-Service	1215270624	1215270624	1	1	KIM, TIFFANY J MD	9/10/2018	207L00000X	NA	Other	026	PHYSICIANS	135601	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
185397	Fee-for-Service	1124176094	1124176094	1	1	KAISER FOUNDATION HLTH	10/18/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN NILES 3 PHARMACY	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
185409	Fee-for-Service	1972655371	1972655371	1	1	KIM, JULIE J E OD	9/24/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1319 S HARBOR BLVD	None	FULLERTON	CA	92832	3001	30	06059	33.858954	-117.924409	Orange County
185450	Fee-for-Service	1184990285	1184990285	1	1	KAMENS, JENNIFER L MD	8/4/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	168829	68	Hematology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
185457	Fee-for-Service	1316562127	1316562127	1	1	KHASHO, NICHOLAS DO	9/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21236	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
185468	Fee-for-Service	1437184025	1437184025	1	1	KELLEY, NEIL R DPM	12/19/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	0	2504 HARRISON AVE	STE B	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
185492	Fee-for-Service	1740330471	1740330471	1	1	KABAKIBI, AHMAD MD	10/27/2008	207R00000X	NA	Other	026	PHYSICIANS	94768	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
185507	Fee-for-Service	1376623538	1376623538	2	4	KERN COUNTY HOSPITAL	9/8/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1804 FLOWER ST	None	BAKERSFIELD	CA	93305	0000	15	06029	35.38220394	-118.9724257	Kern County
185526	Fee-for-Service	1770746638	1770746638	1	1	KUMAR, KARTHIK C MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133576	None	None	0	In state provider	None	2320 BATH STREET	SUITE 113	SANTA BARBARA	CA	93105	4377	42	06083	34.43082689	-119.7223032	Santa Barbara County
185538	Fee-for-Service	1255421749	1255421749	1	1	KIM HIATT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UAMS MEDICAL CENTER	4301 W MARKHAM ST # 783	None	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
185570	Fee-for-Service	1255490876	1255490876	1	1	KIESCHNICK, MEREDITH MD	3/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60980	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
185578	Fee-for-Service	1952670630	1952670630	1	1	KWONG, YUENTING D MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141639	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
185614	Fee-for-Service	1467073502	1467073502	1	2	KC WELLNESS CENTER, A NURSE	6/14/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PRACTITIONER LED NURSING	331 S H ST	None	BAKERSFIELD	CA	93304	3403	15	06029	35.35053984	-119.0213687	Kern County
185616	Fee-for-Service	1841501046	1841501046	1	1	KAPLAN, ANNA R MD	8/20/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	117814	None	None	0	In state provider	None	2500 MILVIA ST.	None	BERKELEY	CA	94704	2636	01	06001	37.86338897	-122.2698455	Alameda County
185640	Fee-for-Service	1619166931	1619166931	1	1	KAO, GARY C MD INC	7/23/2009	207L00000X	NA	Other	026	PHYSICIANS	53740	05	Anesthesiology	0	In state provider	None	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
185650	Fee-for-Service	1720279847	1720279847	1	1	KELLER, STEVEN P MD	1/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109520	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
185671	Fee-for-Service	1609239185	1609239185	1	1	KURTH, JACQUELINE E MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	154441	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
185677	Fee-for-Service	1750492146	1750492146	1	1	KUO, DENNIS J MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84128	79	Neurology-Child	0	In state provider	None	3020 CHILDRENS WY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
185679	Fee-for-Service	1396300208	1396300208	1	1	KAR'S PEDIATRICS	7/7/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	355 PLACENTIA AVE	301	NEWPORT BEACH	CA	92663	3304	30	06059	33.62672719	-117.9312941	Orange County
185709	Fee-for-Service	1922593631	1922593631	1	1	KANDAH, SALLY MD	10/19/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173971	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
185719	Fee-for-Service	1881698132	1881698132	1	1	KOHANDARVISH, SAEID MD	2/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	79439	41	Internal Medicine	0	In state provider	None	24355 LYONS AVE	STE 200	NEWHALL	CA	91321	2333	19	06037	34.37868281	-118.5605291	Los Angeles County
185770	Fee-for-Service	1538854112	1538854112	1	1	KOUR, GURSHARAN NP	2/8/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	10	06019	36.80840238	-119.8594473	Fresno County
185798	Fee-for-Service	1609853092	1609853092	1	1	KWA, RAYMOND E MD	9/30/1992	207R00000X	NA	Other	026	PHYSICIANS	75909	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
185802	Fee-for-Service	1154583722	1154583722	1	1	KULLAR, RAJ S MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110213	20	Orthopedic Surgery	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	96065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
185813	Fee-for-Service	1710250899	1710250899	1	1	KRISHNA GUNDABOLU MD	6/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
185815	Fee-for-Service	1164570818	1164570818	1	1	KAISER FOUNDATION HEALTH PLA	11/14/1984	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	163	789 E COOLEY DR	None	COLTON	CA	92324	4007	36	06071	34.05795035	-117.3040272	San Bernardino County
185857	Fee-for-Service	1265448609	1265448609	1	1	KELLY, KRISTEN M MD	12/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80021	07	Dermatology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
185887	Fee-for-Service	1942436548	1942436548	1	1	KOWALCZYK, JOHN J DO INC	2/23/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1127 WILSHIRE BLVD	805	LOS ANGELES	CA	90017	3909	19	06037	34.05270508	-118.2641005	Los Angeles County
185891	Fee-for-Service	1871097444	1871097444	1	1	KOGAN, DANIEL MD	10/1/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	179767	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
185903	Fee-for-Service	1467073502	1467073502	1	2	KC WELLNESS CENTER, A NURSE	6/14/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PRACTITIONER LED NURSING	331 S H ST	None	BAKERSFIELD	CA	93304	3403	15	06029	35.35053984	-119.0213687	Kern County
185932	Fee-for-Service	1093361487	1093361487	1	1	KINGSTON, BETHANY LCSW	1/14/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
185934	Fee-for-Service	1518934777	1518934777	1	1	KIMBERLEE BOHY	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
185964	Fee-for-Service	1750492146	1750492146	1	1	KUO, DENNIS J MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84128	68	Hematology	0	In state provider	None	3020 CHILDRENS WY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
186001	Fee-for-Service	1336254358	1336254358	2	1	KASTER CONSULTANTS	4/11/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4558 ADMIRALTY WAY	None	MARINA DEL REY	CA	90292	5417	19	06037	33.98325386	-118.4427632	Los Angeles County
186020	Fee-for-Service	1740428804	1740428804	1	1	KHILNANI, RUBINA MD INC	6/24/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	89693	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 BAYWOOD AVENUE	SUITE 9	SAN MATEO	CA	94402	1537	41	06081	37.56513159	-122.3284067	San Mateo County
186046	Fee-for-Service	1255439626	1255439626	1	1	KRAUT, ERIC J MD	10/2/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80835	02	General Surgery	0	In state provider	None	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
186092	Fee-for-Service	1558736892	1558736892	1	1	KNOX, ALICIA LCSW	1/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
186154	Fee-for-Service	1811993199	1811993199	1	1	KENTON, ROBERT W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	RENO RADIOLOGICAL ASSOCI	5250 NEIL RD	STE 103	RENO	NV	89502	6546	00	None	39.47416458	-119.7784756	Washoe County
186165	Fee-for-Service	1639516172	1639516172	1	1	KARNANI, DIRAJ MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132960	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
186175	Fee-for-Service	1942436548	1942436548	1	1	KOWALCZYK, JOHN J DO INC	5/2/2017	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	805	LOS ANGELES	CA	90017	3909	19	06037	34.05270508	-118.2641005	Los Angeles County
186252	Fee-for-Service	1750492146	1750492146	1	1	KUO, DENNIS J MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84128	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
186304	Fee-for-Service	1679759955	1679759955	1	1	KAPUR, VINEET MD INC	1/28/2008	207RC0200X	NA	Other	026	PHYSICIANS	68823	41	Internal Medicine	0	In state provider	None	170 ALAMEDA	None	REDWOOD CITY	CA	94062	2799	41	06081	37.48095011	-122.2532536	San Mateo County
186308	Fee-for-Service	1982818720	1982818720	1	1	KIM, PETER S MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	108581	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
186311	Fee-for-Service	1982995320	1982995320	1	1	KAUSHAL, POONAM MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125996	40	Pediatrics	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
186324	Fee-for-Service	1962439307	1962439307	1	1	KAMIL, ELAINE S MD	10/8/1991	174400000X	NA	Other	026	PHYSICIANS	32359	45	Nephrology (Renal-Kidney)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
186334	Fee-for-Service	1255439626	1255439626	1	1	KRAUT, ERIC J MD	10/2/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80835	70	Clinic (mixed specialty)	0	In state provider	None	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
186352	Fee-for-Service	1356462535	1356462535	1	1	KLOCK, LYNN P MFT	12/10/2014	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11110 LOS ALAMITOS BLVD	STE 213	LOS ALAMITOS	CA	90720	3602	30	06059	33.801516	-118.0717825	Orange County
186382	Fee-for-Service	1669418182	1669418182	1	1	KHALSA, SIRI SAT K MD	10/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	75010	01	General Practice	0	In state provider	None	4312 WOODMAN AVE	SUITE 102	SHERMAN OAKS	CA	91423	5836	19	06037	34.148637	-118.4312035	Los Angeles County
186415	Fee-for-Service	1679975957	1679975957	1	1	KAUR, PARVIDER MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145907	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
186432	Fee-for-Service	1699155416	1699155416	1	1	KIBBI, NOUR MD	7/22/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	168346	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186457	Fee-for-Service	1316108574	1316108574	1	1	KNIGHT, JUSTIN J MD	1/3/2023	207P00000X	NA	Other	026	PHYSICIANS	182985	None	None	0	In state provider	None	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
186474	Fee-for-Service	1558487686	1558487686	1	1	KLEMIN, MICHAEL LMFT	3/28/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1213 COFFEE AVE	STE P	MODESTO	CA	95355	4229	50	06099	37.660401	-120.975669	Stanislaus County
186508	Fee-for-Service	1821590191	1821590191	1	1	KASSER, AARON J PT	7/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	134 SOUTH E ST	None	EXETER	CA	93221	1731	54	06107	36.29571271	-119.1405696	Tulare County
186523	Fee-for-Service	1346226180	1346226180	1	1	KHAVARI, PARISA MD	3/22/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181173	09	Gynecology (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
186559	Fee-for-Service	1447306741	1447306741	1	1	KASZUBOWSKI, PAWEL A MD	2/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	42119	41	Internal Medicine	0	In state provider	None	11333 N SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
186590	Fee-for-Service	1770630097	1770630097	1	1	KAISER FDN HLTH PLAN INC	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #391	30400 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1300	30	06059	33.5224708	-117.6686181	Orange County
186600	Fee-for-Service	1053516609	1053516609	1	1	KIM, SANG D MD	1/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125380	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BOULEVARD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
186602	Fee-for-Service	1720087109	1720087109	1	1	KENNEN B THOMPSON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 SW 7TH ST	None	TOPEKA	KS	66606	2489	00	None	39.05606988	-95.69645284	Shawnee County
186611	Fee-for-Service	1962439307	1962439307	1	1	KAMIL, ELAINE S MD	10/8/1991	174400000X	NA	Other	026	PHYSICIANS	32359	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
186617	Fee-for-Service	1538435938	1538435938	1	1	KHANDELWAL, STUTEE MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119809	41	Internal Medicine	0	In state provider	None	2823 FRESNO STREET	SUITE 203	FRESNO	CA	93721	1327	10	06019	36.7423511	-119.7834688	Fresno County
186639	Fee-for-Service	1225091812	1225091812	1	1	KARIMIAN, SIAMAK MD FACC	5/1/2020	174400000X	NA	Other	026	PHYSICIANS	48218	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
186649	Fee-for-Service	1013927805	1013927805	1	1	KUMAR, ASHOK MD INC	4/30/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4477 W 118TH ST	STE 200	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
186652	Fee-for-Service	1922137611	1922137611	1	1	KANE, AMY R MD	5/14/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	4068	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPRESS WAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
186660	Fee-for-Service	1194945386	1194945386	1	1	KIM, KAP B LAC	7/2/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10359 BALBOA BLVD	None	GRANADA HILLS	CA	91344	7318	19	06037	34.25904	-118.502339	Los Angeles County
186681	Fee-for-Service	1740721372	1740721372	1	1	KAISER FOUNDATION HEALTH	7/6/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	3750 GRAND AVE	1ST FL	CHINO	CA	91710	5478	36	06071	34.00076641	-117.7229121	San Bernardino County
186685	Fee-for-Service	1164671129	1164671129	1	1	KARTHIK REDDY	6/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7373 PERKINS RD	None	BATON ROUGE	LA	70808	4326	00	None	30.39804	-91.1122425	East Baton Rouge Parish
186690	Fee-for-Service	1023173283	1023173283	1	1	KRISTUNAS, LOREN E LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
186744	Fee-for-Service	1326364332	1326364332	1	1	KORT, JONATHAN D MD	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121738	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
186752	Fee-for-Service	1518119767	1518119767	1	1	KANG, HANNA MD	11/21/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105564	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
186768	Fee-for-Service	1932949492	1932949492	1	1	KHAN, SABEEHA	8/1/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	41	06081	0	0	None
186769	Fee-for-Service	1316671902	1316671902	1	1	KAUR, SANDEEP CNP	11/6/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
186777	Fee-for-Service	1023846714	1023846714	1	1	KATHERINE CHI LICENSED CLINI	8/29/2024	251S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER AND A	23 CLINTON ST	None	REDWOOD CITY	CA	94062	1513	41	06081	37.48807715	-122.2417775	San Mateo County
186788	Fee-for-Service	1235668849	1235668849	1	1	KOLMAKOVA, MARIA DO	8/2/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18799	15	Obstetrics (D.O. only)	0	In state provider	None	210 S PALISADE DR	STE 101	SANTA MARIA	CA	93454	5932	42	06083	34.95169604	-120.4120907	Santa Barbara County
186813	Fee-for-Service	1346226180	1346226180	1	1	KHAVARI, PARISA MD	3/22/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181173	15	Obstetrics (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
186846	Fee-for-Service	1457747735	1457747735	1	1	KOLANDJIAN, NATHALIE A MD	7/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153625	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
186847	Fee-for-Service	1942479704	1942479704	1	1	KAISER FOUNDATION HEALTH	5/5/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE PMCY	6650 ALTON PKWY	FL 1	IRVINE	CA	92618	3734	30	06059	33.65911992	-117.7737909	Orange County
186882	Fee-for-Service	1164466249	1164466249	1	1	KENNEDY, HAROLD L MD	10/31/1989	208600000X	NA	General Surgery	026	PHYSICIANS	36544	02	General Surgery	0	In state provider	None	1020 29TH ST	STE 350	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
186892	Fee-for-Service	1841687142	1841687142	1	1	KINGSLEY, JAMES MD	6/18/2021	207R00000X	NA	Other	026	PHYSICIANS	170281	None	None	0	In state provider	None	29826 HAUN	300	MENIFEE	CA	92586	6546	33	06065	33.68719818	-117.1748757	Riverside County
186938	Fee-for-Service	1013927805	1013927805	1	1	KUMAR, ASHOK MD INC	4/30/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4477 W 118TH ST	STE 200	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
186959	Fee-for-Service	1417335845	1417335845	1	1	KORUMILLI, RITESH MD	9/23/2021	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
186968	Fee-for-Service	1467482844	1467482844	1	1	KAPLAN, JORY N MD	1/24/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	42026	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	REDDING ENT HEAD AND NEC	2415 SONOMA ST	None	REDDING	CA	96001	3026	45	06089	40.57308764	-122.4019424	Shasta County
186987	Fee-for-Service	1952937963	1952937963	1	1	KIM, SOOMIN MD	12/27/2022	207R00000X	NA	Other	026	PHYSICIANS	178720	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
187011	Fee-for-Service	1386140499	1386140499	1	1	KOTLARZ, ANNA MD	10/1/2022	207L00000X	NA	Other	026	PHYSICIANS	178506	None	None	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
187058	Fee-for-Service	1548537871	1548537871	1	1	KAUR, PUNEET I MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123867	41	Internal Medicine	0	In state provider	None	815 COURT ST	SUITE 7	JACKSON	CA	95642	2154	03	06005	38.35293152	-120.7676346	Amador County
187072	Fee-for-Service	1265071062	1265071062	1	1	KARMELICH, NANCY M AU	4/9/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	41789 NICOLE LANE	STE B2	TEMECULA	CA	92591	3871	33	06065	33.51886551	-117.153147	Riverside County
187074	Fee-for-Service	1235668849	1235668849	1	1	KOLMAKOVA, MARIA DO	8/2/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18799	09	Gynecology (D.O. only)	0	In state provider	None	210 S PALISADE DR	STE 101	SANTA MARIA	CA	93454	5932	42	06083	34.95169604	-120.4120907	Santa Barbara County
187082	Fee-for-Service	1053372466	1053372466	1	1	KHANNA, PUNEET K MD	4/1/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	45577	01	General Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
187094	Fee-for-Service	1356670038	1356670038	1	1	KOUYOUMJIAN, SHAGHIG MD	1/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112117	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
187109	Fee-for-Service	1588713036	1588713036	1	1	KHADERI, SYED K MD	11/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95963	18	Ophthalmology	0	In state provider	None	39263 MISSION BLVD	None	FREMONT	CA	94539	3037	01	06001	37.56282031	-121.9592214	Alameda County
187166	Fee-for-Service	1124174297	1124174297	1	1	KUMAR, RAJ MD	7/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93854	13	Neurology (M.D. only)	0	In state provider	SAN JOSE PACIFIC	175 N JACKSON AVE	STE 209	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
187171	Fee-for-Service	1407334428	1407334428	1	1	KIM, LYDIA MD	2/20/2025	2084P0804X	NA	Psychiatry	026	PHYSICIANS	165624	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
187203	Fee-for-Service	1114582400	1114582400	1	1	KIANG, SHANNON MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	179149	None	None	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
187249	Fee-for-Service	1902817919	1902817919	1	1	KARM, PHYLLIS D O MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	48104	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3828 SCHAUFELE AVE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
187256	Fee-for-Service	1467482844	1467482844	1	1	KAPLAN, JORY N MD	1/24/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	42026	01	General Practice	0	In state provider	REDDING ENT HEAD AND NEC	2415 SONOMA ST	None	REDDING	CA	96001	3026	45	06089	40.57308764	-122.4019424	Shasta County
187261	Fee-for-Service	1376693655	1376693655	1	1	KRAAI, ERIK P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
187316	Fee-for-Service	1952713570	1952713570	1	1	KEYHANI, SEPEHR MD	8/6/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	141031	None	None	0	In state provider	None	2100 WEBSTER ST	STE 405	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
187321	Fee-for-Service	1235599788	1235599788	1	1	KONOVALOVA, VICTORIA DO	12/6/2022	208600000X	NA	General Surgery	026	PHYSICIANS	20394	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
187324	Fee-for-Service	1952391344	1952391344	1	1	KAZEROUNI ZADEH, HAMID R	7/30/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	92437	41	Internal Medicine	0	In state provider	MD	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
187329	Fee-for-Service	1326104209	1326104209	1	1	KOWALSKI-MCGRAW, MICHELE MD	11/12/2018	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	146191	39	Preventive (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
187354	Fee-for-Service	1649218835	1649218835	1	1	KANE, GLENN I MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33423	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
187387	Fee-for-Service	1881259075	1881259075	1	1	KHAN, NICHOLAS MD	8/29/2023	2080P0204X	NA	Other	026	PHYSICIANS	186186	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
187398	Fee-for-Service	1033144274	1033144274	1	1	KING, MONIQUE E MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69775	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
187402	Fee-for-Service	1336527381	1336527381	1	1	KIM, PAUL M MD	2/17/2022	207L00000X	NA	Other	026	PHYSICIANS	144669	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
187432	Fee-for-Service	1215394036	1215394036	1	1	KC TAN, M.D. MEDICAL CORPORA	10/13/2016	2085N0700X	NA	MRI Provider	026	PHYSICIANS	120081	13	Neurology (M.D. only)	0	In state provider	CORPORATION	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
187459	Fee-for-Service	1982629192	1982629192	1	1	KRANTZ, KENNETH B MD	11/14/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	94774	18	Ophthalmology	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
187472	Fee-for-Service	1497876411	1497876411	1	1	KUTEN, JAY MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	10196	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
187479	Fee-for-Service	1144468430	1144468430	1	1	KARR, LISA D	6/2/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
187492	Fee-for-Service	1609019348	1609019348	1	1	KOSHY, MARIA T MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124887	36	Psychiatry	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
187507	Fee-for-Service	1275586919	1275586919	1	1	KATZMAN, BRAD A DPM	4/30/1981	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	728 N EUCLID AVE	None	ONTARIO	CA	91762	2712	36	06071	34.071399	-117.65061	San Bernardino County
187516	Fee-for-Service	1861480923	1861480923	1	1	KATHY E. GOODMAN D.O.	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 S ANDREWS AVE	None	FT LAUDERDALE	FL	33316	2510	00	None	26.102142	-80.1408645	Broward County
187528	Fee-for-Service	1326537382	1326537382	1	1	KUHFAL, BONNY J	3/23/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2150 APPIAN WAY	104	PINOLE	CA	94564	0001	07	06013	37.9958468	-122.3021554	Contra Costa County
187543	Fee-for-Service	1467482844	1467482844	1	1	KAPLAN, JORY N MD	1/24/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	42026	04	Otology, Laryngology, Rhinology	0	In state provider	REDDING ENT HEAD AND NEC	2415 SONOMA ST	None	REDDING	CA	96001	3026	45	06089	40.57308764	-122.4019424	Shasta County
187550	Fee-for-Service	1982834230	1982834230	1	1	KWOK, EFFIE T LMFT	5/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
187567	Fee-for-Service	1447494497	1447494497	1	1	KILKER, BRET A MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124049	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
187569	Fee-for-Service	1801960513	1801960513	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
187585	Fee-for-Service	1720133945	1720133945	1	1	KIM, CINDY S PHD	11/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 W LA VETA AVENUE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
187637	Fee-for-Service	1467026419	1467026419	1	1	KING, MELODY LMFT	11/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	673 S AUBURN ST	A,B,C,D	GRASS VALLEY	CA	95945	7576	29	06057	39.2060146	-121.0613316	Nevada County
187645	Fee-for-Service	1548295447	1548295447	1	1	KIRKHAM, JENNIFER S LCSW	9/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 HUMBOLT RD	STE 3	CHICO	CA	95928	9699	04	06007	39.73657225	-121.811656	Butte County
187690	Fee-for-Service	1851479760	1851479760	1	1	KULTERMAN, THOMAS R MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54562	01	General Practice	0	In state provider	None	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.25037548	-122.049045	Solano County
187718	Fee-for-Service	1447338926	1447338926	1	1	KAN, LEO H DO	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9163	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
187719	Fee-for-Service	1215394036	1215394036	1	1	KC TAN, M.D. MEDICAL CORPORA	10/13/2016	2085N0700X	NA	MRI Provider	026	PHYSICIANS	120081	30	Radiology	0	In state provider	CORPORATION	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
187804	Fee-for-Service	1164115986	1164115986	1	1	KAREN RIGHTLER, PMHNP-BC, A	2/20/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	23361 EL TORO RD	STE 217	LAKE FOREST	CA	92630	6921	30	06059	33.62369544	-117.6967856	Orange County
187856	Fee-for-Service	1750700464	1750700464	1	1	KINSLEY, THOMAS	8/1/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
187867	Fee-for-Service	1043846033	1043846033	1	1	KOH, ALLYSON MD	8/17/2023	390200000X	NA	Other	026	PHYSICIANS	181080	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
187874	Fee-for-Service	1588281158	1588281158	1	1	KANNER, ARIELLE S DO	6/5/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
187899	Fee-for-Service	1881725869	1881725869	1	1	KIRBY, LISA J NP	5/24/2022	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
187900	Fee-for-Service	1487211884	1487211884	1	1	KIM, MIRI MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	185503	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
187964	Fee-for-Service	1033538004	1033538004	1	1	KWONG, JERRY MD	1/18/2024	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	143237	None	None	0	In state provider	None	220 S 1ST ST	None	ALHAMBRA	CA	91801	3893	19	06037	34.09192598	-118.1259775	Los Angeles County
187966	Fee-for-Service	1124319132	1124319132	1	1	KIM, FRANK H	11/9/2011	2084N0400X	NA	Neurology	026	PHYSICIANS	100043	13	Neurology (M.D. only)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
187967	Fee-for-Service	1609076892	1609076892	1	1	KISLER, TANYA MD	4/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105964	None	None	0	In state provider	None	8283 GROVE AVENUE	SUITE 101	RANCHO CUCAMONGA	CA	91730	3138	36	06071	34.10380433	-117.6285116	San Bernardino County
187985	Fee-for-Service	1639292584	1639292584	1	1	KHAWAJA, OWAIS A MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154356	01	General Practice	0	In state provider	None	415 E HARDING WY	STE D	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
187999	Fee-for-Service	1154478477	1154478477	1	1	KAISER PERMANENTE PHARM	10/13/1988	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	364	23781 MAQUINA AVE	None	MISSION VIEJO	CA	92691	2765	30	06059	33.61792093	-117.6778904	Orange County
188007	Fee-for-Service	1447404025	1447404025	1	1	KAISER FOUNDATION HOSPITALS	5/12/2020	3336I0012X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#28B/282	285 PALLADIO	None	FOLSOM	CA	95630	8741	34	06067	38.647053	-121.120839	Sacramento County
188014	Fee-for-Service	1891932752	1891932752	1	1	KERSHNAR, REBECCA L MD	3/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106418	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
188023	Fee-for-Service	1285862615	1285862615	1	1	KANU, JOHN MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122316	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
188031	Fee-for-Service	1922174572	1922174572	1	1	KOSTOULAS, KATINA KAY	3/3/1989	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3528 TORRANCE BLVD	STE 210	TORRANCE	CA	90503	4826	19	06037	33.83755947	-118.3474935	Los Angeles County
188036	Fee-for-Service	1942219225	1942219225	1	1	KRONSON, JEFFREY W MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53023	02	General Surgery	0	In state provider	None	12291 WASHINGTON BLVD	STE 102	WHITTIER	CA	90606	2500	19	06037	33.96734104	-118.0508773	Los Angeles County
188075	Fee-for-Service	1942516737	1942516737	1	1	KATO, B MAYA MD APC	9/29/2011	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	86538	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	36867 COOK STREET	STE 103	PALM DESERT	CA	92211	6064	33	06065	33.781293	-116.3586555	Riverside County
188122	Fee-for-Service	1184822108	1184822108	1	1	KANG, HOON MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86549	30	Radiology	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
188124	Fee-for-Service	1013904119	1013904119	3	1	KCI USA INC	6/16/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2400 MERCED ST	None	SAN LEANDRO	CA	94577	4211	01	06001	37.70738416	-122.1700145	Alameda County
188125	Fee-for-Service	1205978236	1205978236	1	1	KINTER, JOHANNA LAC	6/9/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 7TH AVE	STE 135	SANTA CRUZ	CA	95062	4670	44	06087	36.96438797	-121.998448	Santa Cruz County
188141	Fee-for-Service	1295761609	1295761609	1	1	KHAY, DARITH S MD INC	3/26/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67883	08	Family Practice	0	In state provider	None	200 JOSE FIGUERES	STE 315	SAN JOSE	CA	95112	1592	43	06085	37.36122014	-121.8505998	Santa Clara County
188156	Fee-for-Service	1306296348	1306296348	1	1	KONG, MELINDA H MD	1/18/2018	390200000X	NA	Other	026	PHYSICIANS	153191	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
188161	Fee-for-Service	1659639011	1659639011	1	1	KU, KEVIN C DO	5/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13063	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
188175	Fee-for-Service	1023049301	1023049301	1	1	KIM, JOHN Y MD	7/1/2001	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	75393	01	General Practice	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
188188	Fee-for-Service	1326094483	1326094483	1	1	KAMENETSKY, MYRON L MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78034	30	Radiology	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
188265	Fee-for-Service	1013361005	1013361005	1	1	KIMURA, KYLE S MD	7/1/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	178079	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
188312	Fee-for-Service	1659572477	1659572477	1	1	KIMURA, TAMAMI C OD	8/22/2008	152WV0400X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19871 YORBA LINDA BLVD	#101	YORBA LINDA	CA	92886	2811	30	06059	33.8897307	-117.7877423	Orange County
188326	Fee-for-Service	1942219225	1942219225	1	1	KRONSON, JEFFREY W MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53023	34	Urology and Urological Surgery	0	In state provider	None	12291 WASHINGTON BLVD	STE 102	WHITTIER	CA	90606	2500	19	06037	33.96734104	-118.0508773	Los Angeles County
188329	Fee-for-Service	1831170844	1831170844	1	1	KILE, SHAWN J MD	11/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73177	13	Neurology (M.D. only)	0	In state provider	None	2800 L ST	STE 340	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
188342	Fee-for-Service	1568994101	1568994101	1	1	KUHN, TAYLOR PHD	9/25/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
188355	Fee-for-Service	1346542263	1346542263	1	1	KIM, DO H MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107240	42	Nuclear Medicine	0	In state provider	None	3545 WILSHIRE BLVD	STE 247	LOS ANGELES	CA	90010	2389	19	06037	34.0617575	-118.301985	Los Angeles County
188379	Fee-for-Service	1235128364	1235128364	1	1	KASSABIAN, JOHN P MD	12/10/1975	2085B0100X	NA	MRI Provider	026	PHYSICIANS	20147	30	Radiology	0	In state provider	None	50 BELLEFONTAINE ST	STE 104	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
188419	Fee-for-Service	1154453710	1154453710	1	1	KATES, LAURA W MD	12/19/2007	207P00000X	NA	Other	026	PHYSICIANS	96771	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
188457	Fee-for-Service	1104866318	1104866318	1	1	KRITCHEVSKY, MARK MD	9/29/1982	2084N0400X	NA	Neurology	026	PHYSICIANS	38155	13	Neurology (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H208	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
188487	Fee-for-Service	1558700187	1558700187	1	1	KOO, JA E MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137368	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
188524	Fee-for-Service	1316925928	1316925928	1	1	KANERIYA, PERRY P MD	12/11/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	101966	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
188550	Fee-for-Service	1407875941	1407875941	1	1	KLEINMAN, LOWELL J MD	4/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51155	01	General Practice	0	In state provider	None	903 SAN RAMON VALLEY BLV	STE 122	DANVILLE	CA	94526	4049	07	06013	37.80814631	-121.9921578	Contra Costa County
188563	Fee-for-Service	1982628665	1982628665	1	2	KONO, YUKO MD	6/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111039	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	SUITE 8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
188573	Fee-for-Service	1740563055	1740563055	1	1	KELVIN H NGUYEN FOOT & ANKLE	2/16/2012	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	210 N GARFIELD AVE	STE 305	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
188657	Fee-for-Service	1073054409	1073054409	1	2	KOPP, JACOB S MD	1/25/2022	208M00000X	NA	Other	026	PHYSICIANS	167064	None	None	0	In state provider	None	360 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5088	29	06057	39.23622963	-121.0549676	Nevada County
188673	Fee-for-Service	1447445564	1447445564	1	1	KELLI J LORENTSEN MD	11/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
188685	Fee-for-Service	1225191505	1225191505	1	1	KWON, YOUNG-JAE MD INC	7/15/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	37514	40	Pediatrics	0	In state provider	None	1040 ELM AVE	STE 200	LONG BEACH	CA	90813	3266	19	06037	33.779799	-118.1879535	Los Angeles County
188687	Fee-for-Service	1427312388	1427312388	1	1	KIRCHOFF, ROBERT MD	6/6/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
188694	Fee-for-Service	1083923817	1083923817	1	1	KALKOUNOS, PEGGY C DO	1/16/2017	208600000X	NA	General Surgery	026	PHYSICIANS	12861	02	General Surgery	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
188697	Fee-for-Service	1962858290	1962858290	1	1	KAZI, ALBERT A MD	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156991	02	General Surgery	0	In state provider	None	4333 TORRANCE BLVD	None	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
188709	Fee-for-Service	1619310752	1619310752	1	1	KADAKIA, KEVIN D MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155711	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
188715	Fee-for-Service	1528497567	1528497567	1	1	KAWAI, KELLI OD	2/19/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4540 DUBLIN BLVD	None	DUBLIN	CA	94568	7564	01	06001	37.70576071	-121.8809157	Alameda County
188745	Fee-for-Service	1639392541	1639392541	1	1	KLETT, ROBERT M MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104533	41	Internal Medicine	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
188764	Fee-for-Service	1093978058	1093978058	1	1	KHONG, AMY A	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111324	36	Psychiatry	0	In state provider	None	710 BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89540759	-122.0573287	Contra Costa County
188769	Fee-for-Service	1588842488	1588842488	1	6	KATZMAN, BARRY MD INC	10/31/1991	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1347 TAVERN RD	STE 4	ALPINE	CA	91901	3886	37	06073	32.83630089	-116.7772152	San Diego County
188796	Fee-for-Service	1871989889	1871989889	1	1	KIM, SARAH K MD	9/13/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	189091	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
188839	Fee-for-Service	1023375821	1023375821	1	1	KUCHENA, ADMIRE MD	8/6/2018	207L00000X	NA	Other	026	PHYSICIANS	157278	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
188843	Fee-for-Service	1942939293	1942939293	1	2	KIM, YURI NP	6/10/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	555 WASHINGTON STREET	None	SAN DIEGO	CA	92103	2289	37	06073	32.74986289	-117.1599343	San Diego County
188865	Fee-for-Service	1306473806	1306473806	1	1	KIM, JENNY MD	7/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185277	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
188879	Fee-for-Service	1548443807	1548443807	1	1	KANE, ALEXANDER M MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89499	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
188890	Fee-for-Service	1720018484	1720018484	1	1	KARNANI, RAJAN H MD	5/23/2010	174400000X	NA	Other	026	PHYSICIANS	60870	01	General Practice	0	In state provider	None	18419 HWY 18	STE 1	APPLE VALLEY	CA	92307	2229	36	06071	34.53946944	-117.2621779	San Bernardino County
188920	Fee-for-Service	1982799730	1982799730	1	1	KAPLAN, JOHN E MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	37958	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	329 W 8TH ST	STE 101	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
188921	Fee-for-Service	1679665459	1679665459	1	1	KHAN, SEEMA MD	2/23/2022	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	176436	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
188985	Fee-for-Service	1467448100	1467448100	1	1	KANDAHARI, MASOOM MD FACP	8/7/2024	207R00000X	NA	Other	026	PHYSICIANS	121807	68	Hematology	0	In state provider	None	450 4TH AVENUE	SUITE 311	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
189001	Fee-for-Service	1700415577	1700415577	1	1	KORNBERG, ZOE MD	9/6/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	186972	09	Gynecology (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
189023	Fee-for-Service	1710147830	1710147830	1	1	KULKARNI, KAUSHAL M MD	9/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121698	18	Ophthalmology	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
189042	Fee-for-Service	1659438802	1659438802	1	1	KRIEGER, LAURENA C OD	9/20/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 COFFEE RD	None	MODESTO	CA	95355	1161	50	06099	37.69158077	-120.9761536	Stanislaus County
189072	Fee-for-Service	1134197528	1134197528	1	1	KONCA, EWA H MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66917	None	None	0	In state provider	None	138 HARVARD AVE	None	CLAREMONT	CA	91711	4716	19	06037	34.095258	-117.716361	Los Angeles County
189086	Fee-for-Service	1811294606	1811294606	1	1	KHALID, SAIMA DO	1/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2075 EAST FLAMINGO RD	None	LAS VEGAS	NV	89119	5188	00	None	36.112671	-115.1248725	Clark County
189088	Fee-for-Service	1598850265	1598850265	1	1	KOMANDURI, KRISHNA V MD	12/5/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	77378	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
189131	Fee-for-Service	1902020571	1902020571	1	1	KALEKA, VIRENDER S MD	10/31/1989	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	43546	None	None	0	In state provider	None	141 N CLARK ST	STE A	FRESNO	CA	93701	2124	10	06019	36.744102	-119.7860465	Fresno County
189136	Fee-for-Service	1952705238	1952705238	1	2	KOSARI, PEJMAN LMFT	5/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5743 CORSA AVE	221	WESTLAKE VILLAGE	CA	91362	4027	19	06037	34.156863	-118.7994295	Los Angeles County
189172	Fee-for-Service	1720018484	1720018484	1	1	KARNANI, RAJAN H MD	5/23/2010	174400000X	NA	Other	026	PHYSICIANS	60870	13	Neurology (M.D. only)	0	In state provider	None	18419 HWY 18	STE 1	APPLE VALLEY	CA	92307	2229	36	06071	34.53946944	-117.2621779	San Bernardino County
189191	Fee-for-Service	1205194578	1205194578	1	1	KOBAYASHI, SOW A MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
189218	Fee-for-Service	1942344015	1942344015	1	1	KELADA, RENEE LCSW	10/31/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
189240	Fee-for-Service	1962605832	1962605832	1	1	KAIPA, SUMANA S PHD	1/12/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
189246	Fee-for-Service	1710032735	1710032735	1	2	KAISER FOUNDATION HOSPITAL	10/15/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17284 SLOVER AVE	SUITE 105	FONTANA	CA	92337	7584	36	06071	34.065396	-117.4277475	San Bernardino County
189248	Fee-for-Service	1659430361	1659430361	1	1	KLINE, JUDY A OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12501 IMPERIAL HWY	STE 400	NORWALK	CA	90650	1419	19	06037	33.91723852	-118.065834	Los Angeles County
189257	Fee-for-Service	1609294107	1609294107	1	1	KUMAR, SALONI MD	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138381	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
189268	Fee-for-Service	1275640336	1275640336	1	1	KAMARA, STEVEN E MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	74800	41	Internal Medicine	0	In state provider	None	6221 WILSHIRE BLVD	STE 518	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
189271	Fee-for-Service	1497984587	1497984587	1	1	KRULIG, ELIANA MD	12/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126869	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
189291	Fee-for-Service	1700415577	1700415577	1	1	KORNBERG, ZOE MD	9/6/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	186972	15	Obstetrics (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
189329	Fee-for-Service	1700946803	1700946803	1	1	KIM, JOSEPH Y OD	4/4/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
189336	Fee-for-Service	1184066367	1184066367	1	1	KUMAR, MAYA MD	4/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126520	None	None	0	In state provider	None	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
189383	Fee-for-Service	1336196849	1336196849	1	1	KEOSHEYAN, RHONDA M MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68656	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
189410	Fee-for-Service	1033500483	1033500483	1	1	KIM, DEBORAH E NP	7/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4618 FOUNTAIN AVE	None	LOS ANGELES	CA	90029	1977	19	06037	34.095582	-118.290195	Los Angeles County
189418	Fee-for-Service	1639107964	1639107964	1	1	KIPPER, MICHAEL S MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	24718	42	Nuclear Medicine	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
189422	Fee-for-Service	1649544289	1649544289	1	1	KOUKLAN, GOLZAR PSYD	2/26/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5820 OBERLIN DR	203	SAN DIEGO	CA	92121	3744	37	06073	32.89348634	-117.1937337	San Diego County
189430	Fee-for-Service	1740660752	1740660752	1	1	KALANSKY, ADIE MD	9/1/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	156885	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
189447	Fee-for-Service	1326306309	1326306309	1	1	KATARIA, NANDINI MD	1/8/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	141404	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90809	1701	19	06037	33.808185	-118.1850575	Los Angeles County
189530	Fee-for-Service	1336431667	1336431667	1	1	KAWADRY, SURAYA MD	2/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171229	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
189550	Fee-for-Service	1952628828	1952628828	1	1	KWAAN, NICHOLAS J MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119571	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
189561	Fee-for-Service	1477676286	1477676286	1	1	KHANNA, PANCHALI MD	8/23/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	112116	67	Endocrinology	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
189624	Fee-for-Service	1942312723	1942312723	1	1	KAUFMAN, RICHARD J LMFT	10/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	505 N TUSTIN AVE	STE 134	SANTA ANA	CA	92705	3712	30	06059	33.74962094	-117.8341227	Orange County
189670	Fee-for-Service	1174038152	1174038152	1	1	KIM, DIANE H NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
189671	Fee-for-Service	1669104261	1669104261	1	1	KORDNAIJ, MELODY OD	3/14/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
189674	Fee-for-Service	1336196849	1336196849	1	1	KEOSHEYAN, RHONDA M MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68656	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
189684	Fee-for-Service	1134235484	1134235484	1	1	KIM, JASUNG MD	4/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159816	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
189692	Fee-for-Service	1427312883	1427312883	1	1	KIRCHER, JOHN MD	9/3/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
189696	Fee-for-Service	1366640708	1366640708	1	1	KENDRA J BAILEY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CORNERSTONE BRIEF THERAP	5925 COUNCIL ST. NE	STE 120	CEDAR RAPIDS	IA	52402	5860	00	None	42.037182	-91.659069	Linn County
189707	Fee-for-Service	1699853481	1699853481	1	1	KIM, KAREN J MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84620	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
189709	Fee-for-Service	1639107964	1639107964	1	1	KIPPER, MICHAEL S MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	24718	41	Internal Medicine	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
189715	Fee-for-Service	1477582104	1477582104	1	1	KAPLANSKY, ARKADY DPM	12/1/1998	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	7260 SUNSET BLVD	STE 207	LOS ANGELES	CA	90046	3417	19	06037	34.0979715	-118.348542	Los Angeles County
189750	Fee-for-Service	1275887283	1275887283	1	1	KIM, NOOLEE	12/15/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
189764	Fee-for-Service	1598765570	1598765570	1	1	KROGER SPECIALTY PHARMACY	10/11/2010	333600000X	NA	Pharmacies	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	INC	3200 LAKE EMMA RD	STE 1000	LAKE MARY	FL	32746	3358	00	None	28.74402	-81.359604	Seminole County
189771	Fee-for-Service	1740539832	1740539832	1	1	KUENNEMEIER, BRIAN PSYD	6/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
189795	Fee-for-Service	1649358367	1649358367	1	1	KASHTAN, JACK M MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34974	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
189797	Fee-for-Service	1215926381	1215926381	1	1	KURTZMAN TRACEY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL	None	TUCSON	AZ	85724	0000	00	None	32.240493	-110.9460825	Pima County
189839	Fee-for-Service	1952628828	1952628828	1	1	KWAAN, NICHOLAS J MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119571	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
189848	Fee-for-Service	1790325090	1790325090	1	1	KAREN TAFRESHI CHIROPRACTIC,	2/19/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	INC.	18837 BROOKHURST ST STE	None	FOUNTAIN VALLEY	CA	92708	7302	30	06059	33.68919119	-117.9542204	Orange County
189883	Fee-for-Service	1407800683	1407800683	1	2	KAWATU, DAVID MD	2/4/2025	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	55375	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
189890	Fee-for-Service	1114415494	1114415494	1	1	KAYE, SHAINA MD	5/16/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164096	None	None	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
189925	Fee-for-Service	1245392869	1245392869	1	1	KIM, YOUNG I CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2621 W OLYMPIC BLVD	STE 101	LOS ANGELES	CA	90006	2878	19	06037	34.05244747	-118.2884985	Los Angeles County
189926	Fee-for-Service	1982687208	1982687208	1	1	KIP, KATRINKA T MD	9/22/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
189949	Fee-for-Service	1558457960	1558457960	1	1	KHALEQ, ABDUL M MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77874	10	Gastroenterology (M.D. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
189959	Fee-for-Service	1932945995	1932945995	1	1	KELLY, GABRIELLE E LCSW	8/5/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
189981	Fee-for-Service	1275865560	1275865560	1	1	KUMAR, DHANANJAY CCC-SLP	9/25/2017	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	939 W EL CAMINO REAL	109	SUNNYVALE	CA	94087	6108	43	06085	37.37138844	-122.0458446	Santa Clara County
189983	Fee-for-Service	1306816947	1306816947	1	1	KUNZ, GREGORY J MD	12/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86368	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
190000	Fee-for-Service	1609947670	1609947670	1	1	KHANG, PETER S MD	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76631	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
190026	Fee-for-Service	1598813313	1598813313	1	1	KAISER FOUNDATION HOSP	3/19/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY ANNEX	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
190080	Fee-for-Service	1649358367	1649358367	1	1	KASHTAN, JACK M MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34974	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
190084	Fee-for-Service	1558430900	1558430900	1	1	KERMEEN, JOYCE A LMFT	7/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1730 AMPHLETT BLVD	215	SAN MATEO	CA	94402	2707	41	06081	37.55782981	-122.3010921	San Mateo County
190087	Fee-for-Service	1689058836	1689058836	1	1	KIM, EUNYOUNG NP	6/22/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
190123	Fee-for-Service	1184633620	1184633620	1	1	KO, GEMMA T MD INC	11/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4511 ROSEMEAD BLVD	None	PICO RIVERA	CA	90660	2032	19	06037	34.0092382	-118.0814466	Los Angeles County
190150	Fee-for-Service	1194253708	1194253708	1	1	KATBAMNA, SHRUTI P MD	8/12/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163529	08	Family Practice	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
190152	Fee-for-Service	1699329052	1699329052	1	1	KENWOOD, IVANNA L DPM	6/6/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2001 SANTA MONICA BLVD	380, 1070, 1080, 1090	SANTA MONICA	CA	90404	2179	19	06037	34.02891163	-118.4797466	Los Angeles County
190236	Fee-for-Service	1558457960	1558457960	1	1	KHALEQ, ABDUL M MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77874	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
190269	Fee-for-Service	1962550863	1962550863	1	1	KWAK, KYU BANG MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33473	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
190305	Fee-for-Service	1619361524	1619361524	1	1	KHAN, AKBAR Z MD	9/15/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176425	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
190354	Fee-for-Service	1669776845	1669776845	1	1	KILANI, MARWA W MD	1/28/2011	193200000X	NA	Other	026	PHYSICIANS	77118	None	None	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	93146	9600	19	06037	34.27904453	-118.459944	Los Angeles County
190368	Fee-for-Service	1255671574	1255671574	1	1	KIRBY, HANNAH E MD	1/17/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171123	None	None	0	In state provider	None	277 RANCHEROS DR.	SUITE 101	SAN MARCOS	CA	92069	2976	37	06073	33.13859391	-117.1604009	San Diego County
190387	Fee-for-Service	1043631427	1043631427	1	1	KAMIAH DIALYSIS LLC	11/17/2014	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2703 S TOWNE AVE	None	POMONA	CA	91766	6206	19	06037	34.02333	-117.7427565	Los Angeles County
190388	Fee-for-Service	1093006793	1093006793	1	1	KINI, SEEMA P MD	10/15/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	155829	07	Dermatology	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
190413	Fee-for-Service	1083331888	1083331888	1	1	KOK, PATTY D NP	2/9/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
190428	Fee-for-Service	1245566264	1245566264	1	1	KANZARIA, HEMAL K MD	7/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110649	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	SUITE 1517	LOS ANGELES	CA	90095	3075	19	06037	34.06633051	-118.4452686	Los Angeles County
190429	Fee-for-Service	1205906740	1205906740	1	1	KURATA, FRED	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49917	18	Ophthalmology	0	In state provider	None	420 E 3RD ST	STE 603	LOS ANGELES	CA	90013	1645	19	06037	34.04702011	-118.241912	Los Angeles County
190460	Fee-for-Service	1427176569	1427176569	2	1	KERN COUNTY HOSPITAL AUTHORI	7/1/2016	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	AUTHORITY	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
190518	Fee-for-Service	1316546351	1316546351	1	1	KINDNESS HOSPICE CARE INC	10/18/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 208	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
190536	Fee-for-Service	1669467114	1669467114	1	1	KWON, MEEAE Y MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63941	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
190551	Fee-for-Service	1912062829	1912062829	1	1	KAHAN, NORMAN J MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	60236	25	Physical Medicine and Rehabilitation	0	In state provider	None	10430 S DE ANZA BLVD	STE 230	CUPERTINO	CA	95014	3019	43	06085	37.3172651	-122.0321678	Santa Clara County
190573	Fee-for-Service	1578971107	1578971107	1	1	K & VAR MANAGEMENT, INC	6/11/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8202 FLORENCE AVENUE	SUITE 100	DOWNEY	CA	90240	3937	19	06037	33.95184693	-118.1266471	Los Angeles County
190624	Fee-for-Service	1558705061	1558705061	1	1	KIM, ERINN N MD	7/16/2021	208200000X	NA	General Surgery	026	PHYSICIANS	134797	None	None	0	In state provider	None	7920 FROST STREET	SUITE 200	SAN DIEGO	CA	92123	4289	37	06073	32.80027449	-117.153846	San Diego County
190669	Fee-for-Service	1972806941	1972806941	1	1	KORSHAK, EVE B NP	8/26/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
190720	Fee-for-Service	1275186512	1275186512	1	1	KNOWLTON, TRAVIS E LCSW	10/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
190722	Fee-for-Service	1750317772	1750317772	1	1	KATZ, BERNARD J MD	11/30/1987	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	45158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
190725	Fee-for-Service	1447546627	1447546627	1	1	KHALILI, IMANUEL MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128772	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
190734	Fee-for-Service	1992801906	1992801906	1	1	KAAKIJIAN, SARKIS A MD	10/15/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50031	None	None	0	In state provider	INC	1500 S CENTRAL AVE	STE 318	GLENDALE	CA	91204	2574	19	06037	34.12736888	-118.257777	Los Angeles County
190764	Fee-for-Service	1508219569	1508219569	1	1	KRUGER, FREDERICK J DPM INC	6/8/2017	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	530 E HERNDON AVE	STE 104	FRESNO	CA	93720	2990	10	06019	36.83764651	-119.7792307	Fresno County
190770	Fee-for-Service	1689020786	1689020786	1	1	KOPER, ANNA V PSYD	4/11/2022	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
190777	Fee-for-Service	1851489421	1851489421	1	1	KEVIN MCCURRY	2/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	521 ADAMS AVE	None	MORTON	WA	98356	9323	00	None	46.55593249	-122.2798365	Lewis County
190798	Fee-for-Service	1679720999	1679720999	1	1	KARKI, MOHAN R MD	8/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167461	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
190807	Fee-for-Service	1316546351	1316546351	1	1	KINDNESS HOSPICE CARE INC	10/18/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 208	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
190820	Fee-for-Service	1801425301	1801425301	1	1	KABBINAVAR, FAIZ MD	11/30/2023	207R00000X	NA	Other	026	PHYSICIANS	188300	None	None	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
190822	Fee-for-Service	1871260968	1871260968	1	1	KWAN, COURTNEY	11/15/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
190841	Fee-for-Service	1912062829	1912062829	1	1	KAHAN, NORMAN J MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	60236	08	Family Practice	0	In state provider	None	10430 S DE ANZA BLVD	STE 230	CUPERTINO	CA	95014	3019	43	06085	37.3172651	-122.0321678	Santa Clara County
190855	Fee-for-Service	1497053755	1497053755	1	1	KAPHLE, UPENDRA R MD	11/9/2019	207R00000X	NA	Other	026	PHYSICIANS	161878	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
190863	Fee-for-Service	1578971107	1578971107	1	1	K & VAR MANAGEMENT, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8202 FLORENCE AVENUE	SUITE 100	DOWNEY	CA	90240	3937	19	06037	33.95184693	-118.1266471	Los Angeles County
190874	Fee-for-Service	1871700856	1871700856	1	1	KATZ, JUDITH A LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
190877	Fee-for-Service	1518944057	1518944057	1	1	KAWANISHI, DAVID T MD	1/1/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35547	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	665 CAMINO DE LOS MARES	STE 210	SAN CLEMENTE	CA	92673	2841	30	06059	33.45730192	-117.6483252	Orange County
190878	Fee-for-Service	1760707715	1760707715	1	1	KUNTZ, HEATHER M MD	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117819	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON STREET	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
190892	Fee-for-Service	1013633262	1013633262	1	1	K&C INSPIRE THERAPY	11/10/2022	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15437 ANACAPA RD	STE. 23	VICTORVILLE	CA	92392	2458	36	06071	34.50557513	-117.3250277	San Bernardino County
190922	Fee-for-Service	1164473906	1164473906	1	1	KOCHAR, MAHENDR S MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51483	08	Family Practice	0	In state provider	None	555 TACHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
190953	Fee-for-Service	1134131725	1134131725	1	1	KARNIK, PRACHI A MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83228	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
190963	Fee-for-Service	1487812640	1487812640	1	1	KAIRU, LEAH MURUGI	6/24/2008	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2110 MERCURY AVE	None	BANNING	CA	92220	1047	33	06065	33.94446626	-116.939214	Riverside County
190982	Fee-for-Service	1083934210	1083934210	1	1	KERKOUTIAN, SUSAN MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110388	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
190994	Fee-for-Service	1316247133	1316247133	1	1	KURIA, SHYLA S	10/6/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	27730 SAND DOLLAR WAY	None	MORENO VALLEY	CA	92555	5766	33	06065	33.91302127	-117.1788763	Riverside County
191032	Fee-for-Service	1700339702	1700339702	1	1	KAJANI, RAHEEM MD	7/9/2019	207R00000X	NA	Other	026	PHYSICIANS	160996	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
191044	Fee-for-Service	1871515627	1871515627	1	1	KIM, JOSEPH K MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80442	05	Anesthesiology	0	In state provider	None	101 CITY DRIVE S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
191045	Fee-for-Service	1407075948	1407075948	1	1	KA WOO MEDICAL CLINIC INC	9/14/2011	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	841 W VALLEY BLVD	STE 107	ALHAMBRA	CA	91803	3251	19	06037	34.07803221	-118.1327862	Los Angeles County
191071	Fee-for-Service	1891781886	1891781886	1	1	KELLER, KENNETH J. MD	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
191074	Fee-for-Service	1225066764	1225066764	1	1	KLEIN, JONATHAN D MD	12/11/2023	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	192049	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
191103	Fee-for-Service	1952057598	1952057598	1	1	KEYSTONE THERAPY AND TRAININ	10/31/2023	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	G SERVICES INC	4415 SONOMA HWY	SUITE A, E/F	SANTA ROSA	CA	95409	4165	49	06097	38.45819154	-122.6759063	Sonoma County
191154	Fee-for-Service	1922029677	1922029677	1	1	KRAHN, DOUGLAS M MD	6/11/2020	208600000X	NA	General Surgery	026	PHYSICIANS	64325	02	General Surgery	0	In state provider	None	401 E HIGHLAND AVE STE 3	None	SAN BERNARDINO	CA	92404	3830	36	06071	34.1358627	-117.2757778	San Bernardino County
191156	Fee-for-Service	1700554540	1700554540	1	1	KWON, AIMEE CCC-SLP	9/13/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
191169	Fee-for-Service	1417282823	1417282823	1	1	KARP, MATTHEW S MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125117	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN STREET	EMERGENCY DEPT	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
191234	Fee-for-Service	1144296542	1144296542	1	1	KEVIN S. MEIER MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2450 RIVERSIDE AVE	None	MINNEAPOLIS	MN	55454	1450	00	None	44.96613258	-93.23756795	Hennepin County
191251	Fee-for-Service	1487812640	1487812640	1	1	KAIRU, LEAH MURUGI	6/24/2008	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2110 MERCURY AVE	None	BANNING	CA	92220	1047	33	06065	33.94446626	-116.939214	Riverside County
191268	Fee-for-Service	1427176569	1427176569	2	3	KERN COUNTY HOSPITAL AUTHORI	1/18/2022	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1111 COLUMBUS ST	None	BAKERSFIELD	CA	93305	1936	15	06029	35.39744148	-118.9822815	Kern County
191282	Fee-for-Service	1316247133	1316247133	1	1	KURIA, SHYLA S	10/6/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	27730 SAND DOLLAR WAY	None	MORENO VALLEY	CA	92555	5766	33	06065	33.91302127	-117.1788763	Riverside County
191287	Fee-for-Service	1154647006	1154647006	1	1	KIM, HANNAH MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117949	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
191319	Fee-for-Service	1942386040	1942386040	1	1	KUHNE, MICHAEL A MD	5/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97169	20	Orthopedic Surgery	0	In state provider	None	1600 ESPLANADE	STE C	CHICO	CA	95928	3369	04	06007	39.74352822	-121.8495394	Butte County
191342	Fee-for-Service	1700050598	1700050598	1	1	KALDAS, FADY M MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89880	None	None	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
191345	Fee-for-Service	1326450685	1326450685	1	1	KREL, MARK A DO	6/9/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	14234	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
191354	Fee-for-Service	1780351072	1780351072	1	1	KIM, RYAN S NP	6/7/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
191374	Fee-for-Service	1629085154	1629085154	1	1	KOZAK, THOMAS J MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78081	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST FOURTH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
191388	Fee-for-Service	1871929810	1871929810	1	1	KANG, JAMES H DO	2/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12962	01	General Practice	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
191392	Fee-for-Service	1003201336	1003201336	1	1	KALLAS, OMAR N MD	7/7/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172587	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
191429	Fee-for-Service	1376691972	1376691972	1	1	KAISER FOUND HLTH PLAN	5/6/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHCY	27303 SLEEPY HOLLOW AVE	None	HAYWARD	CA	94545	4264	01	06001	37.63208871	-122.0939191	Alameda County
191443	Fee-for-Service	1457469926	1457469926	1	1	KOPPER, TIMOTHY E DC	4/30/1992	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1374 SMITH ST	None	KINGSBURG	CA	93631	2217	10	06019	36.51420954	-119.5503723	Fresno County
191466	Fee-for-Service	1023147014	1023147014	1	1	KIM, JAE Y MD	8/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85288	33	Thoracic Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
191514	Fee-for-Service	1952481160	1952481160	1	1	KUBASKA, STEPHEN M MD	6/21/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86545	08	Family Practice	0	In state provider	None	101 CITY DR	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
191548	Fee-for-Service	1750725933	1750725933	1	1	KANG, MIN K MD	9/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146993	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191559	Fee-for-Service	1649480393	1649480393	1	1	KIM, PAUL K MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	104047	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
191582	Fee-for-Service	1336173921	1336173921	1	1	KAGAN, BRUCE MD	8/31/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51023	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
191588	Fee-for-Service	1366603342	1366603342	1	1	KHAN, CHRISTINA T MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114458	26	Psychiatry (child)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
191590	Fee-for-Service	1225491632	1225491632	1	1	KAPLAN, DANIEL MD	4/26/2021	390200000X	NA	Other	026	PHYSICIANS	151015	None	None	0	In state provider	None	13851 EAST 14TH ST	SUITE 308	SAN LEANDRO	CA	94578	2630	01	06001	37.71458918	-122.1418781	Alameda County
191649	Fee-for-Service	1386617058	1386617058	1	1	KUSHIGEMACHI, M MD	4/30/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52214	08	Family Practice	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
191650	Fee-for-Service	1336480615	1336480615	1	1	KELLER, ALEXANDRA PSYD	4/30/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
191664	Fee-for-Service	1629085154	1629085154	1	1	KOZAK, THOMAS J MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78081	08	Family Practice	0	In state provider	None	2400 EAST FOURTH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
191679	Fee-for-Service	1265520803	1265520803	1	1	KWONG, HA T OD INC	12/26/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RAM OD	9959 WALKER ST	None	CYPRESS	CA	90630	3827	30	06059	33.81768404	-118.0369005	Orange County
191742	Fee-for-Service	1134187651	1134187651	1	1	KOERNER, PAUL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	759 CHESTNUT ST	None	SPRINGFIELD	MA	01199	1001	00	None	42.122601	-72.602856	Hampden County
191745	Fee-for-Service	1093789570	1093789570	1	1	KING A LINDA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5230 CENTER AVE	None	PITTSBURGH	PA	15232	1304	00	None	40.45554129	-79.93971305	Allegheny County
191748	Fee-for-Service	1437338605	1437338605	1	1	KIM, LORI C MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109816	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
191776	Fee-for-Service	1780624791	1780624791	1	1	KO, JIMMY MD	12/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93399	77	Infectious Disease	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
191778	Fee-for-Service	1992878631	1992878631	1	1	KANG, CHUL S CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	KANGS ACUPUNCTURE CLINIC	3700 WILSHIRE BLVD	STE 460	LOS ANGELES	CA	90010	2910	19	06037	34.06168851	-118.3068315	Los Angeles County
191789	Fee-for-Service	1477837599	1477837599	1	1	KUHL, JILL R	6/20/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
191866	Fee-for-Service	1548640337	1548640337	1	1	KOO, EUBEE B MD	5/29/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	162895	18	Ophthalmology	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
191871	Fee-for-Service	1033168190	1033168190	1	1	KURIO, GREGORY H T MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72049	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
191876	Fee-for-Service	1366603342	1366603342	1	1	KHAN, CHRISTINA T MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114458	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
191896	Fee-for-Service	1780799379	1780799379	1	1	KIM, COLUMBA Y B LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1537 FRANKLIN ST	STE 306	SAN FRANCISCO	CA	94109	4581	38	06075	37.78883046	-122.4237278	San Francisco County
191906	Fee-for-Service	1730676230	1730676230	1	1	KOUPRINA,NINA	6/13/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	4922	00	None	40.700349	-73.9416015	Kings County
191910	Fee-for-Service	1114965977	1114965977	1	1	KWON, JASON UK MD	9/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76370	05	Anesthesiology	0	In state provider	None	27401 LOS ALTOS	STE 180	MISSION VIEJO	CA	92691	8580	30	06059	33.56489118	-117.665546	Orange County
191920	Fee-for-Service	1255564860	1255564860	1	1	KWAK, ANGELA OD	7/5/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 SOUTH ANAHEIM HILLS	234	ANAHEIM	CA	92856	6526	30	06059	33.8427954	-117.7772895	Orange County
191942	Fee-for-Service	1275501389	1275501389	1	1	KEVIN GRADY ERWIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	95 FAIRWAY DR	None	COVINGTON	LA	70433	4969	00	None	30.40982495	-90.08124472	St. Tammany Parish
191963	Fee-for-Service	1578641346	1578641346	1	1	KING-ANGELL, JOAN	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58410	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
191978	Fee-for-Service	1386660611	1386660611	1	1	KWOK, PUI-YAN MD	3/29/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86455	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191986	Fee-for-Service	1376018176	1376018176	1	1	KANAMOTO, KELLIE M OD	11/9/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
191990	Fee-for-Service	1558492124	1558492124	1	1	KARDOONI, KAVEH DO	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
192036	Fee-for-Service	1437338605	1437338605	1	1	KIM, LORI C MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109816	78	Neoplastic Diseases/Oncology	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192058	Fee-for-Service	1598981508	1598981508	1	1	KEVIN G O'ROURKE JR MD	3/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2602	00	None	39.08455286	-94.57578107	Jackson County
192123	Fee-for-Service	1205997277	1205997277	1	1	KEELER, SEAN M MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	5761 S FORT APACHE RD	None	LAS VEGAS	NV	89148	5506	00	None	36.083673	-115.299972	Clark County
192125	Fee-for-Service	1407395197	1407395197	1	1	KUO, EMMELINE DO	10/27/2020	207R00000X	NA	Other	026	PHYSICIANS	16786	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
192134	Fee-for-Service	1659452159	1659452159	1	1	KING, ELISABETH PSYD	4/1/2020	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	525 W. MAIN ST	UNIT #120	VISALIA	CA	93291	2423	54	06107	36.330003	-119.297439	Tulare County
192161	Fee-for-Service	1033168190	1033168190	1	1	KURIO, GREGORY H T MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72049	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
192181	Fee-for-Service	1861408874	1861408874	1	1	KWON, YOON T MD	2/28/1991	207KA0200X	NA	Other	026	PHYSICIANS	44787	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
192193	Fee-for-Service	1699865204	1699865204	1	1	KIMBALL,EDWARD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N MEDICAL DR	None	SALT LAKE CITY	UT	84132	0100	00	None	40.77197161	-111.8352608	Salt Lake County
192194	Fee-for-Service	1780815449	1780815449	1	1	KUSTER, ANDREA E NP	6/26/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
192212	Fee-for-Service	1669586814	1669586814	1	1	KALCIC, VANCE L MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	62600	01	General Practice	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
192219	Fee-for-Service	1508136326	1508136326	1	1	KATIRAIE, SEPEHR MD INC	3/1/2000	261QP2300X	NA	Other	026	PHYSICIANS	54478	01	General Practice	0	In state provider	None	2638 EAST FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	4708	19	06037	33.97407048	-118.2240182	Los Angeles County
192254	Fee-for-Service	1578641346	1578641346	1	1	KING-ANGELL, JOAN	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58410	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
192259	Fee-for-Service	1942775242	1942775242	1	1	KOUTSOKOSTAS, ALEXANDRIA CC	6/10/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C-SLP	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
192275	Fee-for-Service	1255403069	1255403069	1	1	KELLY, OLGA D MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	50766	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
192297	Fee-for-Service	1528083557	1528083557	1	1	KIM, DOHWA MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56259	38	Geriatrics	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
192305	Fee-for-Service	1568519882	1568519882	1	1	KAISER FOUNDATION HEALTH	12/19/1988	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY	3900 LAKEVILLE HYWY	None	PETALUMA	CA	94952	0000	49	06097	38.2304311	-122.5827918	Sonoma County
192311	Fee-for-Service	1841767282	1841767282	1	1	KIM, JENNIE M LCSW	5/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
192318	Fee-for-Service	1417498890	1417498890	2	1	KAREN BOLL NP	4/15/2021	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
192320	Fee-for-Service	1407157373	1407157373	1	1	KHANKHANIAN, MOIEZ MD INC	6/11/2012	193400000X	NA	Other	026	PHYSICIANS	41134	36	Psychiatry	0	In state provider	None	933 S SUNSET AVE	#105	WEST COVINA	CA	91790	3410	19	06037	34.06428275	-117.9432037	Los Angeles County
192324	Fee-for-Service	1437338605	1437338605	1	1	KIM, LORI C MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109816	68	Hematology	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192341	Fee-for-Service	1780243089	1780243089	1	1	KINIMAKA, ANDREW MD	12/20/2024	207R00000X	NA	Other	026	PHYSICIANS	187138	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
192451	Fee-for-Service	1174608830	1174608830	1	1	KAVANAGH, COLLEEN M MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73968	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
192460	Fee-for-Service	1225218522	1225218522	1	2	KATUKOTA, VIJAYA K MD	10/5/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	38220	-	NOT APPLICABLE	0	In state provider	None	24625 ARCH ST	None	NEWHALL	CA	91321	1111	19	06037	34.38498366	-118.5292907	Los Angeles County
192505	Fee-for-Service	1508136326	1508136326	1	1	KATIRAIE, SEPEHR MD INC	3/1/2000	261QP2300X	NA	Other	026	PHYSICIANS	54478	30	Radiology	0	In state provider	None	2638 EAST FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	4708	19	06037	33.97407048	-118.2240182	Los Angeles County
192508	Fee-for-Service	1255359840	1255359840	1	1	KLTCHIAN, MISSAK S MD	3/31/1993	207R00000X	NA	Other	026	PHYSICIANS	52368	08	Family Practice	0	In state provider	None	4645 HOLLYWOOD BLVD	STE 4	LOS ANGELES	CA	90027	5455	19	06037	34.10033387	-118.290438	Los Angeles County
192517	Fee-for-Service	1346235686	1346235686	1	1	KASTURI, PARVEEN K MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56110	77	Infectious Disease	0	In state provider	None	315 N 3RD AVE	None	COVINA	CA	91723	1905	19	06037	34.08873786	-117.8923869	Los Angeles County
192540	Fee-for-Service	1104807569	1104807569	1	1	KWOK, KEITH MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	96381	None	None	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
192559	Fee-for-Service	1205332392	1205332392	1	1	KIM, JULIA DO	9/10/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	19057	None	None	0	In state provider	None	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
192586	Fee-for-Service	1528083557	1528083557	1	1	KIM, DOHWA MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56259	41	Internal Medicine	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
192587	Fee-for-Service	1780645606	1780645606	1	1	KWON, DANIEL M MD	8/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80417	01	General Practice	0	In state provider	None	11406 LOMA LINDA DR	STE 300	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
192626	Fee-for-Service	1700865151	1700865151	1	1	KIRKLAND-WALSH, HOLLY J	7/12/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	RN	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
192634	Fee-for-Service	1972644482	1972644482	1	1	KRUSE, TORSTEN J MD	2/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	75928	41	Internal Medicine	0	In state provider	None	1300 AVENIDA VISTA HERMO	SA, STE 250	SAN CLEMENTE	CA	92673	6340	30	06059	33.45766933	-117.5920941	Orange County
192638	Fee-for-Service	1346348638	1346348638	1	1	KAMDAR, ANJANA V	3/20/1979	207RN0300X	NA	Nephrology	026	PHYSICIANS	29491	None	None	0	In state provider	None	1701 CESAR CHAVEZ AVE	STE 307	LOS ANGELES	CA	90033	2439	19	06037	34.05112725	-118.2173921	Los Angeles County
192643	Fee-for-Service	1699972109	1699972109	1	1	KYSKAN, CHRISTINA E PHD	7/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
192733	Fee-for-Service	1962933895	1962933895	1	1	KIM, DIANA Y LMFT	7/16/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
192749	Fee-for-Service	1528419710	1528419710	1	1	KARANDISH, SAEID MD	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	171897	41	Internal Medicine	0	In state provider	None	16661 VENTURA BLVD	STE 313	ENCINO	CA	91436	1956	19	06037	34.15820737	-118.496492	Los Angeles County
192784	Fee-for-Service	1578630125	1578630125	1	1	KPADUWA, JULIUS C MD	7/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	51500	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10408 VACCO ST	STE B	EL MONTE	CA	91733	3350	19	06037	34.04727908	-118.0442754	Los Angeles County
192800	Fee-for-Service	1841364247	1841364247	1	2	KAISER FOUNDATION HOSPITAL	8/18/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3900 FREEDOM CIRCLE	SUITE 201	SANTA CLARA	CA	95054	1222	43	06085	37.38769057	-121.9700955	Santa Clara County
192805	Fee-for-Service	1255726048	1255726048	1	1	KADELA, KATARZYNA A MD	8/23/2021	208M00000X	NA	Other	026	PHYSICIANS	173213	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
192806	Fee-for-Service	1942644679	1942644679	1	1	KAUFMAN, ELIZABETH A MD	9/29/2021	207PS0010X	NA	Other	026	PHYSICIANS	135037	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
192811	Fee-for-Service	1609196245	1609196245	1	1	KIRK MEDICAL INCORPORATED	8/16/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	54807	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1505 WILSON TERRACE	STE 220	GLENDALE	CA	91206	4074	19	06037	34.14960934	-118.2313491	Los Angeles County
192840	Fee-for-Service	1558344374	1558344374	1	1	K,WILLIAM KUMLER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	85 MCNAUGHTON RD	STE 120	COLUMBUS	OH	43213	0000	00	None	39.97821715	-82.836363	Franklin County
192893	Fee-for-Service	1083666531	1083666531	1	1	KHALID, SABA H MD	8/5/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70535	40	Pediatrics	0	In state provider	None	938 N CHERRY ST	None	VISALIA	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
192894	Fee-for-Service	1043286842	1043286842	1	1	KUMAR, DINESH M MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55948	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
192899	Fee-for-Service	1093791824	1093791824	1	1	KAMLER, JAN P MD	8/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	880 RYLAND ST	None	RENO	NV	89502	1603	00	None	39.52378631	-119.8009873	Washoe County
192920	Fee-for-Service	1972644482	1972644482	1	1	KRUSE, TORSTEN J MD	2/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	75928	38	Geriatrics	0	In state provider	None	1300 AVENIDA VISTA HERMO	SA, STE 250	SAN CLEMENTE	CA	92673	6340	30	06059	33.45766933	-117.5920941	Orange County
192960	Fee-for-Service	1235558255	1235558255	1	1	KOMPALA, TEJASWI D MD	5/10/2017	390200000X	NA	Other	026	PHYSICIANS	140032	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
192976	Fee-for-Service	1194352799	1194352799	1	1	KHAN, AELIUS MD	8/14/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184503	None	None	0	In state provider	None	3555 KENYON ST	STE 200	SAN DIEGO	CA	92110	5341	37	06073	32.75016963	-117.2160064	San Diego County
193018	Fee-for-Service	1871639682	1871639682	1	2	KHIN, HENRY H MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	64156	-	NOT APPLICABLE	0	In state provider	None	160 E HOLT AVENUE	STE B	POMONA	CA	91767	5406	19	06037	34.06239649	-117.7489613	Los Angeles County
193030	Fee-for-Service	1023246089	1023246089	1	1	KUSHNARYOV, ANTON M MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114550	04	Otology, Laryngology, Rhinology	0	In state provider	None	1701 4TH ST	STE 120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
193057	Fee-for-Service	1144328683	1144328683	1	1	KRONICK, ELWOOD L MD	5/2/1974	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	6310	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1616 N MAIN ST	None	WALNUT CREEK	CA	94596	4609	07	06013	37.90078642	-122.0613559	Contra Costa County
193068	Fee-for-Service	1225605025	1225605025	1	1	KAMAKIA, DENNIS NGUNJIRI	1/12/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13061 MILLER AVENUE	None	NORWALK	CA	90650	3342	19	06037	33.91081782	-118.0536383	Los Angeles County
193089	Fee-for-Service	1841364247	1841364247	1	2	KAISER FOUNDATION HOSPITAL	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3900 FREEDOM CIRCLE	SUITE 201	SANTA CLARA	CA	95054	1222	43	06085	37.38769057	-121.9700955	Santa Clara County
193109	Fee-for-Service	1871889709	1871889709	1	1	KLOSTERMAN, TRISTAN B MD	12/1/2017	390200000X	NA	Other	026	PHYSICIANS	152155	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
193120	Fee-for-Service	1568428233	1568428233	1	1	KUHN, BRENDA G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
193132	Fee-for-Service	1871141036	1871141036	1	1	KANEMOTO, TAKESHI G PT	9/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
193151	Fee-for-Service	1194737601	1194737601	1	1	KUBAL, GARGI G MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88056	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
193153	Fee-for-Service	1154749323	1154749323	1	1	KWAN, ALAN C MD	7/2/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	149280	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
193183	Fee-for-Service	1043286842	1043286842	1	1	KUMAR, DINESH M MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55948	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
193184	Fee-for-Service	1841294337	1841294337	1	1	KWON, ROBERT S G MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63998	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
193187	Fee-for-Service	1174899009	1174899009	1	1	KRISTEN LIVESEY MD	8/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 BOWER HILL RD	None	PITTSBURGH	PA	15243	1873	00	None	40.37744491	-80.06601413	Allegheny County
193234	Fee-for-Service	1174757553	1174757553	1	2	KWAN, PINGCHING N MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119065	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
193263	Fee-for-Service	1154909240	1154909240	1	1	KADAKIA, SAGAR R DO	10/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22587	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
193300	Fee-for-Service	1639209596	1639209596	1	1	KALEIDA HEALTH SYSTEM	9/8/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 HIGH ST	None	BUFFALO	NY	14203	1126	00	None	42.900903	-78.865983	Erie County
193307	Fee-for-Service	1154618122	1154618122	1	1	KAZAK, MARAT D DPM	2/23/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6600 MERCY COURT	STE 150	FAIR OAKS	CA	95628	3190	34	06067	38.666565	-121.309857	Sacramento County
193308	Fee-for-Service	1710978770	1710978770	1	1	KIM, RICHARD T DO	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6774	01	General Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
193335	Fee-for-Service	1073775532	1073775532	1	1	KOOLA, JEJO D MD	6/23/2017	207R00000X	NA	Other	026	PHYSICIANS	122014	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193353	Fee-for-Service	1932688264	1932688264	1	1	KAUR, MANJINDER NP	9/4/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
193358	Fee-for-Service	1225605025	1225605025	1	1	KAMAKIA, DENNIS NGUNJIRI	1/12/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13061 MILLER AVENUE	None	NORWALK	CA	90650	3342	19	06037	33.91081782	-118.0536383	Los Angeles County
193436	Fee-for-Service	1235239443	1235239443	1	1	KATZ, ERNEST R	12/1/1994	2080P0207X	NA	Hematology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
193444	Fee-for-Service	1831317684	1831317684	1	1	KOBAYASHI, MICHAEL S MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99348	None	None	0	In state provider	None	1801 E MARCH LANE	STE A130	STOCKTON	CA	95210	6650	39	06077	38.00315652	-121.2868715	San Joaquin County
193471	Fee-for-Service	1043286842	1043286842	1	1	KUMAR, DINESH M MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55948	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
193473	Fee-for-Service	1841294337	1841294337	1	1	KWON, ROBERT S G MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63998	30	Radiology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
193503	Fee-for-Service	1174605133	1174605133	1	2	KHANI, SAMINA G MD	6/3/2024	207R00000X	NA	Other	026	PHYSICIANS	52731	41	Internal Medicine	0	In state provider	None	13355 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5802	19	06037	33.91091877	-118.3527745	Los Angeles County
193550	Fee-for-Service	1720498959	1720498959	1	1	KOMSOUKANIANTS, ARKADY MD	7/6/2017	208M00000X	NA	Other	026	PHYSICIANS	139258	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193587	Fee-for-Service	1639209596	1639209596	1	1	KALEIDA HEALTH SYSTEM	9/8/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 HIGH ST	None	BUFFALO	NY	14203	1126	00	None	42.900903	-78.865983	Erie County
193600	Fee-for-Service	1366778748	1366778748	1	1	KAPREALIAN, TANIA B MD	5/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98653	78	Neoplastic Diseases/Oncology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91346	1204	19	06037	34.27904453	-118.459944	Los Angeles County
193695	Fee-for-Service	1487723144	1487723144	1	1	KATZMAN, KENNETH A MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52177	08	Family Practice	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
193708	Fee-for-Service	1780830885	1780830885	1	1	KHAN, NAJEEB A MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105128	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
193735	Fee-for-Service	1801233911	1801233911	1	1	KOSMACH, JOSEPH J DO	8/1/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16558	36	Psychiatry	0	In state provider	None	7850 VISTA HILL AVE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
193736	Fee-for-Service	1790858611	1790858611	1	1	KNOTTS, DONALD R MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	35548	41	Internal Medicine	0	In state provider	None	20126 STANTON AVE	STE 201	CASTRO VALLEY	CA	94546	5270	01	06001	37.69722866	-122.090936	Alameda County
193744	Fee-for-Service	1861838260	1861838260	1	1	KARAMANOS, EFSTATHIOS	1/15/2025	2086S0122X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
193768	Fee-for-Service	1538265327	1538265327	1	1	KIM, ESTHER Y MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70313	08	Family Practice	0	In state provider	None	12395 EL CAMINO REAL	None	SAN DIEGO	CA	92130	3082	37	06073	32.94324259	-117.2396525	San Diego County
193776	Fee-for-Service	1831100957	1831100957	1	1	KIRAMITTCHIAN, LAUREN M PT	1/29/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16573 VENTURA BLVD	5	ENCINO	CA	91436	2022	19	06037	34.1578643	-118.4944187	Los Angeles County
193791	Fee-for-Service	1669554887	1669554887	1	1	KER, SHIUN T MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43001	02	General Surgery	0	In state provider	None	600 N GARFIELD AVE	STE 306	MONTEREY PARK	CA	91754	1172	19	06037	34.06820797	-118.1228835	Los Angeles County
193819	Fee-for-Service	1538560578	1538560578	1	1	KANTOR, MADHAVA L CRNA	11/17/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
193834	Fee-for-Service	1316273295	1316273295	1	1	KO, SEILA OD	2/23/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
193847	Fee-for-Service	1083951735	1083951735	1	1	KAUR, SUKHPREET NP	6/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	233 E. CALDWELL AVE	None	VISALIA	CA	93277	7605	54	06107	36.297126	-119.2893975	Tulare County
193848	Fee-for-Service	1053492512	1053492512	1	1	KO, MICHAEL S	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2357 W MARCH LN	None	STOCKTON	CA	95207	5239	39	06077	37.985458	-121.336447	San Joaquin County
193877	Fee-for-Service	1457694705	1457694705	1	1	KIM, JEFFREY S MD	11/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133744	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
193915	Fee-for-Service	1386728574	1386728574	1	1	KONG, STEPHANIE K PSYD	2/11/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
193950	Fee-for-Service	1427309285	1427309285	1	1	KHOUZAM, NOUR MD	9/29/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	136910	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
193984	Fee-for-Service	1487723144	1487723144	1	1	KATZMAN, KENNETH A MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52177	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
194022	Fee-for-Service	1649229691	1649229691	1	1	KING MEDICAL SUPPLY OF	5/1/1991	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	20816 HIGGINS CT	None	TORRANCE	CA	90501	1832	19	06037	33.84107346	-118.310418	Los Angeles County
194090	Fee-for-Service	1497111561	1497111561	1	1	KHAN, RASHIDA LMFT	10/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
194110	Fee-for-Service	1992238406	1992238406	1	1	KASSAMALI, FARAH Z MD	10/16/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	167190	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
194132	Fee-for-Service	1649218611	1649218611	1	1	KRUITBOSCH, SHANE H MD	12/1/2022	207L00000X	NA	Other	026	PHYSICIANS	134131	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
194147	Fee-for-Service	1114975075	1114975075	1	1	KIM, PYONG C. MD	12/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 N DIVISION ST	None	AUBURN	WA	98001	4939	00	None	47.308698	-122.2297715	King County
194168	Fee-for-Service	1639191794	1639191794	1	1	KAMINSKIY, NIKOLAY V MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72300	05	Anesthesiology	0	In state provider	None	725 E SANTA CLARA ST	STE 101	SAN JOSE	CA	95112	1936	43	06085	37.34328626	-121.8756374	Santa Clara County
194177	Fee-for-Service	1326446006	1326446006	1	1	KERSHAW, ALICEN B NP	6/25/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
194227	Fee-for-Service	1962883041	1962883041	1	1	KHORASHADI, MINA MD	11/3/2023	207L00000X	NA	Other	026	PHYSICIANS	149290	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
194236	Fee-for-Service	1679869242	1679869242	1	1	KHACHATRYAN, SHUSHANIK LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
194240	Fee-for-Service	1013441468	1013441468	1	1	KAILASH, SHASHANK MD	11/8/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
194257	Fee-for-Service	1407312093	1407312093	1	1	KELLY, KIERSTEN MD	2/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186162	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300 & 230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
194262	Fee-for-Service	1801240023	1801240023	1	1	KRISHNAN, SINDHU MD	10/6/2021	207L00000X	NA	Other	026	PHYSICIANS	172656	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
194309	Fee-for-Service	1407274087	1407274087	1	1	KARWA, ABHISHEK DO	9/25/2019	207R00000X	NA	Other	026	PHYSICIANS	15761	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
194318	Fee-for-Service	1043509920	1043509920	1	1	KATZ, ANN E MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122158	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
194327	Fee-for-Service	1467957118	1467957118	1	1	KLINGBEIL, KYLE D MD	12/9/2020	208600000X	NA	General Surgery	026	PHYSICIANS	164354	None	None	0	In state provider	None	21263 ERWIN STREET	None	WOODLAND HILLS	CA	91367	3715	19	06037	34.18286951	-118.5949215	Los Angeles County
194368	Fee-for-Service	1386836484	1386836484	1	1	KESARWANI, MANOJ MD	4/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	101908	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
194394	Fee-for-Service	1962642686	1962642686	1	1	KISTIN, SUSAN J LMFT	12/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	820 GRAVENSTEIN HWY S	STE 200	SEBASTOPOL	CA	95472	4557	49	06097	38.39383746	-122.8186945	Sonoma County
194403	Fee-for-Service	1437761186	1437761186	1	1	KIOKO, GRACE N CNP	11/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
194411	Fee-for-Service	1588842488	1588842488	1	3	KATZMAN, BARRY MD INC	7/6/1992	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	968 W VALLEY PKWY	None	ESCONDIDO	CA	92025	2554	37	06073	33.11750926	-117.0956386	San Diego County
194439	Fee-for-Service	1952728313	1952728313	1	1	KUO, DANIEL Z MD	10/28/2019	207RR0500X	NA	Other	026	PHYSICIANS	147195	83	Rheumatology	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
194518	Fee-for-Service	1033214713	1033214713	1	1	KIM,MICHELLE S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 NORTH CENTRAL AVE	STE # 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
194535	Fee-for-Service	1356550909	1356550909	1	1	KUMAR, STEPHEN K MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98655	41	Internal Medicine	0	In state provider	None	25455 BARTON RD	STE 106B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
194540	Fee-for-Service	1316324213	1316324213	1	1	KAINTH, HUNAR S MD	10/27/2020	207L00000X	NA	Other	026	PHYSICIANS	167765	None	None	0	In state provider	None	15466 LOS GATOS BLVD -29	STE 109	LOS GATOS	CA	95032	2542	43	06085	37.24461239	-121.9586642	Santa Clara County
194596	Fee-for-Service	1689051997	1689051997	1	1	KWONG, STEVEN K MD	7/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	149757	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
194600	Fee-for-Service	1043239981	1043239981	1	1	KIM, GRACE J MD	9/30/1993	207P00000X	NA	Other	026	PHYSICIANS	73262	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
194614	Fee-for-Service	1982781472	1982781472	1	1	KOH, AUDREY S MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	45852	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2100 WEBSTER ST	STE 427	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
194658	Fee-for-Service	1386836484	1386836484	1	1	KESARWANI, MANOJ MD	4/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	101908	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
194673	Fee-for-Service	1588663769	1588663769	1	6	KAWEAH DELTA HEALTH CARE	8/29/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4949 W CYPRESS AVE	None	VISALIA	CA	93277	1591	54	06107	36.323172	-119.346795	Tulare County
194679	Fee-for-Service	1760924724	1760924724	1	1	KLEIN, MATTHEW M PT	4/27/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
194696	Fee-for-Service	1568196822	1568196822	1	1	KEENAN, RYAN OD	8/26/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
194713	Fee-for-Service	1770627259	1770627259	1	1	KOSOY, DANIEL HENRI MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60375	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
194720	Fee-for-Service	1467643544	1467643544	1	1	KHAN, MOHAMMED MC INC	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78544	41	Internal Medicine	0	In state provider	None	613 S HOWARD ST	None	CORONA	CA	92879	2254	33	06065	33.87429852	-117.5627049	Riverside County
194766	Fee-for-Service	1619474301	1619474301	1	1	KIRKER, ANDREW LMFT	5/17/2024	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
194774	Fee-for-Service	1124637087	1124637087	1	1	KOORAKI, SOHEIL MD	9/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	181314	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
194797	Fee-for-Service	1326156878	1326156878	1	1	KUSSEROW, KURT S MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91540	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
194843	Fee-for-Service	1407934169	1407934169	1	1	KUBIAK, ELIZABETH MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29782	07	Dermatology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
194866	Fee-for-Service	1396108361	1396108361	1	1	KAHAN, MADELINE D MD	6/8/2022	2084N0402X	NA	Neurology	026	PHYSICIANS	152993	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
194867	Fee-for-Service	1619248945	1619248945	1	1	KIM, KYUNG H LMFT	12/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3727 W 6TH ST	502	LOS ANGELES	CA	90020	5110	19	06037	34.06358655	-118.3037656	Los Angeles County
194895	Fee-for-Service	1932465879	1932465879	1	1	KALAY, RONEN J MD	6/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127115	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
194900	Fee-for-Service	1023203080	1023203080	1	1	KAUR, TARANDEEP MD	4/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158984	08	Family Practice	0	In state provider	None	5137 GOLDEN FOOTHILL PKW	STE 120	EL DORADO HLS	CA	95762	9671	09	06017	38.63972246	-121.0689815	El Dorado County
194909	Fee-for-Service	1255366829	1255366829	1	1	KITA, TETSUJI C	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1322 BROADWAY	None	BURLINGAME	CA	94010	3426	41	06081	37.58517921	-122.3655349	San Mateo County
194939	Fee-for-Service	1003841693	1003841693	1	1	KO, RICHARD H MD	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91662	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
194944	Fee-for-Service	1215957550	1215957550	1	1	KOVACS, GREGORY S PHD	3/7/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
194948	Fee-for-Service	1003136177	1003136177	1	1	KAR, RITA DR INC	3/22/2010	207L00000X	NA	Other	026	PHYSICIANS	52801	05	Anesthesiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1099	19	06037	33.969141	-118.0489095	Los Angeles County
194978	Fee-for-Service	1275577892	1275577892	1	1	KUSCHNER, STUART H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58710	02	General Surgery	0	In state provider	None	9001 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	1840	19	06037	34.06708548	-118.3880025	Los Angeles County
195011	Fee-for-Service	1467643544	1467643544	1	1	KHAN, MOHAMMED MC INC	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78544	45	Nephrology (Renal-Kidney)	0	In state provider	None	613 S HOWARD ST	None	CORONA	CA	92879	2254	33	06065	33.87429852	-117.5627049	Riverside County
195017	Fee-for-Service	1770947384	1770947384	1	1	KELESHIAN, VASKEN L MD	5/24/2020	207R00000X	NA	Other	026	PHYSICIANS	160638	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
195034	Fee-for-Service	1801840780	1801840780	1	1	KALISPELL REGIONAL MEDICAL	2/20/2017	261QE0002X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	CENTER INC	310 SUNNYVIEW LN	None	KALISPELL	MT	59901	3129	00	None	48.214773	-114.3236925	Flathead County
195072	Fee-for-Service	1609943539	1609943539	1	1	KALLIN, KRISTOPHER	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78687	None	None	0	In state provider	None	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
195086	Fee-for-Service	1932514353	1932514353	1	1	KODSI, ALICIA M MD	8/30/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	147976	None	None	0	In state provider	None	8701 CUYAMACA ST	None	SANTEE	CA	92071	4253	37	06073	32.83439779	-116.98366	San Diego County
195090	Fee-for-Service	1275037467	1275037467	1	1	KERNS, SAMANTHA M MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	164596	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
195133	Fee-for-Service	1801818273	1801818273	1	1	KALDOR, ERIC G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	87622	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
195183	Fee-for-Service	1932284650	1932284650	1	1	KASHLINSKAYA, OLGA MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69523	40	Pediatrics	0	In state provider	None	27071 BELFAST LN	None	HAYWARD	CA	94542	2432	01	06001	37.65533469	-122.0422492	Alameda County
195188	Fee-for-Service	1003993957	1003993957	1	1	KHANZODE, LEENA MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66567	36	Psychiatry	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
195189	Fee-for-Service	1871508671	1871508671	1	1	KUMPATI, GANESH S MD	3/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129870	33	Thoracic Surgery	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
195197	Fee-for-Service	1972710341	1972710341	1	1	KRIEGLER, ANGELA D	2/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
195204	Fee-for-Service	1568405470	1568405470	1	1	KO, DAVID B MD	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94772	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
195212	Fee-for-Service	1215129184	1215129184	1	1	KOSEK, JENNIFER B MD	3/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107461	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
195220	Fee-for-Service	1992032569	1992032569	1	1	KHAN, MUHAMMAD MD	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109494	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
195233	Fee-for-Service	1518506815	1518506815	1	1	KESTRA MEDICAL TECHNOLOGY SE	2/28/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	RVICES, INC.	3933 LAKE WASHINGTON BLV	SUITE 200	KIRKLAND	WA	98033	7806	00	None	47.64594357	-122.2018144	King County
195235	Fee-for-Service	1124294517	1124294517	1	1	KANG, MICHAEL MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109353	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
195254	Fee-for-Service	1164954434	1164954434	1	1	KEITH, REBECCA R MD	8/25/2020	207R00000X	NA	Other	026	PHYSICIANS	169277	41	Internal Medicine	0	In state provider	None	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
195268	Fee-for-Service	1154409845	1154409845	1	1	KUACHUSRI, NAMIN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32730	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
195288	Fee-for-Service	1518300920	1518300920	1	1	KUNG, YUNGTAI MD	9/5/2023	207WX0009X	NA	Ophthalmology	026	PHYSICIANS	162629	None	None	0	In state provider	None	800 TRANCAS ST	SUITE A	NAPA	CA	94558	3044	28	06055	38.32419306	-122.2923825	Napa County
195293	Fee-for-Service	1568704914	1568704914	1	1	KATSURA, CHRISTOPHER W MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132868	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
195320	Fee-for-Service	1801840780	1801840780	1	1	KALISPELL REGIONAL MEDICAL	2/20/2017	261QE0002X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	2	Out of state provider	CENTER INC	310 SUNNYVIEW LN	None	KALISPELL	MT	59901	3129	00	None	48.214773	-114.3236925	Flathead County
195326	Fee-for-Service	1558620658	1558620658	1	1	KOPLOY, ANDREA M MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143176	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
195342	Fee-for-Service	1871741132	1871741132	1	1	KALINA, JARED A DO	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11293	05	Anesthesiology	0	In state provider	None	2288 AUBURN BLVD	STE 106	SACRAMENTO	CA	95821	1619	34	06067	38.625345	-121.4114985	Sacramento County
195367	Fee-for-Service	1659598316	1659598316	1	1	KRONICK, KENNETH A OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12328 WASHINGTON PL	STE B	LOS ANGELES	CA	90066	4923	19	06037	33.99963987	-118.4298331	Los Angeles County
195415	Fee-for-Service	1821524877	1821524877	1	1	KOVACS, ALEXANDER MD	2/20/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	160405	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
195418	Fee-for-Service	1801818273	1801818273	1	1	KALDOR, ERIC G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	87622	40	Pediatrics	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
195471	Fee-for-Service	1932284650	1932284650	1	1	KASHLINSKAYA, OLGA MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69523	08	Family Practice	0	In state provider	None	27071 BELFAST LN	None	HAYWARD	CA	94542	2432	01	06001	37.65533469	-122.0422492	Alameda County
195472	Fee-for-Service	1740634013	1740634013	1	1	KIM, DAVID A MD	9/15/2020	207P00000X	NA	Other	026	PHYSICIANS	153518	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195477	Fee-for-Service	1750387122	1750387122	1	1	KAMBHAMPATI, KRISHNA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3421 MEDICAL PARK DR	None	MONROE	LA	71203	2355	00	None	32.57793846	-92.07056949	Ouachita Parish
195480	Fee-for-Service	1790879492	1790879492	1	1	KAZI, ALTAF M MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62945	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
195487	Fee-for-Service	1326035593	1326035593	1	1	KANE, JOHN J MD	12/8/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	28777	08	Family Practice	0	In state provider	None	4646 BROCKTON AVE	None	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
195533	Fee-for-Service	1962778571	1962778571	1	1	KADAKIA, RADHIKA M MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127202	41	Internal Medicine	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
195539	Fee-for-Service	1841280955	1841280955	1	1	KUNGYS, ARNOLDAS S MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86566	20	Orthopedic Surgery	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
195609	Fee-for-Service	1851393540	1851393540	1	1	KHAN, WAJAHAT M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63233	41	Internal Medicine	0	In state provider	A PROF CORP	1180 N INDIAN CANYON DR	STE E420	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
195614	Fee-for-Service	1407880362	1407880362	1	1	KAUFMAN, ROBERT D MD	6/30/1982	207L00000X	NA	Other	026	PHYSICIANS	27293	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
195635	Fee-for-Service	1841386349	1841386349	1	1	KORNU, ROGER MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78140	83	Rheumatology	0	In state provider	None	835 3RD AVE	STE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
195641	Fee-for-Service	1265466551	1265466551	1	1	KO, CHRISTINE Y MD	5/20/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	91210	08	Family Practice	0	In state provider	None	6699 ALVARADO RD	STE 2100	SAN DIEGO	CA	92120	5238	37	06073	32.77665383	-117.0540279	San Diego County
195650	Fee-for-Service	1447540067	1447540067	1	1	KWAN, JOHNSON K Y MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126109	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
195662	Fee-for-Service	1609829415	1609829415	1	1	KEIPP, JOHN A MD	12/8/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22945	01	General Practice	0	In state provider	COMMUNITY MEDICAL GRP	8320 IOWA ST	None	DOWNEY	CA	90241	4928	19	06037	33.93738458	-118.1339974	Los Angeles County
195676	Fee-for-Service	1821392234	1821392234	1	1	KEDIYAL, JAYA DO	9/14/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16528	08	Family Practice	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
195679	Fee-for-Service	1104245075	1104245075	1	1	KU, JOSEPH PT	3/14/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
195708	Fee-for-Service	1073900098	1073900098	1	1	KREPOSTIN, VLADIMIR DO	9/9/2019	207L00000X	NA	Other	026	PHYSICIANS	17001	05	Anesthesiology	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
195756	Fee-for-Service	1558326694	1558326694	1	1	KIM, DAE-CHOONG MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43192	41	Internal Medicine	0	In state provider	None	8862 GARDEN GROVE BLVD	STE 102	GARDEN GROVE	CA	92844	1212	30	06059	33.77379949	-117.977562	Orange County
195763	Fee-for-Service	1275650095	1275650095	1	1	KAISER, WILLIAM W	7/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
195784	Fee-for-Service	1588625982	1588625982	1	1	KANE, NORMAN MD	2/8/2015	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	33041	None	None	0	In state provider	None	9834 GENESEE AVE	STE 228	LA JOLLA	CA	92037	1215	37	06073	32.884074	-117.225855	San Diego County
195785	Fee-for-Service	1568517464	1568517464	1	1	KIM, KYUNG S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	24811	13	Neurology (M.D. only)	0	In state provider	None	3663 W 6TH ST	STE 201	LOS ANGELES	CA	90020	3048	19	06037	34.06360557	-118.30199	Los Angeles County
195789	Fee-for-Service	1427049964	1427049964	1	2	KERN VALLEY HEALTHCARE	7/28/1994	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MESA CLINICAL PHARMACY	12608 MOUNTAIN MESA RD	None	LAKE ISABELLA	CA	93240	9149	15	06029	35.63767218	-118.4018879	Kern County
195809	Fee-for-Service	1588663769	1588663769	1	2	KAWEAH DELTA HEALTH CARE	9/13/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1337 SOUTH LOVERS LANE	None	VISALIA	CA	93292	5249	54	06107	36.318258	-119.2610025	Tulare County
195812	Fee-for-Service	1477631232	1477631232	1	1	KIMATA, SARASA MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90862	45	Nephrology (Renal-Kidney)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
195830	Fee-for-Service	1649241837	1649241837	1	1	KASEL, SHAYLA F MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	78249	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
195869	Fee-for-Service	1942357264	1942357264	1	1	KAISER FOUNDATION HEALTH	10/22/1997	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN MOB PHARMACY #401	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
195899	Fee-for-Service	1194263426	1194263426	1	1	KC, BINJU CRNA	8/2/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
195936	Fee-for-Service	1821766700	1821766700	1	1	KAMBOJ, SYLWIA PT	2/1/2023	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	177 NORTH REINO RD	None	NEWBURY PARK	CA	91320	3710	56	06111	34.18076257	-118.9529104	Ventura County
195945	Fee-for-Service	1215199930	1215199930	1	1	KABLER, AMY LMFT	12/17/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4110 EDISON AVE	206A	CHINO	CA	91710	8417	36	06071	33.99723746	-117.7140555	San Bernardino County
195950	Fee-for-Service	1609829415	1609829415	1	1	KEIPP, JOHN A MD	12/8/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22945	08	Family Practice	0	In state provider	COMMUNITY MEDICAL GRP	8320 IOWA ST	None	DOWNEY	CA	90241	4928	19	06037	33.93738458	-118.1339974	Los Angeles County
195960	Fee-for-Service	1669099628	1669099628	1	1	KODJO, ARNELLE A PT	8/26/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
195973	Fee-for-Service	1780013748	1780013748	1	1	KUPELIAN, CHLOE A DO	6/4/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	17793	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
196009	Fee-for-Service	1245285394	1245285394	1	1	KAWAGUCHI, ALAN T MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55621	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
196015	Fee-for-Service	1487734505	1487734505	1	1	KAMENA, SCOTT M OD	2/21/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1171 MURRIETA BLVD	STE 100	LIVERMORE	CA	94550	4143	01	06001	37.67592941	-121.7802007	Alameda County
196033	Fee-for-Service	1700867470	1700867470	1	1	KNAPP, LISA L OD	2/4/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1545 W 5TH ST	STE 100	OXNARD	CA	93030	6510	56	06111	34.19757729	-119.1961091	Ventura County
196044	Fee-for-Service	1558326694	1558326694	1	1	KIM, DAE-CHOONG MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43192	45	Nephrology (Renal-Kidney)	0	In state provider	None	8862 GARDEN GROVE BLVD	STE 102	GARDEN GROVE	CA	92844	1212	30	06059	33.77379949	-117.977562	Orange County
196056	Fee-for-Service	1932439858	1932439858	1	1	KASHIF SALEEM M.D	7/23/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	602 INDIANA AVE	None	LUBBOCK	TX	79415	3364	00	None	33.58841999	-101.8880101	Lubbock County
196062	Fee-for-Service	1962866947	1962866947	1	1	KC, BINU MD	1/10/2020	207R00000X	NA	Other	026	PHYSICIANS	162845	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
196064	Fee-for-Service	1235751926	1235751926	1	1	KUMAR, AKANKSHA MD	9/12/2023	390200000X	NA	Other	026	PHYSICIANS	183221	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
196103	Fee-for-Service	1811059918	1811059918	1	1	KRPAN, CHRISTOPHER J DO	11/20/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	7650	20	Orthopedic Surgery	0	In state provider	A PROF CORP	1300 KURT DRIVE	#105	ANGELS CAMP	CA	95222	0000	05	06009	38.07476917	-120.5364629	Calaveras County
196134	Fee-for-Service	1144773490	1144773490	1	1	KERN SURGERY CENTER LLC	5/8/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2323 16TH ST	#507	BAKERSFIELD	CA	93301	3420	15	06029	35.37238027	-119.0288508	Kern County
196160	Fee-for-Service	1467416461	1467416461	1	1	KANE, JOHN P MD	7/4/1970	207R00000X	NA	Other	026	PHYSICIANS	20130	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	# M997	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
196174	Fee-for-Service	1750423612	1750423612	1	1	KAN, CURTIS K OD	3/31/1990	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	556 LAS TUNAS DR	STE 105	ARCADIA	CA	91007	8410	19	06037	34.10744855	-118.050822	Los Angeles County
196177	Fee-for-Service	1861525602	1861525602	1	7	KOREAN COMMUNITY SERVICES	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	7212 ORANGETHORPE AVE	SUITE 9A	BUENA PARK	CA	90621	4667	30	06059	33.85890953	-118.007244	Orange County
196196	Fee-for-Service	1164508073	1164508073	1	1	KAUFHOLD, ANNE D MD	5/25/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	88893	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
196302	Fee-for-Service	1205916145	1205916145	1	1	KIM, SUCHA MD	5/31/1995	207R00000X	NA	Other	026	PHYSICIANS	82009	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	STE 514	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
196343	Fee-for-Service	1578715744	1578715744	1	1	KRACER, BERNARDO MD	4/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105794	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
196348	Fee-for-Service	1669932133	1669932133	1	1	KATHERIA, VEERAL DO	3/20/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	19642	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
196372	Fee-for-Service	1104854249	1104854249	1	1	KHANNA, RAJESH MD	1/2/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78474	None	None	0	In state provider	None	31824 VILLAGE CENTER ROA	SUITE F	WESTLAKE VILLAGE	CA	91361	4337	19	06037	34.1466537	-118.814283	Los Angeles County
196374	Fee-for-Service	1912934886	1912934886	1	1	KORN, ABNER P MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	55522	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
196377	Fee-for-Service	1083730105	1083730105	1	1	KAMAT, SHYAMA K MD	3/8/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	108518	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
196414	Fee-for-Service	1598726457	1598726457	1	1	KOLKER, STEVEN E MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	62898	22	Pathology (M.D. only)	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2032	19	06037	34.02980528	-118.4786605	Los Angeles County
196456	Fee-for-Service	1568616365	1568616365	1	1	KHARBANDA, AMEETA MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109134	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
196463	Fee-for-Service	1861525602	1861525602	1	7	KOREAN COMMUNITY SERVICES	10/30/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	7212 ORANGETHORPE AVE	SUITE 9A	BUENA PARK	CA	90621	4667	30	06059	33.85890953	-118.007244	Orange County
196499	Fee-for-Service	1306001391	1306001391	1	1	KIM, STELLA J MD	9/15/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	103434	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
196589	Fee-for-Service	1205916145	1205916145	1	1	KIM, SUCHA MD	5/31/1995	207R00000X	NA	Other	026	PHYSICIANS	82009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1245 WILSHIRE BLVD	STE 514	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
196677	Fee-for-Service	1447327861	1447327861	1	1	KIM, MARIAN KYU-YEN MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73646	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
196725	Fee-for-Service	1134467632	1134467632	1	1	KAISER FOUNDATION HEALTH	7/30/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	26882 TOWNE CENTRE DR	FL 1	FOOTHILL RANCH	CA	92610	2862	30	06059	33.67418809	-117.6611231	Orange County
196735	Fee-for-Service	1497215685	1497215685	1	1	KAUR, GURPREET DO	8/23/2024	207P00000X	NA	Other	026	PHYSICIANS	22415	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
196739	Fee-for-Service	1578615035	1578615035	1	1	KIMPLE, MARYA S	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
196745	Fee-for-Service	1568616365	1568616365	1	1	KHARBANDA, AMEETA MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109134	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
196762	Fee-for-Service	1235453663	1235453663	1	1	KHAN, SAIMA O MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110205	08	Family Practice	0	In state provider	None	1001 RIVERSIDE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
196870	Fee-for-Service	1417954793	1417954793	1	1	KEISNER, SUSAN A R MD	4/29/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41820	08	Family Practice	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
196873	Fee-for-Service	1881638260	1881638260	1	1	KLAPPER, JOSEPH L MD	6/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84033	06	Cardiovascular Disease (M.D. only)	0	In state provider	HEALTHY HEARTS MEDICAL C	901 SUNSET DR	STE 4	HOLLISTER	CA	95023	5613	35	06069	36.83511073	-121.3873227	San Benito County
196877	Fee-for-Service	1205916145	1205916145	1	1	KIM, SUCHA MD	5/31/1995	207R00000X	NA	Other	026	PHYSICIANS	82009	26	Psychiatry (child)	0	In state provider	None	1245 WILSHIRE BLVD	STE 514	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
196888	Fee-for-Service	1275692808	1275692808	1	1	KIOK, JOSHUA P MD	10/31/1982	207R00000X	NA	Other	026	PHYSICIANS	48581	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
196893	Fee-for-Service	1861713729	1861713729	1	1	KOHAN, MATTHEW W MD	1/24/2025	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
196910	Fee-for-Service	1154908960	1154908960	1	1	KOHAN, SIAMAK MD	2/28/2023	207R00000X	NA	Other	026	PHYSICIANS	181974	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
196933	Fee-for-Service	1174566657	1174566657	1	1	KIRK, MICHAEL B MD	4/30/1988	207P00000X	NA	Other	026	PHYSICIANS	58073	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
196950	Fee-for-Service	1538522123	1538522123	1	1	KIM, HANNAH MD	9/24/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155881	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
196974	Fee-for-Service	1285715052	1285715052	1	1	KUDULIS, DEANNA L CNP	11/1/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8831 VILLA LA JOLLA DR	None	LA JOLLA	CA	92037	1949	37	06073	32.869242	-117.230535	San Diego County
196981	Fee-for-Service	1598312845	1598312845	1	1	KAN, TOM W	8/29/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	302 E BULLARD AVE	None	FRESNO	CA	93710	5299	10	06019	36.82305446	-119.783502	Fresno County
197019	Fee-for-Service	1336357839	1336357839	1	1	KAPROW, MARISA T LCSW	9/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
197032	Fee-for-Service	1568616365	1568616365	1	1	KHARBANDA, AMEETA MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109134	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
197087	Fee-for-Service	1083773196	1083773196	1	1	KERR ANDREW	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
197108	Fee-for-Service	1306103791	1306103791	1	1	KOLAHI, ANJANI T MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126913	01	General Practice	0	In state provider	None	165 N CLARK ST	None	FRESNO	CA	93701	2108	10	06019	36.74454278	-119.786043	Fresno County
197118	Fee-for-Service	1023323151	1023323151	1	1	KAISER, FOUNDATION HEALTH	11/22/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #611	2531 CHESTER AVE	MEDICAL OFFICE BLDG	BAKERSFIELD	CA	93301	2012	15	06029	35.382582	-119.0188955	Kern County
197125	Fee-for-Service	1255420378	1255420378	1	1	KONO, GRANT S LCSW	8/13/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35249 YUCAIPA BLVD	STE. B	YUCAIPA	CA	92399	4370	36	06071	34.03383247	-117.035559	San Bernardino County
197142	Fee-for-Service	1942567292	1942567292	1	1	KIM, EUN J DO	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12237	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
197144	Fee-for-Service	1700049574	1700049574	1	1	KVAMME, CORRINE L MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114332	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
197160	Fee-for-Service	1881638260	1881638260	1	1	KLAPPER, JOSEPH L MD	6/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84033	01	General Practice	0	In state provider	HEALTHY HEARTS MEDICAL C	901 SUNSET DR	STE 4	HOLLISTER	CA	95023	5613	35	06069	36.83511073	-121.3873227	San Benito County
197173	Fee-for-Service	1295140739	1295140739	1	1	KUO, DENNIS C MD	10/9/2020	163WP0000X	NA	Other	026	PHYSICIANS	139369	05	Anesthesiology	0	In state provider	None	2888 LONG BEACH BLVD	SUITE 210	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
197192	Fee-for-Service	1326256314	1326256314	1	1	KRINGLEN,MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH ANVEUE + C STREETEET	None	SALT LAKE CITY	UT	84143	0000	00	None	40.76954717	-111.8804873	Salt Lake County
197261	Fee-for-Service	1558418871	1558418871	1	1	KAISER FOUNDATION HEALTH PLA	12/19/1989	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	288	4502 E AVENUE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
197285	Fee-for-Service	1750325882	1750325882	1	1	KEATING, P DENNIS MD	1/1/1979	207W00000X	NA	Ophthalmology	026	PHYSICIANS	24231	18	Ophthalmology	0	In state provider	None	6325 TOPANGA CANYON BLVD	STE 430	WOODLAND HILLS	CA	91367	2040	19	06037	34.184934	-118.6059175	Los Angeles County
197338	Fee-for-Service	1114092632	1114092632	1	1	KHODAYARI, LALEH MD	10/1/1998	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3050 E AIRPORT WAY	None	LONG BEACH	CA	90806	2404	19	06037	33.81043253	-118.156726	Los Angeles County
197345	Fee-for-Service	1285092387	1285092387	1	1	KRULL, ALICE J MD INC	5/14/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	60064	36	Psychiatry	0	In state provider	None	11858 BERNARDO PLAZA CT	STE 210	SAN DIEGO	CA	92128	2411	37	06073	33.02038069	-117.0758947	San Diego County
197356	Fee-for-Service	1699884437	1699884437	1	1	KHADE, USHAKIRAN S	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51021	01	General Practice	0	In state provider	None	2647 INTERNATIONAL BLVD	STE 107	OAKLAND	CA	94601	1500	01	06001	37.7809526	-122.2318629	Alameda County
197361	Fee-for-Service	1912225673	1912225673	1	1	KIM, EUGENE D MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131419	05	Anesthesiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
197390	Fee-for-Service	1306874714	1306874714	1	1	KHONSARI, HAMIDREZA MD	10/22/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48607	08	Family Practice	0	In state provider	None	3903 LONE TREE WAY	STE 104	ANTIOCH	CA	94509	6251	07	06013	37.98216807	-121.8054744	Contra Costa County
197435	Fee-for-Service	1841248549	1841248549	1	1	KHETAN, UMAKANT M	8/8/2005	174400000X	NA	Other	026	PHYSICIANS	38780	None	None	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
197470	Fee-for-Service	1043577224	1043577224	1	1	KIM, CY Y MD	4/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128407	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
197484	Fee-for-Service	1295812956	1295812956	1	1	KWOK, PAUL H DO	3/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	5123	05	Anesthesiology	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
197487	Fee-for-Service	1457356057	1457356057	1	1	KIM, ALEXANDER Y MD	3/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84049	None	None	0	In state provider	None	6386 ALVARADO CT # 110	None	SAN DIEGO	CA	92120	4906	37	06073	32.77666838	-117.0614255	San Diego County
197530	Fee-for-Service	1821451089	1821451089	1	1	KAPLAN, JONATHAN H MD	4/25/2022	207P00000X	NA	Other	026	PHYSICIANS	177078	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
197533	Fee-for-Service	1881753473	1881753473	1	1	KULL, DAVID M MD	10/31/1984	204D00000X	NA	Other	026	PHYSICIANS	33344	20	Orthopedic Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
197534	Fee-for-Service	1134236623	1134236623	1	1	KELLY, THOMAS G MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88790	40	Pediatrics	0	In state provider	None	8010 FROST ST	STE 408	SAN DIEGO	CA	92123	4222	37	06073	32.80026879	-117.1520059	San Diego County
197537	Fee-for-Service	1356801401	1356801401	1	1	KATHIRESU NAGESHWARAN, SATHI	8/8/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	187345	None	None	0	In state provider	JI MD	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
197540	Fee-for-Service	1053940320	1053940320	1	1	KONCHAN, COURTNEY L DO	8/22/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21383	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
197628	Fee-for-Service	1982153672	1982153672	1	1	KOLAHI, KEVIN S MD	6/16/2021	207ZP0101X	NA	Other	026	PHYSICIANS	163690	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197776	Fee-for-Service	1649765405	1649765405	1	1	KHONG, BRIAN DO	9/19/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	17575	None	None	0	In state provider	None	3883 AIRWAY DR	201	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
197786	Fee-for-Service	1447411236	1447411236	1	2	KOREAN TOWN HOME CARE INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1600 SAWTELLE BOULEVARD	SUITE 308	LOS ANGELES	CA	90025	1120	19	06037	34.04700489	-118.4488371	Los Angeles County
197801	Fee-for-Service	1780356402	1780356402	1	1	KIRAKASIAN, SONA CNP	12/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14735 VENTURA BLVD	None	SHERMAN OAKS	CA	91403	3679	19	06037	34.15187275	-118.4543653	Los Angeles County
197817	Fee-for-Service	1740265073	1740265073	1	1	KIM, ESTHER S MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73070	70	Clinic (mixed specialty)	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
197822	Fee-for-Service	1134236623	1134236623	1	1	KELLY, THOMAS G MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88790	67	Endocrinology	0	In state provider	None	8010 FROST ST	STE 408	SAN DIEGO	CA	92123	4222	37	06073	32.80026879	-117.1520059	San Diego County
197842	Fee-for-Service	1376765990	1376765990	1	1	KIM, HYUNJIN J MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116168	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
197916	Fee-for-Service	1558367102	1558367102	1	1	KOBLE, WILLIAM J MD	12/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76138	08	Family Practice	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
197940	Fee-for-Service	1619255445	1619255445	1	1	KRISHNAMURTHI, SWETHA MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	117178	01	General Practice	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
197942	Fee-for-Service	1285752436	1285752436	1	1	KASHANI, SHEIDA A DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	6621	41	Internal Medicine	0	In state provider	None	17822 BEACH BLVD	STE 437	HUNTINGTON BEACH	CA	92647	7181	30	06059	33.70331388	-117.9890471	Orange County
197978	Fee-for-Service	1417341728	1417341728	1	1	KANESHIRO, KAYLEIGH H MD	8/29/2019	207L00000X	NA	Other	026	PHYSICIANS	160126	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
197999	Fee-for-Service	1437530862	1437530862	1	1	KHODAIE, ROYA MD	9/18/2019	207R00000X	NA	Other	026	PHYSICIANS	153964	41	Internal Medicine	0	In state provider	None	800 SOUTH MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
198014	Fee-for-Service	1750388633	1750388633	1	1	KANEKO, SHINOBU L MD	6/19/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80720	08	Family Practice	0	In state provider	None	101 W BEVERLY BLVD	STE 303	MONTEBELLO	CA	90640	4304	19	06037	34.01558729	-118.0986754	Los Angeles County
198034	Fee-for-Service	1285281147	1285281147	1	1	KORDUS-SALONEN, MARCELLA N P	9/10/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HD	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
198036	Fee-for-Service	1942404132	1942404132	1	1	KRISTEN ALLISON BISHOP	4/22/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
198047	Fee-for-Service	1396992632	1396992632	1	1	KORNFELD, HERBERT R MD AMC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	10040	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	SUITE 1207	LOS ANGELES	CA	90067	2010	19	06037	34.05887194	-118.4122914	Los Angeles County
198061	Fee-for-Service	1205254992	1205254992	1	1	KAY, DAVID N DO	2/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14332	None	None	0	In state provider	None	14857 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4617	19	06037	34.22150352	-118.4571405	Los Angeles County
198081	Fee-for-Service	1457361578	1457361578	1	1	KHAN, MAZHAR A	2/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49590	40	Pediatrics	0	In state provider	None	18550 DE PAUL DR	STE 205	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
198106	Fee-for-Service	1013346139	1013346139	2	1	KOCHAN, LINDA A OT	10/12/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
198108	Fee-for-Service	1457680340	1457680340	1	1	KARP, KARYN CRNA INC	6/15/2010	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	PROFESSIONAL NURSING COR	347 ANDRIEUX ST	None	SONOMA	CA	95476	6863	49	06097	38.28843573	-122.4651035	Sonoma County
198125	Fee-for-Service	1427705326	1427705326	1	1	KOZENIEWSKI, MICHELLE NP	1/20/2023	208000000X	NA	Pediatric Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
198135	Fee-for-Service	1952768236	1952768236	1	1	KAISER FOUNDATION HEALTH PLA	3/28/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1600 OWENS STREET	1ST FLOOR	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
198170	Fee-for-Service	1073074944	1073074944	1	1	KHELA, JASKARAN S DO	9/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20134	None	None	0	In state provider	None	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	07	06013	37.95582533	-121.967442	Contra Costa County
198181	Fee-for-Service	1699863209	1699863209	1	1	KAHLE, ROBERT A MD	4/23/1991	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	42207	40	Pediatrics	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
198205	Fee-for-Service	1821582263	1821582263	1	1	KAMDAR, SANA A MD	4/21/2022	207R00000X	NA	Other	026	PHYSICIANS	174716	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
198230	Fee-for-Service	1285752436	1285752436	1	1	KASHANI, SHEIDA A DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	6621	45	Nephrology (Renal-Kidney)	0	In state provider	None	17822 BEACH BLVD	STE 437	HUNTINGTON BEACH	CA	92647	7181	30	06059	33.70331388	-117.9890471	Orange County
198234	Fee-for-Service	1578502928	1578502928	1	1	KEIGER, RICHARD MD	4/2/2024	207P00000X	NA	Other	026	PHYSICIANS	51633	None	None	0	In state provider	None	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
198248	Fee-for-Service	1518996479	1518996479	1	1	KINGDOM MEDICAL	11/27/2006	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DISTRIBUTORS & SUPPLY IN	1256 N EUCLID ST	STE B	ANAHEIM	CA	92801	1928	30	06059	33.851907	-117.941611	Orange County
198306	Fee-for-Service	1952409021	1952409021	1	1	KAMAREI, SHAPARAK M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78688	41	Internal Medicine	0	In state provider	None	26932 OSO PKWY	STE 220	MISSION VIEJO	CA	92691	5815	30	06059	33.58325322	-117.6607886	Orange County
198327	Fee-for-Service	1710313259	1710313259	1	1	KAUR, RAMANDEEP MD	4/19/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	133059	None	None	0	In state provider	None	3466 EL CAMINO REAL	None	SANTA CLARA	CA	95051	2809	43	06085	37.35225555	-121.9921875	Santa Clara County
198336	Fee-for-Service	1396992632	1396992632	1	1	KORNFELD, HERBERT R MD AMC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	10040	10	Gastroenterology (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	SUITE 1207	LOS ANGELES	CA	90067	2010	19	06037	34.05887194	-118.4122914	Los Angeles County
198363	Fee-for-Service	1932529492	1932529492	1	1	KAGEYAMA, RUSSELL P DO	11/15/2019	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14498	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
198374	Fee-for-Service	1053553693	1053553693	1	1	KELLY, CHRISTIAN N MD	2/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113477	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
198388	Fee-for-Service	1881908119	1881908119	1	2	KHIRFAN, KHALDOON T MD	10/24/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	140888	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
198395	Fee-for-Service	1679704472	1679704472	1	1	KETTLE, SAMANTHA PHD	1/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	SUITE 300	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
198408	Fee-for-Service	1477100899	1477100899	1	1	KAGAWA, KENDAL PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
198420	Fee-for-Service	1588620686	1588620686	1	1	KULKARNI, KEDAR MD	7/25/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	143667	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
198437	Fee-for-Service	1043794373	1043794373	1	1	KAUR, RAJWINDER NP	5/5/2023	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1923 W AVENUE L	None	LANCASTER	CA	93534	8827	19	06037	34.66044832	-118.1642484	Los Angeles County
198474	Fee-for-Service	1568572832	1568572832	2	1	KHANNA, PARITOSH MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54827	None	None	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
198488	Fee-for-Service	1073734778	1073734778	1	1	KOMATSU, GLEN I M D	7/7/2010	208VP0000X	NA	Other	026	PHYSICIANS	35086	None	None	0	In state provider	A PROFESSIONAL CORP	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
198518	Fee-for-Service	1245946425	1245946425	1	1	KALYAN-MASIH, PRIYA O DOULA	3/24/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
198519	Fee-for-Service	1225203920	1225203920	1	1	KUREK, ERIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
198525	Fee-for-Service	1972048676	1972048676	1	1	KANE, JOHNATHAN S LMFT	12/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5055 CANYON CREST DR	STE 203	RIVERSIDE	CA	92507	5993	33	06065	33.95862536	-117.3310726	Riverside County
198600	Fee-for-Service	1184661506	1184661506	1	1	KASKA, SERGE C MD	11/30/2009	174400000X	NA	Other	026	PHYSICIANS	73685	None	None	0	In state provider	None	488 E VALLEY PKWY	SUITE 214	ESCONDIDO	CA	93301	1407	37	06073	33.12523814	-117.0769715	San Diego County
198602	Fee-for-Service	1144890898	1144890898	1	1	KANDOLA, MANJOT CRNA	3/11/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
198630	Fee-for-Service	1437369808	1437369808	2	1	KCARE HOMES LLC	9/19/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1756 SWANSTON WAY	None	SAN JOSE	CA	95132	1647	43	06085	37.40560448	-121.8700526	Santa Clara County
198637	Fee-for-Service	1902422280	1902422280	1	2	KHAWAJA MD INC	8/16/2020	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	990 SONOMA AVE	STE 18	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
198722	Fee-for-Service	1063564268	1063564268	1	1	KHALIL, AMBREEN MD	11/4/2021	207R00000X	NA	Other	026	PHYSICIANS	174338	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
198779	Fee-for-Service	1629076856	1629076856	1	1	KAWESKI, SUSAN A	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53909	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3444 KEARNY VILLA RD	STE 401	SAN DIEGO	CA	92123	1964	37	06073	32.80561721	-117.150059	San Diego County
198785	Fee-for-Service	1962963801	1962963801	1	1	KORCZYNSKI, MICHAEL R DO	6/26/2024	390200000X	NA	Other	026	PHYSICIANS	23020	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
198837	Fee-for-Service	1497751424	1497751424	1	1	KIM, HAROLD MD	12/2/2023	207L00000X	NA	Other	026	PHYSICIANS	180257	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
198845	Fee-for-Service	1215394036	1215394036	1	2	KC TAN, M.D. MEDICAL CORPORA	7/1/2020	2085N0700X	NA	MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TION	100 RAYMOND	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
198922	Fee-for-Service	1912219155	1912219155	1	1	KHAING, KATHY MD	7/11/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	127006	45	Nephrology (Renal-Kidney)	0	In state provider	None	340 FOURTH AVE	SUITE 4	CHULA VISTA	CA	91910	4414	37	06073	32.63831293	-117.0833536	San Diego County
198999	Fee-for-Service	1104169283	1104169283	1	1	KELLY, JACQUELINE P MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138813	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
199007	Fee-for-Service	1750743332	1750743332	1	1	KUMAR, ARJUN MD	9/23/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159904	08	Family Practice	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
199027	Fee-for-Service	1861495855	1861495855	1	1	KUA, JOSE S MD INC	8/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	30919	None	None	0	In state provider	#305	16415 COLORADO AVE	STE 305	PARAMOUNT	CA	90723	5053	19	06037	33.8853075	-118.1614695	Los Angeles County
199029	Fee-for-Service	1164752168	1164752168	1	1	KHAIT, ALBERT MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110479	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
199053	Fee-for-Service	1366946170	1366946170	1	1	KAMBOJ, GEORGIA N MD	10/27/2022	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	175031	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
199054	Fee-for-Service	1891561502	1891561502	1	1	KANG, GINA OT	1/19/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	585 SATURN	STE A	SAN DIEGO	CA	92154	4721	37	06073	32.586336	-117.088506	San Diego County
199069	Fee-for-Service	1629076856	1629076856	1	1	KAWESKI, SUSAN A	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53909	24	Plastic Surgery	0	In state provider	None	3444 KEARNY VILLA RD	STE 401	SAN DIEGO	CA	92123	1964	37	06073	32.80561721	-117.150059	San Diego County
199118	Fee-for-Service	1588842488	1588842488	1	4	KATZMAN, BARRY MD INC	10/31/1991	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1662 E MAIN ST	STE 116	EL CAJON	CA	92021	5207	37	06073	32.81045723	-116.9198877	San Diego County
199155	Fee-for-Service	1972997369	1972997369	1	1	KOHN, JOCELYN L MD	8/24/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	167736	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
199160	Fee-for-Service	1710406038	1710406038	1	1	KOURI, DANIELLE M LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
199173	Fee-for-Service	1811262256	1811262256	1	1	KAISER FOUNDATION HEALTH	6/14/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	46900 E MONROE ST	SUITE E	INDIO	CA	92201	4827	33	06065	33.707718	-116.233843	Riverside County
199201	Fee-for-Service	1609213214	1609213214	1	1	KENNEDY, QUENTIN R	6/22/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
199203	Fee-for-Service	1992942478	1992942478	1	1	KAN, CATHERINE A	6/21/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
199237	Fee-for-Service	1891847265	1891847265	1	1	KHAN, HUMA Z MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76483	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
199238	Fee-for-Service	1588842488	1588842488	1	5	KATZMAN, BARRY MD INC	4/1/1998	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2220 E PLAZA BLVD	STE H	NATIONAL CITY	CA	91950	5162	37	06073	32.67833384	-117.0824366	San Diego County
199338	Fee-for-Service	1972709426	1972709426	1	1	KAYLOR, KEVIN J	6/14/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
199339	Fee-for-Service	1740365741	1740365741	1	1	KWOCK, LEONARD LCSW	11/28/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	123 W PADRE ST	SUITE A	SANTA BARBARA	CA	93105	3960	42	06083	34.43007785	-119.7177802	Santa Barbara County
199373	Fee-for-Service	1326023482	1326023482	1	1	KEUNG, YI-KONG MD	3/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53429	78	Neoplastic Diseases/Oncology	0	In state provider	None	707 S GARFIELD AVE	SUITE 304	ALHAMBRA	CA	91801	5861	19	06037	34.088688	-118.123106	Los Angeles County
199393	Fee-for-Service	1477787802	1477787802	1	1	KLIGER, JARED C PHD	10/20/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9655 SEPULVEDA BLVD	None	NORTH HILLS	CA	91343	3307	19	06037	34.246107	-118.4676395	Los Angeles County
199400	Fee-for-Service	1538763594	1538763594	1	1	KINDER CARE HOME HEALTH INC	9/26/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	36330 HIDDEN SPRINGS RD	SUITE F7	WILDOMAR	CA	92595	5803	33	06065	33.59339735	-117.2454691	Riverside County
199418	Fee-for-Service	1518538255	1518538255	1	1	KIPROTCIH, JEFFER CHERENGETI	7/27/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2454 OSWEGO ST	UNIT 106	PASADENA	CA	91107	6339	19	06037	34.14339122	-118.0999369	Los Angeles County
199484	Fee-for-Service	1134215817	1134215817	1	1	KWAK, WONSHIN MD	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55439	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
199489	Fee-for-Service	1285094508	1285094508	1	1	KRONEMYER, DAVID E PHD	3/7/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90045	5631	19	06037	34.07067	-118.4432445	Los Angeles County
199502	Fee-for-Service	1639469133	1639469133	1	1	KUTSCHER, SCOTT J MD	2/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139549	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
199536	Fee-for-Service	1861867640	1861867640	1	1	KHALEEL, HEATHER M CRNA	11/3/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
199606	Fee-for-Service	1013250604	1013250604	1	1	KUBALANZA, KARI MD	5/3/2019	390200000X	NA	Other	026	PHYSICIANS	132542	41	Internal Medicine	0	In state provider	None	2336 SANTA MONICA BLVD	SUITE 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
199660	Fee-for-Service	1326023482	1326023482	1	1	KEUNG, YI-KONG MD	3/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53429	68	Hematology	0	In state provider	None	707 S GARFIELD AVE	SUITE 304	ALHAMBRA	CA	91801	5861	19	06037	34.088688	-118.123106	Los Angeles County
199690	Fee-for-Service	1174638548	1174638548	1	1	KIRKPATRICK, HALEY D NP	8/16/2006	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
199705	Fee-for-Service	1518538255	1518538255	1	1	KIPROTCIH, JEFFER CHERENGETI	7/27/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2454 OSWEGO ST	UNIT 106	PASADENA	CA	91107	6339	19	06037	34.14339122	-118.0999369	Los Angeles County
199718	Fee-for-Service	1538216866	1538216866	1	1	KAISER FOUNDATION HEALTH PLA	7/1/2002	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	O 851	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
199742	Fee-for-Service	1477545838	1477545838	1	1	KRASNER, PAUL P MD	10/31/1985	207RN0300X	NA	Nephrology	026	PHYSICIANS	22235	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	RM 60	GARDEN GROVE	CA	92843	1901	30	06059	33.77450141	-117.9123364	Orange County
199766	Fee-for-Service	1285172296	1285172296	1	1	KELLER, COLIN	8/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
199771	Fee-for-Service	1134215817	1134215817	1	1	KWAK, WONSHIN MD	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55439	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
199826	Fee-for-Service	1063424893	1063424893	1	1	KALPESHKUMAR KANTILAL PANCHA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
199830	Fee-for-Service	1326256678	1326256678	1	1	KUMAR, ARUN MD	2/12/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	132500	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
199955	Fee-for-Service	1265695357	1265695357	1	1	KRALL, DANIEL G OD	7/27/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
199964	Fee-for-Service	1649646753	1649646753	1	1	KALER, KAMALJOT S MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137778	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
199974	Fee-for-Service	1871639682	1871639682	1	3	KHIN, HENRY H MD	7/30/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	64156	36	Psychiatry	0	In state provider	None	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	36	06071	34.09544496	-117.5747968	San Bernardino County
200061	Fee-for-Service	1134215817	1134215817	1	1	KWAK, WONSHIN MD	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55439	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
200064	Fee-for-Service	1558983460	1558983460	1	1	KETANA, NOOR MD	8/17/2023	390200000X	NA	Other	026	PHYSICIANS	187097	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
200088	Fee-for-Service	1144285735	1144285735	1	1	KIRSCH, CARL M MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	44680	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
200090	Fee-for-Service	1447344122	1447344122	1	1	KERCHNER, GEOFFREY A MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91535	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
200120	Fee-for-Service	1457390908	1457390908	1	1	KOENIG, WILLIAM J MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	27652	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
200160	Fee-for-Service	1811144504	1811144504	1	1	KUMAR, BINAY MD	9/19/2024	207R00000X	NA	Other	026	PHYSICIANS	152906	41	Internal Medicine	0	In state provider	None	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
200171	Fee-for-Service	1447694815	1447694815	1	1	KINGMAN EMERGENCY ASSOCIATES	12/28/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	1	Border provider	PLLC	3269 STOCKTON HILL ROAD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
200181	Fee-for-Service	1518360122	1518360122	1	1	KING, JACQUELINE S MD	10/4/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	136096	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
200218	Fee-for-Service	1538303292	1538303292	1	1	KLEIN, ROBIN M DO	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12787	41	Internal Medicine	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
200239	Fee-for-Service	1679619993	1679619993	1	1	KLAIBER, BEVERLY G LMFT	3/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3 GOVERNORS LN	A	CHICO	CA	95926	5503	04	06007	39.75542195	-121.8587226	Butte County
200262	Fee-for-Service	1497748065	1497748065	1	2	KIM, HOSE MD INC	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	58070	None	None	0	In state provider	None	6712 FRIENDS AVE	None	WHITTIER	CA	90601	4432	19	06037	33.980454	-118.033814	Los Angeles County
200289	Fee-for-Service	1942366638	1942366638	1	1	KADIR, LAMIA MD	12/6/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	87494	None	None	0	In state provider	None	638 CAMINO DE LOS MARES	STE D4	SAN CLEMENTE	CA	92673	2855	30	06059	33.45932277	-117.6517315	Orange County
200290	Fee-for-Service	MSS00033F	None	1	1	KINGS/TULARE AREA	3/1/1999	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	AGENCY ON AGING	4025 W NOBLE	STE A	VISALIA	CA	93277	1631	54	06107	36.325845	-119.333835	Tulare County
200306	Fee-for-Service	1114216421	1114216421	1	1	KING, LUCAS R MD	6/3/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	185826	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
200321	Fee-for-Service	1770677429	1770677429	1	1	KAY, ROBERT M MD	4/30/1995	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	49815	20	Orthopedic Surgery	0	In state provider	None	2302 SOUTH GRAMERCY PL	None	LOS ANGELES	CA	90018	1323	19	06037	34.035948	-118.313292	Los Angeles County
200323	Fee-for-Service	1871534578	1871534578	1	1	KHAVKIN, ALBERT DO	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
200336	Fee-for-Service	1881177442	1881177442	1	1	KICKSTART O&P, LLC	11/9/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ETICS	4651 TELEGRAPH AVE	None	OAKLAND	CA	94609	2021	01	06001	37.83414344	-122.2631957	Alameda County
200339	Fee-for-Service	1407187347	1407187347	1	1	KOLLMYER, WILLIAM P	9/26/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	20940 BURBANK BLVD	None	WOODLAND HILLS	CA	91367	6601	19	06037	34.1719401	-118.5881418	Los Angeles County
200354	Fee-for-Service	1346750684	1346750684	1	1	KARIA, PAYAL V	3/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
200380	Fee-for-Service	1144285735	1144285735	1	1	KIRSCH, CARL M MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	44680	01	General Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
200390	Fee-for-Service	1396966875	1396966875	1	1	KHIATANI, VISHAL L MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146186	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
200410	Fee-for-Service	1467849604	1467849604	1	1	KREGER, VANESSA C MD	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	150308	66	Emergency Medicine (Urgent Care)	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	19	06037	34.158213	-118.328112	Los Angeles County
200412	Fee-for-Service	1154515211	1154515211	1	1	KOHANCHI, HILDA	4/25/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6809	19	06037	34.17030266	-118.5881699	Los Angeles County
200422	Fee-for-Service	1629432141	1629432141	1	1	KITTLESON, CARTER MD	9/11/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	151792	47	Miscellaneous	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
200446	Fee-for-Service	1750457719	1750457719	1	1	KLOTZ, RICHARD D MD	9/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	17244	18	Ophthalmology	0	In state provider	None	18800 MAIN ST	STE 101	HUNTINGTON BEACH	CA	92648	1717	30	06059	33.68890364	-117.9949974	Orange County
200483	Fee-for-Service	1174670087	1174670087	1	1	KHORRAM, SARAH CNM	2/2/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3343 4TH AVE	None	SAN DIEGO	CA	92103	5703	37	06073	32.740353	-117.1612435	San Diego County
200493	Fee-for-Service	1699822924	1699822924	1	1	KAISER FOUNDATION HEALTH	11/1/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #833	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
200516	Fee-for-Service	1891108130	1891108130	1	1	KOTWAL, ASHWIN MD	8/7/2019	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	148188	38	Geriatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
200545	Fee-for-Service	1700468485	1700468485	1	1	KHAN, MOHAMMAD DO	9/27/2024	207R00000X	NA	Other	026	PHYSICIANS	22099	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
200573	Fee-for-Service	1255478715	1255478715	2	1	KHANKHANIAN, MOIEZ MD	11/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	41134	36	Psychiatry	0	In state provider	None	933 S SUNSET AVE	#105	WEST COVINA	CA	91790	3410	19	06037	34.06428275	-117.9432037	Los Angeles County
200609	Fee-for-Service	1770677429	1770677429	1	1	KAY, ROBERT M MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2302 SOUTH GRAMERCY PL	None	LOS ANGELES	CA	90018	1323	19	06037	34.035948	-118.313292	Los Angeles County
200671	Fee-for-Service	1265568471	1265568471	1	1	KAPLAN, JULIUS A MD	6/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	32176	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
200708	Fee-for-Service	1053527937	1053527937	2	1	KATHLEEN V. CUETO	10/12/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1935 BIG BEND DRIVE	None	MILPITAS	CA	95035	6603	43	06085	37.42900692	-121.8692977	Santa Clara County
200712	Fee-for-Service	1255371423	1255371423	1	1	KAHN, JOEL S MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	48574	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1246 W 155TH ST	None	GARDENA	CA	90247	4011	19	06037	33.89050425	-118.297444	Los Angeles County
200735	Fee-for-Service	1083127583	1083127583	1	1	KUZMICH, MATTHEW A LCSW	1/13/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95731	-	NOT APPLICABLE	0	In state provider	None	2090 EVANS LN	None	SAN JOSE	CA	95125	2072	43	06085	37.29521613	-121.8762569	Santa Clara County
200744	Fee-for-Service	1336430727	1336430727	1	1	KANG, IRENE M MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124670	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
200747	Fee-for-Service	1023135464	1023135464	1	1	KRUEGER, JAMES J MD INC	11/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	45160	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	701 E 28TH ST	STE 400	LONG BEACH	CA	90806	2778	19	06037	33.80803441	-118.1847137	Los Angeles County
200774	Fee-for-Service	1104321892	1104321892	1	1	KWOK, CHRISTINA OT	8/19/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
200793	Fee-for-Service	1215394036	1215394036	1	4	KC TAN, M.D. MEDICAL CORPORA	7/1/2020	2085N0700X	NA	MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TION	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
200827	Fee-for-Service	1225290174	1225290174	1	1	KAN-DI-KI LLC	4/27/2010	No Taxonomy Provided	NA	None	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	2820 N ONTARIO STREET	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
200836	Fee-for-Service	1649388109	1649388109	1	1	KAPLAN, STUART H MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	55704	01	General Practice	0	In state provider	None	435 N ROXBURY DR	STE 210	BEVERLY HILLS	CA	90210	5004	19	06037	34.06777102	-118.4067032	Los Angeles County
200837	Fee-for-Service	1003484387	1003484387	1	1	KHORRAMI, GHAZAL MD	7/31/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	5 BON AIR ROAD	STE 105	LARKSPUR	CA	94939	1137	21	06041	37.9438204	-122.5395357	Marin County
200849	Fee-for-Service	1891873584	1891873584	1	1	KING, REBECCA L MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71804	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95616	6325	57	06113	38.5399459	-121.7284328	Yolo County
200854	Fee-for-Service	1013400399	1013400399	1	1	KAO, JESSICA DO	10/7/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	20277	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
200883	Fee-for-Service	1902108855	1902108855	1	2	KHANNA VISION INSTITUTE, A M	2/21/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EDICAL CORPORATION	144 LOS ANGELES AVE	SUITE 111	MOORPARK	CA	93021	4218	56	06111	34.2788817	-118.8802748	Ventura County
200927	Fee-for-Service	1114160603	1114160603	1	1	KUMAR, SAURABH MD	7/26/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176908	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
200929	Fee-for-Service	1881045995	1881045995	1	1	KIM, ELAINE Y	9/30/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
200941	Fee-for-Service	1598265639	1598265639	1	1	KRAUS, KATELYN PT	10/23/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
200968	Fee-for-Service	1689654923	1689654923	1	1	KUBO & KUBO ODS	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2409 15TH ST	None	SACRAMENTO	CA	95818	2238	34	06067	38.56272612	-121.4933176	Sacramento County
200976	Fee-for-Service	1548332539	1548332539	2	1	KATZ, RICHARD A MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	22825	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5555 RESERVOIR DRIVE	SUITE 112	SAN DIEGO	CA	92120	5195	37	06073	32.77628471	-117.0563688	San Diego County
200991	Fee-for-Service	1235100447	1235100447	1	1	KORNREICH, LEONARD M MD	12/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21973	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	685 3RD AVE	STE A	CHULA VISTA	CA	91910	5703	37	06073	32.62788873	-117.0746104	San Diego County
201001	Fee-for-Service	1033262977	1033262977	1	1	KITTLESON,KEVIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 HOSP DR	PO BOX 100	KETCHUM	ID	83340	0000	00	None	43.6482607	-114.3490716	Blaine County
201035	Fee-for-Service	1710902499	1710902499	1	1	KANAGALA, SAMATA MD	6/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65024	41	Internal Medicine	0	In state provider	None	1133 E STANLEY BLVD	None	LIVERMORE	CA	94550	4200	01	06001	37.67914693	-121.7810206	Alameda County
201037	Fee-for-Service	1336430727	1336430727	1	1	KANG, IRENE M MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124670	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
201051	Fee-for-Service	1447933536	1447933536	1	1	KATERS, ROBYN A BIRTH DOULA	9/8/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
201056	Fee-for-Service	1780816314	1780816314	1	1	KOSHY, SHINTO J MD	3/3/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	139304	25	Physical Medicine and Rehabilitation	0	In state provider	None	72780 COUNTRY CLUB DR	STE C300	RANCHO MIRAGE	CA	92270	4150	33	06065	33.75795596	-116.392246	Riverside County
201071	Fee-for-Service	1508426420	1508426420	1	1	KUONG NGANN DO CORP	12/5/2020	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
201088	Fee-for-Service	1235139841	1235139841	1	1	KINGSLAND, RICHARD C MD	9/28/1994	207P00000X	NA	Other	026	PHYSICIANS	70664	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
201100	Fee-for-Service	1851719892	1851719892	1	1	KHALID, AHSAN S MD	12/16/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159121	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
201107	Fee-for-Service	1861811762	1861811762	1	1	KWEE, BENSON DO	2/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15662	01	General Practice	0	In state provider	None	1420 S CENTRAL AVENUE	None	GLENDALE	CA	91204	1000	19	06037	34.12811155	-118.2577764	Los Angeles County
201143	Fee-for-Service	1891013462	1891013462	1	1	KIPPS, KRISTEN A MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124562	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
201170	Fee-for-Service	1902108855	1902108855	1	2	KHANNA VISION INSTITUTE, A M	2/21/2024	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	EDICAL CORPORATION	144 LOS ANGELES AVE	SUITE 111	MOORPARK	CA	93021	4218	56	06111	34.2788817	-118.8802748	Ventura County
201258	Fee-for-Service	1144665571	1144665571	1	1	KANG, VICTORIA M DO	2/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13638	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
201260	Fee-for-Service	1871609271	1871609271	1	1	KOH, JOSHUA KRITSADA MD	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	50936	36	Psychiatry	0	In state provider	PROFESSIONAL PSYCH CORP	1173 N DIXIE DRIVE	SUITE 101	SAN DIMAS	CA	91773	1200	19	06037	34.123185	-117.800536	Los Angeles County
201282	Fee-for-Service	1114102639	1114102639	1	1	KIM, JOHN C MD	5/16/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	91661	39	Preventive (M.D. only)	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
201283	Fee-for-Service	1235100447	1235100447	1	1	KORNREICH, LEONARD M MD	12/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21973	40	Pediatrics	0	In state provider	INC	685 3RD AVE	STE A	CHULA VISTA	CA	91910	5703	37	06073	32.62788873	-117.0746104	San Diego County
201293	Fee-for-Service	1619940384	1619940384	1	1	KENNEDY, EMMALEE N MD	1/20/2009	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	2912	00	None	35.208594	-111.645099	Coconino County
201306	Fee-for-Service	1639465701	1639465701	1	1	KIM, DEBBIE J OD	11/17/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
201324	Fee-for-Service	1326457839	1326457839	1	1	KIM-ORDEN, MICHAEL MD	8/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	138771	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
201325	Fee-for-Service	1336430727	1336430727	1	1	KANG, IRENE M MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124670	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
201410	Fee-for-Service	1851851976	1851851976	1	1	KIM, PATRICK MD	7/30/2024	390200000X	NA	Other	026	PHYSICIANS	180736	30	Radiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
201456	Fee-for-Service	1295831485	1295831485	1	1	KT TONNU OD AN OPT CORP	4/28/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	POMONA OPTOMETRY	1101 E HOLT AVE	STE D	POMONA	CA	91767	5800	19	06037	34.06297561	-117.7280971	Los Angeles County
201473	Fee-for-Service	1184353112	1184353112	1	1	KEITH, KRISTIE	8/25/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3221 HARLAN WAY	None	MODESTO	CA	95354	3310	50	06099	37.64123347	-120.934188	Stanislaus County
201508	Fee-for-Service	1689007445	1689007445	1	1	KUCHLER, WILLIAM R LMFT	3/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
201511	Fee-for-Service	1619330859	1619330859	1	1	KENMORE, SEAN MD	9/5/2019	208M00000X	NA	Other	026	PHYSICIANS	153315	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
201526	Fee-for-Service	1992963920	1992963920	1	1	KULUVA, JOSHUA E MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109267	36	Psychiatry	0	In state provider	None	1860 PENNSYLVANIA AVE	STE 320	FAIRFIELD	CA	94533	3550	48	06095	38.261952	-122.0498745	Solano County
201528	Fee-for-Service	1316990567	1316990567	1	1	KIM, BRIAN MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77566	78	Neoplastic Diseases/Oncology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
201550	Fee-for-Service	1902253156	1902253156	1	1	KIM, TAE HUN MD	7/6/2020	207ZP0102X	NA	Other	026	PHYSICIANS	149573	22	Pathology (M.D. only)	0	In state provider	None	2011 ZONAL AVE	STE 303	LOS ANGELES	CA	90089	0110	19	06037	34.05979479	-118.2053794	Los Angeles County
201552	Fee-for-Service	1326019019	1326019019	1	1	KAISER, GREG W OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SUITE A	1352 LOS OSOS VALLEY RD	None	LOS OSOS	CA	93402	3343	40	06079	35.31043582	-120.8260989	San Luis Obispo County
201579	Fee-for-Service	1063568947	1063568947	1	1	KOHAN, JAMES M MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54757	None	None	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
201598	Fee-for-Service	1831726827	1831726827	1	1	KHAW, ANDREW C MD	7/5/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176871	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
201618	Fee-for-Service	1013953199	1013953199	1	1	KOA HOLDINGS, LLC	3/1/2006	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE CENTER	1391 E MADISON AVE	None	EL CAJON	CA	92021	8568	37	06073	32.80015949	-116.932077	San Diego County
201687	Fee-for-Service	1689787061	1689787061	1	1	KRISHNAMURTHY,	10/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93122	08	Family Practice	0	In state provider	PADMAPRIY MD	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
201690	Fee-for-Service	1306131925	1306131925	1	1	KIM, JUDY Y MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122885	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
201693	Fee-for-Service	1689696411	1689696411	1	1	KIRA, DAVID T MD	4/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77637	18	Ophthalmology	0	In state provider	None	635 ANDERSON RD	STE 1	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
201708	Fee-for-Service	1154485753	1154485753	1	1	KING, WARREN D MD	6/30/1991	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	53371	None	None	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
201753	Fee-for-Service	1497951065	1497951065	1	1	KIRK, JASON B MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94388	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
201754	Fee-for-Service	1376524231	1376524231	1	1	KJELDSEN, LEIGH F	4/18/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2415 HIGH SCHOOL AVE	STE 300	CONCORD	CA	94520	1815	07	06013	37.98481374	-122.0347555	Contra Costa County
201762	Fee-for-Service	1184353112	1184353112	1	1	KEITH, KRISTIE	8/25/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3221 HARLAN WAY	None	MODESTO	CA	95354	3310	50	06099	37.64123347	-120.934188	Stanislaus County
201810	Fee-for-Service	1578538740	1578538740	1	1	KAUSHAL, SANDEEP K MD	1/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55061	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
201815	Fee-for-Service	1992963920	1992963920	1	1	KULUVA, JOSHUA E MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109267	13	Neurology (M.D. only)	0	In state provider	None	1860 PENNSYLVANIA AVE	STE 320	FAIRFIELD	CA	94533	3550	48	06095	38.261952	-122.0498745	Solano County
201833	Fee-for-Service	1912584905	1912584905	1	1	KUMAR, RISHI DO	8/22/2024	207R00000X	NA	Other	026	PHYSICIANS	22528	41	Internal Medicine	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
201860	Fee-for-Service	1245584333	1245584333	1	1	KING, TRINA L LCSW	10/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
201869	Fee-for-Service	1801992268	1801992268	2	1	KAUFMAN, JOHN D MD	6/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	35644	20	Orthopedic Surgery	0	In state provider	None	23861 MCBEAN PKWY	STE E30	VALENCIA	CA	91355	2077	19	06037	34.39567343	-118.5542698	Los Angeles County
201907	Fee-for-Service	1609833631	1609833631	1	1	KHILFEH, YASER S MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
201908	Fee-for-Service	1306882949	1306882949	1	1	KLONOFF, DAVID C MD	2/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	35726	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
201915	Fee-for-Service	1598899957	1598899957	1	1	KASAMATSU, ROBERT K DPM	9/17/2004	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	330 E HILLCREST BLVD	None	INGLEWOOD	CA	90301	2406	19	06037	33.96006193	-118.3506293	Los Angeles County
201933	Fee-for-Service	1487862520	1487862520	1	1	KATUKURI, NEELIMA MD	8/24/2017	207R00000X	NA	Other	026	PHYSICIANS	141198	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	350 30TH ST	STE 411	OAKLAND	CA	94609	3424	01	06001	37.81892183	-122.2640154	Alameda County
201940	Fee-for-Service	1780124172	1780124172	1	1	KAHAL, SANDEEP MD	4/19/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	172452	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
201946	Fee-for-Service	1508822016	1508822016	1	1	KAPLAN, MICHAEL R MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	22816	18	Ophthalmology	0	In state provider	None	17742 BEACH BLVD	STE 305	HUNTINGTON BEACH	CA	92647	6853	30	06059	33.704487	-117.989061	Orange County
201953	Fee-for-Service	1770929432	1770929432	1	1	KRASKIN, CHRISTOPHER LCSW	6/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
201996	Fee-for-Service	1407878515	1407878515	1	1	KOOZEKANANI, ROSHAN S MD	8/12/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171720	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
201998	Fee-for-Service	1396868774	1396868774	1	1	KOTIKIAN, ARMOND MD	4/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106145	84	Surgery-Head and Neck	0	In state provider	None	300 W HUNTINGTON DRIVE	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
202017	Fee-for-Service	1902897085	1902897085	1	1	KAYES, ANDREW V. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 MAHALANI STREET	None	WAILUKEE	HI	96793	0000	00	None	20.88554026	-156.4902142	Maui County
202058	Fee-for-Service	1659715860	1659715860	1	2	KERBAWY, SOFIA MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132140	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
202070	Fee-for-Service	1487761433	1487761433	1	1	KOEHLER, STEPHEN C MD	11/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	31293	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
202098	Fee-for-Service	1366477028	1366477028	1	1	KAPLAN, JEFFREY S MD	7/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74514	None	None	0	In state provider	None	301 S MILLER ST	SUITE 204	SANTA MARIA	CA	93454	5205	42	06083	34.950501	-120.431509	Santa Barbara County
202109	Fee-for-Service	1790817849	1790817849	1	1	KAZARYAN, KARINA LMFT	5/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8617 FORSYTHE STREET	None	SUNLAND	CA	91040	2370	19	06037	34.26626535	-118.3207432	Los Angeles County
202115	Fee-for-Service	1104137546	1104137546	1	1	KADIR, NASIBO H MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 N DURANGO DR	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
202126	Fee-for-Service	1821253261	1821253261	1	1	KHOYLYAN, GAGIK MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100597	40	Pediatrics	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
202132	Fee-for-Service	1780248328	1780248328	1	1	KIM, JENNIFER MD	5/3/2022	390200000X	NA	Other	026	PHYSICIANS	177354	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
202141	Fee-for-Service	1316909864	1316909864	1	1	KANTOR, SAMUEL A MD	3/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	5701 W CHARLESTON # 100	None	LAS VEGAS	NV	89146	1256	00	None	36.15908651	-115.219719	Clark County
202164	Fee-for-Service	1134115215	1134115215	1	1	KUEKER, RICHARD J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	515 WASHINGTON ST	None	CONCORDIA	KS	66901	2116	00	None	39.57242845	-97.66098504	Cloud County
202197	Fee-for-Service	1902108855	1902108855	1	4	KHANNA VISION INSTITUTE, A M	6/13/2024	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	645 AERICK ST	None	INGLEWOOD	CA	90301	4881	19	06037	33.96358227	-118.3450075	Los Angeles County
202212	Fee-for-Service	1427345800	1427345800	1	1	KIKUCHI, PHILIP M MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134832	18	Ophthalmology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
202256	Fee-for-Service	1750364345	1750364345	2	2	KAN-DI-KI LLC	10/15/2021	291U00000X	NA	Other	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	15200 STAGG ST	1	VAN NUYS	CA	91405	1056	19	06037	34.21204247	-118.464102	Los Angeles County
202259	Fee-for-Service	1750411070	1750411070	2	1	KOUDSI, NABIL MD	11/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33797	02	General Surgery	0	In state provider	None	811 E 11TH STREET	SUITE 207	UPLAND	CA	91786	4872	36	06071	34.1034335	-117.6398415	San Bernardino County
202284	Fee-for-Service	1396868774	1396868774	1	1	KOTIKIAN, ARMOND MD	4/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106145	02	General Surgery	0	In state provider	None	300 W HUNTINGTON DRIVE	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
202288	Fee-for-Service	1285793760	1285793760	1	1	KARNATH,BERNARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 UNIVERSITY BLVD	None	GALVESTON	TX	77555	5302	00	None	29.311137	-94.777929	Galveston County
202356	Fee-for-Service	1487761433	1487761433	1	1	KOEHLER, STEPHEN C MD	11/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	31293	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
202364	Fee-for-Service	1710999396	1710999396	1	1	KEEFE, MICHAEL A MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	46089	04	Otology, Laryngology, Rhinology	0	In state provider	None	8933 ACTIVITY RD	None	SAN DIEGO	CA	92126	4427	37	06073	32.89637448	-117.133497	San Diego County
202377	Fee-for-Service	1053793141	1053793141	1	1	KIM, DORIS MD	8/5/2020	208600000X	NA	General Surgery	026	PHYSICIANS	169648	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
202391	Fee-for-Service	1912197666	1912197666	1	1	KOH, JOYCE Y MD	7/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106687	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
202435	Fee-for-Service	1679788285	1679788285	1	1	KAPINYA, KRISZTIAN J MD	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109726	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
202488	Fee-for-Service	1902108855	1902108855	1	4	KHANNA VISION INSTITUTE, A M	6/13/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	645 AERICK ST	None	INGLEWOOD	CA	90301	4881	19	06037	33.96358227	-118.3450075	Los Angeles County
202572	Fee-for-Service	1316445430	1316445430	1	1	KOBAYASHI, KAREN INC	3/5/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10831	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
202581	Fee-for-Service	1245532613	1245532613	1	1	KUO, YI JU	3/1/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12881 KNOTT ST	STE 103	GARDEN GROVE	CA	92841	3939	30	06059	33.77542911	-118.0080111	Orange County
202583	Fee-for-Service	1457728859	1457728859	1	1	KANSTEINER, LAURA J LMFT	7/30/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50406	-	NOT APPLICABLE	0	In state provider	None	1317 DEL NORTE RD	SUITE 200	CAMARILLO	CA	93010	8368	56	06111	34.22312217	-119.1046861	Ventura County
202613	Fee-for-Service	1811378052	1811378052	1	1	KAO, YU DO	9/1/2019	207R00000X	NA	Other	026	PHYSICIANS	17470	41	Internal Medicine	0	In state provider	None	2330 W COVELL BLVD	None	DAVIS	CA	95616	5658	57	06113	38.56097929	-121.7800614	Yolo County
202650	Fee-for-Service	1710999396	1710999396	1	1	KEEFE, MICHAEL A MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	46089	24	Plastic Surgery	0	In state provider	None	8933 ACTIVITY RD	None	SAN DIEGO	CA	92126	4427	37	06073	32.89637448	-117.133497	San Diego County
202672	Fee-for-Service	1275083792	1275083792	1	1	KRUGER, BRENDA M	5/26/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	37594 HOUSTON ST	None	LUCERNE VALLEY	CA	92356	7983	36	06071	34.44566559	-116.8432044	San Bernardino County
202682	Fee-for-Service	1891737201	1891737201	1	1	KAFI, REZA MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84048	07	Dermatology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
202691	Fee-for-Service	1568842300	1568842300	1	1	KAENKUMCHORN, TANYAPORN K MD	6/18/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172712	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
202708	Fee-for-Service	1073578134	1073578134	1	1	KAMRAS & POLANSKY MDS IN	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
202720	Fee-for-Service	1841556354	1841556354	1	1	KLOTZ, JENNA M MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126517	79	Neurology-Child	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
202740	Fee-for-Service	1497262141	1497262141	1	1	KOHARAEYE, PC	3/14/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	3831 HUGHES AVE	104	CULVER CITY	CA	90232	6834	19	06037	34.02243278	-118.3981492	Los Angeles County
202766	Fee-for-Service	1558555755	1558555755	1	1	KIM, EUGENE P MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99315	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
202824	Fee-for-Service	1447702824	1447702824	1	1	KOLHEDE, KAYLA M LP	12/23/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
202841	Fee-for-Service	1063642973	1063642973	1	1	KELLOGG, MARISSA A MD MPH	3/23/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	-	13	Neurology (M.D. only)	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
202858	Fee-for-Service	1063297281	1063297281	1	1	KAUR, JESSICA CNP	4/24/2024	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
202887	Fee-for-Service	1619088184	1619088184	1	1	KHAZENI, NAYER MD	5/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92380	41	Internal Medicine	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
202939	Fee-for-Service	1275948481	1275948481	1	1	KEATING, MATTHEW J MD	5/22/2020	390200000X	NA	Other	026	PHYSICIANS	139205	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
202940	Fee-for-Service	1861570608	1861570608	1	1	KHAN, SABIR A.	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49324	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
202942	Fee-for-Service	1639114283	1639114283	1	1	KASHFIAN, PAYAM MD	4/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	77407	30	Radiology	0	In state provider	None	9808 VENICE BLVD	FL 2	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
202959	Fee-for-Service	1275083792	1275083792	1	1	KRUGER, BRENDA M	5/26/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	37594 HOUSTON ST	None	LUCERNE VALLEY	CA	92356	7983	36	06071	34.44566559	-116.8432044	San Bernardino County
202968	Fee-for-Service	1245340454	1245340454	1	1	KARP, HARRY R MD	5/20/1990	207L00000X	NA	Other	026	PHYSICIANS	40287	05	Anesthesiology	0	In state provider	None	2840 LONG BEACH BLVD	STE 110	LONG BEACH	CA	90806	7504	19	06037	33.808743	-118.189341	Los Angeles County
202997	Fee-for-Service	1720291222	1720291222	2	1	KURMANALIEVA, TAMARA T MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	98504	01	General Practice	0	In state provider	None	13925 INDIAN ST	None	MORENO VALLEY	CA	92553	5718	33	06065	33.91832269	-117.2350208	Riverside County
203001	Fee-for-Service	1063475135	1063475135	1	1	KOPPLE, JOEL D MD	3/31/1994	207RN0300X	NA	Nephrology	026	PHYSICIANS	10375	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
203005	Fee-for-Service	1346317245	1346317245	1	1	KORB, JAMES R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24988	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
203056	Fee-for-Service	1245686815	1245686815	1	1	KHAN, BILAL MD	6/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172783	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
203083	Fee-for-Service	1003018755	1003018755	1	1	KIM, JOHN J MD INC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	29493	41	Internal Medicine	0	In state provider	None	591 N 13TH AVE	STE 5	UPLAND	CA	91786	4968	36	06071	34.10081218	-117.6336095	San Bernardino County
203091	Fee-for-Service	1689687634	1689687634	1	1	KHATCHATRIAN, KARINE H MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53513	36	Psychiatry	0	In state provider	None	11770 BERNARDO PLAZA CT	SUITE 370	SAN DIEGO	CA	92128	2425	37	06073	33.02003995	-117.0767619	San Diego County
203116	Fee-for-Service	1417004730	1417004730	1	1	KAISER FOUND HLTH PLAN	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #396	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
203128	Fee-for-Service	1538744941	1538744941	1	1	KAISER FOUNDATION HEALTH PLA	5/4/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	370	905 MAPLE ST	FL 1 RM 1250	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
203138	Fee-for-Service	1073577623	1073577623	1	1	KAGAWA, FRANK T MD	5/31/1988	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53908	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	# A200	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
203187	Fee-for-Service	1609956960	1609956960	1	1	KARAVITI, LEFKOTHEA P MD	2/1/2022	2080P0205X	NA	Endocrinology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
203191	Fee-for-Service	1154719219	1154719219	1	1	KAETHLER, RENETA A	4/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
203207	Fee-for-Service	1689202798	1689202798	1	1	KADAKIA, SAURIN MD	11/16/2023	207R00000X	NA	Other	026	PHYSICIANS	184462	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
203222	Fee-for-Service	1871940353	1871940353	1	1	KARIMI, NIKA MD	8/15/2022	207L00000X	NA	Other	026	PHYSICIANS	177440	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
203237	Fee-for-Service	1295872562	1295872562	1	1	KOMAKULA, SIRISHA T MD	11/23/2010	390200000X	NA	Other	026	PHYSICIANS	114018	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
203243	Fee-for-Service	1891936795	1891936795	1	1	KHANNA, PAVAN MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116085	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
203292	Fee-for-Service	1336193218	1336193218	1	1	KAYE, ROBERT P MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59089	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
203311	Fee-for-Service	1588663769	1588663769	1	18	KAWEAH DELTA HEALTH CARE	8/9/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93291	6237	54	06107	36.359649	-119.331567	Tulare County
203345	Fee-for-Service	1942449285	1942449285	1	1	KHALIFA, AHMAD S MD APC	12/5/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79995	38	Geriatrics	0	In state provider	GY AND WOMEN'S HEALTH	720 ALAMITOS AVE	None	LONG BEACH	CA	90813	4726	19	06037	33.77576654	-118.1800352	Los Angeles County
203375	Fee-for-Service	1003018755	1003018755	1	1	KIM, JOHN J MD INC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	29493	10	Gastroenterology (M.D. only)	0	In state provider	None	591 N 13TH AVE	STE 5	UPLAND	CA	91786	4968	36	06071	34.10081218	-117.6336095	San Bernardino County
203402	Fee-for-Service	1750488359	1750488359	2	1	KELLY, ROBERT B MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	665 WINTER ST SE	None	SALEM	OR	97301	3919	00	None	44.933211	-123.0355125	Marion County
203403	Fee-for-Service	1043215270	1043215270	1	1	KASS, RONALD A MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42006	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	545 E CLEVELAND ST	STE C	STOCKTON	CA	95204	5535	39	06077	37.97379447	-121.2893338	San Joaquin County
203439	Fee-for-Service	1962514927	1962514927	1	1	KISSEL, PHILLIP MD APC	1/1/1995	207T00000X	NA	General Surgery	026	PHYSICIANS	53048	14	Neurological Surgery	0	In state provider	None	699 CALIFORNIA BLVD	STE A	SAN LUIS OBISPO	CA	93401	2507	40	06079	35.28853572	-120.6568105	San Luis Obispo County
203529	Fee-for-Service	1144208943	1144208943	1	1	KING, WENDY L MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
203540	Fee-for-Service	1760554232	1760554232	1	1	KINZINGER, KEVIN MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	55613	02	General Surgery	0	In state provider	None	333 W BASTANCHURY RD	None	FULLERTON	CA	92835	3420	30	06059	33.89358012	-117.9327635	Orange County
203554	Fee-for-Service	1922289784	1922289784	1	1	KAUFFMAN, KARL F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2727 MCCLELLAND BLVD	None	JOPLIN	MO	64804	1626	00	None	37.06080628	-94.53202788	Jasper County
203572	Fee-for-Service	1164602496	1164602496	1	1	KHURANA, KRISHAN MD INC	12/16/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	25829	41	Internal Medicine	0	In state provider	None	2220 E FRUIT ST	STE 216	SANTA ANA	CA	92701	4459	30	06059	33.75277851	-117.8354745	Orange County
203600	Fee-for-Service	1093847022	1093847022	1	1	KIMBERG, LEIGH S MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76137	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
203630	Fee-for-Service	1457844144	1457844144	1	1	KOC, ZEYNEP MD	7/8/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
203631	Fee-for-Service	1942449285	1942449285	1	1	KHALIFA, AHMAD S MD APC	12/5/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79995	41	Internal Medicine	0	In state provider	GY AND WOMEN'S HEALTH	720 ALAMITOS AVE	None	LONG BEACH	CA	90813	4726	19	06037	33.77576654	-118.1800352	Los Angeles County
203642	Fee-for-Service	1902959612	1902959612	1	1	KOPLIK, SHERI MD	3/18/2008	207R00000X	NA	Other	026	PHYSICIANS	96659	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
203663	Fee-for-Service	1750540605	1750540605	1	1	KOCH, BOMI MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106739	40	Pediatrics	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
203691	Fee-for-Service	1043215270	1043215270	1	1	KASS, RONALD A MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42006	41	Internal Medicine	0	In state provider	None	545 E CLEVELAND ST	STE C	STOCKTON	CA	95204	5535	39	06077	37.97379447	-121.2893338	San Joaquin County
203693	Fee-for-Service	1750364345	1750364345	2	1	KAN-DI-KI LLC	10/17/2008	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2820 N ONTARIO STREET	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
203714	Fee-for-Service	1497928733	1497928733	1	1	KILLEBREW, ELLEN J MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	14853	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
203764	Fee-for-Service	1760679633	1760679633	1	1	KEMSLEY, PAOLA LMFT	6/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
203784	Fee-for-Service	1295096105	1295096105	1	1	KIM, MINSO MD	3/16/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	175345	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
203795	Fee-for-Service	1033796040	1033796040	1	1	KRISHNAN, ARCHANA MD	9/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
203814	Fee-for-Service	1851727598	1851727598	1	1	KROMMENHOEK, DAVID	10/14/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3288 BELL ROAD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
203834	Fee-for-Service	1417080649	1417080649	1	1	KLEBEL, WOLFGANG A PHD	1/12/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	623 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74934351	-116.9656065	Riverside County
203920	Fee-for-Service	1942449285	1942449285	1	1	KHALIFA, AHMAD S MD APC	12/5/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79995	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GY AND WOMEN'S HEALTH	720 ALAMITOS AVE	None	LONG BEACH	CA	90813	4726	19	06037	33.77576654	-118.1800352	Los Angeles County
203923	Fee-for-Service	1386738870	1386738870	1	1	KAMINSKY, CORNELIA K MD	9/1/1995	2085P0229X	NA	Other	026	PHYSICIANS	57793	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
203949	Fee-for-Service	1922048396	1922048396	1	1	KAPUR, PATRICIA A MD	4/30/1987	207L00000X	NA	Other	026	PHYSICIANS	34662	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
203957	Fee-for-Service	1952531758	1952531758	1	1	KYLE, DAVID J	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	7590	None	None	0	In state provider	None	890 SUNSET DR	B2	HOLLISTER	CA	95023	5651	35	06069	36.83514342	-121.3877091	San Benito County
203993	Fee-for-Service	1306880596	1306880596	1	2	KURAISHI, AQDAS MD	10/22/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31370	08	Family Practice	0	In state provider	None	31720 TEMECULA PKWY	203	TEMECULA	CA	92592	5895	33	06065	33.4799323	-117.1033702	Riverside County
203998	Fee-for-Service	1316232465	1316232465	1	1	KUHN-RIORDON, KARA M MD	6/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123477	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
204004	Fee-for-Service	1093791816	1093791816	2	1	KELLER, BRIAN P DPM	8/26/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	841 STERLING PARKWAY	SUITE 130	LINCOLN	CA	95648	7324	31	06061	38.869569	-121.294548	Placer County
204007	Fee-for-Service	1093005837	1093005837	1	1	KARPOWICZ, SCOTT M MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122009	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	4633	07	06013	38.00771973	-122.1331484	Contra Costa County
204015	Fee-for-Service	1003200171	1003200171	1	1	KELLY, WILLIAM J MD	4/6/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156668	40	Pediatrics	0	In state provider	None	24226 SUNNYMEAD BLVD	None	MORENO VALLEY	CA	92553	7739	33	06065	33.93909391	-117.2399351	Riverside County
204027	Fee-for-Service	1649545096	1649545096	1	1	KAPLAN, JUAN B MD INC	9/27/2013	208800000X	NA	Other	026	PHYSICIANS	31146	34	Urology and Urological Surgery	0	In state provider	None	14350 E WHITTIER BLVD	SUITE 225	WHITTIER	CA	90605	2103	19	06037	33.95501294	-118.0185665	Los Angeles County
204035	Fee-for-Service	1922214915	1922214915	1	1	KIM, ELIZABETH H MD	10/12/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170100	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
204050	Fee-for-Service	1689768848	1689768848	1	1	KIM, KEVIN T MD	6/1/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	84507	68	Hematology	0	In state provider	None	1325 E CHURCH ST STE 301	None	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
204095	Fee-for-Service	1255867321	1255867321	1	1	KUO, DAVID MD	10/17/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	160529	18	Ophthalmology	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
204105	Fee-for-Service	1942975982	1942975982	1	1	KOCHKARIAN, YERAZ A OD	9/7/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1046 W AVENUE K	None	LANCASTER	CA	93534	5918	19	06037	34.67482357	-118.1505547	Los Angeles County
204116	Fee-for-Service	1073179784	1073179784	1	1	KUBAT, BROOKE MD	11/26/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	TWO MEDICAL PLAZA	STE 205	ROSEVILLE	CA	95661	3044	31	06061	38.76507948	-121.2477476	Placer County
204119	Fee-for-Service	1316110364	1316110364	1	1	KAUFFMAN, CHRISTOPHER MD	9/30/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
204157	Fee-for-Service	1689036139	1689036139	1	1	KIM, JEREMY J MD	9/3/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168403	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
204174	Fee-for-Service	1821239740	1821239740	1	1	KIMBERLEE I SMITH M.D	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	751 NE BLAKELY DR	None	ISSAQUAH	WA	98029	6201	00	None	47.53652154	-122.0220045	King County
204228	Fee-for-Service	1437169539	1437169539	1	1	KUBRICHT, KIMBERLY K CRNA	12/9/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8635 FIRESTONE BLVD	STE 100	DOWNEY	CA	90241	5242	19	06037	33.93691837	-118.1265474	Los Angeles County
204238	Fee-for-Service	1073891420	1073891420	1	1	KILPATRICK, ERIN C LMFT	3/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
204284	Fee-for-Service	1477551646	1477551646	1	1	KATTERHAGEN, CHRISTINE M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
204285	Fee-for-Service	1689047284	1689047284	1	1	KCB PHARMACY INC	12/21/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3378 S BRISTOL ST	None	SANTA ANA	CA	92704	8203	30	06059	33.70209286	-117.8856779	Orange County
204302	Fee-for-Service	1003200171	1003200171	1	1	KELLY, WILLIAM J MD	4/6/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156668	08	Family Practice	0	In state provider	None	24226 SUNNYMEAD BLVD	None	MORENO VALLEY	CA	92553	7739	33	06065	33.93909391	-117.2399351	Riverside County
204310	Fee-for-Service	1891086567	1891086567	1	1	KWON, DANIEL I MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122074	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	SUITE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
204335	Fee-for-Service	1174978522	1174978522	1	1	KUM, PAMELA H MD	9/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157903	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
204341	Fee-for-Service	1649496605	1649496605	1	2	KONOCTI UNIF SCHOOL DIST	4/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	9430B LAKE ST	None	LOWER LAKE	CA	95457	8600	17	06033	38.91493279	-122.6088084	Lake County
204345	Fee-for-Service	1154375830	1154375830	1	1	KOLLAR, DENIS J MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	25046	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
204383	Fee-for-Service	1386679231	1386679231	1	1	KIRSCH, JOSHUA T LCSW	4/6/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
204386	Fee-for-Service	1568669190	1568669190	1	1	KERRY E SHEA DO	12/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4745 ARAPAHOE AVE	STE 320	BOULDER	CO	80303	1082	00	None	40.01483448	-105.2366985	Boulder County
204388	Fee-for-Service	1245458520	1245458520	1	1	KOLHATKAR, GAURI K MD	4/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94390	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
204394	Fee-for-Service	1427038074	1427038074	1	1	KAUR, HARRUP MD	11/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97285	18	Ophthalmology	0	In state provider	None	1805 N CALIFORNIA ST	STE #101	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
204440	Fee-for-Service	1164748182	1164748182	1	1	KIM, JOON H MD	3/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109241	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
204462	Fee-for-Service	1487761631	1487761631	1	1	KRAFT, COLLEEN A MD	5/9/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150407	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
204492	Fee-for-Service	1548585417	1548585417	1	1	KRAFT, HAROLD H MD	4/4/2018	261QP3300X	NA	Other	026	PHYSICIANS	136863	05	Anesthesiology	0	In state provider	None	1200 ROSECRANS AVE	105	MANHATTAN BEACH	CA	90266	2462	19	06037	33.90178953	-118.3931775	Los Angeles County
204579	Fee-for-Service	1992877799	1992877799	1	1	KRAWIEC, AMY T MD	9/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65029	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
204633	Fee-for-Service	1154375830	1154375830	1	1	KOLLAR, DENIS J MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	25046	41	Internal Medicine	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
204638	Fee-for-Service	1053870832	1053870832	1	1	KOGACHI, KAITLIN MD	9/25/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187825	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
204649	Fee-for-Service	1346542628	1346542628	1	1	KURIEN, ERICA P DO	2/11/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10797	08	Family Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
204683	Fee-for-Service	1528383833	1528383833	1	1	KHAN, AKBAR DO	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13486	25	Physical Medicine and Rehabilitation	0	In state provider	None	632 WEST GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
204747	Fee-for-Service	1831266717	1831266717	1	1	KASWICK, JON A MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	24717	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
204757	Fee-for-Service	1720422561	1720422561	1	1	KHARSA, ZENA C MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131768	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
204791	Fee-for-Service	1639672306	1639672306	1	1	KIM, HELEN Y PSYD	4/22/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
204798	Fee-for-Service	1871577106	1871577106	1	1	KOURI, STEPHEN T MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	75403	05	Anesthesiology	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
204806	Fee-for-Service	1801441522	1801441522	1	1	KUKULA, ASHLYN E CCC-SLP	5/2/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2505 W SHAW AVE	STE. 101	FRESNO	CA	93711	3334	10	06019	36.80619423	-119.8359004	Fresno County
204828	Fee-for-Service	1093724791	1093724791	1	1	KILCLINE, CHRISTINE D MD	5/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72400	07	Dermatology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
204843	Fee-for-Service	1114457025	1114457025	1	1	KIM, LINA DO	10/15/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16691	08	Family Practice	0	In state provider	None	1325 N ROSE DR	SUITE 210	PLACENTIA	CA	92870	3840	30	06059	33.8868003	-117.8420447	Orange County
204871	Fee-for-Service	1093905754	1093905754	1	1	KANESHIRO, ALAN Y MD	11/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85717	30	Radiology	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
204924	Fee-for-Service	1518104488	1518104488	1	1	KAUFLER, ORLY LMFT	5/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2716 S VERMONT AVE	UNIT 9	LOS ANGELES	CA	90007	2671	19	06037	34.029891	-118.2915225	Los Angeles County
204931	Fee-for-Service	1205464740	1205464740	1	1	KEESLER, DANIEL MD	1/13/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
204970	Fee-for-Service	1831403831	1831403831	1	1	KOZONO, BRIAN K	5/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
205005	Fee-for-Service	1750999140	1750999140	1	1	KAMLESH K SANKHALA MD INC	8/10/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	9100 WILSHIRE BLVD	840W	BEVERLY HILLS	CA	90212	3556	19	06037	34.06703047	-118.390212	Los Angeles County
205011	Fee-for-Service	1316949928	1316949928	1	1	KHRONUSOVA, YEKATERINA	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	A MD	5701 W CHARLESTON BLVD	STE 100	LAS VEGAS	NV	89146	1256	00	None	36.15908651	-115.219719	Clark County
205021	Fee-for-Service	1477551638	1477551638	1	1	KINCADE, ROBERT C	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65669	33	Thoracic Surgery	0	In state provider	None	5301 F ST	STE 111	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
205022	Fee-for-Service	1538479951	1538479951	1	1	KERMAN UNIFIED SCHOOL	12/8/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	151 S FIRST STREET	None	KERMAN	CA	93630	1029	10	06019	36.732843	-120.0647365	Fresno County
205029	Fee-for-Service	1134261050	1134261050	1	1	KING, LAURENCE COOPER	7/1/2000	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3520 OAKDALE RD	STE B	MODESTO	CA	95357	0714	50	06099	37.689786	-120.9579635	Stanislaus County
205043	Fee-for-Service	1417374786	1417374786	1	1	KIM, STEPHANIE J MD	4/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138199	01	General Practice	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
205113	Fee-for-Service	1093724791	1093724791	1	1	KILCLINE, CHRISTINE D MD	5/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72400	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
205134	Fee-for-Service	1477671634	1477671634	1	1	KIRK, ALEXANDER J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
205151	Fee-for-Service	1740611821	1740611821	1	2	KHOUBIAN, FARZAD JACOB MD	2/21/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	95916	18	Ophthalmology	0	In state provider	None	1026 W WEST COVINA PKWY	#B	WEST COVINA	CA	91790	2810	19	06037	34.06855822	-117.9319371	Los Angeles County
205193	Fee-for-Service	1053475608	1053475608	1	1	KIM, JAMES J MD INC	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49011	79	Neurology-Child	0	In state provider	INC	520 S VIRGIL AVE	STE 307	LOS ANGELES	CA	90020	1442	19	06037	34.064487	-118.2870305	Los Angeles County
205241	Fee-for-Service	1932567617	1932567617	1	1	KU, KAI LMFT	11/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	256 CAJON ST	SUITE E	REDLANDS	CA	92373	5278	36	06071	34.05204454	-117.1802319	San Bernardino County
205281	Fee-for-Service	1952358087	1952358087	1	1	KHALID ABOUSY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2300 OPITZ BLVD	None	WOODBRIDGE	VA	22191	3360	00	None	38.63718	-77.2863255	Prince William County
205298	Fee-for-Service	1750999140	1750999140	1	1	KAMLESH K SANKHALA MD INC	8/10/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	9100 WILSHIRE BLVD	840W	BEVERLY HILLS	CA	90212	3556	19	06037	34.06703047	-118.390212	Los Angeles County
205310	Fee-for-Service	1235241548	1235241548	1	1	KERR, BONNIE J MD	6/23/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	65305	None	None	0	In state provider	None	3883 AIRWAY DR	203	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
205321	Fee-for-Service	1588262042	1588262042	1	1	KENDALL, SARAH L LMFT	6/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
205322	Fee-for-Service	1841245412	1841245412	3	1	KAIZEN COMPOUNDING PHARMACY	8/30/2022	3336C0004X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC.	2025 COURT ST	SUITE B	REDDING	CA	96001	0003	45	06089	40.57812322	-122.3935669	Shasta County
205330	Fee-for-Service	1952510091	1952510091	1	1	KOLLI, RAMESH MD	10/1/2020	207R00000X	NA	Other	026	PHYSICIANS	167902	None	None	0	In state provider	None	9655 MONTE VISTA AVE	STE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
205342	Fee-for-Service	1558304089	1558304089	1	1	KLEIN, PAUL Y PSYD	6/15/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
205345	Fee-for-Service	1306868450	1306868450	1	1	KATZ, GERALD F. MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	75401	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	112 LA CASA VIA	STE 200	WALNUT CREEK	CA	94598	3011	07	06013	37.91229899	-122.0423696	Contra Costa County
205404	Fee-for-Service	1750946364	1750946364	1	1	KNIGHT-ORTIZ, KIMBERLY	5/9/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
205459	Fee-for-Service	1104010818	1104010818	1	1	KHALSA, GURU N S MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100003	40	Pediatrics	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
205476	Fee-for-Service	1003153214	1003153214	1	1	KHOURY, GHASSAN H MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152785	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
205484	Fee-for-Service	1053475608	1053475608	1	1	KIM, JAMES J MD INC	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49011	13	Neurology (M.D. only)	0	In state provider	INC	520 S VIRGIL AVE	STE 307	LOS ANGELES	CA	90020	1442	19	06037	34.064487	-118.2870305	Los Angeles County
205525	Fee-for-Service	1144332586	1144332586	1	1	KARANTH, NIKHIL S MD	3/13/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	2031 MCDANIEL ST	SUITE 140	NORTH LAS VEGAS	NV	89030	6303	00	None	36.19740597	-115.1207123	Clark County
205529	Fee-for-Service	1548725856	1548725856	1	1	KHLOK, DAVID RCP	2/19/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
205534	Fee-for-Service	1366683062	1366683062	1	1	KOCH, BRADLEY F LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
205546	Fee-for-Service	1598862229	1598862229	1	1	KING, MARGARET W MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60295	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
205582	Fee-for-Service	1407967557	1407967557	1	1	KLAMATH HOSPICE	12/9/2002	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	610 W 3RD ST	None	DORRIS	CA	96023	0000	47	06093	41.9642673	-121.9241778	Siskiyou County
205594	Fee-for-Service	1306815873	1306815873	1	1	KUJATH, SCOTT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV PHYS ASSOC	2301 HOLMES ST	None	KANSAS CITY	MO	64108	0000	00	None	39.08455286	-94.57578107	Jackson County
205603	Fee-for-Service	1134581663	1134581663	1	1	KHULLAR, NITASHA MD	11/15/2021	207RR0500X	NA	Other	026	PHYSICIANS	174774	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
205622	Fee-for-Service	1992825954	1992825954	1	1	KRYGIER, JEFFREY E MD	7/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104292	20	Orthopedic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
205641	Fee-for-Service	1396976627	1396976627	1	1	KNIGHT, STACY N	4/1/2022	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
205648	Fee-for-Service	1588290589	1588290589	1	1	KIRKHAM-GARCIA, CALI L MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	184489	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
205649	Fee-for-Service	1194484741	1194484741	1	1	KING CARE HOME HEALTH	9/19/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	525 N BRAND BLVD	STE 104	GLENDALE	CA	91203	3991	19	06037	34.15383	-118.255138	Los Angeles County
205685	Fee-for-Service	1750836912	1750836912	1	1	KRUSE, KIMBERLY J LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
205689	Fee-for-Service	1780620609	1780620609	2	1	KINSEY, THERON H PHD	12/26/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9268 MADISON AVE	None	ORANGEVALE	CA	95662	5858	34	06067	38.668779	-121.208481	Sacramento County
205692	Fee-for-Service	1891938817	1891938817	1	1	KIM, ESTHER J MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113529	14	Neurological Surgery	0	In state provider	None	25455 BARTON ROAD	SUITE A 108	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
205716	Fee-for-Service	1275030397	1275030397	1	1	KAR, ABHIPSA MD	8/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166961	08	Family Practice	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
205747	Fee-for-Service	1104010818	1104010818	1	1	KHALSA, GURU N S MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100003	41	Internal Medicine	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
205769	Fee-for-Service	1902944457	1902944457	2	1	KALMAR, PETER J LMFT	9/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2267 LAVA RIDGE COURT	SUITE 125	ROSEVILLE	CA	95661	3062	31	06061	38.74670949	-121.2455565	Placer County
205785	Fee-for-Service	1497076467	1497076467	1	1	KUHL, KATHERINE V CNP	4/4/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
205796	Fee-for-Service	1346738002	1346738002	1	1	KANWAR, MAMTA MD	8/18/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180436	None	None	0	In state provider	None	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
205868	Fee-for-Service	1407967557	1407967557	1	1	KLAMATH HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	610 W 3RD ST	None	DORRIS	CA	96023	0000	47	06093	41.9642673	-121.9241778	Siskiyou County
205872	Fee-for-Service	1841495876	1841495876	1	1	KILLION, JILL M	6/14/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
205873	Fee-for-Service	1164696449	1164696449	1	1	KOMIN, MICHAEL MD INC	1/7/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1150 E LERDO HWY	STE C	SHAFTER	CA	93263	9420	15	06029	35.49996992	-119.2613936	Kern County
205933	Fee-for-Service	1891800124	1891800124	1	1	KARISHEV, NATALIE MD	11/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105280	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 ROWLAND WAY	STE 220	NOVATO	CA	94945	5056	21	06041	38.09755172	-122.5591766	Marin County
205957	Fee-for-Service	1194712331	1194712331	3	2	KCI USA INC	4/6/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1155 E. NORTH AVE.	STE 105	FRESNO	CA	93725	1947	10	06019	36.69225851	-119.76903	Fresno County
205990	Fee-for-Service	1891711990	1891711990	1	1	KARASIC, DAN H MD	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	65105	-	NOT APPLICABLE	0	In state provider	None	1930 MARKET ST	None	SAN FRANCISCO	CA	94102	6228	38	06075	37.77037155	-122.4255051	San Francisco County
206063	Fee-for-Service	1770791709	1770791709	1	2	KANTER, ADAM S MD	10/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100288	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	RM A808	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
206073	Fee-for-Service	1346997459	1346997459	1	1	KUTSCHER, BRIANA PT	8/7/2023	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29650 BRADLEY RD	None	MENIFEE	CA	92586	6521	33	06065	33.6899672	-117.1885767	Riverside County
206075	Fee-for-Service	1376597500	1376597500	1	1	KRUGER, JASON A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	555 S 70TH ST	None	LINCOLN	NE	68510	2462	00	None	40.808151	-96.62516802	Lancaster County
206088	Fee-for-Service	1720076631	1720076631	1	1	KIM, HUI-KYUNG TINA MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85684	07	Dermatology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
206102	Fee-for-Service	1033563234	1033563234	1	1	KATHERINE SHREYDER MD	8/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 BOWER HILL RD	None	PITTSBURGH	PA	15243	1873	00	None	40.37744491	-80.06601413	Allegheny County
206104	Fee-for-Service	1467940452	1467940452	1	1	KOLOMENSKY, ANDREW MD	1/8/2025	207L00000X	NA	Other	026	PHYSICIANS	180973	05	Anesthesiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
206138	Fee-for-Service	1467656249	1467656249	1	1	KIRANE, AMANDA R MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144572	02	General Surgery	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
206146	Fee-for-Service	1285671024	1285671024	1	1	KURLAN, JULIA G MD	2/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51819	07	Dermatology	0	In state provider	None	2067 W VISTA WAY	STE 250	VISTA	CA	92083	6034	37	06073	33.18505594	-117.285958	San Diego County
206152	Fee-for-Service	1396977187	1396977187	1	1	KOZAK, KERRI L	6/28/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
206162	Fee-for-Service	1164696449	1164696449	1	1	KOMIN, MICHAEL MD INC	1/7/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1150 E LERDO HWY	STE C	SHAFTER	CA	93263	9420	15	06029	35.49996992	-119.2613936	Kern County
206168	Fee-for-Service	1275704611	1275704611	1	1	KHOURY, ANTOINE E MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53187	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
206189	Fee-for-Service	1639445364	1639445364	1	1	KREUTZBERG, ANDREI M MD	11/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	126708	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
206197	Fee-for-Service	1487289021	1487289021	1	1	KAUR, AMANDEEP RN PNP	10/31/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4664 AMERICAN AVE	STE B	BAKERSFIELD	CA	93309	4017	15	06029	35.34068389	-119.0546534	Kern County
206200	Fee-for-Service	1427120682	1427120682	1	1	KIDNEY CONSULTANTS	3/1/1995	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC.	11550 INDIAN HILLS RD	STE 371	MISSION HILLS	CA	91345	1252	19	06037	34.28024575	-118.4588775	Los Angeles County
206216	Fee-for-Service	1184044166	1184044166	1	1	KHAN, SANA S MD	10/18/2017	208M00000X	NA	Other	026	PHYSICIANS	151383	41	Internal Medicine	0	In state provider	None	4053 LONE TREE WAY	101	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
206220	Fee-for-Service	1891800124	1891800124	1	1	KARISHEV, NATALIE MD	11/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105280	08	Family Practice	0	In state provider	None	101 ROWLAND WAY	STE 220	NOVATO	CA	94945	5056	21	06041	38.09755172	-122.5591766	Marin County
206228	Fee-for-Service	1003902180	1003902180	1	1	KHOO, EVELYN MD	9/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	77162	08	Family Practice	0	In state provider	None	1501 TROUSDALE DRIVE	3RD FLOOR	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
206269	Fee-for-Service	1184716581	1184716581	1	1	KOREAN COMMUNITY SERVICES	9/21/2015	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	1060 SOUTH BROOKHURST RD	None	FULLERTON	CA	92833	3709	30	06059	33.860331	-117.9593015	Orange County
206284	Fee-for-Service	1881606309	1881606309	1	1	KURISU, WAYNE OWEN MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64273	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
206293	Fee-for-Service	1831187046	1831187046	1	1	KARDOS, LESLIE S MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73453	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
206314	Fee-for-Service	1871176594	1871176594	1	1	KAUR, GURINDER G NP	1/13/2023	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
206320	Fee-for-Service	1679570527	1679570527	1	1	KHWAJA, SHAMSUDDIN MD	8/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85907	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	STE 415	LOS ANGELES	CA	90033	5306	19	06037	34.06287152	-118.2029433	Los Angeles County
206321	Fee-for-Service	1396339255	1396339255	1	1	KIM TANG, M.D., INC.	7/1/2021	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	+ COSMETIC CENTER	23832 ROCKFIELD BLVD	SUITE 210	LAKE FOREST	CA	92630	2876	30	06059	33.6263651	-117.7142932	Orange County
206382	Fee-for-Service	1831246206	1831246206	1	1	KOTIN, BARBARA B MD	1/1/1982	2080P0207X	NA	Hematology	026	PHYSICIANS	33578	40	Pediatrics	0	In state provider	None	51ST & GROVE ST	None	OAKLAND	CA	94609	0000	01	06001	37.83637691	-122.2678962	Alameda County
206391	Fee-for-Service	1548268873	1548268873	1	1	KO, WILLIAM W MD	3/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73648	18	Ophthalmology	0	In state provider	None	117 S MISSION DR	None	SAN GABRIEL	CA	91776	1101	19	06037	34.10196423	-118.1109533	Los Angeles County
206403	Fee-for-Service	1144422254	1144422254	1	1	KAMAL, ROBIN N MD	11/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132685	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206415	Fee-for-Service	1124414925	1124414925	1	1	KIM, ERNEST S MD	9/11/2022	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	156221	None	None	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
206439	Fee-for-Service	1952693756	1952693756	1	1	KANN, ELIZABETH G MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127067	01	General Practice	0	In state provider	None	8170 LAGUNA BLVD	SUITE 101	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
206456	Fee-for-Service	1275704611	1275704611	1	1	KHOURY, ANTOINE E MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53187	34	Urology and Urological Surgery	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
206507	Fee-for-Service	1083077077	1083077077	1	1	KOH, JUSTIN MD	9/28/2023	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	185882	None	None	0	In state provider	None	8635 W 3RD ST	STE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
206527	Fee-for-Service	1265518427	1265518427	1	1	KALAISELVI RAJENDRAN	4/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 PINE AVE	None	NIAGARA FALLS	NY	14301	1755	00	None	43.0947	-79.055658	Niagara County
206534	Fee-for-Service	1467987156	1467987156	1	1	KENDRIC, KAYLA MD	4/13/2021	207P00000X	NA	Other	026	PHYSICIANS	158149	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
206536	Fee-for-Service	1356617534	1356617534	1	1	KOSS, SHIRA L MD	8/5/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	162506	04	Otology, Laryngology, Rhinology	0	In state provider	None	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
206547	Fee-for-Service	1861525602	1861525602	1	1	KOREAN COMMUNITY SERVICES	8/15/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INC	7212 ORANGETHORPE AVE	SUITE 9A	BUENA PARK	CA	90621	4667	30	06059	33.85890953	-118.007244	Orange County
206555	Fee-for-Service	1689674582	1689674582	1	1	KOUNANG, ROBERTUS MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40627	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
206573	Fee-for-Service	1750365045	1750365045	1	1	KITCHENS, CHARLES H MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	33961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	650 SANITARIUM RD	None	DEER PARK	CA	94576	9710	28	06055	38.5417293	-122.4756328	Napa County
206582	Fee-for-Service	1689673568	1689673568	1	1	KLEIN, MILTON S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HOUSTON CARDIOVASCULAR	6560 FANNIN, STE 1654	None	HOUSTON	TX	77030	0000	00	None	29.71042898	-95.40043393	Harris County
206583	Fee-for-Service	1962662510	1962662510	1	1	KHURSHID, AMBREEN MD INC	10/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	52016	10	Gastroenterology (M.D. only)	0	In state provider	None	451 E ALMOND AVE	STE 103	MADERA	CA	93637	5562	20	06039	36.94554615	-120.0523936	Madera County
206609	Fee-for-Service	1679570527	1679570527	1	1	KHWAJA, SHAMSUDDIN MD	8/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85907	01	General Practice	0	In state provider	None	1510 SAN PABLO ST	STE 415	LOS ANGELES	CA	90033	5306	19	06037	34.06287152	-118.2029433	Los Angeles County
206624	Fee-for-Service	1902289440	1902289440	1	1	KHODAKIVSKA, OLGA MD	8/6/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	167521	13	Neurology (M.D. only)	0	In state provider	None	47647 CALEO BAY DR	SUITE 101	LA QUINTA	CA	92253	8857	33	06065	33.70305235	-116.2936509	Riverside County
206666	Fee-for-Service	1649274150	1649274150	1	1	KHAN, DAVID C MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65774	30	Radiology	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
206674	Fee-for-Service	1316496698	1316496698	1	1	KT WORLDACU AND HERB CORP	10/31/2016	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2120 W 8TH ST	STE 210	LOS ANGELES	CA	90057	4019	19	06037	34.05522552	-118.2786479	Los Angeles County
206696	Fee-for-Service	1265510077	1265510077	1	1	KONSON, YAN G MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64633	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
206699	Fee-for-Service	1851681928	1851681928	1	1	KAHN, SARAH S MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116052	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
206729	Fee-for-Service	1447232822	1447232822	1	1	KOLANZ, ROBERT A MD	12/31/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55707	30	Radiology	0	In state provider	None	3531 FASHION WAY	None	TORRANCE	CA	90503	4807	19	06037	33.8352235	-118.348254	Los Angeles County
206732	Fee-for-Service	1326054206	1326054206	1	1	KRISTY GRIFFITH	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6655 S YALE AVE	None	TULSA	OK	74136	3326	00	None	36.06542494	-95.92006491	Tulsa County
206804	Fee-for-Service	1134314677	1134314677	1	1	KASHKOULI, PARISA MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101493	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
206807	Fee-for-Service	1679852909	1679852909	1	1	KYNASTON, KELLY A	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14750	None	None	0	In state provider	None	1625 PINE STREET	STE 102	REDDING	CA	96001	1018	45	06089	40.58321511	-122.388937	Shasta County
206832	Fee-for-Service	1639829435	1639829435	1	1	KIM, TIMOTHY DO	6/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
206836	Fee-for-Service	1861525602	1861525602	1	1	KOREAN COMMUNITY SERVICES	8/15/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INC	7212 ORANGETHORPE AVE	SUITE 9A	BUENA PARK	CA	90621	4667	30	06059	33.85890953	-118.007244	Orange County
206841	Fee-for-Service	1366630386	1366630386	1	1	KEARNS, JOY A CCC-SLP	7/31/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3518 JEFFERSON AVE	None	REDWOOD CITY	CA	94062	3136	41	06081	37.46715891	-122.2492205	San Mateo County
206847	Fee-for-Service	1851533038	1851533038	1	1	KOO, BONNIE MD	3/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113763	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
206888	Fee-for-Service	1134358641	1134358641	1	1	KOTHAKOTA, BHARAT MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128255	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
206896	Fee-for-Service	1043637234	1043637234	1	1	KOLB, JENNIFER M MD	6/29/2020	390200000X	NA	Other	026	PHYSICIANS	168145	10	Gastroenterology (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
206897	Fee-for-Service	1679570527	1679570527	1	1	KHWAJA, SHAMSUDDIN MD	8/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85907	33	Thoracic Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 415	LOS ANGELES	CA	90033	5306	19	06037	34.06287152	-118.2029433	Los Angeles County
206911	Fee-for-Service	1770540882	1770540882	1	1	KUMAR, ALOK MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132238	40	Pediatrics	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1234	10	06019	36.7423511	-119.7834688	Fresno County
206940	Fee-for-Service	1316147671	1316147671	1	1	KIM, STEVE S MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	81433	34	Urology and Urological Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
206943	Fee-for-Service	1841386174	1841386174	1	1	KUZIS, CLAUDIA S MD	9/1/2000	207RR0500X	NA	Other	026	PHYSICIANS	69085	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
206947	Fee-for-Service	1407945496	1407945496	1	1	KORN, JEFFREY DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3989 32ND ST	None	SAN DIEGO	CA	92104	2001	37	06073	32.75020917	-117.1251946	San Diego County
206955	Fee-for-Service	1649274150	1649274150	1	1	KHAN, DAVID C MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65774	78	Neoplastic Diseases/Oncology	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
206957	Fee-for-Service	1336186907	1336186907	1	1	KAHNG, RANDALL S MD	2/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52612	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
206985	Fee-for-Service	1588682769	1588682769	1	1	KIM, ANNA B MD	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81160	41	Internal Medicine	0	In state provider	None	2025 E ROUTE 66	None	GLENDORA	CA	91740	4670	19	06037	34.12802719	-117.8255325	Los Angeles County
206995	Fee-for-Service	1427028323	1427028323	1	1	KASSEN, DAVID V MD	11/10/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	51355	30	Radiology	0	In state provider	None	10111 HOLE AVENUE	None	RIVERSIDE	CA	92503	3441	33	06065	33.91431544	-117.4585034	Riverside County
207033	Fee-for-Service	1396892394	1396892394	1	1	KIM, PAUL S MD	12/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93149	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
207052	Fee-for-Service	1619695293	1619695293	1	1	KAVA CARE LLC	10/17/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6520 N IRWINDALE AVE	STE 228	IRWINDALE	CA	91702	2867	19	06037	34.13156204	-117.9335291	Los Angeles County
207068	Fee-for-Service	1780609503	1780609503	1	1	KOTHA, AKTHER J MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	45440	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 RESERVOIR DR	STE 309	SAN DIEGO	CA	92120	5193	37	06073	32.77628471	-117.0563688	San Diego County
207074	Fee-for-Service	1588708218	1588708218	1	1	KOSCHESKI, PAUL V MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103701	30	Radiology	0	In state provider	None	1901 OUTLET CENTER DRIVE	SUITE 120	OXNARD	CA	93036	0664	56	06111	34.21965581	-119.1491337	Ventura County
207091	Fee-for-Service	1366633547	1366633547	1	1	KANG, SUNDEEP K MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133087	None	None	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
207102	Fee-for-Service	1639550437	1639550437	1	1	KIM, JOHNATHAN J MD	7/23/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	149386	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
207123	Fee-for-Service	1861525602	1861525602	1	1	KOREAN COMMUNITY SERVICES	8/15/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INC	7212 ORANGETHORPE AVE	SUITE 9A	BUENA PARK	CA	90621	4667	30	06059	33.85890953	-118.007244	Orange County
207128	Fee-for-Service	1356435051	1356435051	1	1	KUKREJA, SUDEEP MD	7/27/1988	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	43878	None	None	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
207129	Fee-for-Service	1700215308	1700215308	1	1	KINSER, JENNIFER B	5/21/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
207149	Fee-for-Service	1669437810	1669437810	1	1	KIRKWOOD, KIMBERLY S MD	2/28/1988	208600000X	NA	General Surgery	026	PHYSICIANS	63343	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
207192	Fee-for-Service	1902108855	1902108855	1	1	KHANNA VISION INSTITUTE, A M	1/2/2024	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	EDICAL CORPORATION	31824 VILLAGE CENTER ROA	SUITE F	WESTLAKE VILLAGE	CA	91361	4337	19	06037	34.1466537	-118.814283	Los Angeles County
207199	Fee-for-Service	1770540882	1770540882	1	1	KUMAR, ALOK MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132238	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1234	10	06019	36.7423511	-119.7834688	Fresno County
207232	Fee-for-Service	1841386174	1841386174	1	1	KUZIS, CLAUDIA S MD	9/1/2000	207RR0500X	NA	Other	026	PHYSICIANS	69085	83	Rheumatology	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
207265	Fee-for-Service	1881774164	1881774164	1	1	KERR, MICHELLE F OD	4/14/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	895 TRANCAS STREET	None	NAPA	CA	94558	3040	28	06055	38.32406807	-122.2928218	Napa County
207267	Fee-for-Service	1851417547	1851417547	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
207268	Fee-for-Service	1265486856	1265486856	1	1	KURRA, PRATAP S MD	7/27/2020	207L00000X	NA	Other	026	PHYSICIANS	43255	05	Anesthesiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
207277	Fee-for-Service	1588682769	1588682769	1	1	KIM, ANNA B MD	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81160	40	Pediatrics	0	In state provider	None	2025 E ROUTE 66	None	GLENDORA	CA	91740	4670	19	06037	34.12802719	-117.8255325	Los Angeles County
207297	Fee-for-Service	1689167330	1689167330	1	1	KALLURI, MANASA MD	11/4/2021	208M00000X	NA	Other	026	PHYSICIANS	173788	None	None	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
207311	Fee-for-Service	1720300783	1720300783	1	1	KIDZ KINGDOM INC	1/13/2011	3140N1450X	NA	Skilled Nursing Facility	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13022 SHERMAN WAY	None	NORTH HOLLYWOOD	CA	91605	4955	19	06037	34.20117552	-118.416879	Los Angeles County
207336	Fee-for-Service	1083157093	1083157093	1	1	KLINGLER, MATTHEW C	6/12/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
207355	Fee-for-Service	1780609503	1780609503	1	1	KOTHA, AKTHER J MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	45440	83	Rheumatology	0	In state provider	None	5555 RESERVOIR DR	STE 309	SAN DIEGO	CA	92120	5193	37	06073	32.77628471	-117.0563688	San Diego County
207377	Fee-for-Service	1760778427	1760778427	1	1	KULTHIA, ARUN S MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127279	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
207413	Fee-for-Service	1861525602	1861525602	1	1	KOREAN COMMUNITY SERVICES	8/15/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INC	7212 ORANGETHORPE AVE	SUITE 9A	BUENA PARK	CA	90621	4667	30	06059	33.85890953	-118.007244	Orange County
207436	Fee-for-Service	1164451282	1164451282	1	1	KONDURI, VINAYA P MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105406	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
207437	Fee-for-Service	1902435431	1902435431	1	1	KORNBLUTH, NATALIE G CNP	8/21/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
207462	Fee-for-Service	1538320437	1538320437	1	1	KYLE SANDERS MD	4/26/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 W MAPLE ST	None	FARMINGTON	NM	87401	5630	00	None	36.72440889	-108.2169193	San Juan County
207463	Fee-for-Service	1376939702	1376939702	1	1	KUNDU, BORNALI MD	5/31/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	176104	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
207482	Fee-for-Service	1902108855	1902108855	1	1	KHANNA VISION INSTITUTE, A M	1/2/2024	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EDICAL CORPORATION	31824 VILLAGE CENTER ROA	SUITE F	WESTLAKE VILLAGE	CA	91361	4337	19	06037	34.1466537	-118.814283	Los Angeles County
207501	Fee-for-Service	1134194616	1134194616	1	1	KEIM SAMUEL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY MEDICAL CNTR	1501 N CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
207520	Fee-for-Service	1922113331	1922113331	1	1	KOGELNIK, ANDREAS M MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76408	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
207528	Fee-for-Service	1457316184	1457316184	1	1	KAMRAS, MARVIN H MD	5/10/1977	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	29268	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
207577	Fee-for-Service	1386791614	1386791614	1	1	KAISER FOUND HOSP PHCY	9/11/1978	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#955	765 W COLLEGE ST	None	LOS ANGELES	CA	90012	5923	19	06037	34.0661756	-118.2435934	Los Angeles County
207585	Fee-for-Service	1912149352	1912149352	1	1	KIRKLAND, JENNIFER B PHD	7/23/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
207605	Fee-for-Service	1255033973	1255033973	1	1	KOOK, MATTHEW S CRNA	7/17/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
207643	Fee-for-Service	1780609503	1780609503	1	1	KOTHA, AKTHER J MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	45440	41	Internal Medicine	0	In state provider	None	5555 RESERVOIR DR	STE 309	SAN DIEGO	CA	92120	5193	37	06073	32.77628471	-117.0563688	San Diego County
207658	Fee-for-Service	1841327012	1841327012	1	1	KIRAKOSIAN, LENA M NP	4/11/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
207696	Fee-for-Service	1972984227	1972984227	1	1	K & K HOME HEALTH CARE, INC	6/16/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7728 FOOTHILL BLVD	STE B	TUJUNGA	CA	91042	2194	19	06037	34.25732597	-118.300939	Los Angeles County
207712	Fee-for-Service	1447296090	1447296090	1	1	KATZ, ERIN E MD	1/15/2019	208800000X	NA	Other	026	PHYSICIANS	55995	34	Urology and Urological Surgery	0	In state provider	None	4244 RIVERWALK PKWY	SUITE 240	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
207716	Fee-for-Service	1801134036	1801134036	1	1	KANG, MIN J LAC	6/20/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4155 MOORPARK AVE	STE 16	SAN JOSE	CA	95117	1714	43	06085	37.31587947	-121.974255	Santa Clara County
207720	Fee-for-Service	1558397869	1558397869	1	1	KY, TOM MD	10/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81281	41	Internal Medicine	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
207743	Fee-for-Service	1447501135	1447501135	1	1	KOBAYASHI, CORI A	10/8/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	980 ROOSEVELT	STE 100	IRVINE	CA	92620	3670	30	06059	33.69380208	-117.7653165	Orange County
207763	Fee-for-Service	1548234750	1548234750	1	1	KELLY BEAMS	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CTY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
207819	Fee-for-Service	1205847993	1205847993	1	1	KIM, K W MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34031	41	Internal Medicine	0	In state provider	None	1205 EVERGREEN ST	None	SELMA	CA	93662	3808	10	06019	36.56701154	-119.599857	Fresno County
207849	Fee-for-Service	1801232384	1801232384	1	1	KHAN, FARHAN S MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139479	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
207855	Fee-for-Service	1255625786	1255625786	1	1	KHAN, TONY K DO	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12067	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
207889	Fee-for-Service	1013932136	1013932136	1	1	KIM, YANG J MD INC	7/22/1996	207L00000X	NA	Other	026	PHYSICIANS	36422	05	Anesthesiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93755	5657	10	06019	36.741663	-119.7841005	Fresno County
207943	Fee-for-Service	1780872192	1780872192	1	1	KHAN, ZEEST MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103991	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
207945	Fee-for-Service	1992350185	1992350185	1	1	KEVIN & LUZ ENTERPRISES INC	4/6/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1600 SACRAMENTO INN WAY	STE 216	SACRAMENTO	CA	95815	3461	34	06067	38.60775	-121.429233	Sacramento County
207962	Fee-for-Service	1982730370	1982730370	1	1	KIM, SANG HO	12/7/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	461 S WESTERN AVE	None	LOS ANGELES	CA	90020	4102	19	06037	34.065486	-118.309136	Los Angeles County
207968	Fee-for-Service	1306403837	1306403837	1	1	KHODAPARAST, NAFISEH DO	10/2/2023	390200000X	NA	Other	026	PHYSICIANS	20930	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
208004	Fee-for-Service	1104358472	1104358472	1	1	KEAR, BREELAN M MD	11/4/2019	207P00000X	NA	Other	026	PHYSICIANS	158385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
208019	Fee-for-Service	1962006940	1962006940	1	1	KAPLAN HOSPICE CARE INC	8/15/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 131	NORTH HOLLYWOOD	CA	91601	2249	19	06037	34.1721655	-118.3608315	Los Angeles County
208020	Fee-for-Service	1114347531	1114347531	1	1	KILBOURNE, KATHERINE E	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
208028	Fee-for-Service	1477610087	1477610087	1	1	KOHN, JEAN G MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	2347	40	Pediatrics	0	In state provider	None	520 SAND HILL RD	None	PALO ALTO	CA	94304	2001	43	06085	37.44266576	-122.1739246	Santa Clara County
208038	Fee-for-Service	1689044695	1689044695	1	1	KUNG, HERMAN	12/21/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
208045	Fee-for-Service	1962428102	1962428102	1	1	KHAJA, NAZIR-UDDIN MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	24571	41	Internal Medicine	0	In state provider	None	20911 EARL ST	STE 180	TORRANCE	CA	90503	4353	19	06037	33.840459	-118.3580985	Los Angeles County
208076	Fee-for-Service	1952677452	1952677452	1	1	KELEMEN, BENJAMIN W MD	2/24/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150128	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
208101	Fee-for-Service	1205102787	1205102787	1	1	KIM, WILLIAM K MD	12/12/2017	208800000X	NA	Other	026	PHYSICIANS	128187	34	Urology and Urological Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
208106	Fee-for-Service	1780262733	1780262733	1	1	KASSAB-GRAY, ANN	5/30/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
208124	Fee-for-Service	1023384526	1023384526	1	1	KAKAR, FRESHTA DO	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14541	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1779 DOMINICAN WAY	STE B	SANTA CRUZ	CA	95065	1526	44	06087	36.9902958	-121.9808957	Santa Cruz County
208154	Fee-for-Service	1104373430	1104373430	1	1	KU, YUN CHIEN	12/18/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	115583	-	NOT APPLICABLE	0	In state provider	None	2218 N FIRST ST	None	SAN JOSE	CA	95131	2007	43	06085	37.37769052	-121.9213491	Santa Clara County
208192	Fee-for-Service	1619055274	1619055274	1	1	KHERAJ, MALIKA N MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53958	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
208255	Fee-for-Service	1790895167	1790895167	1	1	KIMURA, ROBYN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73719	40	Pediatrics	0	In state provider	None	900 FLORIN RD	STE B	SACRAMENTO	CA	95831	3501	34	06067	38.49606	-121.5264645	Sacramento County
208262	Fee-for-Service	1932277316	1932277316	1	1	KIM, MIHWA OD	9/22/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2633 TELEGRAPH AVE	APT 106	OAKLAND	CA	94612	1744	01	06001	37.81569491	-122.2680696	Alameda County
208276	Fee-for-Service	1558589762	1558589762	1	1	KENNY, LAURA M MD	4/20/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162143	09	Gynecology (D.O. only)	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
208290	Fee-for-Service	1770970055	1770970055	1	1	KWON, MELISSA A MD	10/31/2018	207R00000X	NA	Other	026	PHYSICIANS	145146	41	Internal Medicine	0	In state provider	None	1375 SUTTER ST	308	SAN FRANCISCO	CA	94109	5466	38	06075	37.78738239	-122.4229066	San Francisco County
208306	Fee-for-Service	1962006940	1962006940	1	1	KAPLAN HOSPICE CARE INC	8/15/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 131	NORTH HOLLYWOOD	CA	91601	2249	19	06037	34.1721655	-118.3608315	Los Angeles County
208318	Fee-for-Service	1225424500	1225424500	1	1	KATHRYN J SWIM	7/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	91-241 FORT WEAVER RD	None	EWA BEACH	HI	96706	2944	00	None	21.31380624	-157.9975704	City and County of Honolulu
208350	Fee-for-Service	1649395146	1649395146	1	1	KARIMI, MEHRNAZ	2/10/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6670 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
208354	Fee-for-Service	1487748364	1487748364	1	1	KEECH, RICHARD C MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	29047	01	General Practice	0	In state provider	None	3475 TORRANCE BLVD	STE G	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
208404	Fee-for-Service	1093716375	1093716375	1	1	KUDISCH, MARC MD	12/18/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	50419	10	Gastroenterology (M.D. only)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
208454	Fee-for-Service	1932156684	1932156684	1	1	KANZARIA, KANTILAL V MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	39152	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
208460	Fee-for-Service	1386633279	1386633279	1	1	KLEIN, KEVIN DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3000 MEDICAL PARK DR	STE 500	TAMPA	FL	33613	6600	00	None	28.07133378	-82.42518855	Hillsborough County
208490	Fee-for-Service	1255783080	1255783080	1	1	KOPP-YATES, HANNAH R CNM	1/15/2017	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	583 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	5239	49	06097	38.45268	-122.672088	Sonoma County
208543	Fee-for-Service	1841233715	1841233715	1	1	KROES, JEREMY S MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74428	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
208563	Fee-for-Service	1558589762	1558589762	1	1	KENNY, LAURA M MD	4/20/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162143	15	Obstetrics (D.O. only)	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
208565	Fee-for-Service	1518984178	1518984178	1	1	KEEPERMAN, JACOB B MD	3/22/2021	207LC0200X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
208577	Fee-for-Service	1174548291	1174548291	1	1	KIERNAN, WILLIAM H OD	3/1/2000	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
208591	Fee-for-Service	1689660755	1689660755	1	1	KANG, AERI Y	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85347	41	Internal Medicine	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
208634	Fee-for-Service	1841796406	1841796406	1	1	KARUBUS, KATHERINE M MD	9/26/2023	208600000X	NA	General Surgery	026	PHYSICIANS	187992	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
208649	Fee-for-Service	1326069246	1326069246	1	1	KARAM, DORIS E MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133518	None	None	0	In state provider	None	1541 FLORIDA AVE	200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
208683	Fee-for-Service	1770788655	1770788655	1	1	KUEHNERT, JAMES M	6/6/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
208729	Fee-for-Service	1104373430	1104373430	1	2	KU, YUN-CHIEN LMFT	12/18/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	115583	-	NOT APPLICABLE	0	In state provider	None	2202 N 1ST ST	STE 2210	SAN JOSE	CA	95131	2007	43	06085	37.37749791	-121.921213	Santa Clara County
208730	Fee-for-Service	1144395666	1144395666	1	1	KIM,EUNAE G LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CHUNJIIN ACUPUNCTURE &	18682 BEACH BLVD	STE 105	HUNTINGTON BEACH	CA	92648	2049	30	06059	33.69152695	-117.9887007	Orange County
208734	Fee-for-Service	1699864629	1699864629	1	1	KLEINMAN, LAURIE A.	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67676	01	General Practice	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
208793	Fee-for-Service	1053991919	1053991919	1	1	KULYN, JACOB MD	7/26/2024	208M00000X	NA	Other	026	PHYSICIANS	191623	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
208844	Fee-for-Service	1447425194	1447425194	1	1	KURIEN, PHILIP A MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111335	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
208871	Fee-for-Service	1003853755	1003853755	1	1	KAPLAN, AARON M MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69522	30	Radiology	0	In state provider	None	20103 LAKE CHABOT RD	STE 103	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
208874	Fee-for-Service	1063737302	1063737302	1	1	KANTER, JENNA R MD	3/29/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	159115	13	Neurology (M.D. only)	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
208902	Fee-for-Service	1033381124	1033381124	1	1	KLEID, JACK J MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	20415	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3660 CLAIREMONT DR	STE 6	SAN DIEGO	CA	92117	5994	37	06073	32.80759429	-117.2010737	San Diego County
208924	Fee-for-Service	1609301373	1609301373	1	1	KULKARNI, MRUNAL R MD	8/18/2020	208M00000X	NA	Other	026	PHYSICIANS	169650	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
208961	Fee-for-Service	1235222902	1235222902	1	1	KIM, EUISHIN E MD	12/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51151	42	Nuclear Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
208975	Fee-for-Service	1174617799	1174617799	1	1	KNOBLE, MARK E MD	1/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77414	None	None	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
209007	Fee-for-Service	1154007912	1154007912	1	1	KANINI, SUSAN MUNINI	10/11/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2603 MULHOLLAND DRIVE	None	LATHROP	CA	95330	7105	39	06077	37.81318969	-121.3429788	San Joaquin County
209042	Fee-for-Service	1851331417	1851331417	1	1	KAUFMAN, WAYNE A MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74049	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
209044	Fee-for-Service	1639542723	1639542723	1	1	KELLY, SONDRA K PT	3/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1338 MAIN ST	None	RAMONA	CA	92065	0000	37	06073	33.03880322	-116.8742834	San Diego County
209052	Fee-for-Service	1417052341	1417052341	1	1	KING, MELISSA K MD	8/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95240	77	Infectious Disease	0	In state provider	None	12555 GARDEN GROVE BLVD	#405	GARDEN GROVE	CA	92843	1904	30	06059	33.77450946	-117.913041	Orange County
209061	Fee-for-Service	1023218161	1023218161	1	1	KRIEG, CAROLYN F DO	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10026	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
209077	Fee-for-Service	1750385100	1750385100	1	1	KAMINSKI, BRIAN J MD	12/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83410	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13855 E 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
209163	Fee-for-Service	1588126601	1588126601	1	1	KHACHERYAN, LEVON DO	3/1/2024	390200000X	NA	Other	026	PHYSICIANS	20895	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
209172	Fee-for-Service	1093006421	1093006421	1	1	KALANTAR, EDMOND O DO	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12466	41	Internal Medicine	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
209181	Fee-for-Service	1811025471	1811025471	1	1	KURI, MAURICIO MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103935	24	Plastic Surgery	0	In state provider	None	2320 WOOLSEY STEET	202	BERKELEY	CA	94705	1975	01	06001	37.85282167	-122.2609028	Alameda County
209244	Fee-for-Service	1205099553	1205099553	1	1	KHALID, EJAZ MD	5/9/2019	207R00000X	NA	Other	026	PHYSICIANS	160776	41	Internal Medicine	0	In state provider	None	6601 WHITE FEATHER ROAD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
209252	Fee-for-Service	1235222902	1235222902	1	1	KIM, EUISHIN E MD	12/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51151	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
209281	Fee-for-Service	1790197051	1790197051	1	1	KIM, EDWIN MD	6/14/2019	390200000X	NA	Other	026	PHYSICIANS	142048	02	General Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
209297	Fee-for-Service	1154007912	1154007912	1	1	KANINI, SUSAN MUNINI	10/11/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2603 MULHOLLAND DRIVE	None	LATHROP	CA	95330	7105	39	06077	37.81318969	-121.3429788	San Joaquin County
209305	Fee-for-Service	1669560041	1669560041	1	1	KIM, VIVIAN Y MD	6/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	65668	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1045 S ST	None	FRESNO	CA	93721	1406	10	06019	36.74077211	-119.7813343	Fresno County
209362	Fee-for-Service	1003100579	1003100579	1	1	KILLEEN, JAMES D III MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126081	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
209395	Fee-for-Service	1841330735	1841330735	1	1	KOZEL, ROBERT P MD	9/1/1998	207P00000X	NA	Other	026	PHYSICIANS	65272	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
209414	Fee-for-Service	1770536179	1770536179	1	1	KOVAR, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10101 RIDGEGATE PKWY	None	LONETREE	CO	80124	5522	00	None	39.529305	-104.870799	Douglas County
209436	Fee-for-Service	1578093050	1578093050	1	1	KANABOLO, BARIASA C	12/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 N EUCLID ST	STE 208	ANAHEIM	CA	92801	4132	30	06059	33.8420837	-117.9415765	Orange County
209437	Fee-for-Service	1982823936	1982823936	1	1	KULKARNI, SHUBHADA R MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92612	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
209446	Fee-for-Service	1689657512	1689657512	1	1	KENYON, NICHOLAS J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64546	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
209459	Fee-for-Service	1942239306	1942239306	1	1	KUMAR, DINESH MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84090	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
209462	Fee-for-Service	1164812327	1164812327	1	1	K & T PHARMACY, INC	5/5/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3116 E. CHAPMAN AVE	None	ORANGE	CA	92869	3708	30	06059	33.78777454	-117.8202105	Orange County
209469	Fee-for-Service	1487056982	1487056982	1	1	KUNNAWUTHIDEE, K MD INC	10/27/2014	261QP2300X	NA	Other	026	PHYSICIANS	35557	01	General Practice	0	In state provider	None	1300 N VERMONT AVE	STE 702	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
209480	Fee-for-Service	1427083211	1427083211	1	1	KELLY, BURNETT S MD JR	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83773	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
209526	Fee-for-Service	1518992114	1518992114	1	1	KIAHASHEMI, MASOUMEH LMFT	9/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
209556	Fee-for-Service	1437418167	1437418167	1	1	KIM, TAYLOR O MD	1/19/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	183682	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
209586	Fee-for-Service	1497483358	1497483358	1	1	KAMALPREET SINGH MD PC	7/16/2024	2085R0204X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ENTIONAL SPECIALISTS	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
209616	Fee-for-Service	1871906875	1871906875	1	1	KALANTARIAN, SHADI MD	7/20/2022	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	145597	None	None	0	In state provider	None	1950 UNIVERSITY AVE	STE 160	EAST PALO ALTO	CA	94303	2285	41	06081	37.45832977	-122.141591	San Mateo County
209636	Fee-for-Service	1982775896	1982775896	1	1	KHARESTAN, ARASH MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61501	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
209684	Fee-for-Service	1841397445	1841397445	2	1	KELLY, ROBERT R MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	665 WINTER ST SE	None	SALEM	OR	97301	3919	00	None	44.933211	-123.0355125	Marion County
209695	Fee-for-Service	1780615625	1780615625	1	1	KOB,ALEXANDER H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH STREET	None	VANCOUVER	WA	98682	2742	00	None	45.720117	-122.647986	Clark County
209711	Fee-for-Service	1376685644	1376685644	1	1	KEATING, LIAM MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	68204	04	Otology, Laryngology, Rhinology	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
209725	Fee-for-Service	1417902974	1417902974	1	1	KOSSUTH, SARA L DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5955	41	Internal Medicine	0	In state provider	S L K DO PC	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	93215	0000	36	06071	34.24602097	-116.8885243	San Bernardino County
209733	Fee-for-Service	1689657512	1689657512	1	1	KENYON, NICHOLAS J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64546	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
209755	Fee-for-Service	1487056982	1487056982	1	1	KUNNAWUTHIDEE, K MD INC	10/27/2014	261QP2300X	NA	Other	026	PHYSICIANS	35557	40	Pediatrics	0	In state provider	None	1300 N VERMONT AVE	STE 702	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
209765	Fee-for-Service	1720576796	1720576796	1	1	KADI, RAYYAN MD	9/7/2022	207P00000X	NA	Other	026	PHYSICIANS	176947	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
209767	Fee-for-Service	1598828345	1598828345	1	1	KIM, LAWRENCE Y MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71258	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
209786	Fee-for-Service	1487919445	1487919445	1	1	KURIAKOSE, KEVIN MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
209819	Fee-for-Service	1477574846	1477574846	1	1	KATZ, MICHAEL MD	2/20/2004	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	34537	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
209832	Fee-for-Service	1023558822	1023558822	1	1	KREPS, JANELLE LMFT	5/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
209909	Fee-for-Service	1962941203	1962941203	1	1	KAREMORE HOSPICE INC	7/5/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	505 S VILLA REAL	STE 211	ANAHEIM	CA	92807	3407	30	06059	33.83712262	-117.8220203	Orange County
209930	Fee-for-Service	1962402941	1962402941	1	1	KRAMER, JONATHAN MD	1/7/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	54187	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
209967	Fee-for-Service	1386799286	1386799286	1	2	KAISER FOUNDATION HOSPITALS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10605 BALBOA BLVD	STE 330	GRANADA HILLS	CA	91344	6358	19	06037	34.263378	-118.5022965	Los Angeles County
209971	Fee-for-Service	1356513402	1356513402	1	1	KWAN, ALICE MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121571	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
209993	Fee-for-Service	1134296908	1134296908	1	1	KIM, JEMY F NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
210005	Fee-for-Service	1639344229	1639344229	1	1	KUKREJA, NAVEEN MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
210016	Fee-for-Service	1417902974	1417902974	1	1	KOSSUTH, SARA L DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5955	66	Emergency Medicine (Urgent Care)	0	In state provider	S L K DO PC	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	93215	0000	36	06071	34.24602097	-116.8885243	San Bernardino County
210023	Fee-for-Service	1689657512	1689657512	1	1	KENYON, NICHOLAS J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64546	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
210047	Fee-for-Service	1407935539	1407935539	1	1	KWOK, CHI-WAI MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	50513	42	Nuclear Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
210089	Fee-for-Service	1801196894	1801196894	1	1	KAISER FOUNDATION HEALTH	1/19/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #336	1550 W MANCHESTER AVE	FLR 1	LOS ANGELES	CA	90047	5424	19	06037	33.95996247	-118.3043925	Los Angeles County
210145	Fee-for-Service	1205993623	1205993623	1	1	KHAN, SAIMA MD FAAP	3/26/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	95964	40	Pediatrics	0	In state provider	None	1271 ROSS AVE	None	EL CENTRO	CA	92243	4304	13	06025	32.78145047	-115.5673098	Imperial County
210160	Fee-for-Service	1376585349	1376585349	1	1	KATZ, CECILIA E MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	39012	41	Internal Medicine	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
210196	Fee-for-Service	1962941203	1962941203	1	1	KAREMORE HOSPICE INC	7/5/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	505 S VILLA REAL	STE 211	ANAHEIM	CA	92807	3407	30	06059	33.83712262	-117.8220203	Orange County
210200	Fee-for-Service	1366558678	1366558678	2	1	KHUAT, LIEN M NP	1/5/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DRIVE	SUITE 8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
210228	Fee-for-Service	1083899397	1083899397	1	1	KHADIVI, BAHRAM S MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100290	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
210255	Fee-for-Service	1386799286	1386799286	1	2	KAISER FOUNDATION HOSPITALS	8/30/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10605 BALBOA BLVD	STE 330	GRANADA HILLS	CA	91344	6358	19	06037	34.263378	-118.5022965	Los Angeles County
210261	Fee-for-Service	1750469474	1750469474	1	1	KOTAK, SHANU MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82984	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
210393	Fee-for-Service	1326107996	1326107996	1	1	KALMAN, ANNA MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55520	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
210428	Fee-for-Service	1073774873	1073774873	1	1	KARANJIA, NAVAZ P MD	10/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99879	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
210433	Fee-for-Service	1811973092	1811973092	1	1	KRISHNAMURTHY, ANITA MD	12/28/2007	207R00000X	NA	Other	026	PHYSICIANS	92332	41	Internal Medicine	0	In state provider	None	140 BROOKWOOD RD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
210448	Fee-for-Service	1578958682	1578958682	1	1	KAPPICO, JACLYN M MD	10/28/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	148463	None	None	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
210521	Fee-for-Service	1851596332	1851596332	1	1	KATKOV, WILLIAM M LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
210523	Fee-for-Service	1780755678	1780755678	1	1	KUSZTYK, GEORGE M OD	12/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6650 ALTON PKWY	None	IRVINE	CA	92618	3734	30	06059	33.65911992	-117.7737909	Orange County
210593	Fee-for-Service	1417016825	1417016825	1	1	KIDSPEACE CHILDRENS HOSPITAL	2/13/2013	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	4085 INDEPENDENCE DR	None	SCHNECKSVILLE	PA	18078	2574	00	None	40.65903125	-75.59904463	Lehigh County
210600	Fee-for-Service	1790779791	1790779791	1	1	KIM, STANLEY T MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151887	30	Radiology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
210601	Fee-for-Service	1225103286	1225103286	1	1	KIEFFER, JAMES R MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	22949	40	Pediatrics	0	In state provider	None	3796 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
210611	Fee-for-Service	1376199927	1376199927	1	1	KRAUSE, ADAM T PT	11/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
210615	Fee-for-Service	1457372823	1457372823	1	1	KATZ, JONATHAN S MD	1/1/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	54410	13	Neurology (M.D. only)	0	In state provider	None	505 CENTRAL AVE	STE 200	PACIFIC GROVE	CA	93950	2755	27	06053	36.62163848	-121.9151648	Monterey County
210619	Fee-for-Service	1972675700	1972675700	1	1	KUNG, BETTY J MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54734	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
210674	Fee-for-Service	1700164548	1700164548	1	1	KAISER FOUNDATION	4/23/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH PLAN INC	10305 PROMENADE PKWY	FL 1	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
210675	Fee-for-Service	1578701041	1578701041	1	1	KETTMANN, LAUREN E PSYD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
210683	Fee-for-Service	1689613408	1689613408	1	1	KIRSCH, DANIEL L MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	70339	30	Radiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
210809	Fee-for-Service	1912934050	1912934050	1	1	KERREY, BENJAMIN	2/19/2024	2080P0204X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
210871	Fee-for-Service	1235557075	1235557075	1	1	KHACHATRYAN, IRINA MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141010	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
210879	Fee-for-Service	1417016825	1417016825	1	1	KIDSPEACE CHILDRENS HOSPITAL	2/13/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	4085 INDEPENDENCE DR	None	SCHNECKSVILLE	PA	18078	2574	00	None	40.65903125	-75.59904463	Lehigh County
210901	Fee-for-Service	1235189994	1235189994	1	1	KUSSIN, LARRY MD	6/30/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20370	30	Radiology	0	In state provider	None	15243 VANOWEN ST	STE 106	VAN NUYS	CA	91405	3632	19	06037	34.19394848	-118.4654115	Los Angeles County
210905	Fee-for-Service	1982836771	1982836771	1	1	KENNARD, ELIZABETH N LMFT	5/25/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
210953	Fee-for-Service	1356346225	1356346225	1	1	KILMER, RENEE L M DO	3/10/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	8455	-	NOT APPLICABLE	0	In state provider	None	234 N MAGNOLIA AVE	None	EL CAJON	CA	92020	3906	37	06073	32.7970926	-116.9623736	San Diego County
210969	Fee-for-Service	1174066922	1174066922	1	1	KAMPE, KATHERINE L MD	12/12/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151336	08	Family Practice	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
210972	Fee-for-Service	1447424684	1447424684	1	1	KEELE, LINDA MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130572	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
210980	Fee-for-Service	1609940915	1609940915	1	1	KU, WILLIAM PAO CHUENG	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	60637	02	General Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
211008	Fee-for-Service	1316576606	1316576606	1	1	KOCHAR, MOHIT S DO	8/14/2023	207P00000X	NA	Other	026	PHYSICIANS	20934	None	None	0	In state provider	None	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
211016	Fee-for-Service	1831118876	1831118876	1	1	KUBAK, BERNARD M	7/31/1989	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	66501	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
211036	Fee-for-Service	1437237211	1437237211	1	1	KO, ANTHONY C MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67962	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
211067	Fee-for-Service	1801976089	1801976089	1	1	KAHN, YOUNG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1112 E MCDOWELL RD	None	PHOENIX	AZ	85006	2611	00	None	33.466041	-112.0577625	Maricopa County
211093	Fee-for-Service	1982065702	1982065702	1	1	KAISER FOUNDATION HEALTH	7/13/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	1450 10TH ST	FL 2	SANTA MONICA	CA	90401	2857	19	06037	34.01992119	-118.4882747	Los Angeles County
211096	Fee-for-Service	1912934050	1912934050	1	1	KERREY, BENJAMIN	2/19/2024	2080P0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
211099	Fee-for-Service	1023182953	1023182953	1	1	KAUTZKY, SHARI L	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
211165	Fee-for-Service	1538212337	1538212337	1	1	KONG, CHRISTINA MD	9/1/1998	207ZP0102X	NA	Other	026	PHYSICIANS	77567	22	Pathology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	BLDG 3	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
211199	Fee-for-Service	1912743246	1912743246	1	1	KUPERSHMIDT, DEMITRIA	8/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	19	06037	34.148637	-118.4312035	Los Angeles County
211207	Fee-for-Service	1952667883	1952667883	1	1	KARLSBERG, DANIEL W MD	7/29/2019	207R00000X	NA	Other	026	PHYSICIANS	141238	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
211245	Fee-for-Service	1477583110	1477583110	1	1	KORNDER, BEVERLEY G MD	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	48072	01	General Practice	0	In state provider	None	425 HAALAND DR	STE 103	THOUSAND OAKS	CA	91361	5230	56	06111	34.17512608	-118.8697623	Ventura County
211261	Fee-for-Service	1447424684	1447424684	1	1	KEELE, LINDA MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130572	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
211263	Fee-for-Service	1346669561	1346669561	1	1	KOHN, LUCINDA L MD	9/24/2024	207NP0225X	NA	Dermatology	026	PHYSICIANS	142093	07	Dermatology	0	In state provider	None	5000 CIVIC CENTER DR	None	SAN RAFAEL	CA	94903	4184	21	06041	38.006091	-122.539414	Marin County
211265	Fee-for-Service	1326704529	1326704529	1	1	KAWEAH DELTA HEALTH CARE DIS	1/3/2022	261QM1300X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	SURGERY CLINIC	505 W MAIN ST	STE. B	VISALIA	CA	93291	6237	54	06107	36.330003	-119.297097	Tulare County
211344	Fee-for-Service	1912924440	1912924440	1	1	KAMENA, MARK D PHD	1/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11 SAGEBRUSH CT	None	SAN RAFAEL	CA	94901	1591	21	06041	37.99137259	-122.4760844	Marin County
211370	Fee-for-Service	1295395051	1295395051	1	1	KOURY, ELLIOTT B MD	12/15/2022	207R00000X	NA	Other	026	PHYSICIANS	180974	41	Internal Medicine	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
211407	Fee-for-Service	1578727152	1578727152	1	1	KLINESTEKER, SHAWNA MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101699	41	Internal Medicine	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
211429	Fee-for-Service	1083031322	1083031322	1	1	KOBLENZ, ERIC T LMFT	7/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1934 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	2519	38	06075	37.7876268	-122.4403257	San Francisco County
211465	Fee-for-Service	1417222050	1417222050	1	1	KUO, DEBBIE S MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125172	18	Ophthalmology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
211503	Fee-for-Service	1104865625	1104865625	1	1	KHAN, RUKHSANA A MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52862	36	Psychiatry	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
211545	Fee-for-Service	1902302359	1902302359	1	1	KURIAKOSE, ROBIN K	6/21/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	163776	None	None	0	In state provider	None	1237 B ST	None	HAYWARD	CA	94541	2915	01	06001	37.67566503	-122.0786821	Alameda County
211612	Fee-for-Service	1609818103	1609818103	1	1	KENNEDY, AUDRA L CRNA	10/7/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
211614	Fee-for-Service	1285835033	1285835033	1	1	KENNEDY, PATRICIA E	9/1/2004	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7646 AIRLIE DR	None	TUJUNGA	CA	91042	1202	19	06037	34.2715602	-118.2986665	Los Angeles County
211651	Fee-for-Service	1528130523	1528130523	1	1	KATHIRIA, NAZIMA N DO	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10245	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
211652	Fee-for-Service	1235558313	1235558313	1	1	KHAN, FARAZ MD	12/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144193	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
211668	Fee-for-Service	1720048663	1720048663	1	1	KALAFUT, MARY A MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81598	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA PLAZA	STE B200	LOS ANGELES	CA	90024	0000	19	06037	34.06465655	-118.4461	Los Angeles County
211701	Fee-for-Service	1760645121	1760645121	1	1	KAO, JAMES C MD	10/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113337	10	Gastroenterology (M.D. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
211716	Fee-for-Service	1760530570	1760530570	1	1	KAISER PHARMACY MOB1	1/17/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION HEALTH PLAN	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
211743	Fee-for-Service	1164570974	1164570974	1	1	KHAN, SHAHZAD A MD	5/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51043	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
211753	Fee-for-Service	1699236471	1699236471	1	1	KAHL, NICOLAS MD	6/7/2023	207P00000X	NA	Other	026	PHYSICIANS	178400	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
211773	Fee-for-Service	1437160538	1437160538	1	1	KERR, DARREL K MD	3/3/2014	207R00000X	NA	Other	026	PHYSICIANS	75402	41	Internal Medicine	0	In state provider	None	815 COURT ST	STE 7	JACKSON	CA	95642	2154	03	06005	38.35293152	-120.7676346	Amador County
211818	Fee-for-Service	1295998300	1295998300	1	1	KERMANI, REZA MD	9/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111955	89	Surgery-Traumatic	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
211821	Fee-for-Service	1295346419	1295346419	1	1	KELLY, DYLAN L PT	1/26/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3901 LAS POSAS RD	STE 8	CAMARILLO	CA	93010	1502	56	06111	34.2415821	-119.0183756	Ventura County
211853	Fee-for-Service	1225068943	1225068943	1	1	KUNDA, UMA A MD	12/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91762	41	Internal Medicine	0	In state provider	None	2030 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
211861	Fee-for-Service	1467676460	1467676460	1	1	KIM, JOHN J MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100557	None	None	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
211872	Fee-for-Service	1952869851	1952869851	1	1	KATHLEEN A ROONEY MD INC	8/31/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	2277 FAIR OAKS BLVD	355	SACRAMENTO	CA	95825	5595	34	06067	38.575404	-121.4121195	Sacramento County
211910	Fee-for-Service	1467524546	1467524546	1	1	KAKU, ROY F MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30385	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
211917	Fee-for-Service	1548688328	1548688328	1	1	KBBA INC	11/13/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 E VALLEY BLVD	SUITE #103	SAN GABRIEL	CA	91776	6510	19	06037	34.07983028	-118.097176	Los Angeles County
211955	Fee-for-Service	1164929287	1164929287	1	1	KERR, LAUREN S CCC-SLP	8/2/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
212014	Fee-for-Service	1851602080	1851602080	1	1	KAREN M DANG	3/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
212025	Fee-for-Service	1891158663	1891158663	1	1	KHOO, KENDRICK M MD	8/1/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	151090	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
212031	Fee-for-Service	1164570974	1164570974	1	1	KHAN, SHAHZAD A MD	5/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51043	26	Psychiatry (child)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
212058	Fee-for-Service	1952408247	1952408247	1	1	KYAW, MYA S MD	8/20/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	88326	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
212062	Fee-for-Service	1437160538	1437160538	1	1	KERR, DARREL K MD	3/3/2014	207R00000X	NA	Other	026	PHYSICIANS	75402	01	General Practice	0	In state provider	None	815 COURT ST	STE 7	JACKSON	CA	95642	2154	03	06005	38.35293152	-120.7676346	Amador County
212088	Fee-for-Service	1568647691	1568647691	1	1	KOS, MICHAEL MD	6/12/2013	193400000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	A PROFESSIONAL CORPORATI	10745 DOUBLE R BLVD	BLDG 13	RENO	NV	89521	8979	00	None	39.42668697	-119.7515571	Washoe County
212159	Fee-for-Service	1710963095	1710963095	1	1	KOBASHI, LUIS I MD INC	4/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	21727	34	Urology and Urological Surgery	0	In state provider	None	1140 W LA VETA AVE	STE 750	ORANGE	CA	92868	4217	30	06059	33.7802984	-117.8651669	Orange County
212231	Fee-for-Service	1427596618	1427596618	1	1	KOFMAN, MARINA NP	7/28/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
212264	Fee-for-Service	1336465517	1336465517	1	1	KAHN, ESTELLE C MD	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123807	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
212290	Fee-for-Service	1013142348	1013142348	1	1	KARACHALIOS, MICHAEL D MD	1/16/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	149992	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
212350	Fee-for-Service	1225218522	1225218522	1	3	KATUKOTA, VIJAYA K MD	8/24/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	38220	-	NOT APPLICABLE	0	In state provider	None	109 E 11TH ST	SUITE 1	CORONA	CA	92879	2157	33	06065	33.87018535	-117.5668144	Riverside County
212351	Fee-for-Service	1639385479	1639385479	1	1	KIM, KAREN C MD	12/12/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	182389	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
212363	Fee-for-Service	1831438613	1831438613	1	1	KOZLOWSKI, LISA LCSW	9/18/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2813 S MAIN ST	None	CORONA	CA	92882	5942	33	06065	33.84741266	-117.570694	Riverside County
212396	Fee-for-Service	1356838809	1356838809	1	1	KIM, EDWARD MD	2/11/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
212399	Fee-for-Service	1245437730	1245437730	1	1	KADON HINTZ M.D.	5/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
212416	Fee-for-Service	1932200672	1932200672	1	1	KONZEN, LARRY T MD	9/30/1980	207R00000X	NA	Other	026	PHYSICIANS	43960	41	Internal Medicine	0	In state provider	None	6475 ALVARADO RD	STE 225	SAN DIEGO	CA	92120	5013	37	06073	32.77826653	-117.061265	San Diego County
212421	Fee-for-Service	1891791133	1891791133	1	1	KUTZSCHER, BERND M MD	11/21/1996	207W00000X	NA	Ophthalmology	026	PHYSICIANS	53132	18	Ophthalmology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
212422	Fee-for-Service	1952372831	1952372831	1	1	KAY ESTHER CASE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 SE STRATUS AVE	UNIT 405	MCMINNVILLE	OR	97128	6258	00	None	45.20010494	-123.1656951	Yamhill County
212433	Fee-for-Service	1548512809	1548512809	1	1	KHATIBI, KASRA MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127670	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
212444	Fee-for-Service	1740800457	1740800457	1	1	KHETARPAL, ANUJ MD	11/25/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
212514	Fee-for-Service	1881642700	1881642700	1	1	KAPLAN, GLENN S MD	11/8/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	141201	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
212517	Fee-for-Service	1760588578	1760588578	1	1	KVASNICKA, ANNA L MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75525	01	General Practice	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
212531	Fee-for-Service	1568994184	1568994184	1	1	KRAUSE, ANDREW MD	8/2/2021	207R00000X	NA	Other	026	PHYSICIANS	171917	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
212567	Fee-for-Service	1699799601	1699799601	1	1	KATZIN, DAVID SM MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33424	18	Ophthalmology	0	In state provider	None	8631 W 3RD ST	STE 610E	LOS ANGELES	CA	90048	5910	19	06037	34.07361928	-118.3803143	Los Angeles County
212570	Fee-for-Service	1003901810	1003901810	1	1	KALAVATI PAILA	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
212583	Fee-for-Service	1821254848	1821254848	1	1	KAISER FOUNDATION HEALTH	1/30/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #525	27309 MADISON AVE	1ST FLR	TEMECULA	CA	92590	5685	33	06065	33.52449693	-117.166286	Riverside County
212624	Fee-for-Service	1952938425	1952938425	1	1	KOH, JENNIFER J MD	6/22/2023	208M00000X	NA	Other	026	PHYSICIANS	185414	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
212633	Fee-for-Service	1902914773	1902914773	1	1	KIM, JUNG H MD	7/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37421	40	Pediatrics	0	In state provider	None	18614 SHERMAN WAY	None	RESEDA	CA	91335	4138	19	06037	34.20102454	-118.539117	Los Angeles County
212683	Fee-for-Service	1205276425	1205276425	1	1	KRIEGER, ANDREW R MD	12/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141271	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
212685	Fee-for-Service	1922644988	1922644988	1	1	KURAMOTO, ERI NP	6/18/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
212744	Fee-for-Service	1265423917	1265423917	1	1	KINGMAN HEALTHCARE, INC	3/27/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DICAL CENTER	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3691	00	None	35.220006	-114.0380145	Mohave County
212748	Fee-for-Service	1982040259	1982040259	1	1	KARDASHIAN, ANI A MD	10/1/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	135171	10	Gastroenterology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
212761	Fee-for-Service	1639332786	1639332786	1	1	KEYASHIAN, PEYMAN MD	9/12/2012	207L00000X	NA	Other	026	PHYSICIANS	121564	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
212780	Fee-for-Service	1649658212	1649658212	1	1	KWONG, MICHAEL MD	4/30/2021	207R00000X	NA	Other	026	PHYSICIANS	162758	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
212791	Fee-for-Service	1548588239	1548588239	1	1	KNEDEL, MATTHEW MD	1/29/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	120052	None	None	0	In state provider	None	1377 E HERNDON AVE	STE 104	FRESNO	CA	93720	3022	10	06019	36.83704387	-119.7641113	Fresno County
212821	Fee-for-Service	1407210537	1407210537	1	1	KOLODGE, GAVIN M DO	9/4/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	18281	20	Orthopedic Surgery	0	In state provider	None	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
212832	Fee-for-Service	1992851422	1992851422	1	1	KONKEL-WHITE, SUSAN M LMFT	9/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1881 COMMERCENTER DRIVE	SUITE 232	SAN BERNARDINO	CA	92408	3479	36	06071	34.06789529	-117.2822533	San Bernardino County
212862	Fee-for-Service	1649315698	1649315698	1	1	KWONG, YAT-CHOI	12/31/1990	2080P0201X	NA	Neurology	026	PHYSICIANS	71385	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
212865	Fee-for-Service	1386831097	1386831097	1	1	KAILA, GURJEET R	5/19/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2195 E PROSPERITY AVENUE	None	TULARE	CA	93274	7754	54	06107	36.2258605	-119.314602	Tulare County
212891	Fee-for-Service	1588155477	1588155477	1	1	KIM, CHRISTOPHER S MD	3/7/2022	208600000X	NA	General Surgery	026	PHYSICIANS	174317	None	None	0	In state provider	None	7901 SANTA MONICA BLVD	STE 101	WEST HOLLYWOOD	CA	90046	5178	19	06037	34.09089561	-118.3615405	Los Angeles County
212895	Fee-for-Service	1386645497	1386645497	1	1	KIM, JOHN I MD	4/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43769	05	Anesthesiology	0	In state provider	None	2700 DOLBER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
212903	Fee-for-Service	1598843310	1598843310	1	1	KHANNA, ATUL K MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66763	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
212932	Fee-for-Service	1376375881	1376375881	1	1	KAISER FOUNDATION HEALTH PLA	1/7/2025	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	991	1930 N DAVIS RD	FL 1 RM 01R240	SALINAS	CA	93907	2533	27	06053	36.7195222	-121.6679785	Monterey County
212942	Fee-for-Service	1437278603	1437278603	1	1	KHODDAMI, SEYED M MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109665	34	Urology and Urological Surgery	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
212972	Fee-for-Service	1710921457	1710921457	1	1	KOPEL, ROBERT F MD	9/1/1995	207L00000X	NA	Other	026	PHYSICIANS	41029	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
212988	Fee-for-Service	1851553424	1851553424	1	1	KHAN, JAVAID M DO	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13876	03	Allergy	0	In state provider	None	7471 N FRESNO STREET	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
213020	Fee-for-Service	1750341673	1750341673	1	1	KERSHAW, ROBERT J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62020	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
213027	Fee-for-Service	1265423917	1265423917	1	1	KINGMAN HEALTHCARE, INC	12/1/1978	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DICAL CENTER	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3691	00	None	35.220006	-114.0380145	Mohave County
213032	Fee-for-Service	1538439963	1538439963	1	1	KORDIC, KAIA M LMFT	5/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2386 BRIARWOOD CIR	None	EUREKA	CA	95503	7500	12	06023	40.73131725	-124.1415582	Humboldt County
213058	Fee-for-Service	1336675198	1336675198	1	1	KASAP, CORYNN S MD	6/26/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	162743	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
213063	Fee-for-Service	1811254386	1811254386	1	1	KHAMISA, SORAIYA LCSW	9/15/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
213075	Fee-for-Service	1609849876	1609849876	1	1	KIM, BRIAN HWAN MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79339	41	Internal Medicine	0	In state provider	None	5301 F ST	STE 117	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
213081	Fee-for-Service	1376807990	1376807990	1	1	KULKARNI, GANESH MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136635	41	Internal Medicine	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
213090	Fee-for-Service	1225472152	1225472152	1	1	KATHY GERAETS	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4405 E 26TH ST	None	SIOUX FALLS	SD	57103	4187	00	None	43.528572	-96.6732075	Minnehaha County
213104	Fee-for-Service	1023039468	1023039468	1	1	KENNETH M LITTLE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	1309	00	None	43.61455048	-116.256231	Ada County
213113	Fee-for-Service	1841220621	1841220621	1	1	KHADAVI, ALAN O MD	7/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109088	03	Allergy	0	In state provider	None	2809 TWEEDY BLVD	None	SOUTH GATE	CA	90280	2938	19	06037	33.94599284	-118.2211199	Los Angeles County
213123	Fee-for-Service	1336432608	1336432608	1	1	KNICKERBOCKER, PETER F	6/22/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	12420	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
213126	Fee-for-Service	1073533899	1073533899	1	1	KUPFER, DAVID M MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57621	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
213130	Fee-for-Service	1982863759	1982863759	1	1	KIM, JORGE S MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109844	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
213159	Fee-for-Service	1053724476	1053724476	1	2	KHAN, ZARA M MD	8/28/2017	390200000X	NA	Other	026	PHYSICIANS	137632	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
213169	Fee-for-Service	1326116799	1326116799	1	1	KAVIPURAPU, PRABHAKAR MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50693	None	None	0	In state provider	None	555 TACHEVAH DR	2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
213205	Fee-for-Service	1902011620	1902011620	1	1	KEITH, MELANIE LAC	12/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
213213	Fee-for-Service	1013227099	1013227099	1	1	KND DEVELOPMENT 54 LLC	11/1/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2224 MEDICAL CENTER DR	None	PERRIS	CA	92571	5638	33	06065	33.8123212	-117.2217309	Riverside County
213232	Fee-for-Service	1043716038	1043716038	1	1	KHETAN, VARUN MD DO	8/9/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164962	None	None	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
213241	Fee-for-Service	1245838325	1245838325	1	1	KAFKAS, KATERINA E CNP	3/4/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
213244	Fee-for-Service	1477874071	1477874071	1	1	KORMAN, SHERRI M MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130728	07	Dermatology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
213285	Fee-for-Service	1912950890	1912950890	1	1	KLEINHENZ, MARY E MD	6/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87357	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
213308	Fee-for-Service	1750341673	1750341673	1	1	KERSHAW, ROBERT J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62020	08	Family Practice	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
213323	Fee-for-Service	1215498936	1215498936	1	1	KING, KASSANDRA A DO	1/7/2025	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	20242	38	Geriatrics	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
213345	Fee-for-Service	1124124540	1124124540	1	2	KOEHNE, WILLIAM	11/7/1981	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21938	None	None	0	In state provider	None	610 E ROMIE LN	None	SALINAS	CA	93901	4209	27	06053	36.65952777	-121.6444287	Monterey County
213348	Fee-for-Service	1437177755	1437177755	1	1	KIDD, VALERIE J MD	10/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56027	01	General Practice	0	In state provider	None	800 DOUGLAS RD	None	STOCKTON	CA	95207	3607	39	06077	38.00786919	-121.3210892	San Joaquin County
213361	Fee-for-Service	1609849876	1609849876	1	1	KIM, BRIAN HWAN MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79339	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5301 F ST	STE 117	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
213389	Fee-for-Service	1346305786	1346305786	1	1	KAMEN,AURORA A MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54754	40	Pediatrics	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
213400	Fee-for-Service	1235549692	1235549692	1	1	KARAVAN JAHROMI, MAHSA MD	2/25/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	155708	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
213403	Fee-for-Service	1588806228	1588806228	1	1	KHORASANI, SARA MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121696	13	Neurology (M.D. only)	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
213408	Fee-for-Service	1285665422	1285665422	1	1	KEFALAS, STEPHEN G MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109465	66	Emergency Medicine (Urgent Care)	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
213429	Fee-for-Service	1558625798	1558625798	1	1	KOSARI, KAMBIZ MD INC	10/24/2012	208600000X	NA	General Surgery	026	PHYSICIANS	94773	02	General Surgery	0	In state provider	None	6850 SEPULVEDA BLVD	STE 210	VAN NUYS	CA	91405	4446	19	06037	34.1955	-118.4661705	Los Angeles County
213438	Fee-for-Service	1215026869	1215026869	1	1	KANEKO, RYAN J MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82219	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
213475	Fee-for-Service	1558313809	1558313809	1	1	KRISTEN SEAMAN MD	8/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 BOWER HILL RD	None	PITTSBURGH	PA	15243	1873	00	None	40.37744491	-80.06601413	Allegheny County
213499	Fee-for-Service	1013227099	1013227099	1	1	KND DEVELOPMENT 54 LLC	11/1/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2224 MEDICAL CENTER DR	None	PERRIS	CA	92571	5638	33	06065	33.8123212	-117.2217309	Riverside County
213501	Fee-for-Service	1629436514	1629436514	1	1	KRYSTAL PHAM OB/GYN INC	2/18/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	ER	11160 WARNER AVE	219	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71630854	-117.934317	Orange County
213560	Fee-for-Service	1548278534	1548278534	1	1	KARL JOHSENS MD & DRUSILLA	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	LDH LEE MD INC	540 SOQUEL AVE	None	SANTA CRUZ	CA	95062	2353	44	06087	36.97609942	-122.0170592	Santa Cruz County
213562	Fee-for-Service	1417117417	1417117417	1	1	KIURU, MAIJA H MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130177	07	Dermatology	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
213600	Fee-for-Service	1336607506	1336607506	1	1	KAISER FOUNDATION HEALTH PLA	5/7/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #061	3100 DUBLIN BLVD	FL 1	DUBLIN	CA	94568	4363	01	06001	37.70453535	-121.8586496	Alameda County
213612	Fee-for-Service	1215498936	1215498936	1	1	KING, KASSANDRA A DO	1/7/2025	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	20242	41	Internal Medicine	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
213629	Fee-for-Service	1114005279	1114005279	1	1	KWAN, ARDEN J F MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50697	42	Nuclear Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
213633	Fee-for-Service	1396935698	1396935698	1	1	KAIRYS, CHARLES F PHD	10/27/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3625 E THOUSAND OAKS BLV	SUITE 209	WESTLAKE VILLAGE	CA	91362	3566	56	06111	34.16480359	-118.8299997	Ventura County
213711	Fee-for-Service	1255673646	1255673646	1	1	KLEEN, JONATHAN K MD	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134638	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
213730	Fee-for-Service	1720163363	1720163363	1	1	KARTUN, KAREN F MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	71674	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
213742	Fee-for-Service	1851154694	1851154694	1	1	KIARIE, MONICAH WANJIRU	3/13/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14072 SPRINGWATER LN	None	EASTVALE	CA	92880	8596	33	06065	33.94259429	-117.5901375	Riverside County
213769	Fee-for-Service	1164470647	1164470647	1	1	KAO, LISA MD	12/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53552	40	Pediatrics	0	In state provider	None	191 S BUENA VISTA ST	SUITE 240	BURBANK	CA	91505	4559	19	06037	34.15872557	-118.3283863	Los Angeles County
213783	Fee-for-Service	1548759269	1548759269	1	1	KOUTASSEVITCH, KATRIN L LCSW	11/5/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
213786	Fee-for-Service	1871639682	1871639682	1	1	KHIN, HENRY H MD	3/21/2011	2084P0800X	NA	Psychiatry	026	PHYSICIANS	64156	None	None	0	In state provider	None	2331 EL CAPITAN AVE	None	ARCADIA	CA	91006	5112	19	06037	34.11182269	-118.0283426	Los Angeles County
213821	Fee-for-Service	1861783904	1861783904	1	1	KHAN, MARYAM MD	2/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124614	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
213826	Fee-for-Service	1124035266	1124035266	1	1	KEMPERT, PAMELA MD	5/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	35851	68	Hematology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
213865	Fee-for-Service	1750500609	1750500609	1	1	KALIOUNDJI, GUS MD	7/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89365	25	Physical Medicine and Rehabilitation	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
213874	Fee-for-Service	1114028453	1114028453	1	1	KWOK, ROBERT MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	46470	40	Pediatrics	0	In state provider	None	825 POLLARD ROAD	SUITE 108	LOS GATOS	CA	95032	1435	43	06085	37.26258492	-121.9706149	Santa Clara County
213893	Fee-for-Service	1922423201	1922423201	1	1	KOPINGA, ELAINE NP	7/11/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	16147 WHITTIER BLVD	None	WHITTIER	CA	90603	2560	19	06037	33.94157588	-117.9859969	Los Angeles County
213911	Fee-for-Service	1194979856	1194979856	1	1	KAURA, NEIL V MD	3/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
213916	Fee-for-Service	1851337059	1851337059	1	1	KING, RICKEY D MD	7/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	280 MAPLE	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
213933	Fee-for-Service	1457332843	1457332843	1	1	KUHARIK, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 ALBANY ST	STE 9066	BEECH GROVE	IN	46107	1555	00	None	39.7235553	-86.09943399	Marion County
213946	Fee-for-Service	1477900751	1477900751	1	1	KOURA MD INC	6/7/2016	193400000X	NA	Other	026	PHYSICIANS	125775	77	Infectious Disease	0	In state provider	None	751 MEDICAL CENTER DR	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
213947	Fee-for-Service	1528228251	1528228251	1	1	KASKOWITZ, ALEXA P MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131503	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
213949	Fee-for-Service	1962409938	1962409938	1	1	KNUTSON, THOMAS R MD INC	12/21/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	50268	20	Orthopedic Surgery	0	In state provider	None	161 N DATE ST	None	ESCONDIDO	CA	92025	3405	37	06073	33.12662288	-117.070312	San Diego County
213980	Fee-for-Service	1972597094	1972597094	1	1	KONG, ANTHONY K MD	3/28/1994	207L00000X	NA	Other	026	PHYSICIANS	69744	05	Anesthesiology	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
213991	Fee-for-Service	1700435716	1700435716	1	1	KOMODA, LEANNE PT	4/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10900 WARNER AVE	STE 117	FOUNTAIN VALLEY	CA	92708	7203	30	06059	33.71628153	-117.9388215	Orange County
214033	Fee-for-Service	1851154694	1851154694	1	1	KIARIE, MONICAH WANJIRU	3/13/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14072 SPRINGWATER LN	None	EASTVALE	CA	92880	8596	33	06065	33.94259429	-117.5901375	Riverside County
214066	Fee-for-Service	1508132093	1508132093	1	1	KRULL, LEAH K MD	2/4/2020	207RR0500X	NA	Other	026	PHYSICIANS	166603	41	Internal Medicine	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
214067	Fee-for-Service	1043564362	1043564362	1	1	KATARIA, HARDEEP K OD	5/6/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44815 FIG AVE	None	LANCASTER	CA	93534	3144	19	06037	34.69630244	-118.1431105	Los Angeles County
214068	Fee-for-Service	1578527008	1578527008	1	1	KWO, PAUL Y MD	12/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145613	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
214098	Fee-for-Service	1346392727	1346392727	1	1	KOH, PATRICIA J MD	6/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90949	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
214108	Fee-for-Service	1568660538	1568660538	1	1	KAO, SARAH W MD	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102786	None	None	0	In state provider	None	455 HICKEY BLVD	STE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
214120	Fee-for-Service	1740487164	1740487164	1	1	KANDIS, STEPHEN A LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
214158	Fee-for-Service	1942696380	1942696380	1	1	KATZ, BRYAN D DPM	7/7/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15366 ELEVENTH STREET	SUITE A	VICTORVILLE	CA	92395	3726	36	06071	34.530156	-117.292539	San Bernardino County
214198	Fee-for-Service	1154681278	1154681278	1	1	KARUNAMUNI, JENNIFER F MD	12/6/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	128958	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
214227	Fee-for-Service	1063755734	1063755734	1	1	KIM, KEVIN H MD	8/9/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	152384	07	Dermatology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
214232	Fee-for-Service	1831759505	1831759505	1	1	KIM, CHRISTINA I OD	11/15/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
214233	Fee-for-Service	1497924294	1497924294	1	1	KIM, ESTHER MD	1/27/2011	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	84017	25	Physical Medicine and Rehabilitation	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
214237	Fee-for-Service	1477900751	1477900751	1	1	KOURA MD INC	6/7/2016	193400000X	NA	Other	026	PHYSICIANS	125775	41	Internal Medicine	0	In state provider	None	751 MEDICAL CENTER DR	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
214248	Fee-for-Service	1639405178	1639405178	1	1	KASED, NORBERT MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110689	78	Neoplastic Diseases/Oncology	0	In state provider	None	916 SYCAMORE AVE	None	VISTA	CA	92081	7815	37	06073	33.15990889	-117.2205717	San Diego County
214260	Fee-for-Service	1548531965	1548531965	1	1	KALL, RONALD J JR MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123112	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
214275	Fee-for-Service	1508290586	1508290586	1	1	KANEL, JASON A MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147060	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
214284	Fee-for-Service	1275952376	1275952376	1	1	KATHERINE M BECKETT MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
214286	Fee-for-Service	1235583360	1235583360	1	1	KAMYAB, MARIAM CNP	5/19/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4700 NORTHGATE BLVD	STE 100	SACRAMENTO	CA	95834	1149	34	06067	38.654262	-121.4770455	Sacramento County
214288	Fee-for-Service	1831478528	1831478528	1	1	KO, JOCELYN MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141259	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	STE 270	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
214337	Fee-for-Service	1932287554	1932287554	1	1	KAN, TIN-NA J MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82980	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
214352	Fee-for-Service	1518485937	1518485937	1	1	KUO, SUYEU	3/10/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
214354	Fee-for-Service	1508132093	1508132093	1	1	KRULL, LEAH K MD	2/4/2020	207RR0500X	NA	Other	026	PHYSICIANS	166603	83	Rheumatology	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
214355	Fee-for-Service	1578527008	1578527008	1	1	KWO, PAUL Y MD	12/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145613	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
214363	Fee-for-Service	1699822916	1699822916	1	1	KAISER FOUND HP PHCY	4/11/1979	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
214364	Fee-for-Service	1235198581	1235198581	1	1	KERR, ROGER M MD	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49498	30	Radiology	0	In state provider	None	2501 S HOPE ST	None	LOS ANGELES	CA	90007	2667	19	06037	34.02798845	-118.2731102	Los Angeles County
214383	Fee-for-Service	1093121535	1093121535	1	1	KORSHUNOVA, TATIANA MD	11/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131077	41	Internal Medicine	0	In state provider	None	3288 BELL ROAD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
214385	Fee-for-Service	1740202134	1740202134	1	1	KAPUR, VENKATESHWAR E MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91698	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
214390	Fee-for-Service	1114193489	1114193489	1	1	KNOPP, KEVIN M CRNA	10/13/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
214407	Fee-for-Service	1073903878	1073903878	1	1	KWOFIE, INA B LCSW	6/26/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
214430	Fee-for-Service	1255663308	1255663308	1	1	KNIGHT, TANYA M	12/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
214464	Fee-for-Service	1003292426	1003292426	1	1	KATSUYAMA, YVONNE D	1/3/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3017 DOUGLAS BLVD.	220	ROSEVILLE	CA	95661	3836	31	06061	38.74412077	-121.232331	Placer County
214576	Fee-for-Service	1134626047	1134626047	1	1	KIM, KEVIN Y MD	4/3/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163905	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
214595	Fee-for-Service	1740936111	1740936111	1	1	KENDALL, RACHAEL CNP	7/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1792 GARNET AVE	None	SAN DIEGO	CA	92109	3350	37	06073	32.80054833	-117.2374979	San Diego County
214624	Fee-for-Service	1730190281	1730190281	1	1	KHONSARI, SEPEHR MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85324	25	Physical Medicine and Rehabilitation	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
214681	Fee-for-Service	1326451436	1326451436	1	1	KJELLSSON, KRISTINE B MD	3/22/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158013	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
214689	Fee-for-Service	1205403862	1205403862	1	1	KU, TIFFANY MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	182539	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
214704	Fee-for-Service	1659940534	1659940534	1	1	KATHLEEN TELSER, LMFT, PSYCH	6/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	OLOGY, INC	1910 HUNTINGTON DR	18	SOUTH PASADENA	CA	91030	4887	19	06037	34.10428151	-118.143801	Los Angeles County
214747	Fee-for-Service	1245685635	1245685635	1	1	KHURANA, STEFFI M MD	2/16/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	164578	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
214763	Fee-for-Service	1215027347	1215027347	1	1	KAUR,SUMANDEEP MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97162	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
214770	Fee-for-Service	1639589278	1639589278	1	1	KAO, MANDY C MD	3/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140774	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
214803	Fee-for-Service	1508939943	1508939943	1	1	KMA EMERGENCY SERVICES	5/17/1995	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WESTMED AMBULANCE SRVC	3972 BARRANCA PARKWAY	SUITE J430	IRVINE	CA	92606	8656	30	06059	33.68533162	-117.810266	Orange County
214805	Fee-for-Service	1386966927	1386966927	1	1	KILIAN, CAROLINE A MD	4/8/2014	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	114652	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
214825	Fee-for-Service	1831359348	1831359348	1	1	KRINGS, GREGOR MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112244	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
214828	Fee-for-Service	1568540243	1568540243	1	1	KIRNON, ROSALIND A MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50546	04	Otology, Laryngology, Rhinology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
214872	Fee-for-Service	1346862323	1346862323	1	1	KUCHMENKO, INNA LMFT	10/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
214894	Fee-for-Service	1457633919	1457633919	1	1	KIM, DONG H MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112453	30	Radiology	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
214945	Fee-for-Service	1831432764	1831432764	1	1	KITTLE, JESSIE T MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131953	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
214981	Fee-for-Service	1508062738	1508062738	1	1	KASSABIAN, GARBIS MD INC	8/28/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	A PROFESSIONAL CORP	14901 RINALDI ST	STE 305	MISSION HILLS	CA	91345	1204	19	06037	34.27903452	-118.457433	Los Angeles County
215013	Fee-for-Service	1669992137	1669992137	1	1	KAKKAR, AYOOSH MD	9/8/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170029	None	None	0	In state provider	None	801 SENECA ST	STE 340	VENTURA	CA	93001	1411	56	06111	34.30762576	-119.2837994	Ventura County
215028	Fee-for-Service	1790886034	1790886034	1	1	KWOK, ESTER C MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	50957	41	Internal Medicine	0	In state provider	None	825 POLLARD ROAD	SUITE 108	LOS GATOS	CA	95032	1435	43	06085	37.26258492	-121.9706149	Santa Clara County
215042	Fee-for-Service	1770745119	1770745119	1	1	KAPOOR, SHREYA MD	3/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116505	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
215046	Fee-for-Service	1568868289	1568868289	1	1	KEMP, MARY S LMFT	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
215049	Fee-for-Service	1912908880	1912908880	1	1	KARR, DANIEL J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PRWY	None	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
215057	Fee-for-Service	1457507527	1457507527	1	1	KIM, CHARLES B MD	8/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89105	6205	00	None	36.135288	-115.1368705	Clark County
215074	Fee-for-Service	1184609943	1184609943	1	1	KON, ALEXANDER A MD	8/12/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54894	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
215085	Fee-for-Service	1518346717	1518346717	1	1	KING, KRISTIN H MD	2/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145288	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
215120	Fee-for-Service	1811942238	1811942238	1	1	KPH-CONSOLIDATION, INC.	12/2/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	22999 US HIGHWAY 59 N	None	KINGWOOD	TX	77339	4438	00	None	30.05048643	-95.25299941	Montgomery County
215168	Fee-for-Service	1295437499	1295437499	1	1	KHALAF, HAYA PT	10/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
215194	Fee-for-Service	1487623948	1487623948	1	1	KING, LAURA A MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	32685	None	None	0	In state provider	None	3772 KATELLA AVE	STE 206	LOS ALAMITOS	CA	90720	6428	30	06059	33.8029895	-118.0670445	Orange County
215238	Fee-for-Service	1649711391	1649711391	1	1	KIM, ANGELA Y DO	8/30/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	18991	None	None	0	In state provider	None	350 DEL NORTE AVENUE	None	YUBA CITY	CA	95991	4123	51	06101	39.14502655	-121.615685	Sutter County
215269	Fee-for-Service	1508062738	1508062738	1	1	KASSABIAN, GARBIS MD INC	11/1/2000	193400000X	NA	Other	026	PHYSICIANS	79982	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	14901 RINALDI ST	STE 305	MISSION HILLS	CA	91345	1204	19	06037	34.27903452	-118.457433	Los Angeles County
215273	Fee-for-Service	1114925898	1114925898	1	1	KAPLOVE, CHARLES MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42208	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
215293	Fee-for-Service	1851417547	1851417547	1	1	KAISER FOUNDATION HOSP	1/18/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
215300	Fee-for-Service	1811040132	1811040132	1	1	KPI INC	1/1/2002	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29525 CANWOOD ST	None	AGOURA HILLS	CA	91301	4233	19	06037	34.14724223	-118.7675471	Los Angeles County
215355	Fee-for-Service	1184119653	1184119653	1	1	KASTELOWITZ-LIEBERMAN, NOAH	6/26/2023	2085R0001X	NA	Other	026	PHYSICIANS	163626	None	None	0	In state provider	MD	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
215357	Fee-for-Service	1174670491	1174670491	1	1	KAISER PERMANENTE	7/9/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #553	1255 W ARROW HWY	None	SAN DIMAS	CA	91773	2340	19	06037	34.10676133	-117.8312617	Los Angeles County
215378	Fee-for-Service	1912910357	1912910357	1	1	KONG, JANE BOMEEN MD	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	97227	01	General Practice	0	In state provider	None	16510 BLOOMFIELD AVE	None	CERRITOS	CA	90703	9346	19	06037	33.88108335	-118.0639087	Los Angeles County
215410	Fee-for-Service	1811942238	1811942238	1	1	KPH-CONSOLIDATION, INC.	12/2/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	22999 US HIGHWAY 59 N	None	KINGWOOD	TX	77339	4438	00	None	30.05048643	-95.25299941	Montgomery County
215417	Fee-for-Service	1336438670	1336438670	1	1	KELLEY, KANWAR S MD	6/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123114	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
215449	Fee-for-Service	1285176941	1285176941	1	1	KANG, SUSANNAH K LAC	7/10/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	9872 CHAPMAN AVE	STE 114	GARDEN GROVE	CA	92841	2718	30	06059	33.78849498	-117.9605144	Orange County
215507	Fee-for-Service	1902971583	1902971583	1	1	KRAWETZ, ADRIENNE L LMFT	1/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1022 W HEDDING ST	None	SAN JOSE	CA	95126	1245	43	06085	37.34156642	-121.9218482	Santa Clara County
215530	Fee-for-Service	1861805756	1861805756	1	1	KALIDASU, SAILAJA MD	7/4/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
215554	Fee-for-Service	1508992108	1508992108	1	1	KISTLER, HENRY B JR MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132141	18	Ophthalmology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
215557	Fee-for-Service	1508062738	1508062738	1	1	KASSABIAN, GARBIS MD INC	8/28/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	14901 RINALDI ST	STE 305	MISSION HILLS	CA	91345	1204	19	06037	34.27903452	-118.457433	Los Angeles County
215625	Fee-for-Service	1972864700	1972864700	1	1	KANNAN, INDU MD	6/13/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	136809	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
215628	Fee-for-Service	1043733827	1043733827	1	1	KIM, DALILA NP	5/9/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
215639	Fee-for-Service	1528271517	1528271517	1	1	KOLE, MICHELLE L PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2760 FIFTH AVE	#205	SAN DIEGO	CA	92103	6325	37	06073	32.734269	-117.1603475	San Diego County
215644	Fee-for-Service	1598813511	1598813511	1	1	KIM, DENNIS H MD	8/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86556	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
215659	Fee-for-Service	1023002953	1023002953	1	1	KERMAN, BENJAMIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MT AUBURN PROFESSIONAL	330 MT AUBURN STREET	None	CAMBRIDGE	MA	02238	0000	00	None	42.373899	-71.1342405	Middlesex County
215663	Fee-for-Service	1407821283	1407821283	1	1	KLAUSNER, TODD S MD	11/5/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	169204	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
215694	Fee-for-Service	1578792891	1578792891	1	1	KAO, KELLY C OD	9/21/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
215739	Fee-for-Service	1568132249	1568132249	1	1	KARTAN, SHIV CNP	3/15/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
215751	Fee-for-Service	1053451328	1053451328	1	1	KAVEH, KIAN DO	9/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11542	41	Internal Medicine	0	In state provider	None	520 WEST I STREET	None	LOS BANOS	CA	93635	3419	24	06047	37.06346603	-120.8593647	Merced County
215783	Fee-for-Service	1669531463	1669531463	1	1	KANG, JOHN C MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84086	02	General Surgery	0	In state provider	None	3130 W OLYMPIC BLVD	STE 340	LOS ANGELES	CA	90006	2494	19	06037	34.05258529	-118.3039795	Los Angeles County
215784	Fee-for-Service	1447693916	1447693916	1	1	KLICK, ANASTASIA R MD	3/2/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	143114	08	Family Practice	0	In state provider	None	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
215804	Fee-for-Service	1700016854	1700016854	1	1	KHAN, WAQAS A MD	3/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108929	41	Internal Medicine	0	In state provider	None	2101 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
215823	Fee-for-Service	1407387822	1407387822	1	1	KREICHER, KATHRYN MD	11/6/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	None	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
215834	Fee-for-Service	1952125106	1952125106	1	1	KLINE, TESSA J PT	12/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
215836	Fee-for-Service	1821296591	1821296591	1	1	KAWAYEH, ANAS MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109588	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
215844	Fee-for-Service	1508062738	1508062738	1	1	KASSABIAN, GARBIS MD INC	8/28/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	A PROFESSIONAL CORP	14901 RINALDI ST	STE 305	MISSION HILLS	CA	91345	1204	19	06037	34.27903452	-118.457433	Los Angeles County
215863	Fee-for-Service	1629050430	1629050430	1	1	KUMAR, SAMUEL P MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42476	01	General Practice	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
215871	Fee-for-Service	1588655898	1588655898	1	1	KWAK, CHRISTINE M MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88325	20	Orthopedic Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
215876	Fee-for-Service	1215188693	1215188693	1	1	KIM, CARLEN E	5/3/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
215880	Fee-for-Service	1104244490	1104244490	1	1	KAISER FOUNDATION HEALTH	9/1/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	25821 S VERMONT AVE	FL 1	HARBOR CITY	CA	90710	3518	19	06037	33.78934581	-118.2936765	Los Angeles County
215883	Fee-for-Service	1982917894	1982917894	1	1	KAO, DANIEL J MD	1/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90174	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
215887	Fee-for-Service	1487141586	1487141586	1	1	KOCOL, DUSTIN MD	9/11/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	191425	09	Gynecology (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
215913	Fee-for-Service	1982897146	1982897146	1	1	KOO, ANTHONY MD	4/1/2024	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
215920	Fee-for-Service	1508202813	1508202813	1	1	KAPSIMALLIS, STEPHANIE L CNP	9/20/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 E ROMIE LN	SUITE F	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
215921	Fee-for-Service	1194739292	1194739292	1	1	KENDALL, JOHN L MD	1/22/2024	207P00000X	NA	Other	026	PHYSICIANS	78548	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
215936	Fee-for-Service	1346827276	1346827276	1	1	KISHNANI, SANIYA MD	5/21/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	182962	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
215951	Fee-for-Service	1528059607	1528059607	1	1	KIM, DAVID SUNG MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87971	08	Family Practice	0	In state provider	None	250 E YALE LOOP	STE 200	IRVINE	CA	92604	4697	30	06059	33.67473753	-117.7880547	Orange County
216040	Fee-for-Service	1265069108	1265069108	1	1	KAN, JOSHUA MD	9/26/2023	207R00000X	NA	Other	026	PHYSICIANS	184623	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
216041	Fee-for-Service	1194895227	1194895227	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
216092	Fee-for-Service	1386608388	1386608388	1	1	KANG, YOUNG S MD	10/31/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70861	30	Radiology	0	In state provider	None	2577 SAMARITAN DR	STE 715	SAN JOSE	CA	95124	4103	43	06085	37.25246494	-121.9501879	Santa Clara County
216124	Fee-for-Service	1790341832	1790341832	1	1	KOLB, FREDERIC J MD	11/1/2019	208200000X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
216157	Fee-for-Service	1437361185	1437361185	1	1	KAREN LIN	3/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1303 N MAIN ST	None	CEDAR CITY	UT	84721	9746	00	None	37.699596	-113.0664465	Iron County
216167	Fee-for-Service	1265591887	1265591887	1	1	KURZNER, PHILLIP M MD	7/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41911	34	Urology and Urological Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
216174	Fee-for-Service	1487141586	1487141586	1	1	KOCOL, DUSTIN MD	9/11/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	191425	15	Obstetrics (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 400	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
216295	Fee-for-Service	1518016773	1518016773	1	1	KIDNEY CENTER A MEDICAL	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75701	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP INC	3838 SAN DIMAS ST	STE A100	BAKERSFIELD	CA	93301	2286	15	06029	35.3946385	-119.008203	Kern County
216321	Fee-for-Service	1568995421	1568995421	1	1	KAUFMAN, ELIZABETH T MD	7/7/2020	208M00000X	NA	Other	026	PHYSICIANS	158887	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216332	Fee-for-Service	1710984208	1710984208	1	1	KANGAVARI, SIMON MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69521	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90017	3907	19	06037	34.05270508	-118.2641005	Los Angeles County
216342	Fee-for-Service	1114023900	1114023900	1	1	KATZ, WAYNE B MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	35331	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
216392	Fee-for-Service	1174029458	1174029458	1	1	KAUSHIK, SARVESH MD	8/5/2022	207L00000X	NA	Other	026	PHYSICIANS	180020	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
216458	Fee-for-Service	1083244016	1083244016	1	1	KEO, MONICA NP	1/19/2022	2084P0800X	NA	Psychiatry	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
216472	Fee-for-Service	1407921646	1407921646	1	1	KODJABABIAN, GARO H MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	21436	05	Anesthesiology	0	In state provider	None	7706 VALE DR	None	WHITTIER	CA	90602	1918	19	06037	33.97348309	-118.0189277	Los Angeles County
216482	Fee-for-Service	1548334865	1548334865	1	1	KIM, LUCY J MD	12/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83306	02	General Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
216572	Fee-for-Service	1588125280	1588125280	1	1	KLOSOWIAK, EMIL	9/12/2023	207P00000X	NA	Other	026	PHYSICIANS	183721	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
216580	Fee-for-Service	1942651096	1942651096	1	1	KONTUREK, THOMAS J MD	3/23/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	161554	10	Gastroenterology (M.D. only)	0	In state provider	None	408 S BEACH BLVD	STE 211	ANAHEIM	CA	92804	1853	30	06059	33.82709101	-117.9932293	Orange County
216586	Fee-for-Service	1518016773	1518016773	1	1	KIDNEY CENTER A MEDICAL	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75701	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP INC	3838 SAN DIMAS ST	STE A100	BAKERSFIELD	CA	93301	2286	15	06029	35.3946385	-119.008203	Kern County
216591	Fee-for-Service	1306250246	1306250246	1	1	KADON, KURT S MD	7/8/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	179522	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
216592	Fee-for-Service	1912939604	1912939604	1	1	KAUFMAN, HOWARD S MD	8/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50932	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
216609	Fee-for-Service	1710034236	1710034236	1	1	KONICEK, ANNA G DO	11/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13552	01	General Practice	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
216695	Fee-for-Service	1609973734	1609973734	1	1	KIM, EUNICE J MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91126	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
216718	Fee-for-Service	1689900581	1689900581	1	1	KNOX, CHRISTIE K DO	1/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	10967	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
216790	Fee-for-Service	1205493558	1205493558	1	1	KUMARAVEL, SAIRA DPM	9/25/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
216815	Fee-for-Service	1801928148	1801928148	1	1	KIM, ASHLEE LMFT	6/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
216830	Fee-for-Service	1003270588	1003270588	1	1	KROGH, KATRINA MD	7/19/2022	207ZP0101X	NA	Other	026	PHYSICIANS	171300	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
216856	Fee-for-Service	1770921132	1770921132	1	1	KRISHNARAO, PRIYA M MD	6/12/2017	390200000X	NA	Other	026	PHYSICIANS	127418	30	Radiology	0	In state provider	None	1001 POTRERO AVE	ROOM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
216873	Fee-for-Service	1518016773	1518016773	1	1	KIDNEY CENTER A MEDICAL	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75701	41	Internal Medicine	0	In state provider	GROUP INC	3838 SAN DIMAS ST	STE A100	BAKERSFIELD	CA	93301	2286	15	06029	35.3946385	-119.008203	Kern County
216882	Fee-for-Service	1760480271	1760480271	1	1	KLEIN, CRAIG R MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81067	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	17822 BEACH BLVD	STE 473	HUNTINGTON BEACH	CA	92647	7168	30	06059	33.70331388	-117.9890471	Orange County
216905	Fee-for-Service	1801991872	1801991872	2	1	KANG, RICHARD J MD	3/2/2015	2080P0203X	NA	Other	026	PHYSICIANS	83965	40	Pediatrics	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE 265	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
216926	Fee-for-Service	1962508945	1962508945	1	2	KING, DAVID R OD INC	6/19/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2020 HIGH STREET	SUITE I	SELMA	CA	93662	3518	10	06019	36.56926799	-119.612517	Fresno County
216955	Fee-for-Service	1235887969	1235887969	1	1	KAISER FOUNDATION HEALTH PLA	7/27/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	951	110 COOPER ST	None	SANTA CRUZ	CA	95060	4574	44	06087	36.97506931	-122.0260896	Santa Cruz County
216974	Fee-for-Service	1851349609	1851349609	1	1	KARPMAN, EDWARD MD	7/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73115	34	Urology and Urological Surgery	0	In state provider	None	205 SOUTH DR	None	MOUNTAIN VIEW	CA	94040	4323	43	06085	37.36723252	-122.0797125	Santa Clara County
217003	Fee-for-Service	1427431147	1427431147	1	1	KANDASWAMY, SHAKTHISHREE MD	3/10/2021	207R00000X	NA	Other	026	PHYSICIANS	157620	None	None	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
217042	Fee-for-Service	1265587703	1265587703	1	1	KISHIMOTO, WAYNE M MD	3/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	81757	30	Radiology	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
217052	Fee-for-Service	1740711357	1740711357	1	1	KIM, ALICE Y MD	9/20/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	170116	None	None	0	In state provider	None	3000 W OLYMPIC BLVD	201	LOS ANGELES	CA	90006	2588	19	06037	34.05260947	-118.3003335	Los Angeles County
217061	Fee-for-Service	1720228778	1720228778	1	1	KUO, JARRET MD	10/25/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170637	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
217091	Fee-for-Service	1376137372	1376137372	1	1	KIRKPATRICK, BAILEIGH PSYD	11/20/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5820 OBERLIN DR	203	SAN DIEGO	CA	92121	3744	37	06073	32.89348634	-117.1937337	San Diego County
217148	Fee-for-Service	1538547716	1538547716	1	1	KIM, CHRISTINA M MD	3/11/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175290	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
217165	Fee-for-Service	1205151032	1205151032	1	1	KASSAR, SAMUEL N MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130965	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	315 E ROUTE 66	None	GLENDORA	CA	91740	6244	19	06037	34.1288429	-117.8607244	Los Angeles County
217170	Fee-for-Service	1760480271	1760480271	1	1	KLEIN, CRAIG R MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81067	41	Internal Medicine	0	In state provider	None	17822 BEACH BLVD	STE 473	HUNTINGTON BEACH	CA	92647	7168	30	06059	33.70331388	-117.9890471	Orange County
217171	Fee-for-Service	1053434910	1053434910	1	1	KARNI, RON J MD	12/5/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
217182	Fee-for-Service	1861619942	1861619942	1	1	KEZIRIAN, JANICE MD	9/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98211	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
217184	Fee-for-Service	1336502707	1336502707	1	1	KUYBU, OKKES MD	6/8/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	185015	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
217239	Fee-for-Service	1275517062	1275517062	1	1	KHAMISHON, ILYA L MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	54344	41	Internal Medicine	0	In state provider	FOLSOM	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
217243	Fee-for-Service	1447468798	1447468798	1	1	KESALA, RENATA L DO	2/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	9336	30	Radiology	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
217249	Fee-for-Service	1790274298	1790274298	1	1	KOTECKI, KEITH DO	10/8/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2650 N TENAYA WAY	STE 301	LAS VEGAS	NV	89128	1112	00	None	36.20804839	-115.2501292	Clark County
217251	Fee-for-Service	1780835058	1780835058	1	1	KU, ELAINE Y MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105713	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
217267	Fee-for-Service	1417187147	1417187147	1	1	KISTLER, MIRA L MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114678	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
217270	Fee-for-Service	1285253765	1285253765	1	1	KIM, YONG MIN DO	8/12/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22718	15	Obstetrics (D.O. only)	0	In state provider	None	8100 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3948	19	06037	34.21771742	-118.3701303	Los Angeles County
217289	Fee-for-Service	1396893194	1396893194	1	1	KAISER FOUNDATION HEALTH	4/11/1989	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE 027	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
217341	Fee-for-Service	1942377858	1942377858	1	1	KOHLER, STEVEN W MD	8/1/1998	207P00000X	NA	Other	026	PHYSICIANS	61541	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217347	Fee-for-Service	1174548184	1174548184	1	1	KENNEDY, PAUL B MD	8/21/1996	207L00000X	NA	Other	026	PHYSICIANS	73178	01	General Practice	0	In state provider	None	1040 W TOWN AND COUNTRY	None	ORANGE	CA	92868	4716	30	06059	33.77652153	-117.862461	Orange County
217358	Fee-for-Service	1922467679	1922467679	1	1	KARIMI, ELIZABETH LMFT	2/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	630	ENCINO	CA	91436	2255	19	06037	34.15687678	-118.4876342	Los Angeles County
217388	Fee-for-Service	1245473651	1245473651	1	1	KELEMEWORK, ALEMAYEHU T MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118480	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
217393	Fee-for-Service	1851347736	1851347736	1	1	KAMATH, SONIA C MD	12/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103545	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
217448	Fee-for-Service	1588641898	1588641898	1	1	KOSTALLAS, ANTHONY OD	2/1/2000	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6325 PACIFIC BLVD	STE 104	HUNTINGTON PARK	CA	90255	4100	19	06037	33.98273522	-118.2252261	Los Angeles County
217464	Fee-for-Service	1437473253	1437473253	1	1	KAMDAR, BINA A MD INC	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50638	08	Family Practice	0	In state provider	None	520 W FOOTHILL BLVD	None	AZUSA	CA	91702	2343	19	06037	34.13348555	-117.913005	Los Angeles County
217482	Fee-for-Service	1558340034	1558340034	1	1	KHORSANDI, MEHRAN J MD	6/3/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	61809	None	None	0	In state provider	None	18226 VENTURA BLVD	102	TARZANA	CA	91356	4246	19	06037	34.16628399	-118.5299288	Los Angeles County
217483	Fee-for-Service	1225119209	1225119209	1	1	KIYOMOTO, MICHAEL G OD	1/31/1986	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2035 SAN PABLO AVE	None	BERKELEY	CA	94702	1613	01	06001	37.86851338	-122.2918601	Alameda County
217485	Fee-for-Service	1992845218	1992845218	1	1	KAPLOWITZ, STUART A LMFT	11/3/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12530 10TH ST	STE C	CHINO	CA	91710	3520	36	06071	34.0258983	-117.6869086	San Bernardino County
217553	Fee-for-Service	1346455086	1346455086	1	1	KALBERER, JAMES	5/20/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1485 CIVIC COURT	STE 1330	CONCORD	CA	94520	5228	07	06013	37.97203702	-122.0490271	Contra Costa County
217585	Fee-for-Service	1467619643	1467619643	1	1	KARODY, RAMESH MD INC	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	39790	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6860 BROCKTON AVE	STE 11	RIVERSIDE	CA	92506	3816	33	06065	33.948999	-117.396722	Riverside County
217671	Fee-for-Service	1730749201	1730749201	1	1	KHAKALI, LYDIA N	9/18/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	34360 CRENSHAW ST	None	BEAUMONT	CA	92223	7448	33	06065	33.96174128	-117.0675558	Riverside County
217695	Fee-for-Service	1588803340	1588803340	1	2	KHOROMI, SUZAN MD	11/21/2016	2084N0400X	NA	Neurology	026	PHYSICIANS	136006	13	Neurology (M.D. only)	0	In state provider	None	5850 OBERLIN DRIVE	STE 100	SAN DIEGO	CA	92121	4710	37	06073	32.894677	-117.1928626	San Diego County
217713	Fee-for-Service	1588778666	1588778666	1	1	KULHANJIAN, JULIE A MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	58884	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
217725	Fee-for-Service	1114609930	1114609930	1	1	KAUR, RIPON DEEP NP	2/13/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4043 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	0000	15	06029	35.35411151	-119.0532915	Kern County
217739	Fee-for-Service	1720755929	1720755929	1	1	KING, JONATHAN	12/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
217752	Fee-for-Service	1437473253	1437473253	1	1	KAMDAR, BINA A MD INC	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50638	41	Internal Medicine	0	In state provider	None	520 W FOOTHILL BLVD	None	AZUSA	CA	91702	2343	19	06037	34.13348555	-117.913005	Los Angeles County
217771	Fee-for-Service	1225061021	1225061021	1	1	KOLTERMAN, ORVILLE MD	9/30/1983	207RE0101X	NA	Endocrinology	026	PHYSICIANS	31926	67	Endocrinology	0	In state provider	None	225 DICKINSON ST	# H207	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
217782	Fee-for-Service	1518029412	1518029412	1	1	KUIPER, JOHN M PHD	3/21/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1936 SHASTA ST	A	REDDING	CA	96001	0407	45	06089	40.58466985	-122.3987744	Shasta County
217810	Fee-for-Service	1013627587	1013627587	1	1	KHAN, NOOR-UL-AIN F CRNA	1/4/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
217819	Fee-for-Service	1407055296	1407055296	1	1	KAZI, DHRUV S MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97847	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
217842	Fee-for-Service	1275550840	1275550840	1	1	KENNEDY, CASSANDRA A MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	79397	02	General Surgery	0	In state provider	None	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
217844	Fee-for-Service	1639500408	1639500408	1	1	KRAMER, JONATHAN D MD	12/12/2018	163WX0800X	NA	Other	026	PHYSICIANS	136263	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217863	Fee-for-Service	1760699557	1760699557	1	1	KARUNA, KEM DO	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9517	08	Family Practice	0	In state provider	None	7373 W LANE	None	STOCKTON	CA	95210	3377	39	06077	0	0	None
217871	Fee-for-Service	1467619643	1467619643	1	1	KARODY, RAMESH MD INC	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	39790	41	Internal Medicine	0	In state provider	None	6860 BROCKTON AVE	STE 11	RIVERSIDE	CA	92506	3816	33	06065	33.948999	-117.396722	Riverside County
217885	Fee-for-Service	1558962324	1558962324	1	1	KHALITCHI, MARJANEH PSYD	7/23/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
217890	Fee-for-Service	1194819797	1194819797	1	1	KELLEY, DIANE R PHD	4/1/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1633 GATES AVE	None	MANHATTAN BEACH	CA	90266	7028	19	06037	33.8785115	-118.3839885	Los Angeles County
217905	Fee-for-Service	1750790051	1750790051	1	1	KIRK, CANDICE L LCSW	8/27/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
217931	Fee-for-Service	1558419432	1558419432	1	1	KAISER FOUND HEALTH PLAN	6/13/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MAIN PHARMACY	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
217943	Fee-for-Service	1124202023	1124202023	1	1	KIM, MICHAEL S MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99077	08	Family Practice	0	In state provider	None	250 E YALE LOOP	STE 200	IRVINE	CA	92604	4697	30	06059	33.67473753	-117.7880547	Orange County
217959	Fee-for-Service	1730749201	1730749201	1	1	KHAKALI, LYDIA N	9/18/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	34360 CRENSHAW ST	None	BEAUMONT	CA	92223	7448	33	06065	33.96174128	-117.0675558	Riverside County
217961	Fee-for-Service	1699160168	1699160168	1	1	KELLEY, MICHELLE MD	7/1/2018	208M00000X	NA	Other	026	PHYSICIANS	153041	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
218001	Fee-for-Service	1083118616	1083118616	1	1	KORESSEL, JOSEPH E MD	8/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	185816	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
218027	Fee-for-Service	1275637290	1275637290	1	1	KON, LEANNE MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90701	34	Urology and Urological Surgery	0	In state provider	None	701 E 28TH ST	STE 212	LONG BEACH	CA	90806	2774	19	06037	33.80803441	-118.1847137	Los Angeles County
218031	Fee-for-Service	1255859674	1255859674	1	1	KARMEL HOME HEALTH	4/22/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13746 VICTORY BLVD	STE 301	VAN NUYS	CA	91401	6725	19	06037	34.18664551	-118.432764	Los Angeles County
218039	Fee-for-Service	1588878623	1588878623	1	1	KELLEY, ELLEN L	10/18/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3527 W FLORIDA AVE	None	HEMET	CA	92545	3564	33	06065	33.745347	-117.0091125	Riverside County
218048	Fee-for-Service	1881154888	1881154888	1	1	KHATIWALA, ROSHNI V MD	2/13/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	178072	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
218062	Fee-for-Service	1609850833	1609850833	1	1	KING, JOHN ALLEN MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56789	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
218070	Fee-for-Service	1750450276	1750450276	1	1	KWONG, LOUIS M MD	3/31/1989	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	55440	20	Orthopedic Surgery	0	In state provider	None	436 N BEDFORD DR	STE 218	BEVERLY HILLS	CA	90210	4312	19	06037	34.0685329	-118.4056227	Los Angeles County
218079	Fee-for-Service	1376743526	1376743526	1	1	KAPADIA, ANUJA D MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115162	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
218098	Fee-for-Service	1386715498	1386715498	1	1	KLEIN, ROBERT B MD	4/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75013	34	Urology and Urological Surgery	0	In state provider	None	18350 ROSCOE BLVD	STE 701	NORTHRIDGE	CA	91325	4109	19	06037	34.22071855	-118.5341175	Los Angeles County
218107	Fee-for-Service	1962401919	1962401919	1	1	KUDLER, STEVE	3/8/2005	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	22110 ROSCOE BLVD	SUITE 103	CANOGA PARK	CA	91304	3845	19	06037	34.21957849	-118.6082685	Los Angeles County
218130	Fee-for-Service	1275550840	1275550840	1	1	KENNEDY, CASSANDRA A MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	79397	01	General Practice	0	In state provider	None	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
218149	Fee-for-Service	1295735298	1295735298	1	1	KARP, BRUCE L PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7238 VALLEY VISTA AVE	None	YUCCA VALLEY	CA	92284	0000	36	06071	34.1204997	-116.4130802	San Bernardino County
218197	Fee-for-Service	1386708014	1386708014	1	1	KWAN, MINDY MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128486	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
218220	Fee-for-Service	1720019748	1720019748	1	2	KAMLOT, ANDREAS MD	9/28/2018	208600000X	NA	General Surgery	026	PHYSICIANS	69922	70	Clinic (mixed specialty)	0	In state provider	None	1320 EL CAPITAN DR	120	DANVILLE	CA	94526	6260	07	06013	37.78476866	-121.9658691	Contra Costa County
218239	Fee-for-Service	1942559455	1942559455	1	1	KROLL, BECKY MD INC	11/9/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112974	01	General Practice	0	In state provider	None	18181 BUTTERFIELD BLVD	STE 180	MORGAN HILL	CA	95037	8112	43	06085	37.13904584	-121.6547035	Santa Clara County
218312	Fee-for-Service	1275637290	1275637290	1	1	KON, LEANNE MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90701	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E 28TH ST	STE 212	LONG BEACH	CA	90806	2774	19	06037	33.80803441	-118.1847137	Los Angeles County
218315	Fee-for-Service	1164463006	1164463006	1	1	KEMBERLING, PATRICIA MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	49873	04	Otology, Laryngology, Rhinology	0	In state provider	None	866 PLUMAS ST	SUITE D	YUBA CITY	CA	95991	4022	51	06101	39.14154171	-121.6177237	Sutter County
218317	Fee-for-Service	1073981320	1073981320	1	1	KATTEN, SAMARA LCSW	9/2/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
218336	Fee-for-Service	1538393889	1538393889	1	1	KANG, STEVE MD	2/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106744	20	Orthopedic Surgery	0	In state provider	None	280 S MAIN ST	STE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
218365	Fee-for-Service	1255408266	1255408266	1	1	KRAMER, LEWIS L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33599	07	Dermatology	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
218370	Fee-for-Service	1922062835	1922062835	1	1	KWAN, LAWRENCE Y MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75257	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
218382	Fee-for-Service	1770626327	1770626327	1	1	KHAN, SHAISTA Y MD	5/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	103508	36	Psychiatry	0	In state provider	None	751 SOUTH BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
218412	Fee-for-Service	1114468568	1114468568	1	1	KUMALA, ERICA MD	8/7/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166452	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
218415	Fee-for-Service	1518904580	1518904580	1	1	KLAUSE, ELVIRA MD	7/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81744	02	General Surgery	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
218418	Fee-for-Service	1811683121	1811683121	1	1	KEARNS, BRENDAN A LCSW	10/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
218483	Fee-for-Service	1043836778	1043836778	1	1	KHAVARI, ALI DPM	10/23/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
218503	Fee-for-Service	1992886154	1992886154	1	1	KOFOED, JOHN C MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	46595	20	Orthopedic Surgery	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
218516	Fee-for-Service	1043979966	1043979966	1	1	KAMPAS, EMILY NP	5/23/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
218529	Fee-for-Service	1942559455	1942559455	1	1	KROLL, BECKY MD INC	11/9/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112974	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18181 BUTTERFIELD BLVD	STE 180	MORGAN HILL	CA	95037	8112	43	06085	37.13904584	-121.6547035	Santa Clara County
218579	Fee-for-Service	1598164659	1598164659	1	1	KARAGUEZIAN, ALAIN MD PC	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109354	None	None	0	In state provider	None	18546 ROSCOE BLVD	SUITE 304	NORTHRIDGE	CA	91324	9998	19	06037	34.22069869	-118.537684	Los Angeles County
218583	Fee-for-Service	1831726744	1831726744	1	1	KIM, ELIZABETH Y	7/18/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
218597	Fee-for-Service	1568540227	1568540227	1	1	KAO, STEVEN B MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	58774	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
218610	Fee-for-Service	1811596901	1811596901	1	1	KD MEDICAL INC	6/9/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1108 E CLARK AVENUE	#114	ORCUTT	CA	93455	4073	42	06083	34.86500553	-120.4181055	Santa Barbara County
218639	Fee-for-Service	1508851056	1508851056	1	1	KELTON, ALAN G MD	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76211	41	Internal Medicine	0	In state provider	None	2828 FRESNO STREET	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
218660	Fee-for-Service	1922062835	1922062835	1	1	KWAN, LAWRENCE Y MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75257	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
218672	Fee-for-Service	1386600484	1386600484	1	1	KAO, LILY C MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	44759	79	Neurology-Child	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
218674	Fee-for-Service	1275832768	1275832768	1	1	KOO, EUNA B MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123115	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
218715	Fee-for-Service	1144262213	1144262213	1	1	KREMER, LISA B MD INC	10/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76815	83	Rheumatology	0	In state provider	None	4725 HOEN AVE	# A	SANTA ROSA	CA	95405	7862	49	06097	38.442564	-122.664141	Sonoma County
218726	Fee-for-Service	1154973584	1154973584	1	1	KHAN, MUHAMMAD S MD	7/19/2022	207R00000X	NA	Other	026	PHYSICIANS	176688	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
218789	Fee-for-Service	1992886154	1992886154	1	1	KOFOED, JOHN C MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	46595	66	Emergency Medicine (Urgent Care)	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
218814	Fee-for-Service	1629367073	1629367073	1	1	KHANGURA, RAJKAMAL S MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138257	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
218822	Fee-for-Service	1063898831	1063898831	1	1	KUMAR, SAIRAM A MD	1/14/2022	2080P0006X	NA	Psychiatry	026	PHYSICIANS	155499	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
218827	Fee-for-Service	1932283934	1932283934	1	1	KOENIG, TITUS R MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51766	30	Radiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
218870	Fee-for-Service	1902830524	1902830524	1	1	KLAMATH CHILD AND FAMILY TRE	4/12/2021	251V00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	2	Out of state provider	LTH	2210 N ELDORADO AVE	None	KLAMATH FALLS	OR	97601	6418	00	None	42.24804214	-121.786476	Klamath County
218927	Fee-for-Service	1548416555	1548416555	1	1	KAMRAVA, ALLEN MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103694	28	Proctology (colon and rectal)	0	In state provider	None	222 W EULALIA ST	STE 100 A	GLENDALE	CA	91204	2508	19	06037	34.12653215	-118.257121	Los Angeles County
218957	Fee-for-Service	1386600484	1386600484	1	1	KAO, LILY C MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	44759	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
219003	Fee-for-Service	1144262213	1144262213	1	1	KREMER, LISA B MD INC	10/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76815	41	Internal Medicine	0	In state provider	None	4725 HOEN AVE	# A	SANTA ROSA	CA	95405	7862	49	06097	38.442564	-122.664141	Sonoma County
219043	Fee-for-Service	1649711862	1649711862	1	1	KHAYYAT, OMAR S MD	8/1/2020	390200000X	NA	Other	026	PHYSICIANS	163653	41	Internal Medicine	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
219049	Fee-for-Service	1215316302	1215316302	1	1	KASKO, SARAH N DO	12/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15482	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
219068	Fee-for-Service	1548715063	1548715063	1	1	KERN COUNTY HOSPITAL AUTHORI	11/14/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	None	9300 STOCKDALE HWY	100-300	BAKERSFIELD	CA	93311	3613	15	06029	35.3545315	-119.1053925	Kern County
219074	Fee-for-Service	1114953593	1114953593	1	1	KAM, ALBERT C MD	8/30/1991	207R00000X	NA	Other	026	PHYSICIANS	74747	41	Internal Medicine	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
219079	Fee-for-Service	1538237755	1538237755	1	1	KLIKOFF, ALEXANDRA MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83647	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3275 APTOS RANCHO RD	STE E	APTOS	CA	95003	3971	44	06087	36.9795274	-121.9068693	Santa Cruz County
219086	Fee-for-Service	1225660848	1225660848	1	1	KLN COMFORT CARE HOSPICE INC	8/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	728 S HILL ST	UNIT 1201	LOS ANGELES	CA	90014	2706	19	06037	34.04525076	-118.2550818	Los Angeles County
219105	Fee-for-Service	1225018393	1225018393	1	1	KEATS, JOEL B MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	35344	30	Radiology	0	In state provider	None	1520 SAN PABLO ST	LL#1600	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
219155	Fee-for-Service	1316979917	1316979917	1	1	KHAZAENI, LEILA M MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92331	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
219180	Fee-for-Service	1669715884	1669715884	1	1	KEIBEL, ANDREW J MD	11/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134459	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
219205	Fee-for-Service	1881648467	1881648467	1	1	KAUFMAN, WAYNE A	8/6/1986	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1133 E FLORIDA AVE	None	HEMET	CA	92543	4512	33	06065	33.74752984	-116.959811	Riverside County
219230	Fee-for-Service	1790195618	1790195618	1	1	KLEIN, REBECCA LCSW	7/31/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2100 LAKESHORE AVE.	C	OAKLAND	CA	94606	1187	01	06001	37.80436219	-122.2510798	Alameda County
219266	Fee-for-Service	1609890714	1609890714	1	1	KAMRAN,HAMID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ARLINGTON GASTRO SERVICE	515 WEST MAYFIELD RD	STE#403	ARLINGTON	TX	76014	2085	00	None	32.69114847	-97.1129745	Tarrant County
219282	Fee-for-Service	1851449896	1851449896	1	1	KOLSKI, BRIAN C MD	2/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93984	41	Internal Medicine	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
219306	Fee-for-Service	1245677624	1245677624	1	1	KAISER, STEPHEN D MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134560	36	Psychiatry	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
219317	Fee-for-Service	1407149529	1407149529	1	1	KURTZ, SARA R MFT	7/26/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	91274	-	NOT APPLICABLE	0	In state provider	None	3430 COGSWELL RD	None	EL MONTE	CA	91203	1662	19	06037	34.06742714	-118.0166026	Los Angeles County
219322	Fee-for-Service	1902967557	1902967557	1	1	KAHEN, PAYAM J MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	97561	01	General Practice	0	In state provider	None	9700 WOODMAN AVE	STE A-10	ARLETA	CA	91331	8040	19	06037	34.24604728	-118.4474624	Los Angeles County
219325	Fee-for-Service	1548614563	1548614563	1	1	KIM, DONGHYUN J DO	7/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17139	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
219355	Fee-for-Service	1548715063	1548715063	1	1	KERN COUNTY HOSPITAL AUTHORI	11/14/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	9300 STOCKDALE HWY	100-300	BAKERSFIELD	CA	93311	3613	15	06029	35.3545315	-119.1053925	Kern County
219371	Fee-for-Service	1225660848	1225660848	1	1	KLN COMFORT CARE HOSPICE INC	8/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	728 S HILL ST	UNIT 1201	LOS ANGELES	CA	90014	2706	19	06037	34.04525076	-118.2550818	Los Angeles County
219379	Fee-for-Service	1225456098	1225456098	1	1	KIM, LISA T DO	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15056	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
219424	Fee-for-Service	1033471511	1033471511	1	1	KONG, FRANCES LMFT	1/3/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
219439	Fee-for-Service	1932768173	1932768173	1	1	KHAN, NATASHA MD	8/17/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178448	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
219487	Fee-for-Service	1558494328	1558494328	1	1	KERL, UTA B MD	5/30/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80294	40	Pediatrics	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
219513	Fee-for-Service	1851498737	1851498737	1	1	KALECHSTEIN, ARI D PHD	9/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
219515	Fee-for-Service	1679640569	1679640569	1	1	KIEU, DAO A MD	7/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48785	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
219528	Fee-for-Service	1215959945	1215959945	1	1	KRIDER, JAMES C MD	1/23/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48897	08	Family Practice	0	In state provider	SANTA FE FAMILY HEALTH	18182 US HIGHWAY 18	STE 105	APPLE VALLEY	CA	92307	2200	36	06071	34.54087945	-117.267147	San Bernardino County
219541	Fee-for-Service	1215920038	1215920038	1	1	KERRIGAN, MARY T MD	5/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55547	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
219563	Fee-for-Service	1174690036	1174690036	1	1	KUDVA, ARCHANA K MR	8/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	80881	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
219570	Fee-for-Service	1437411956	1437411956	1	1	KELLY, AMANDA G MD	6/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140443	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
219581	Fee-for-Service	1083784672	1083784672	1	3	KAISER FNDTN HOSP FRESNO	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
219613	Fee-for-Service	1164536264	1164536264	1	1	KUMAR, CHANDRA M MD	10/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50480	01	General Practice	0	In state provider	None	730 WOODSIDE ROAD	None	REDWOOD CITY	CA	94061	3749	41	06081	37.46743742	-122.2240658	San Mateo County
219641	Fee-for-Service	1548715063	1548715063	1	1	KERN COUNTY HOSPITAL AUTHORI	11/14/2019	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	46	Hand Surgery	0	In state provider	None	9300 STOCKDALE HWY	100-300	BAKERSFIELD	CA	93311	3613	15	06029	35.3545315	-119.1053925	Kern County
219709	Fee-for-Service	1629081195	1629081195	1	1	KONKIN, LESLIE A MD	11/23/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	24534	89	Surgery-Traumatic	0	In state provider	None	1501 OAKDALE RD	STE 301	MODESTO	CA	95355	3382	50	06099	37.665279	-120.957607	Stanislaus County
219729	Fee-for-Service	1467237834	1467237834	1	1	KIELMEYER, REANIN NP	11/13/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
219821	Fee-for-Service	1376825851	1376825851	1	1	KATARIA, PREETIKA MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142711	01	General Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
219849	Fee-for-Service	1437360682	1437360682	1	1	KULKARNI, MONA S MD	7/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111656	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
219850	Fee-for-Service	1932210481	1932210481	1	1	KILGORE, KATHERINE M PHD	1/9/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13405 FOLSOM BLVD	SUITE 220	FOLSOM	CA	95630	4738	34	06067	38.657493	-121.1840775	Sacramento County
219878	Fee-for-Service	1316921596	1316921596	1	1	KIME, BRAD	2/15/2013	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 HWY 101 NORTH	None	CRESCENT CITY	CA	95531	2844	08	06015	41.75954236	-124.1979678	Del Norte County
219891	Fee-for-Service	1902053663	1902053663	1	1	KIA, FARID MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125119	25	Physical Medicine and Rehabilitation	0	In state provider	None	10 SANTA ROSA STREET	STE 201	SAN LUIS OBISPO	CA	93405	5825	40	06079	35.29325417	-120.667547	San Luis Obispo County
219901	Fee-for-Service	1508253063	1508253063	1	1	KESINGER, STEVEN T	5/26/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
219902	Fee-for-Service	1104873199	1104873199	1	1	KHAVARI, NASHA N MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88023	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94134	2204	38	06075	37.7634502	-122.4579779	San Francisco County
219914	Fee-for-Service	1699856237	1699856237	1	1	KIM, ANDREW J MD	5/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83129	79	Neurology-Child	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
219997	Fee-for-Service	1629081195	1629081195	1	1	KONKIN, LESLIE A MD	11/23/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	24534	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1501 OAKDALE RD	STE 301	MODESTO	CA	95355	3382	50	06099	37.665279	-120.957607	Stanislaus County
220000	Fee-for-Service	1609821230	1609821230	1	1	KNESS,SEAN T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
220030	Fee-for-Service	1689872343	1689872343	1	1	KIRSCHNER, STEPHANIE LMFT	8/9/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23480 PARK SORRENTO	STE 209	CALABASAS	CA	91302	1359	19	06037	34.15596723	-118.6400253	Los Angeles County
220046	Fee-for-Service	1548335284	1548335284	1	1	KOHLER, LORI S MD	1/31/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76494	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
220079	Fee-for-Service	1093883415	1093883415	1	1	KYSER, ELIZABETH A PHD	9/6/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
220134	Fee-for-Service	1326085291	1326085291	1	1	KERNOFF, RACHEL	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80692	None	None	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
220190	Fee-for-Service	1104873199	1104873199	1	1	KHAVARI, NASHA N MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88023	10	Gastroenterology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94134	2204	38	06075	37.7634502	-122.4579779	San Francisco County
220234	Fee-for-Service	1679037733	1679037733	1	1	KOBLISKA, KAREN J PSYD	12/4/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
220244	Fee-for-Service	1457551087	1457551087	1	1	KWON, PAUL S MD	1/26/2011	2084N0400X	NA	Neurology	026	PHYSICIANS	97061	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
220255	Fee-for-Service	1720116502	1720116502	1	1	KOHUT, KAREN G MD	4/2/2004	174400000X	NA	Other	026	PHYSICIANS	81814	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	320 DARDANELLI LN	STE 20 B	LOS GATOS	CA	95032	1419	43	06085	37.262079	-121.9673345	Santa Clara County
220256	Fee-for-Service	1063569390	1063569390	1	1	KAISER PERMANENTE	7/14/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #179	10850 ARROW RTE	None	RANCHO CUCAMONGA	CA	91730	4833	36	06071	34.0991609	-117.5680267	San Bernardino County
220271	Fee-for-Service	1437876802	1437876802	1	1	KIHONGE, ANNIE C	11/3/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1748 BATHGATE CT	None	FOLSOM	CA	95630	6228	34	06067	38.650887	-121.111686	Sacramento County
220284	Fee-for-Service	1780829754	1780829754	1	1	KHUDDUS, UMME HANI MD	9/14/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	106144	None	None	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
220293	Fee-for-Service	1154516409	1154516409	1	1	KENDRICK, AMANDA N PSYD	6/28/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	595 E COLORADO BLVD STE	324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
220312	Fee-for-Service	1063609618	1063609618	1	1	KAUFMAN, BILL LMFT	1/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2510 MAIN ST	SUITE 201	SANTA MONICA	CA	90405	3535	19	06037	34.00312088	-118.4847822	Los Angeles County
220315	Fee-for-Service	1407932353	1407932353	1	1	KIM, JONATHAN H DO	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7774	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
220325	Fee-for-Service	1811289101	1811289101	1	1	KNIGHT, CURTIS A MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130268	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
220378	Fee-for-Service	1720540610	1720540610	1	1	KOUKLIS, GAYLE K MD	10/15/2022	207P00000X	NA	Other	026	PHYSICIANS	181137	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
220385	Fee-for-Service	1306438064	1306438064	1	1	KARAPETIAN, ARLET LMFT	2/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4835 VAN NUYS BLVD	1-200	SHERMAN OAKS	CA	91403	2139	19	06037	34.1587068	-118.4487394	Los Angeles County
220453	Fee-for-Service	1821679531	1821679531	1	1	KAUR, HARPREET MD	8/8/2024	208M00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
220459	Fee-for-Service	1386617942	1386617942	1	1	KIELTY, MICHELE M DO	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	7083	40	Pediatrics	0	In state provider	None	1430 E MAIN STREET	#201	SANTA MARIA	CA	93454	4832	42	06083	34.9528467	-120.4127301	Santa Barbara County
220471	Fee-for-Service	1184967861	1184967861	1	1	KOTTER, HALEIGH C MD	2/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133256	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
220504	Fee-for-Service	1891490173	1891490173	1	1	KERN COUNTY TRANSIT TECH LLC	10/5/2023	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4420 EASTON DR	203C	BAKERSFIELD	CA	93309	1085	15	06029	35.36987536	-119.0520419	Kern County
220526	Fee-for-Service	1417955162	1417955162	1	1	KHURANA, GURVIR S MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93172	40	Pediatrics	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
220538	Fee-for-Service	1710514674	1710514674	1	1	KOVALENKO, OLGA MD	12/16/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1401 SPANOS CT	STE 130	MODESTO	CA	95355	2815	50	06099	37.66975543	-120.9724048	Stanislaus County
220549	Fee-for-Service	1073846044	1073846044	1	1	KULPA, CARL G NP	7/19/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
220559	Fee-for-Service	1437876802	1437876802	1	1	KIHONGE, ANNIE C	11/3/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1748 BATHGATE CT	None	FOLSOM	CA	95630	6228	34	06067	38.650887	-121.111686	Sacramento County
220631	Fee-for-Service	1912052838	1912052838	1	1	KAISER FOUNDATION HOSPITALS	8/13/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	TRI CENTRAL HHA	12200 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2804	19	06037	33.922494	-118.1253235	Los Angeles County
220656	Fee-for-Service	1225292766	1225292766	1	1	KAHWAGI, MAYA MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145339	38	Geriatrics	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
220673	Fee-for-Service	1346292539	1346292539	1	1	KEYSER, DARREL B MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54893	46	Hand Surgery	0	In state provider	THE HAND TREATMENT CNTR	27206 CALAROGA AVE	STE 115	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
220688	Fee-for-Service	1356379119	1356379119	1	1	KRAUS, ROBERT M MD	7/31/1996	174400000X	NA	Other	026	PHYSICIANS	7757	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	453 N BEDFORD DR	None	BEVERLY HILLS	CA	90210	4302	19	06037	34.0685367	-118.4057519	Los Angeles County
220698	Fee-for-Service	1225554736	1225554736	1	1	KESHISHYAN, NAIRA LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
220744	Fee-for-Service	1063567071	1063567071	1	2	KOUWABUNPAT, DAN MD	11/7/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67820	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	FLOOR 2	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
220795	Fee-for-Service	1932190436	1932190436	1	1	KEENAN, SEAN C MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102742	30	Radiology	0	In state provider	None	2655 CAMINO DEL RIO N	STE 330	SAN DIEGO	CA	92108	1633	37	06073	32.77261373	-117.1347389	San Diego County
220828	Fee-for-Service	1710514674	1710514674	1	1	KOVALENKO, OLGA MD	12/16/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1401 SPANOS CT	STE 130	MODESTO	CA	95355	2815	50	06099	37.66975543	-120.9724048	Stanislaus County
220837	Fee-for-Service	1174630925	1174630925	1	1	KARIM, ARIF A DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7151	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
220864	Fee-for-Service	1891726725	1891726725	1	1	KERN, AARON R MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	46016	41	Internal Medicine	0	In state provider	None	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
220884	Fee-for-Service	1114234572	1114234572	1	1	KIM, JULIA R PT	10/24/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 DEERPARK DR	None	FULLERTON	CA	92831	2286	30	06059	33.88668862	-117.8789387	Orange County
220895	Fee-for-Service	1871980029	1871980029	1	1	KANI, CAMELLIA MD	1/1/2020	207R00000X	NA	Other	026	PHYSICIANS	158565	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
220914	Fee-for-Service	1487624045	1487624045	1	1	KHAW, MELVIN MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	70617	77	Infectious Disease	0	In state provider	None	16030 VENTURA BLVD	STE 680	ENCINO	CA	91436	4443	19	06037	34.15615339	-118.4824038	Los Angeles County
220920	Fee-for-Service	1669834727	1669834727	1	1	KIANG, ALAN MD	8/25/2024	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150933	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
220932	Fee-for-Service	1225663958	1225663958	1	1	KEY COMMUNICATION SPEECH & L	6/21/2024	261QH0700X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ANGUAGE SERVICES, INC	2910 INLAND EMPIRE BLVD	SUITE 114	ONTARIO	CA	91764	4896	36	06071	34.06986	-117.589617	San Bernardino County
220945	Fee-for-Service	1225292766	1225292766	1	1	KAHWAGI, MAYA MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145339	08	Family Practice	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
220950	Fee-for-Service	1689200594	1689200594	1	1	KOJAYAN, GREG MD	6/14/2024	390200000X	NA	Other	026	PHYSICIANS	190679	05	Anesthesiology	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
220971	Fee-for-Service	1356375307	1356375307	1	1	KITTITAS VALLEY COMM HOSP	9/15/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	603 S CHESTNUT ST	None	ELLENSBURG	WA	98926	3897	00	None	46.98723465	-120.53678	Kittitas County
220975	Fee-for-Service	1356379119	1356379119	1	1	KRAUS, ROBERT M MD	7/31/1996	174400000X	NA	Other	026	PHYSICIANS	7757	41	Internal Medicine	0	In state provider	None	453 N BEDFORD DR	None	BEVERLY HILLS	CA	90210	4302	19	06037	34.0685367	-118.4057519	Los Angeles County
221029	Fee-for-Service	1811075138	1811075138	1	1	KIMBLE COUNTY EMS	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	151 HOSPITAL DR	None	JUNCTION	TX	76849	3020	00	None	30.4974373	-99.78114284	Kimble County
221060	Fee-for-Service	1831506757	1831506757	1	1	KHIYANI, SHEETAL MD	2/3/2022	2080P0204X	NA	Other	026	PHYSICIANS	148959	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
221195	Fee-for-Service	1396792677	1396792677	1	1	KIM, HYONG JUN MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63995	41	Internal Medicine	0	In state provider	None	340 W CENTRAL AVE	STE 110	BREA	CA	92821	3006	30	06059	33.93198898	-117.9008269	Orange County
221202	Fee-for-Service	1669834727	1669834727	1	1	KIANG, ALAN MD	8/25/2024	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150933	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
221203	Fee-for-Service	1285763433	1285763433	1	1	KEEN, NAYELA N MD	4/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99883	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
221236	Fee-for-Service	1982688040	1982688040	1	1	KLEIN, KEITH L MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	22950	45	Nephrology (Renal-Kidney)	0	In state provider	None	8900 WILSHIRE BLVD	STE 350	BEVERLY HILLS	CA	90211	1959	19	06037	34.06703955	-118.3859235	Los Angeles County
221250	Fee-for-Service	1457372906	1457372906	1	1	KAMMERER, WILLIAM F MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	72332	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 MARINE BLVD	None	MOSS BEACH	CA	94038	9641	41	06081	37.52703039	-122.5075216	San Mateo County
221252	Fee-for-Service	1215455803	1215455803	1	1	KELLY, CATHERINE C LMFT	3/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1030 NEVADA ST.	SUITE 103	REDLANDS	CA	92374	2957	36	06071	34.064172	-117.217431	San Bernardino County
221255	Fee-for-Service	1639404189	1639404189	1	1	KASHAK, VANESSA SHAWMCMINN	9/30/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	0D	17675 VAN BUREN BLVD	SUITE C	RIVERSIDE	CA	92504	6076	33	06065	33.88266109	-117.35497	Riverside County
221267	Fee-for-Service	1295049740	1295049740	1	1	KAUR, RUBINDER MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124671	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAYFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
221274	Fee-for-Service	1780136093	1780136093	1	1	KIOWA DIALYSIS LLC	12/11/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	14101 FRANCISQUITO AVE	None	BALDWIN PARK	CA	91706	6100	19	06037	34.06468129	-117.9687926	Los Angeles County
221278	Fee-for-Service	1336778661	1336778661	1	1	KAUR, SARABJIT NP	10/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
221331	Fee-for-Service	1699068601	1699068601	1	1	KEENAN, PETER F III MD	5/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140040	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
221338	Fee-for-Service	1720115850	1720115850	1	1	KIM, HETTY Y OD	8/19/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
221345	Fee-for-Service	1164665204	1164665204	1	1	KOMANAPALLI, ESTHER S MD	6/27/2012	207L00000X	NA	Other	026	PHYSICIANS	113076	05	Anesthesiology	0	In state provider	None	9902 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70162305	-117.9565301	Orange County
221361	Fee-for-Service	1902118458	1902118458	1	1	KHAN, AMEER H MD	6/19/2019	207RC0200X	NA	Other	026	PHYSICIANS	162420	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
221391	Fee-for-Service	1811239981	1811239981	1	1	KHALID, ABDULLAH M MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141918	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA STREET	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
221408	Fee-for-Service	1649848672	1649848672	1	1	KOYA MEDICAL, INC.	6/13/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2461 PERALTA ST	None	OAKLAND	CA	94607	1703	01	06001	37.81898985	-122.2879129	Alameda County
221430	Fee-for-Service	1164692570	1164692570	1	1	KAPUR, NITIN MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149817	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
221438	Fee-for-Service	1922097054	1922097054	1	2	KARAM, JOSEPH A MD	6/25/2020	363AS0400X	NA	Physician Assistant	026	PHYSICIANS	88497	89	Surgery-Traumatic	0	In state provider	GERY	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
221445	Fee-for-Service	1366645616	1366645616	1	1	KOHLI, NEELU MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	87993	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17264 FOOTHILL BLVD	STE A	FONTANA	CA	92335	9050	36	06071	34.10678654	-117.4277541	San Bernardino County
221511	Fee-for-Service	1760530372	1760530372	1	1	KAISER FOUNDATION HEALTH	8/31/1990	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY NO. 3	1840 SIERRA GARDENS DR	None	ROSEVILLE	CA	95661	2912	31	06061	38.74730831	-121.2613758	Placer County
221522	Fee-for-Service	1326205857	1326205857	1	1	KARKARE, NAKUL V MD	9/19/2008	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	104759	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
221526	Fee-for-Service	1982688040	1982688040	1	1	KLEIN, KEITH L MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	22950	22	Pathology (M.D. only)	0	In state provider	None	8900 WILSHIRE BLVD	STE 350	BEVERLY HILLS	CA	90211	1959	19	06037	34.06703955	-118.3859235	Los Angeles County
221527	Fee-for-Service	1861466682	1861466682	1	1	KATZ, STANLEY G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49280	20	Orthopedic Surgery	0	In state provider	None	1801 W ROMNEYA DR	STE 208	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
221530	Fee-for-Service	1942462791	1942462791	1	1	KORDA, SARAH L	8/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4216 18TH ST	SUITE 3	SAN FRANCISCO	CA	94114	2410	38	06075	37.76082619	-122.4364305	San Francisco County
221565	Fee-for-Service	1255779930	1255779930	1	1	KYAN, LIAM S MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137900	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
221568	Fee-for-Service	1588296180	1588296180	1	1	KNOWLEDGE ENLIGHTENS YOU	7/1/2019	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	(KEY) ACADEMY	1570 WARD STREET	None	HAYWARD	CA	94541	3030	01	06001	37.67708818	-122.071887	Alameda County
221599	Fee-for-Service	1982782165	1982782165	1	1	KIM, HYUN J MD	10/14/2008	207R00000X	NA	Other	026	PHYSICIANS	102394	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
221621	Fee-for-Service	1528055001	1528055001	1	1	KHAN, GULAM ASHFAQ HUSAIN M	3/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171772	None	None	0	In state provider	D	9320 BASELINE RD	STE C	RANCHO CUCAMONGA	CA	91701	5829	36	06071	34.12156453	-117.6018255	San Bernardino County
221622	Fee-for-Service	1861029738	1861029738	1	1	KOTHARI, POOJA MD	9/25/2023	207R00000X	NA	Other	026	PHYSICIANS	188566	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
221634	Fee-for-Service	1871849984	1871849984	1	1	KATO, ANNE M MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142291	18	Ophthalmology	0	In state provider	None	160 GREEN VALLEY ROAD	SUITE 202	FREEDOM	CA	95019	3160	44	06087	36.93732602	-121.7715374	Santa Cruz County
221645	Fee-for-Service	1316041726	1316041726	1	1	KIM, JAMES M MD	8/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95965	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
221705	Fee-for-Service	1114304839	1114304839	1	1	KAUFMAN, AMY L MD	6/13/2019	207R00000X	NA	Other	026	PHYSICIANS	159458	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
221730	Fee-for-Service	1366645616	1366645616	1	1	KOHLI, NEELU MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	87993	01	General Practice	0	In state provider	None	17264 FOOTHILL BLVD	STE A	FONTANA	CA	92335	9050	36	06071	34.10678654	-117.4277541	San Bernardino County
221733	Fee-for-Service	1336567783	1336567783	1	1	KAISER FOUNDATION HEALTH	7/30/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	4867 SUNSET BLVD	FL 1	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
221774	Fee-for-Service	1821336058	1821336058	1	1	KUMAR, ARVIND MD	1/9/2019	282N00000X	NA	Hospitals	026	PHYSICIANS	156892	41	Internal Medicine	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
221798	Fee-for-Service	1417062894	1417062894	1	1	KWOK, RONALD S	11/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62690	41	Internal Medicine	0	In state provider	None	1240 BROADWAY	None	SAN DIEGO	CA	92101	5613	37	06073	32.71580142	-117.1533903	San Diego County
221815	Fee-for-Service	1306137476	1306137476	1	1	KHACHATRIAN, AELITA MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127694	83	Rheumatology	0	In state provider	None	14901 RINALDI STREET	SUITE 315	LOS ANGELES	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
221862	Fee-for-Service	1942230503	1942230503	1	1	KATO, EAMON K MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95586	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	STE 200	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
221865	Fee-for-Service	1316907330	1316907330	1	1	KRISS, ROBERT S DO	3/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11971	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
221921	Fee-for-Service	1770093452	1770093452	1	1	KEITH, COURTNEY LCSW	9/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
221932	Fee-for-Service	1518981059	1518981059	1	1	KIM, ROBIN Y MD AMC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79796	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
221935	Fee-for-Service	1881744480	1881744480	1	1	KONSTAS, ANGELOS A MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114761	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
221972	Fee-for-Service	1871639302	1871639302	1	1	KAMPALATH, RONY MD	4/27/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	124207	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
222006	Fee-for-Service	1164586566	1164586566	1	1	KIM, BORA MD	8/1/2000	207R00000X	NA	Other	026	PHYSICIANS	62364	41	Internal Medicine	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
222017	Fee-for-Service	1811261530	1811261530	1	1	KLEIN, JOSEPH A PT	12/16/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1180 W. OLIVE AVE	SUITE I	MERCED	CA	95348	1900	24	06047	37.31910454	-120.4885665	Merced County
222042	Fee-for-Service	1063406163	1063406163	1	1	KOSTER, DAVID JAMES MD	1/1/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	64875	68	Hematology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
222057	Fee-for-Service	1184672156	1184672156	1	1	KELSOE, JOHN R MD	7/31/1988	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50102	36	Psychiatry	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
222063	Fee-for-Service	1538666458	1538666458	1	1	KHAN, JEHANZAEB J	10/23/2024	208M00000X	NA	Other	026	PHYSICIANS	188625	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
222068	Fee-for-Service	1124108063	1124108063	1	1	KIRBY, MARIE E	10/21/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2600 E BIDWELL ST	220	FOLSOM	CA	95630	6441	34	06067	38.65914	-121.1281065	Sacramento County
222069	Fee-for-Service	1871976431	1871976431	1	1	KARLAN, MARY E	12/26/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 COAST BLVD	8	LA JOLLA	CA	92037	4625	37	06073	32.83955485	-117.2810903	San Diego County
222103	Fee-for-Service	1568988590	1568988590	1	1	KONDRADZHYAN, MANVEL MD	1/16/2019	207R00000X	NA	Other	026	PHYSICIANS	150538	41	Internal Medicine	0	In state provider	None	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
222153	Fee-for-Service	1336596964	1336596964	1	1	KHAN, IMRAN A MD	4/1/2023	207P00000X	NA	Other	026	PHYSICIANS	184128	None	None	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
222234	Fee-for-Service	1033589783	1033589783	1	1	KIM, MICHELLE NP	1/15/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5311 WEST CENTINELA AVE	None	LOS ANGELES	CA	90045	8803	19	06037	33.97728749	-118.3728026	Los Angeles County
222262	Fee-for-Service	1306836770	1306836770	1	1	KADHIUM, SABAH A MD	7/1/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56488	08	Family Practice	0	In state provider	None	1234 FOOTHILL BLVD	STE 2	LA VERNE	CA	91750	3329	19	06037	34.11800774	-117.7794559	Los Angeles County
222298	Fee-for-Service	1821010752	1821010752	1	1	KIRKHAM, DANIEL MD	2/1/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	1	Border provider	None	2874 N CARSON ST	STE 300	CARSON CITY	NV	89706	1683	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
222306	Fee-for-Service	1134567092	1134567092	1	1	KAUR, RAVDEEP MD	6/17/2019	207R00000X	NA	Other	026	PHYSICIANS	159126	03	Allergy	0	In state provider	None	1100 PEAR TREE LN	None	NAPA	CA	94558	6446	28	06055	38.32087983	-122.2946228	Napa County
222326	Fee-for-Service	1568539476	1568539476	1	1	KIM, KIMBERLY H MD	8/31/1991	207R00000X	NA	Other	026	PHYSICIANS	50074	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
222330	Fee-for-Service	1063406163	1063406163	1	1	KOSTER, DAVID JAMES MD	1/1/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	64875	01	General Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
222351	Fee-for-Service	1306151048	1306151048	1	1	KEY, ROGER W RCP	2/15/2019	101YA0400X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
222370	Fee-for-Service	1952516304	1952516304	1	1	KARIMIAN, MERSEDEH DO	5/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9115	05	Anesthesiology	0	In state provider	None	18300 HWY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
222380	Fee-for-Service	1235420274	1235420274	1	1	KATE E. PINO, M.D.	4/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3000 N TRIUMPH BLVD	None	LEHI	UT	84043	4999	00	None	40.42593191	-111.8802049	Utah County
222421	Fee-for-Service	1093772444	1093772444	1	1	KUMAR'S PORTABLE X-RAY	3/16/1989	No Taxonomy Provided	NA	None	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	JUNE OR MICHELLE	3621 GLENCREST DRIVE	None	MODESTO	CA	95355	8431	50	06099	37.6787156	-120.9288821	Stanislaus County
222439	Fee-for-Service	1023577160	1023577160	1	1	KOLO, CATHERINE T MD	6/23/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178089	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
222471	Fee-for-Service	1346501723	1346501723	1	1	KUMARESAN, ABIRAMI MD	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153356	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
222492	Fee-for-Service	1912964925	1912964925	1	1	KIMONIS, VIRGINIA E MD	5/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52311	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
222528	Fee-for-Service	1578092318	1578092318	1	1	KHAYYAT, SINAN MD	3/10/2020	207R00000X	NA	Other	026	PHYSICIANS	165198	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
222558	Fee-for-Service	1558520379	1558520379	1	1	KOGAN, ANNA MD	5/25/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	108645	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DR	STE 103	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
222573	Fee-for-Service	1588778542	1588778542	1	1	KAY, KELVIN N MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	81668	01	General Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
222578	Fee-for-Service	1316075229	1316075229	1	1	KINGS CO HLTH DEPT	12/1/1977	No Taxonomy Provided	NA	None	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	FAM PLNNG CLINIC	330 CAMPUS DR	None	HANFORD	CA	93230	4375	16	06031	36.32674062	-119.6636908	Kings County
222595	Fee-for-Service	1487697132	1487697132	1	2	KOSSARI, SHAHRAM MD	6/18/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	68579	None	None	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
222619	Fee-for-Service	1063406163	1063406163	1	1	KOSTER, DAVID JAMES MD	1/1/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	64875	78	Neoplastic Diseases/Oncology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
222635	Fee-for-Service	1427282714	1427282714	1	1	KIM, SUEJIN S MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	95237	10	Gastroenterology (M.D. only)	0	In state provider	None	2850 COMMERCIAL CROSSING	None	SANTA CRUZ	CA	95065	1725	44	06087	36.98796413	-121.9825327	Santa Cruz County
222641	Fee-for-Service	1790890309	1790890309	1	1	KML PHARMACY INC	9/19/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KML PHARMACY INC	1655 S DE ANZA BLVD	STE 2	CUPERTINO	CA	95014	5319	43	06085	37.29471512	-122.0323738	Santa Clara County
222677	Fee-for-Service	1376584680	1376584680	1	1	KURRE, RAJABABU MD	9/1/1994	2084P0800X	NA	Psychiatry	026	PHYSICIANS	47982	36	Psychiatry	0	In state provider	None	770 MAGNOLIA AVE	SUITE 1F	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
222696	Fee-for-Service	1780690313	1780690313	1	1	KOGAN, MARK H MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	60809	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
222714	Fee-for-Service	1417515123	1417515123	1	1	KOTSAGIANNIDOU, ANASTASIA C	5/14/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	CC-SLP	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
222752	Fee-for-Service	1558420158	1558420158	1	1	KORPMAN, THELMA Z MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	30625	05	Anesthesiology	0	In state provider	None	3788 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1408	15	06029	35.39420177	-119.0081678	Kern County
222778	Fee-for-Service	1093248353	1093248353	1	1	KANG, DANIEL MD	11/8/2022	390200000X	NA	Other	026	PHYSICIANS	171158	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
222820	Fee-for-Service	1053448373	1053448373	1	1	KIM, YOUNG RAE MD INC	11/24/2009	207RR0500X	NA	Other	026	PHYSICIANS	52615	41	Internal Medicine	0	In state provider	None	3010 W ORANGE AVE	STE 409	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
222833	Fee-for-Service	1306873922	1306873922	1	1	KADEVARI, RAVINDER MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	52443	66	Emergency Medicine (Urgent Care)	0	In state provider	None	22429 HESPERIAN BLVD	None	HAYWARD	CA	94541	7010	01	06001	37.65859962	-122.1138947	Alameda County
222843	Fee-for-Service	1922396449	1922396449	1	1	KAHLON, ANGELINA K OD	3/21/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	STE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
222877	Fee-for-Service	1134299522	1134299522	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN FRANCISCO	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
222889	Fee-for-Service	1558317032	1558317032	1	1	KULCHYCKI, LARA K MD	3/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54499	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
222891	Fee-for-Service	1417950205	1417950205	1	1	KADYAN,VIVEK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	BOISE PHYS MED & REHAB	1055 N CURTIS RD	None	BOISE	ID	83706	0000	00	None	43.61455048	-116.256231	Ada County
222893	Fee-for-Service	1417134065	1417134065	1	1	KANADA, DANIEL J MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102808	30	Radiology	0	In state provider	None	1001 POTRERO AVE	ROOM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
222952	Fee-for-Service	1194145920	1194145920	1	1	KRISHNAMOORTHY, MALA K MD	11/7/2018	207R00000X	NA	Other	026	PHYSICIANS	140784	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
222977	Fee-for-Service	1396838728	1396838728	1	1	KAPUR, RIDHIKA MD	8/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86476	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
222985	Fee-for-Service	1780690313	1780690313	1	1	KOGAN, MARK H MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	60809	10	Gastroenterology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
223076	Fee-for-Service	1932631736	1932631736	1	1	KO, SUK MOON MD	8/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171668	None	None	0	In state provider	None	455 OCONNOR DR	SUITE 210	SAN JOSE	CA	95128	1633	43	06085	37.326654	-121.939897	Santa Clara County
223088	Fee-for-Service	1114053618	1114053618	1	1	KNUDSON, ALLAN A MD	1/1/1979	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9036	01	General Practice	0	In state provider	None	440 GREENFIELD AVE	STE G	HANFORD	CA	93230	3568	16	06031	36.32904	-119.6582155	Kings County
223098	Fee-for-Service	1063400380	1063400380	1	1	KHAN, ABDUL R MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53877	01	General Practice	0	In state provider	None	1711 W TEMPLE ST	STE 5613	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
223106	Fee-for-Service	1053448373	1053448373	1	1	KIM, YOUNG RAE MD INC	11/24/2009	207RR0500X	NA	Other	026	PHYSICIANS	52615	83	Rheumatology	0	In state provider	None	3010 W ORANGE AVE	STE 409	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
223109	Fee-for-Service	1396289070	1396289070	1	1	KENNEDY, KRISTIN D NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
223116	Fee-for-Service	1386663433	1386663433	1	1	KIM, TERESA H MD	8/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96068	02	General Surgery	0	In state provider	None	365 HAWTHORNE AVE	SUITE 101	OAKLAND	CA	94609	3117	01	06001	37.82079728	-122.2633226	Alameda County
223120	Fee-for-Service	1306873922	1306873922	1	1	KADEVARI, RAVINDER MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	52443	08	Family Practice	0	In state provider	None	22429 HESPERIAN BLVD	None	HAYWARD	CA	94541	7010	01	06001	37.65859962	-122.1138947	Alameda County
223170	Fee-for-Service	1770747024	1770747024	1	1	KAMA, NDEYE F MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107631	41	Internal Medicine	0	In state provider	None	8510 BALBOA BLVD	SUITE 150	NORTHRIDGE	CA	91325	5810	19	06037	34.224507	-118.5026015	Los Angeles County
223178	Fee-for-Service	1992872105	1992872105	1	1	KIM, ERIC C MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68949	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
223188	Fee-for-Service	1770071680	1770071680	1	1	KIM, TIADORA PSYD	12/16/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
223263	Fee-for-Service	1245894997	1245894997	1	1	KHUSHIGIAN, DANIEL A DO	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	19436	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
223275	Fee-for-Service	1487911293	1487911293	1	1	KWOH, ERIC J H MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129678	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
223308	Fee-for-Service	1609413053	1609413053	1	1	KLIMKIV, LILIYA MD	6/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182995	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
223340	Fee-for-Service	1265846109	1265846109	1	1	KHATTAR, NEERA MD	8/29/2020	207P00000X	NA	Other	026	PHYSICIANS	162538	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
223408	Fee-for-Service	1306873922	1306873922	1	1	KADEVARI, RAVINDER MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	52443	41	Internal Medicine	0	In state provider	None	22429 HESPERIAN BLVD	None	HAYWARD	CA	94541	7010	01	06001	37.65859962	-122.1138947	Alameda County
223442	Fee-for-Service	1750364345	1750364345	2	3	KAN-DI-KI LLC	9/6/2022	335V00000X	NA	Other	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	RATORIES & RADIOLOGY	15200 STAGG ST	1	VAN NUYS	CA	91405	1056	19	06037	34.21204247	-118.464102	Los Angeles County
223445	Fee-for-Service	1558465708	1558465708	1	1	KAMJOO, KAMYAR MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77563	45	Nephrology (Renal-Kidney)	0	In state provider	None	4910 VAN NUYS BLVD	SUITE 306	SHERMAN OAKS	CA	91403	1770	19	06037	34.15979697	-118.4486826	Los Angeles County
223468	Fee-for-Service	1841679065	1841679065	1	1	KAISER FOUNDATION HEALTH	7/30/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	1100 N PALM CANYON DR	STE 204	PALM SPRINGS	CA	92262	5504	33	06065	33.838182	-116.546744	Riverside County
223483	Fee-for-Service	1659377935	1659377935	1	1	KOCI, TIMOTHY M MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
223533	Fee-for-Service	1497210835	1497210835	1	1	KOUKEYAN, KARIN H CCC-SLP	1/26/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3407 W SIXTH STREET	STE 716	LOS ANGELES	CA	90020	2764	19	06037	34.06363337	-118.295759	Los Angeles County
223573	Fee-for-Service	1861658486	1861658486	1	1	KIM, MICHAEL J MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116203	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
223591	Fee-for-Service	1285897454	1285897454	1	1	KRISHAMOORTHY, SRICHARITHA	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113443	08	Family Practice	0	In state provider	MD	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
223601	Fee-for-Service	1942838818	1942838818	1	1	KOHAN, SALAR MD	8/18/2024	207R00000X	NA	Other	026	PHYSICIANS	181444	41	Internal Medicine	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
223616	Fee-for-Service	1790057784	1790057784	1	1	KROON, MARK T CRNA	3/13/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
223654	Fee-for-Service	1316136476	1316136476	1	1	KEENE, JAMES H MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122261	41	Internal Medicine	0	In state provider	None	75 NEILSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.92823955	-121.792905	Santa Cruz County
223655	Fee-for-Service	1336489319	1336489319	1	1	KOREAN COMMUNITY SERVICES	9/21/2015	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	7281 GARDEN GROVE BLVD	SUITE H	GARDEN GROVE	CA	92841	4212	30	06059	33.77373947	-118.004067	Orange County
223698	Fee-for-Service	1578652111	1578652111	1	1	KUMAR, NIRMAL MD INC	9/22/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	29459	45	Nephrology (Renal-Kidney)	0	In state provider	None	2750 E WASHINGTON BLVD	STE 340	PASADENA	CA	91107	1451	19	06037	34.1680038	-118.0943955	Los Angeles County
223762	Fee-for-Service	1306893847	1306893847	1	1	KHOURY, BASEL MD	1/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144688	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
223794	Fee-for-Service	1073033213	1073033213	1	1	KOULISIS, NICOLE MD	7/5/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	157849	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
223797	Fee-for-Service	1720223845	1720223845	1	1	KULWANT, SINGH	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105095	34	Urology and Urological Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
223871	Fee-for-Service	1063603009	1063603009	1	1	KARAGUEZIAN, ALAIN A MD	1/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109354	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
223878	Fee-for-Service	1285897454	1285897454	1	1	KRISHAMOORTHY, SRICHARITHA	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113443	01	General Practice	0	In state provider	MD	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
223892	Fee-for-Service	1023025863	1023025863	1	1	KONDLE, VENU M MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73939	45	Nephrology (Renal-Kidney)	0	In state provider	None	1101 SMITH LANE	None	ROSEVILLE	CA	95661	4103	31	06061	38.73801017	-121.2748212	Placer County
223894	Fee-for-Service	1710034038	1710034038	1	1	KAISER FOUNDATION HEALTH	10/3/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #366	6 WILLARD	None	IRVINE	CA	92604	4694	30	06059	33.67534801	-117.7900415	Orange County
223900	Fee-for-Service	1831357144	1831357144	1	2	KASRAIE, ALEX A MD	5/25/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	105588	None	None	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	0722	36	06071	34.05016907	-117.1793443	San Bernardino County
223905	Fee-for-Service	1285019687	1285019687	1	1	KONG, CHRISTOPHER Y MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141106	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
223931	Fee-for-Service	1386946127	1386946127	1	1	KLASS, JANA N LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
223968	Fee-for-Service	1003963331	1003963331	1	1	KAISER FOUNDATION HLTH	10/26/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY	801 TRAEGER AVE	None	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
223969	Fee-for-Service	1689641169	1689641169	1	1	KABACK, ELIZABETH MD	5/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83368	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
223988	Fee-for-Service	1578652111	1578652111	1	1	KUMAR, NIRMAL MD INC	9/22/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	29459	41	Internal Medicine	0	In state provider	None	2750 E WASHINGTON BLVD	STE 340	PASADENA	CA	91107	1451	19	06037	34.1680038	-118.0943955	Los Angeles County
224009	Fee-for-Service	1659353522	1659353522	1	1	KELTNER, JOHN L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	15710	18	Ophthalmology	0	In state provider	UCD PROF SVCS GRP	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
224013	Fee-for-Service	1245421353	1245421353	1	1	KIM, HONG SIK MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45579	41	Internal Medicine	0	In state provider	None	12655 GARDEN GROVE BLVD	STE 503	GARDEN GROVE	CA	92843	1908	30	06059	33.7745283	-117.912017	Orange County
224039	Fee-for-Service	1588664767	1588664767	1	1	KELLY, RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2930 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1854	00	None	48.77232859	-122.4750679	Whatcom County
224053	Fee-for-Service	1578336111	1578336111	1	1	KOLBECK, SHILO PT	12/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1630 W REDLANDS BLVD.	SUITE L	REDLANDS	CA	92373	8032	36	06071	34.06293049	-117.2104992	San Bernardino County
224056	Fee-for-Service	1255099008	1255099008	1	1	KING, NOOSHA NP	3/13/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
224073	Fee-for-Service	1508204702	1508204702	1	1	KAZMER-MURILLO, EUFEMIA LCS	8/30/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
224083	Fee-for-Service	1841266046	1841266046	1	1	KIRSONIS, ANDRIUS A MD	8/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	43231	01	General Practice	0	In state provider	None	929 GEORGIA ST	None	LOS ANGELES	CA	90015	1321	19	06037	34.04665394	-118.2663654	Los Angeles County
224101	Fee-for-Service	1417013079	1417013079	1	1	KERNBACH, KLAUS J DPM	10/23/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	975 SERENO DRV	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
224124	Fee-for-Service	1205914306	1205914306	1	1	KATZ, MICHAEL P MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38410	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
224139	Fee-for-Service	1629003637	1629003637	1	1	KOBERNICK, MARC MD	7/31/1987	207P00000X	NA	Other	026	PHYSICIANS	52533	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
224162	Fee-for-Service	1063603009	1063603009	1	1	KARAGUEZIAN, ALAIN A MD	1/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109354	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
224172	Fee-for-Service	1740611821	1740611821	1	1	KHOUBIAN, FARZAD JACOB MD	2/21/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	95916	18	Ophthalmology	0	In state provider	INC	11245 E WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
224192	Fee-for-Service	1134290992	1134290992	1	1	KIRKPATRICK, STANLEY MD	4/28/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	29232	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	8001 FROST STREET	ENTRANCE 9	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
224207	Fee-for-Service	1194895227	1194895227	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
224219	Fee-for-Service	1568881977	1568881977	1	1	KHAN, MUHAMMAD S MD	6/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168924	08	Family Practice	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
224244	Fee-for-Service	1992886337	1992886337	1	1	KAHN, TALAT A MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68736	41	Internal Medicine	0	In state provider	MULTISPCLTY & OCUP INJ	703 MAGNOLIA AVE	None	CORONA	CA	92879	3118	33	06065	33.85828352	-117.5557208	Riverside County
224278	Fee-for-Service	1053441907	1053441907	1	1	KALEIDA HEALTH SYSTEM	8/2/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1540 MAPLE RD	None	WILLIAMSVILLE	NY	14221	3647	00	None	42.994008	-78.7301595	Erie County
224288	Fee-for-Service	1912230558	1912230558	1	1	KALASHO, RONNY O DO	11/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10760	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
224305	Fee-for-Service	1831749498	1831749498	1	1	KING, TONYA LMFT	6/15/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	131855	-	NOT APPLICABLE	0	In state provider	None	6022 VARIEL AVENUE	None	WOODLAND HILLS	CA	91367	3719	19	06037	34.180029	-118.592771	Los Angeles County
224315	Fee-for-Service	1730706714	1730706714	1	1	KIM, WILLIAM MD	9/15/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188523	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
224321	Fee-for-Service	1295811248	1295811248	1	1	KELSCH, TODD A OD	3/2/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
224329	Fee-for-Service	1831256031	1831256031	1	1	KASSEL, STEPHEN H MD	2/28/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	PEDIATRIC PATHOLOGY	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
224343	Fee-for-Service	1558646620	1558646620	1	2	KAY, JAMES L DO PC	3/18/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	24432 MUIRLANDS BLVD	SUITE 111	LAKE FOREST	CA	92630	3939	30	06059	33.62755212	-117.7028876	Orange County
224353	Fee-for-Service	1821362740	1821362740	1	1	KAGY, KENTON E DO	7/22/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	15777	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
224396	Fee-for-Service	1790340503	1790340503	1	1	KILPATRICK, MATTHEW MD	10/1/2024	207ZP0102X	NA	Other	026	PHYSICIANS	None	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2036 RAILROAD AVE	None	REDDING	CA	96001	1801	45	06089	40.57806515	-122.3920754	Shasta County
224407	Fee-for-Service	1659720126	1659720126	1	1	KINGHORN, KRYSTINA R CRNA	6/22/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
224423	Fee-for-Service	1396249322	1396249322	1	1	KLEIN, DANIEL J MD	9/14/2021	207P00000X	NA	Other	026	PHYSICIANS	164486	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
224457	Fee-for-Service	1255317160	1255317160	1	1	KIMBERLY CASE, ARNP	12/30/2023	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1111 DUFF AVE	None	AMES	IA	50010	5745	00	None	42.03263238	-93.61063235	Story County
224471	Fee-for-Service	1033739180	1033739180	1	1	KHALID, UMAIR MD	6/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185393	None	None	0	In state provider	None	2006 SHAW AVE	None	CLOVIS	CA	93611	4192	10	06019	36.80848025	-119.6771991	Fresno County
224478	Fee-for-Service	1134290992	1134290992	1	1	KIRKPATRICK, STANLEY MD	4/28/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	29232	40	Pediatrics	0	In state provider	None	8001 FROST STREET	ENTRANCE 9	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
224555	Fee-for-Service	1750510194	1750510194	1	1	KIM-HWANG,JUDY E MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114430	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
224564	Fee-for-Service	1053441907	1053441907	1	1	KALEIDA HEALTH SYSTEM	8/2/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1540 MAPLE RD	None	WILLIAMSVILLE	NY	14221	3647	00	None	42.994008	-78.7301595	Erie County
224574	Fee-for-Service	1639223506	1639223506	1	1	KERN COUNTY CCS	11/1/2002	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	MCKINLEY MTU	601 4TH ST	STE 40	BAKERSFIELD	CA	93304	2221	15	06029	35.36074048	-119.0089215	Kern County
224647	Fee-for-Service	1851598379	1851598379	1	1	KUROKAWA, CHAD H	6/14/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12001 W WASHINGTON BLVD	None	LOS ANGELES	CA	90066	5801	19	06037	33.99760695	-118.4228296	Los Angeles County
224690	Fee-for-Service	1467507491	1467507491	1	1	KRAFT, DAN C LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	810 W LA VETA AVE	None	ORANGE	CA	92868	3918	30	06059	33.78059251	-117.860994	Orange County
224725	Fee-for-Service	1124777024	1124777024	1	1	KASRAZADEH, PAUL C MD	10/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187723	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
224754	Fee-for-Service	1508913781	1508913781	1	1	KIRZ, JOSHUA L PHD	4/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
224805	Fee-for-Service	1043380991	1043380991	1	1	KANE COUNTY HUMAN RESOURCE	1/18/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	355 N MAIN ST	None	KANAB	UT	84741	3260	00	None	37.054485	-112.5286185	Kane County
224837	Fee-for-Service	1508904939	1508904939	1	1	KUMAR, SUSEELA MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141467	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
224854	Fee-for-Service	1013276872	1013276872	1	1	KHACHATRYAN, TIGRAN MD	3/22/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127412	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
224855	Fee-for-Service	1689817983	1689817983	1	1	KRISHNA, SHEILA M MD	5/8/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	125915	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
224869	Fee-for-Service	1265610737	1265610737	1	1	KU, JOSEPH K MD APC	11/10/2008	193400000X	NA	Other	026	PHYSICIANS	77679	24	Plastic Surgery	0	In state provider	None	3975 JACKSON ST	STE 205	RIVERSIDE	CA	92503	3948	33	06065	33.92729721	-117.4413503	Riverside County
224876	Fee-for-Service	1679763635	1679763635	1	1	KISHBAUGH, GRETCHEN PHD	1/3/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7 FOURTH STREET	SUITE 47	PETALUMA	CA	94952	3043	49	06097	38.23300765	-122.640298	Sonoma County
224884	Fee-for-Service	1073075339	1073075339	1	1	KELLER, JOHANNA F MD	5/24/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177374	36	Psychiatry	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
224911	Fee-for-Service	1952527335	1952527335	1	1	KWEE, JOSEPH A MD	2/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81802	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
224921	Fee-for-Service	1710373485	1710373485	1	1	KANACK, MELISSA D MD	6/29/2022	208200000X	NA	General Surgery	026	PHYSICIANS	144388	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
224956	Fee-for-Service	1760560429	1760560429	1	1	KLINKE, GREGORY J MD	7/10/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62991	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
225030	Fee-for-Service	1134395726	1134395726	1	1	KALPAKIAN, MARY A MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85804	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
225045	Fee-for-Service	1659437424	1659437424	1	1	KUPER, BRADLEY D PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
225058	Fee-for-Service	1043278518	1043278518	1	1	KALLMEYER, STEVEN MD	3/25/2023	207LP3000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
225063	Fee-for-Service	1548649361	1548649361	1	1	KONG, ANNA W MD	7/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151239	08	Family Practice	0	In state provider	None	1332 NATIVIDAD RD	STE C	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
225070	Fee-for-Service	1609833060	1609833060	1	1	KHAWAJA, WASEEM A MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
225089	Fee-for-Service	1013081611	1013081611	1	1	KUJOK, HUSSAM MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92291	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
225092	Fee-for-Service	1609074970	1609074970	1	1	KO, SABRINA V PT	4/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
225119	Fee-for-Service	1952987901	1952987901	1	1	KURSINSKIS, ALEXANDRA MD	9/12/2023	390200000X	NA	Other	026	PHYSICIANS	185647	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
225140	Fee-for-Service	1689980690	1689980690	1	1	KING, JENNIFER	8/16/2023	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	113650	None	None	0	In state provider	None	2100 LYNN RD	STE 125	THOUSAND OAKS	CA	91360	8032	56	06111	34.2074907	-118.8854443	Ventura County
225144	Fee-for-Service	1013276872	1013276872	1	1	KHACHATRYAN, TIGRAN MD	3/22/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127412	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
225167	Fee-for-Service	1265416002	1265416002	1	1	KLEPAC, STEVEN R MD	7/20/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172873	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
225170	Fee-for-Service	1194079293	1194079293	1	1	KAMEN, RACHEL M	8/22/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
225176	Fee-for-Service	1053326793	1053326793	1	1	KHURSHEED, MOHAMMED MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25010	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
225182	Fee-for-Service	1104844760	1104844760	1	1	KELLMAN, GARY M MD	4/4/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183989	None	None	0	In state provider	None	1808 VERDUGO BLVD	SUITE 112	GLENDALE	CA	91208	1464	19	06037	34.2056211	-118.2154553	Los Angeles County
225239	Fee-for-Service	1396745048	1396745048	1	1	KARTCHNER, GLEN R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
225244	Fee-for-Service	1144490822	1144490822	1	1	KUMAR, NIRMAL MD INC	7/1/2000	207RN0300X	NA	Nephrology	026	PHYSICIANS	29459	45	Nephrology (Renal-Kidney)	0	In state provider	None	1350 N ALTADENA DR	SUITE 100	PASADENA	CA	91107	1488	19	06037	34.16938442	-118.0982267	Los Angeles County
225254	Fee-for-Service	1083962088	1083962088	1	1	KELDGORD, KRISTEN F LMFT	4/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
225294	Fee-for-Service	1528084175	1528084175	1	1	KULKARNI, MALABIKA MD	10/28/2017	207L00000X	NA	Other	026	PHYSICIANS	79003	05	Anesthesiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
225296	Fee-for-Service	1467418178	1467418178	1	1	KODY, EDWARD J MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60423	40	Pediatrics	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
225318	Fee-for-Service	1417069295	1417069295	1	1	KOVEN, STEPHANIE C MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	86188	41	Internal Medicine	0	In state provider	None	8635 W 3RD STREET	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
225321	Fee-for-Service	1568639995	1568639995	1	1	KIM, GIL S MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105679	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
225322	Fee-for-Service	1184988396	1184988396	1	1	KUMAR, LATHA S MD	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133286	41	Internal Medicine	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
225326	Fee-for-Service	1184011462	1184011462	1	1	KRYTUSA, DAWN DO	12/20/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	16324	47	Miscellaneous	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
225330	Fee-for-Service	1750624821	1750624821	1	1	KWOH, LAURA K MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142111	66	Emergency Medicine (Urgent Care)	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
225346	Fee-for-Service	1275558215	1275558215	1	1	KATHRYN F HATCH MD	10/8/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1233 N 30TH ST	None	BILLINGS	MT	59101	0127	00	None	45.79335	-108.5182155	Yellowstone County
225381	Fee-for-Service	1023188935	1023188935	1	1	KUMAR, PRADEEP MD	11/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52032	36	Psychiatry	0	In state provider	None	3131 BROWNS VALLEY RD	None	NAPA	CA	94558	5422	28	06055	38.30367773	-122.3214694	Napa County
225389	Fee-for-Service	1689672040	1689672040	1	1	KUKULKA, RICK MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 W LEOTA ST	None	NORTH PLATTE	NE	69101	6525	00	None	41.12078954	-100.7706728	Lincoln County
225401	Fee-for-Service	1396988259	1396988259	1	1	KATZ, JEREMY R MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123678	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
225402	Fee-for-Service	1770902900	1770902900	1	1	KAYALEH, RAOUF A MD PROF	12/22/2014	207R00000X	NA	Other	026	PHYSICIANS	41449	29	Pulmonary Diseases (M.D. only)	0	In state provider	MEDICAL CORP	1125 E 17TH STREET	SUITE E 109	SANTA ANA	CA	92701	2214	30	06059	33.76004145	-117.854838	Orange County
225407	Fee-for-Service	1265847123	1265847123	1	1	KOLBACH, CELIA NP	2/14/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
225431	Fee-for-Service	1447261144	1447261144	1	1	KHUSHIGIAN, JACOB M MD	6/1/1999	207P00000X	NA	Other	026	PHYSICIANS	63744	08	Family Practice	0	In state provider	None	470 GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.32996137	-119.6580167	Kings County
225435	Fee-for-Service	1295051290	1295051290	1	1	KAPLINSKI, MICHELLE A MD	7/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119151	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
225471	Fee-for-Service	1972583185	1972583185	1	1	KENNEDY, JASIRI MD	5/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81294	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5176 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
225476	Fee-for-Service	1962917021	1962917021	1	1	KERN PSYCHIATRIC HEALTH AND	10/5/2023	103TM1800X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	8329 BRIMHALL RD	804	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
225509	Fee-for-Service	1851492136	1851492136	1	1	KORMAN, IRINA MD	4/27/2006	207R00000X	NA	Other	026	PHYSICIANS	56408	41	Internal Medicine	0	In state provider	None	2863 YORBA ST	None	SAN FRANCISCO	CA	94116	2748	38	06075	37.73459757	-122.4976143	San Francisco County
225526	Fee-for-Service	1588624084	1588624084	1	1	KELLY, DAVID J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39942	40	Pediatrics	0	In state provider	None	8337 TELEGRAPH RD	STE 119	PICO RIVERA	CA	90660	4941	19	06037	33.96454327	-118.1134473	Los Angeles County
225532	Fee-for-Service	1144490822	1144490822	1	1	KUMAR, NIRMAL MD INC	7/1/2000	207RN0300X	NA	Nephrology	026	PHYSICIANS	29459	41	Internal Medicine	0	In state provider	None	1350 N ALTADENA DR	SUITE 100	PASADENA	CA	91107	1488	19	06037	34.16938442	-118.0982267	Los Angeles County
225547	Fee-for-Service	1578095774	1578095774	1	1	KASIMOGLU, ISMAIL MD	8/5/2020	390200000X	NA	Other	026	PHYSICIANS	158416	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
225576	Fee-for-Service	1396934014	1396934014	1	1	KUMAR MEDICAL CORPORATION	7/1/1995	193400000X	NA	Other	026	PHYSICIANS	39354	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	44215 15TH ST W	STE 215	LANCASTER	CA	93534	4014	19	06037	34.68666415	-118.1568572	Los Angeles County
225590	Fee-for-Service	1982647392	1982647392	1	1	KERR, KIM MD	12/31/1991	207RC0200X	NA	Other	026	PHYSICIANS	68491	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3001 COLBY ST	None	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
225613	Fee-for-Service	1609954270	1609954270	1	2	KENNEDY, JOHN M MD FACC	9/8/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	77565	None	None	0	In state provider	None	1145 REDONDO BEACH	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
225624	Fee-for-Service	1407266950	1407266950	1	1	KIM, THOMAS J MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149264	41	Internal Medicine	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
225643	Fee-for-Service	1215075767	1215075767	1	1	KALLMANN, KARL DC	5/11/2004	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	575 N THOMPSON RD	None	TIPTON	CA	93272	9756	54	06107	36.06399345	-119.3122406	Tulare County
225655	Fee-for-Service	1265215156	1265215156	1	1	KARAPUTA, OLGA NP	10/31/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	34	06067	38.599524	-121.437738	Sacramento County
225659	Fee-for-Service	1104129634	1104129634	1	1	KENNEY, PATRICK J DO	11/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14090	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
225675	Fee-for-Service	1831509421	1831509421	1	1	KEATING, SARAH L MD	7/30/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	138324	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
225684	Fee-for-Service	1598250052	1598250052	1	1	KAJANI, SURINA R MD	8/19/2020	207R00000X	NA	Other	026	PHYSICIANS	166477	41	Internal Medicine	0	In state provider	None	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
225689	Fee-for-Service	1770902900	1770902900	1	1	KAYALEH, RAOUF A MD PROF	12/22/2014	207R00000X	NA	Other	026	PHYSICIANS	41449	41	Internal Medicine	0	In state provider	MEDICAL CORP	1125 E 17TH STREET	SUITE E 109	SANTA ANA	CA	92701	2214	30	06059	33.76004145	-117.854838	Orange County
225701	Fee-for-Service	1174787113	1174787113	1	1	KUCINSKY, RASTISLAV MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	2200 BRYANT WILLIANS DR	None	KLAMATH FALLS	OR	97601	1120	00	None	42.25198664	-121.7841082	Klamath County
225721	Fee-for-Service	1447261144	1447261144	1	1	KHUSHIGIAN, JACOB M MD	6/1/1999	207P00000X	NA	Other	026	PHYSICIANS	63744	66	Emergency Medicine (Urgent Care)	0	In state provider	None	470 GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.32996137	-119.6580167	Kings County
225733	Fee-for-Service	1952478869	1952478869	1	1	KARPMAN, ALAN J MD	5/31/1982	2085B0100X	NA	MRI Provider	026	PHYSICIANS	30245	30	Radiology	0	In state provider	None	466 E OLIVE AVE	None	BURBANK	CA	91501	2111	19	06037	34.1839959	-118.3053285	Los Angeles County
225747	Fee-for-Service	1548624661	1548624661	1	1	KIPP, LUCAS B MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137774	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
225764	Fee-for-Service	1962917021	1962917021	1	1	KERN PSYCHIATRIC HEALTH AND	10/5/2023	103TM1800X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8329 BRIMHALL RD	804	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
225776	Fee-for-Service	1578505608	1578505608	1	1	KRANE, LOREN H PHD	3/11/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
225860	Fee-for-Service	1700016375	1700016375	1	1	KENT M HART MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CITY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
225862	Fee-for-Service	1033182530	1033182530	1	1	KARLYN-NAVARRO, KRISTIN J MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	63407	41	Internal Medicine	0	In state provider	None	3160 E DEL MAR BLVD	STE 110	PASADENA	CA	91107	4649	19	06037	34.14217551	-118.085292	Los Angeles County
225863	Fee-for-Service	1396934014	1396934014	1	1	KUMAR MEDICAL CORPORATION	7/1/1995	193400000X	NA	Other	026	PHYSICIANS	39354	41	Internal Medicine	0	In state provider	None	44215 15TH ST W	STE 215	LANCASTER	CA	93534	4014	19	06037	34.68666415	-118.1568572	Los Angeles County
225894	Fee-for-Service	1063740736	1063740736	1	1	KUNSTER, KATHLEEN A PSYD	10/15/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	320 TENTH ST	STE 205	SANTA ROSA	CA	95401	5291	49	06097	38.443572	-122.719698	Sonoma County
225924	Fee-for-Service	1558528968	1558528968	1	1	KIM, WON MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115678	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
225941	Fee-for-Service	1881955516	1881955516	1	1	KING, LACEY L MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137607	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
225955	Fee-for-Service	1124307327	1124307327	1	1	KALLAM, AVYAKTA	12/2/2022	207RH0000X	NA	Hematology	026	PHYSICIANS	133163	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
225956	Fee-for-Service	1467995233	1467995233	1	1	KELLEY DUNCAN, LAUREN P MD	8/12/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152033	08	Family Practice	0	In state provider	None	1818 VERDUGO BLVD	STE 200	GLENDALE	CA	91208	1408	19	06037	34.20560177	-118.216054	Los Angeles County
225999	Fee-for-Service	1487736419	1487736419	1	1	KUO, MICHAEL D MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66021	30	Radiology	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
226007	Fee-for-Service	1679916886	1679916886	1	1	KIM, JULIET P H MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146188	04	Otology, Laryngology, Rhinology	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
226017	Fee-for-Service	1366223406	1366223406	1	1	KRYSKA, EMILY OT	6/10/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
226022	Fee-for-Service	1700980315	1700980315	1	1	KAHLON, KANWALJIT S MD	12/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54684	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
226024	Fee-for-Service	1578508271	1578508271	1	1	KARA SHAY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MEDICAL VILLAGE DR	None	EDGEWOOD	KY	41017	3403	00	None	39.01457332	-84.56298791	Kenton County
226051	Fee-for-Service	1962917021	1962917021	1	1	KERN PSYCHIATRIC HEALTH AND	6/6/2024	103TM1800X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	8329 BRIMHALL RD	804	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
226154	Fee-for-Service	1679651442	1679651442	1	1	KARUNAKAR, TANUJA A DO	6/20/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
226155	Fee-for-Service	1659053262	1659053262	1	1	KAUR, RAMANDEEP NP	2/20/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4043 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	0000	15	06029	35.35411151	-119.0532915	Kern County
226174	Fee-for-Service	1730750985	1730750985	1	1	KONG, JEFFREY J OD	8/15/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
226188	Fee-for-Service	1891938106	1891938106	1	1	KUMARASWAMY, MONIKA MD	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120345	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
226194	Fee-for-Service	1245303353	1245303353	1	1	KOBAYASHI, GARY MD	10/15/1991	207R00000X	NA	Other	026	PHYSICIANS	58496	41	Internal Medicine	0	In state provider	None	145 THUNDER DR	None	VISTA	CA	92083	6010	37	06073	33.18535652	-117.288201	San Diego County
226222	Fee-for-Service	1992349765	1992349765	1	1	KASIMOGLU-TRAN, ELVIN MD	8/4/2022	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	70852	None	None	0	In state provider	None	1045 N TUSTIN ST	None	ORANGE	CA	92867	5904	30	06059	33.80481643	-117.8356481	Orange County
226243	Fee-for-Service	1245663228	1245663228	1	1	KIM, JESSICA Y DO	7/1/2019	207R00000X	NA	Other	026	PHYSICIANS	17031	07	Dermatology	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
226248	Fee-for-Service	1205231933	1205231933	1	1	KALITA, TATIANA A MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134970	41	Internal Medicine	0	In state provider	None	1515 EAST OCEAN AVENUE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
226261	Fee-for-Service	1295016475	1295016475	1	1	KO, BRYCE R MD	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111956	66	Emergency Medicine (Urgent Care)	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
226325	Fee-for-Service	1366694606	1366694606	1	1	KREMER PRILL, MARNIE J MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109358	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
226336	Fee-for-Service	1457965865	1457965865	1	1	KIDWELL, MALLORY C PHD	3/21/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
226353	Fee-for-Service	1881941250	1881941250	1	1	KWONG, HOI YAN NP	6/28/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
226399	Fee-for-Service	1871994731	1871994731	1	1	KHALSA, GURU SHABD LMFT	9/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
226473	Fee-for-Service	1225302755	1225302755	1	1	KENAN, JOSEPH MD	3/12/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	66080	36	Psychiatry	0	In state provider	None	9735 WILSHIRE BLVD	STE 212	BEVERLY HILLS	CA	90212	2102	19	06037	34.06711051	-118.4074605	Los Angeles County
226476	Fee-for-Service	1891938106	1891938106	1	1	KUMARASWAMY, MONIKA MD	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120345	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
226542	Fee-for-Service	1114095098	1114095098	1	1	KHAN, IFTIKHAR A MD	11/21/2010	207R00000X	NA	Other	026	PHYSICIANS	36824	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 E BEVERLY BLVD	STE 301	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
226580	Fee-for-Service	1184657330	1184657330	1	1	KAO, HELEN S MD	4/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88688	38	Geriatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
226596	Fee-for-Service	1730492059	1730492059	1	1	KIM, MIN H MD	10/19/2018	2080P0207X	NA	Hematology	026	PHYSICIANS	158596	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
226602	Fee-for-Service	1881079382	1881079382	1	1	KERTH, LINDSEY PT	8/9/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
226615	Fee-for-Service	1205008463	1205008463	1	1	KOURI, BENNA M	1/11/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
226633	Fee-for-Service	1659826493	1659826493	1	1	KIMBER, BRENDON PT	3/22/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5337 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	2807	15	06029	35.36721148	-119.0622416	Kern County
226716	Fee-for-Service	1295909455	1295909455	1	1	KIM, INA W MD	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148685	34	Urology and Urological Surgery	0	In state provider	None	3 MEDICAL PLAZA DRIVE	None	ROSEVILLE	CA	95661	3089	31	06061	38.76566391	-121.2457432	Placer County
226771	Fee-for-Service	1861401382	1861401382	1	1	KARCH, DAVID B MD	11/25/2020	207P00000X	NA	Other	026	PHYSICIANS	169269	None	None	0	In state provider	None	10 WOODLAND RD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
226797	Fee-for-Service	1285992644	1285992644	1	1	KAUNG, AUNG MD	12/12/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	127983	10	Gastroenterology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
226809	Fee-for-Service	1376588624	1376588624	1	1	KAHSAI, DANIEL N MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80570	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
226825	Fee-for-Service	1164483103	1164483103	1	1	KHAN, NAGUIB R MD INC	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	37775	05	Anesthesiology	0	In state provider	None	16501 VENTURA BLVD	STE 103	ENCINO	CA	91436	2064	19	06037	34.15764432	-118.4927792	Los Angeles County
226833	Fee-for-Service	1114095098	1114095098	1	1	KHAN, IFTIKHAR A MD	11/21/2010	207R00000X	NA	Other	026	PHYSICIANS	36824	41	Internal Medicine	0	In state provider	None	101 E BEVERLY BLVD	STE 301	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
226848	Fee-for-Service	1720302458	1720302458	1	1	KODALI, ARUNA D MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144501	26	Psychiatry (child)	0	In state provider	None	1801 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
226863	Fee-for-Service	1881058105	1881058105	1	1	KIM, ERIC C MD	7/9/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152213	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
226901	Fee-for-Service	1255429510	1255429510	1	1	KIM, JUNGBONG MD	5/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100599	05	Anesthesiology	0	In state provider	None	18300 HWY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
226918	Fee-for-Service	1972626646	1972626646	1	1	KEYVAN, BEHNAM LMFT	7/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50755	-	NOT APPLICABLE	0	In state provider	None	7101 BAIRD AVE	None	RESEDA	CA	91335	4150	19	06037	34.1995012	-118.5373824	Los Angeles County
226923	Fee-for-Service	1114007754	1114007754	1	1	KYU HYUN KIM, M.D. INC	1/25/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	15243 VANOWEN ST	STE 300	VAN NUYS	CA	91405	3605	19	06037	34.19394848	-118.4654115	Los Angeles County
226998	Fee-for-Service	1366835928	1366835928	1	1	KWAN, STEPHEN S W OD	7/22/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
227064	Fee-for-Service	1346449675	1346449675	1	1	KORNFELD, SHOSHANA R PHD	8/14/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
227082	Fee-for-Service	1326239468	1326239468	1	1	KWON, ERIC O MD	3/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105176	34	Urology and Urological Surgery	0	In state provider	None	975 MAPLE STREET	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
227109	Fee-for-Service	1609371293	1609371293	1	1	KIM, SUJUNG MD	1/3/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177580	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
227127	Fee-for-Service	1083974968	1083974968	1	1	KLACANSKY, ROBERT PSYD	5/1/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
227147	Fee-for-Service	1467764308	1467764308	1	1	KPC GLOBAL MEDICAL CENTERS	11/30/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	28400 MCCALL BLVD	None	SUN CITY	CA	92585	9658	33	06065	33.71805454	-117.1672547	Riverside County
227190	Fee-for-Service	1982641767	1982641767	1	1	KENNETH STONE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHN'S MEDICAL CENTER	1615 DELAWARE ST	None	LONGVIEW	WA	98632	0000	00	None	46.1309207	-122.9408931	Cowlitz County
227233	Fee-for-Service	1699934638	1699934638	1	1	KIM, SO YOUNG MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107241	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
227244	Fee-for-Service	1831328251	1831328251	1	1	KINKELAAR, DEBRA D LCSW	3/12/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	13279	-	NOT APPLICABLE	0	In state provider	None	1135 S ALVARADO ST	None	LOS ANGELES	CA	90006	4100	19	06037	34.04932111	-118.2814182	Los Angeles County
227247	Fee-for-Service	1336855576	1336855576	1	1	KORKOIAN, LAURA A PSYD	4/26/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
227262	Fee-for-Service	1235175902	1235175902	1	1	KIVETT, WILLIAM F MD	1/10/2000	207N00000X	NA	Dermatology	026	PHYSICIANS	34668	07	Dermatology	0	In state provider	MEDICAL CENTER OF CA	2463 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	7815	49	06097	38.441277	-122.6622825	Sonoma County
227286	Fee-for-Service	1780164061	1780164061	1	1	KUBULAN-SIMMONS, GABRIELLE	4/29/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
227290	Fee-for-Service	1487732236	1487732236	1	1	KUNO, RICHARD C MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83621	30	Radiology	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
227293	Fee-for-Service	1427083393	1427083393	1	1	KLEIN, VASUDHA L MD	1/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	158879	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
227296	Fee-for-Service	1669528758	1669528758	1	1	KAPLAN, GORDON S MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60714	02	General Surgery	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
227311	Fee-for-Service	1386176402	1386176402	1	1	KIM, GRACE LMFT	4/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
227332	Fee-for-Service	1811093461	1811093461	1	1	KESSLER, BRUCE E MD	1/1/1982	174400000X	NA	Other	026	PHYSICIANS	31775	41	Internal Medicine	0	In state provider	None	4555 VALLEY WEST BLVD	None	ARCATA	CA	95521	4683	12	06023	40.89911057	-124.0835325	Humboldt County
227381	Fee-for-Service	1396821807	1396821807	1	1	KOJOURI, KOUROSH MD	4/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86065	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
227388	Fee-for-Service	1689137853	1689137853	1	1	KIMHAK, KEVIN	11/9/2022	207R00000X	NA	Other	026	PHYSICIANS	180367	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
227404	Fee-for-Service	1699268425	1699268425	1	1	KARIUKI, ANNE M	7/18/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	30056 PENROSE LANE	None	CASTAIC	CA	91384	4566	19	06037	34.46434089	-118.6198226	Los Angeles County
227435	Fee-for-Service	1467764308	1467764308	1	1	KPC GLOBAL MEDICAL CENTERS	11/30/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	28400 MCCALL BLVD	None	SUN CITY	CA	92585	9658	33	06065	33.71805454	-117.1672547	Riverside County
227532	Fee-for-Service	1750452645	1750452645	1	1	KHINE, ERNEST A MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	63408	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
227539	Fee-for-Service	1598225112	1598225112	1	1	KAPLAN, TESSA M MD	9/8/2022	207R00000X	NA	Other	026	PHYSICIANS	179759	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
227542	Fee-for-Service	1912059114	1912059114	1	1	KWON, CHOO EUI CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	8700 RESEDA BLVD	STE 105	NORTHRIDGE	CA	91324	5386	19	06037	34.229988	-118.536062	Los Angeles County
227549	Fee-for-Service	1548948763	1548948763	1	1	KAUR, DALJIT NP	12/12/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
227578	Fee-for-Service	1427083393	1427083393	1	1	KLEIN, VASUDHA L MD	1/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	158879	78	Neoplastic Diseases/Oncology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
227583	Fee-for-Service	1669528758	1669528758	1	1	KAPLAN, GORDON S MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60714	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
227625	Fee-for-Service	1467582676	1467582676	1	1	KARAYAN, RONNIE MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85683	13	Neurology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
227640	Fee-for-Service	1922234434	1922234434	1	1	KETWAROO, PAMELA M MD	8/18/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
227654	Fee-for-Service	1255842035	1255842035	1	1	KIM, KYOUNGJUN PHD	5/22/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
227692	Fee-for-Service	1699268425	1699268425	1	1	KARIUKI, ANNE M	7/18/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	30056 PENROSE LANE	None	CASTAIC	CA	91384	4566	19	06037	34.46434089	-118.6198226	Los Angeles County
227721	Fee-for-Service	1508906405	1508906405	1	1	KULKARNI, BADRINATH MD	12/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51562	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
227733	Fee-for-Service	1508811571	1508811571	1	1	KACZAYNSKI, STEPHEN S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3990 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	1461	00	None	32.27923074	-110.943756	Pima County
227736	Fee-for-Service	1881772366	1881772366	1	1	KILLAM, SHAWN B MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	53270	05	Anesthesiology	0	In state provider	None	1701 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	0000	30	06059	33.69159109	-117.8479042	Orange County
227765	Fee-for-Service	1184046195	1184046195	1	1	KANG, HYUN K DPM	5/5/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3130 W OLYMPIC BLVD	STE 340	LOS ANGELES	CA	90006	2494	19	06037	34.05258529	-118.3039795	Los Angeles County
227786	Fee-for-Service	1407826423	1407826423	1	1	KOLB, BRADFORD A	6/21/2000	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	80765	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6135 AVALON CT	STE 101	LONG BEACH	CA	90803	4807	19	06037	33.76610114	-118.1191055	Los Angeles County
227798	Fee-for-Service	1457813628	1457813628	1	1	KHALSA, ANOOP K MD	2/17/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178036	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
227820	Fee-for-Service	1750452645	1750452645	1	1	KHINE, ERNEST A MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	63408	10	Gastroenterology (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
227828	Fee-for-Service	1518117191	1518117191	1	1	KENT, BRENDA P LMFT	6/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1060 W SIERRA AVE	STE 105	FRESNO	CA	93711	2063	10	06019	36.83009575	-119.8099386	Fresno County
227868	Fee-for-Service	1487681417	1487681417	1	1	KASSAN, ROB M MD	9/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67840	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1260 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.0273959	-118.4860069	Los Angeles County
227869	Fee-for-Service	1710001193	1710001193	1	1	KERWIN, WALTER F MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75336	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	8631 W THIRD ST	STE 1017E	LOS ANGELES	CA	90048	5913	19	06037	34.07361928	-118.3803143	Los Angeles County
227872	Fee-for-Service	1770583601	1770583601	1	1	KHOSLA, RAGAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S. DOBSON ROAD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
227874	Fee-for-Service	1063611234	1063611234	1	1	KOMPELLA, SUVARCHALA S	2/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101614	None	None	0	In state provider	R MD	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
227876	Fee-for-Service	1245386879	1245386879	1	1	KESSLER, ELIZABETH R MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
227909	Fee-for-Service	1699834259	1699834259	1	1	KIM, BRUCE MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58705	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
227923	Fee-for-Service	1447486048	1447486048	1	1	KHAN, AMNA F MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113647	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
227924	Fee-for-Service	1255490660	1255490660	1	1	KHALEELI, MOYEEN MD INC	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	26266	41	Internal Medicine	0	In state provider	None	4305 TORRANCE BLVD	STE 306	TORRANCE	CA	90503	4414	19	06037	33.83759546	-118.359342	Los Angeles County
228069	Fee-for-Service	1194128827	1194128827	1	1	KRUSI, SHARON D LMFT	5/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12586 SUMMIT RIDGE DR	None	NEVADA CITY	CA	95959	9534	29	06057	39.26573346	-120.9052616	Nevada County
228081	Fee-for-Service	1669590204	1669590204	1	1	KAPUR, VIMI R MD	1/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105170	05	Anesthesiology	0	In state provider	None	25470 MEDICAL CENTER DR	SUITE 206	MURRIETA	CA	92562	4901	33	06065	33.55723646	-117.1859554	Riverside County
228083	Fee-for-Service	1376074971	1376074971	1	1	KREMEN, ELIZABETH MD	9/20/2022	207L00000X	NA	Other	026	PHYSICIANS	174071	None	None	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
228115	Fee-for-Service	1669820437	1669820437	1	1	K B PEDIATRICS INC	6/6/2017	261QH0100X	NA	Other	026	PHYSICIANS	66270	40	Pediatrics	0	In state provider	None	1005 S HARBOR BLVD	None	SANTA ANA	CA	92704	2337	30	06059	33.73435322	-117.9198462	Orange County
228121	Fee-for-Service	1477818938	1477818938	1	1	KELLER, LAUREN P DO	4/19/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	13001	None	None	0	In state provider	None	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	34	06067	38.599524	-121.437738	Sacramento County
228132	Fee-for-Service	1750607099	1750607099	1	1	KALOOSTIAN, SEAN W MD	9/17/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	118917	14	Neurological Surgery	0	In state provider	None	6276 RIVER CREST DR	STE. A	RIVERSIDE	CA	92507	0783	33	06065	33.93782112	-117.2922842	Riverside County
228162	Fee-for-Service	1710001193	1710001193	1	1	KERWIN, WALTER F MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75336	06	Cardiovascular Disease (M.D. only)	0	In state provider	A MEDICAL CORPORATION	8631 W THIRD ST	STE 1017E	LOS ANGELES	CA	90048	5913	19	06037	34.07361928	-118.3803143	Los Angeles County
228164	Fee-for-Service	1497340962	1497340962	1	1	KWIATKOWSKI, KRISTIN L LMFT	2/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
228195	Fee-for-Service	1821865528	1821865528	1	1	KIM, CHRISTINE LPCC	11/21/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	614 GRAND AVE	SUITE 203	OAKLAND	CA	94610	3554	01	06001	37.80970653	-122.2493811	Alameda County
228198	Fee-for-Service	1699834259	1699834259	1	1	KIM, BRUCE MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58705	08	Family Practice	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
228201	Fee-for-Service	1154987329	1154987329	1	1	KIRBY, SHEYANN R DO	7/25/2023	207P00000X	NA	Other	026	PHYSICIANS	21150	None	None	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
228220	Fee-for-Service	1447926548	1447926548	1	1	KINGS HOME HEALTH INC	9/1/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15600 DEVONSHIRE ST	STE 203	GRANADA HILLS	CA	91344	7242	19	06037	34.25730352	-118.473084	Los Angeles County
228303	Fee-for-Service	1467407692	1467407692	1	1	KLAPMAN, GARY MD	6/30/1988	207P00000X	NA	Other	026	PHYSICIANS	30792	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1625 THE ALAMEDA	STE 202	SAN JOSE	CA	95126	2223	43	06085	37.3357723	-121.9172682	Santa Clara County
228305	Fee-for-Service	1639348808	1639348808	1	1	KATHERINE MCMULLIN JONES, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE CHILDRENS PLACE	CAMPUS BOX 8515	ST LOUIS	MO	63110	1002	00	None	38.63728519	-90.26492064	St. Louis city
228328	Fee-for-Service	1992098206	1992098206	1	1	KAGGIE, AMBER N PSYD	11/4/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
228349	Fee-for-Service	1912573866	1912573866	1	1	KINNEN, ELIZABETH CCC-SLP	8/31/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
228362	Fee-for-Service	1609334457	1609334457	1	1	KOZYCZ, SUZANNE N PT	9/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
228374	Fee-for-Service	1114007754	1114007754	1	2	KYU HYUN KIM, M.D. INC	9/17/2020	2251P0200X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3000 W OLYMPIC BLVD	SUITE 304	LOS ANGELES	CA	90006	6513	19	06037	34.05260947	-118.3003335	Los Angeles County
228440	Fee-for-Service	1356357347	1356357347	1	1	KRAMER, ALAN M MD	4/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	42969	41	Internal Medicine	0	In state provider	None	350 PARNASSUS AVE	STE 701	SAN FRANCISCO	CA	94117	3619	38	06075	37.76403932	-122.4561371	San Francisco County
228453	Fee-for-Service	1821063686	1821063686	2	1	KOCH, WILLIAM J MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	36829	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
228458	Fee-for-Service	1144320599	1144320599	1	1	KRAMER, MARC E MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	48066	66	Emergency Medicine (Urgent Care)	0	In state provider	SUITE 208	8929 UNIVERSITY CENTER L	# L	SAN DIEGO	CA	92122	1006	37	06073	32.87036657	-117.2263573	San Diego County
228464	Fee-for-Service	1174152631	1174152631	1	1	KWON, SUE MIN	4/10/2024	207R00000X	NA	Other	026	PHYSICIANS	186401	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
228516	Fee-for-Service	1902953235	1902953235	1	1	KAISER PERMANENTE PHCY	8/22/1982	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#216	215 S HICKORY ST	None	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
228538	Fee-for-Service	1366790438	1366790438	1	1	KAKKANAD, JIMMY J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119114	40	Pediatrics	0	In state provider	None	4650 W SUNSET AVE	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
228557	Fee-for-Service	1972699304	1972699304	1	1	KLEIN, JEFFREY A MD	10/9/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	37375	07	Dermatology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
228590	Fee-for-Service	1093386203	1093386203	1	1	KOHLER, DANE M NP	3/22/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
228594	Fee-for-Service	1033376660	1033376660	1	1	KAYNAN DOCTOR MD	7/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 ROCKLAND RD	None	WILMINGTON	DE	19803	3607	00	None	39.779298	-75.555387	New Castle County
228643	Fee-for-Service	1952692089	1952692089	1	1	KADAKIA, SEJAL P MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124680	67	Endocrinology	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
228645	Fee-for-Service	1467906321	1467906321	1	1	KEVIN T. MURPHY, MD A PROFES	4/9/2021	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12625 HIGH BLUFF	318	SAN DIEGO	CA	92130	2054	37	06073	32.94734997	-117.2404952	San Diego County
228651	Fee-for-Service	1568145639	1568145639	1	1	KAVONIAN, MARY PT	10/31/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2895 LOMA VISTA ROAD	SUITE H	VENTURA	CA	93003	1542	56	06111	34.27543868	-119.2574459	Ventura County
228672	Fee-for-Service	1831114842	1831114842	1	1	KAMALI, HENRY MD	7/1/2001	207L00000X	NA	Other	026	PHYSICIANS	68106	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 108	LOS GATOS	CA	95032	7691	43	06085	37.25302151	-121.966891	Santa Clara County
228692	Fee-for-Service	1043573074	1043573074	1	1	KAUR, PARVINDERJIT MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137228	01	General Practice	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
228704	Fee-for-Service	1285861427	1285861427	1	1	KAO, JEFFREY S MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127527	30	Radiology	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
228707	Fee-for-Service	1881609741	1881609741	1	1	KAMELL, RALPH M MD	7/28/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	24865	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
228751	Fee-for-Service	1144320599	1144320599	1	1	KRAMER, MARC E MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	48066	04	Otology, Laryngology, Rhinology	0	In state provider	SUITE 208	8929 UNIVERSITY CENTER L	# L	SAN DIEGO	CA	92122	1006	37	06073	32.87036657	-117.2263573	San Diego County
228760	Fee-for-Service	1770619355	1770619355	1	1	KIM, YOUN-HEE MD	9/30/1987	207N00000X	NA	Dermatology	026	PHYSICIANS	58071	07	Dermatology	0	In state provider	None	300 PASTEUR DR	# A200	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
228794	Fee-for-Service	1396143939	1396143939	1	1	KOLTA, REBECCA K	8/18/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
228798	Fee-for-Service	1114489705	1114489705	1	1	KHALID, SAMEEHA DO	8/9/2022	207R00000X	NA	Other	026	PHYSICIANS	19746	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
228802	Fee-for-Service	1740699073	1740699073	1	1	KLESCEWSKI, POLLY B	9/25/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
228803	Fee-for-Service	1053645671	1053645671	1	1	KALAFER, MICHAEL MD	3/17/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	23959	41	Internal Medicine	0	In state provider	None	11895 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99056515	-117.0752322	San Diego County
228804	Fee-for-Service	1245224997	1245224997	1	1	KILKENNY, MARTHA NP	4/9/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
228839	Fee-for-Service	1558552471	1558552471	1	1	KARAGYOZYAN, DANIELA S MD	7/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101804	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
228945	Fee-for-Service	1750806634	1750806634	1	1	KAN, LILIN LAC	1/19/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4305 TORRANCE BLVD.	SUITE 307	TORRANCE	CA	90503	4414	19	06037	33.83759546	-118.359342	Los Angeles County
228947	Fee-for-Service	1114999588	1114999588	1	1	KALLMANN, KAREN OD	9/22/1994	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5710 CAHALAN AVE	STE 5B	SAN JOSE	CA	95123	3010	43	06085	37.248225	-121.8473454	Santa Clara County
229003	Fee-for-Service	1164799656	1164799656	1	1	KESAVAN, SHUBHANGI N MD	8/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125704	None	None	0	In state provider	None	1407 N TRACY BLVD	None	TRACY	CA	95376	3445	39	06077	37.74353911	-121.4350246	San Joaquin County
229036	Fee-for-Service	1548346984	1548346984	1	1	KACHALIA, AMIT P MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93508	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VAN OWEN ST	None	LOS ANGELES	CA	91405	4598	19	06037	34.19395645	-118.463265	Los Angeles County
229054	Fee-for-Service	1396150041	1396150041	1	1	KEI, JUSTIN Y MD	9/20/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	138266	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
229092	Fee-for-Service	1053645671	1053645671	1	1	KALAFER, MICHAEL MD	3/17/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	23959	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11895 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99056515	-117.0752322	San Diego County
229183	Fee-for-Service	1003905092	1003905092	1	1	KULA HOSPITAL & CLINIC	12/1/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 KEOKEA PLACE	None	KULA	HI	96790	0000	00	None	20.70160237	-156.3575903	Maui County
229198	Fee-for-Service	1487944492	1487944492	1	1	KAISER FOUNDATION HEALTH	8/1/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 FRANKLIN PKWY W	FL 1	SAN MATEO	CA	94403	0000	41	06081	37.54034923	-122.2975544	San Mateo County
229221	Fee-for-Service	1487099081	1487099081	1	1	KAISER FOUNDATION HEALTH	3/10/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	18600 S FIGUEROA ST	FLOOR 1	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
229228	Fee-for-Service	1609954270	1609954270	1	1	KENNEDY, JOHN M MD FACC	12/1/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	77565	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
229239	Fee-for-Service	1528259744	1528259744	1	1	KHUU, PHUONG T MD	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87498	07	Dermatology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
229267	Fee-for-Service	1346313269	1346313269	1	1	KIMMERLING, GEORGE MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25421	41	Internal Medicine	0	In state provider	None	3838 CALIFORNIA ST	STE 1	SAN FRANCISCO	CA	94118	1522	38	06075	37.78591809	-122.4575439	San Francisco County
229289	Fee-for-Service	1063495166	1063495166	1	1	KLEIN, LLOYD W MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149163	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
229337	Fee-for-Service	1699206136	1699206136	1	1	KIM, JESSICA S MD	9/12/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	157839	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
229355	Fee-for-Service	1740784321	1740784321	1	1	KIWAKYOU, LARISSA M MD	6/15/2022	207L00000X	NA	Other	026	PHYSICIANS	163721	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
229364	Fee-for-Service	1447526603	1447526603	1	1	KHAN, MUHIBB N MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128877	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA STREET	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
229368	Fee-for-Service	1326542812	1326542812	1	1	KWON, SEBASTIAN T MD	8/15/2022	390200000X	NA	Other	026	PHYSICIANS	165826	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
229376	Fee-for-Service	1972869782	1972869782	1	1	KANG, JASON R MD	9/10/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	126414	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
229430	Fee-for-Service	1679923841	1679923841	1	1	KELLER, MELISSA MD	10/30/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	191563	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
229434	Fee-for-Service	1417127317	1417127317	1	1	KELLEY, DAVID M MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	59774	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1520 SAN PABLO	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
229448	Fee-for-Service	1619053139	1619053139	1	1	KRAMER, DAVID MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62666	18	Ophthalmology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
229526	Fee-for-Service	1528259744	1528259744	1	1	KHUU, PHUONG T MD	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87498	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
229527	Fee-for-Service	1356781132	1356781132	1	1	KIM, PHILIP MD	8/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166209	None	None	0	In state provider	None	21300 SHERMAN WAY STE 3	None	CANOGA PARK	CA	91303	3672	19	06037	34.20095853	-118.5957675	Los Angeles County
229617	Fee-for-Service	1952377079	1952377079	1	2	KIM, CANDACE J MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	54498	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
229620	Fee-for-Service	1417512898	1417512898	1	1	KHOURY, AMANDA DPM	6/12/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
229654	Fee-for-Service	1477081941	1477081941	1	1	KWON, YOUNG HAN MD	7/8/2023	1223S0112X	NA	Dental Provider	026	PHYSICIANS	183091	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
229659	Fee-for-Service	1417137571	1417137571	1	1	KOLESIAK, AMY L CNP	4/30/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10565 CIVIC CENTER DR	WEST BLDG., SUITE 165	RANCHO CUCAMONGA	CA	91730	3853	36	06071	34.10278226	-117.5747989	San Bernardino County
229660	Fee-for-Service	1942316849	1942316849	1	1	KEITH F KORVER, MD INC	11/1/2001	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3510 UNOCAL PLACE	SUITE 207	SANTA ROSA	CA	95403	0918	49	06097	38.479032	-122.721759	Sonoma County
229732	Fee-for-Service	1548687015	1548687015	1	1	KIM, DAVID J MD	5/18/2017	207P00000X	NA	Other	026	PHYSICIANS	139472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
229760	Fee-for-Service	1447456983	1447456983	1	1	KAISER FND HLTH PLAN	8/23/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #447	700 LAWRENCE EXPY	1ST FLR DEPT 138	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
229767	Fee-for-Service	1578541900	1578541900	1	1	KAHLE, ERIC J MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84371	18	Ophthalmology	0	In state provider	None	6880 PALM AVE	None	SEBASTOPOL	CA	95472	4270	49	06097	38.39599965	-122.8192479	Sonoma County
229768	Fee-for-Service	1609071406	1609071406	1	1	KIME, CHRISTOPHER R	6/10/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
229779	Fee-for-Service	1114975588	1114975588	1	1	KLIEGER, MICHAEL R MD	11/21/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	105793	30	Radiology	0	In state provider	None	1524 MCHENRY AVE	SUITE 100	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
229804	Fee-for-Service	1184983215	1184983215	1	1	KUNG, JONATHAN S MD	1/3/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	132143	10	Gastroenterology (M.D. only)	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
229840	Fee-for-Service	1790746378	1790746378	1	1	KAWEAH DELTA HLTH CARE	12/3/1980	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY	403 W MAIN STREET	None	VISALIA	CA	93291	6240	54	06107	36.3301148	-119.2960182	Tulare County
229865	Fee-for-Service	1962847228	1962847228	1	1	KRISHNAMOORTHY, BHUVANESWARI	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126561	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
229911	Fee-for-Service	1578525531	1578525531	1	1	KHUNTIA, DEEPAK MD	11/10/2010	2085R0001X	NA	Other	026	PHYSICIANS	54268	30	Radiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
229947	Fee-for-Service	1487976007	1487976007	1	1	KARTSONIS, LOUIS MD INC	9/1/1999	193400000X	NA	Other	026	PHYSICIANS	37754	18	Ophthalmology	0	In state provider	None	4747 MISSION BLVD	SUITE 5	SAN DIEGO	CA	92109	2541	37	06073	32.80002925	-117.2565267	San Diego County
229954	Fee-for-Service	1326128455	1326128455	1	1	KUPPERMAN, BARUCH MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63254	18	Ophthalmology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
229969	Fee-for-Service	1154411049	1154411049	1	1	KENNETH W FELDMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	None	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
230040	Fee-for-Service	1811938525	1811938525	1	1	KACHUCK, NORMAN J MD	4/30/1990	2084N0400X	NA	Neurology	026	PHYSICIANS	63328	13	Neurology (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	STE 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
230074	Fee-for-Service	1225236516	1225236516	1	3	KASARJIAN, JULIE K MD	7/1/2008	207P00000X	NA	Other	086	MEDICAL DIRECTORS	98419	-	NOT APPLICABLE	0	In state provider	None	4440 UNIVERSITY AVE	#1,#2,#3,#4,#5,#6,#7,#8,	RIVERSIDE	CA	92501	3199	33	06065	33.986006	-117.3833861	Riverside County
230095	Fee-for-Service	1003964800	1003964800	1	1	KAISER FND HLTH PLAN,INC	3/1/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHAR #515	1425 S MAIN ST 1ST FL	CENTRAL	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
230102	Fee-for-Service	1356553192	1356553192	1	1	KINDERMAN, ANNE L MD	5/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95071	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230111	Fee-for-Service	1831100619	1831100619	2	1	KEMP, JENNIFER L MD	1/31/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183555	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
230117	Fee-for-Service	1467039107	1467039107	1	1	KANTARIA, TINA D MD	4/5/2024	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
230138	Fee-for-Service	1114950060	1114950060	1	1	KRAUSS, HOWARD R MD	4/4/1991	207W00000X	NA	Ophthalmology	026	PHYSICIANS	37539	18	Ophthalmology	0	In state provider	None	2001 SANTA MONICA BLVD	STE 665W	SANTA MONICA	CA	90404	2118	19	06037	34.02891163	-118.4797466	Los Angeles County
230139	Fee-for-Service	1427092071	1427092071	1	1	KIRAKOSYAN, KARINE MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84127	01	General Practice	0	In state provider	None	500 E OLIVE AVE	STE 315	BURBANK	CA	91501	3329	19	06037	34.1845331	-118.3048131	Los Angeles County
230149	Fee-for-Service	1730116526	1730116526	1	1	KIM, ROSEANNE LMFT	2/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
230212	Fee-for-Service	1528075660	1528075660	1	1	KEUNE, LYNNAIA LMFT	12/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
230248	Fee-for-Service	1306800677	1306800677	1	1	KURANI, SANJAY B MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68317	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
230261	Fee-for-Service	1609812577	1609812577	1	1	KEH, CHOCK-HO MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54073	01	General Practice	0	In state provider	None	14785 JEFFREY RD	STE 212	IRVINE	CA	92618	0413	30	06059	33.68773634	-117.7707575	Orange County
230293	Fee-for-Service	1174017131	1174017131	1	1	KEANE, KELSEY LCSW	5/15/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	570 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3212	43	06085	37.25054647	-121.840839	Santa Clara County
230298	Fee-for-Service	1013105972	1013105972	1	1	KOTZEN, MICHAEL D DPM	8/1/2008	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INC	15243 VANOWEN	STE 411B	VAN NUYS	CA	91405	3663	19	06037	34.19394848	-118.4654115	Los Angeles County
230306	Fee-for-Service	1669787040	1669787040	1	1	KUMAR, GUNJAN MD	2/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119086	05	Anesthesiology	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
230318	Fee-for-Service	1700134830	1700134830	1	1	KARMUR, AMIT B DO	8/25/2021	208600000X	NA	General Surgery	026	PHYSICIANS	14549	None	None	0	In state provider	None	36320 INLAND VALLEY DR	SUITE 201	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
230382	Fee-for-Service	1639513955	1639513955	1	1	KIM, AHLEE MD	12/6/2022	2080P0205X	NA	Endocrinology	026	PHYSICIANS	182014	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
230418	Fee-for-Service	1881666360	1881666360	1	1	KEARNS, MICHEL J MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82110	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
230434	Fee-for-Service	1568431120	1568431120	1	1	KRIEG, JAMES P MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42427	41	Internal Medicine	0	In state provider	None	28125 BRADLEY RD	STE 170	SUN CITY	CA	92586	2248	33	06065	33.71309746	-117.1898349	Riverside County
230454	Fee-for-Service	1952384620	1952384620	1	1	KESSELMAN, MICHAEL S PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5100 N 6TH ST	STE 114	FRESNO	CA	93710	7506	10	06019	36.810666	-119.763204	Fresno County
230460	Fee-for-Service	1215968573	1215968573	1	1	KATHI L MAKOROFF M.D.	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
230490	Fee-for-Service	1770012668	1770012668	1	1	KIRBY, MEGAN M LMFT	8/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
230531	Fee-for-Service	1831367903	1831367903	1	1	KANG, HELEN H MD	8/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103988	02	General Surgery	0	In state provider	None	1510 SAN PABLO STREET	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
230534	Fee-for-Service	1174577654	1174577654	1	1	KANDA, ANJALA	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	14642 NEWPORT AVE	STE 300	TUSTIN	CA	92780	6059	30	06059	33.73082212	-117.8293987	Orange County
230537	Fee-for-Service	1104039825	1104039825	1	1	KATHIRIYA, IRFAN S MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99881	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
230541	Fee-for-Service	1861719551	1861719551	1	1	KENDLE, RYAN F MD	3/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	119332	78	Neoplastic Diseases/Oncology	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
230542	Fee-for-Service	1851454615	1851454615	1	1	KIM, SAM Y MD	7/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99387	04	Otology, Laryngology, Rhinology	0	In state provider	None	1351 E SPRUCE AVE	None	FRESNO	CA	93720	3342	10	06019	36.84136088	-119.7588077	Fresno County
230543	Fee-for-Service	1336238310	1336238310	1	1	KHONG, DOAN M MD	6/29/1981	207R00000X	NA	Other	026	PHYSICIANS	36911	41	Internal Medicine	0	In state provider	None	324 LEAVENWORTH ST	None	SAN FRANCISCO	CA	94102	2613	38	06075	37.78402186	-122.4142655	San Francisco County
230565	Fee-for-Service	1982243507	1982243507	1	2	KIDS HEALTH FIRST PEDIATRICS	10/8/2021	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC.	79440 CORPORATE CENTER D	STE 108	LA QUINTA	CA	92253	7243	33	06065	33.70937862	-116.2788139	Riverside County
230595	Fee-for-Service	1144249269	1144249269	1	1	KIM, WOO S DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	545 S ALVARADO ST	None	LOS ANGELES	CA	90057	2903	19	06037	34.06009726	-118.2745484	Los Angeles County
230612	Fee-for-Service	1679597835	1679597835	1	1	KIM, JIN R MD	11/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55676	None	None	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
230639	Fee-for-Service	1346232790	1346232790	1	1	KIDD, MATTHEW C MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	37237	01	General Practice	0	In state provider	None	2248 PASEO DEL REY ST	None	NEEDLES	CA	92363	3520	36	06071	34.82477226	-114.6086814	San Bernardino County
230643	Fee-for-Service	1740680651	1740680651	1	1	KHALIL, ALIA DO	9/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13367	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
230645	Fee-for-Service	1407268550	1407268550	1	1	KIM, HAYOON MD	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148768	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
230716	Fee-for-Service	1114238433	1114238433	1	1	KARAKI, FATIMA MD	9/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127274	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230757	Fee-for-Service	1518157585	1518157585	1	1	KIM, HYESUN MD	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100945	40	Pediatrics	0	In state provider	None	62 CORPORATE PARK	STE 125	IRVINE	CA	92606	3132	30	06059	33.69197468	-117.8247858	Orange County
230764	Fee-for-Service	1619690872	1619690872	1	1	KERN PODIATRY - FOOT AND ANK	11/16/2022	261QP1100X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	LINIC	3553 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1605	15	06029	35.39221983	-119.0082381	Kern County
230765	Fee-for-Service	1154518801	1154518801	1	1	KLOSTERMANN, ERIC J DPM	1/1/1979	261QP1100X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INC	4560 ADMIRALTY WAY	STE 351	MARINA DEL REY	CA	90292	5446	19	06037	33.98364904	-118.4449069	Los Angeles County
230767	Fee-for-Service	1821143405	1821143405	1	1	KARNO, MITCHELL P PHD	3/15/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1129 STATE ST	26	SANTA BARBARA	CA	93101	6767	42	06083	34.42286108	-119.7039095	Santa Barbara County
230829	Fee-for-Service	1992883680	1992883680	1	1	KEZMOH, MICHAEL P MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85932	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
230840	Fee-for-Service	1669927323	1669927323	1	1	KRILETICH, HEATHER	5/16/2022	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
230854	Fee-for-Service	1982243507	1982243507	1	2	KIDS HEALTH FIRST PEDIATRICS	10/8/2021	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC.	79440 CORPORATE CENTER D	STE 108	LA QUINTA	CA	92253	7243	33	06065	33.70937862	-116.2788139	Riverside County
230888	Fee-for-Service	1346314663	1346314663	1	1	KUMAR, SHEENA MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96109	08	Family Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
230910	Fee-for-Service	1568763662	1568763662	1	1	KAM, YING LCSW	7/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
230938	Fee-for-Service	1700978954	1700978954	1	1	KEARL, YVETTE LIZA MD	12/1/1996	2080P0204X	NA	Other	026	PHYSICIANS	81679	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
230960	Fee-for-Service	1518990274	1518990274	1	1	KASSAMALI, SULTANALI MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	32525	41	Internal Medicine	0	In state provider	None	949 CALHOUN PL	STE G	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
230964	Fee-for-Service	1922315472	1922315472	1	1	KHORASANI, MOHAMMAD R MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131555	30	Radiology	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	6337	34	06067	38.669886	-121.3127505	Sacramento County
230972	Fee-for-Service	1093251779	1093251779	1	2	KUALA-GILBERT, KEHAU K LCSW	7/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28125 BRADLEY RD	260	SUN CITY	CA	92586	2248	33	06065	33.71309746	-117.1898349	Riverside County
231011	Fee-for-Service	1073760435	1073760435	1	1	KIM, SANGHUN MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	107204	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
231047	Fee-for-Service	1326591777	1326591777	1	1	KALLAS, NICOLE LMFT	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
231056	Fee-for-Service	1730342817	1730342817	1	1	KATZ, MICHAEL S MD FACS	2/23/2023	2086S0102X	NA	General Surgery	026	PHYSICIANS	131463	None	None	0	In state provider	None	838 NORDAHL RD	SUITE 270	SAN MARCOS	CA	92069	3513	37	06073	33.13569751	-117.1191477	San Diego County
231061	Fee-for-Service	1497872840	1497872840	1	1	KILLPACK, LORRAINE PHD	12/21/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
231077	Fee-for-Service	1548609472	1548609472	1	1	KINETIX SURGERY CENTER, INC	12/16/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5651 SEPULVEDA BLVD	SUITE 101	SHERMAN OAKS	CA	91411	2954	19	06037	34.173639	-118.466176	Los Angeles County
231087	Fee-for-Service	1003106816	1003106816	1	1	KUREK, LAURA Y MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135663	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
231094	Fee-for-Service	1679652317	1679652317	1	1	KIM, JOHN H MD	10/3/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81600	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3100 SUMMIT ST	None	OAKLAND	CA	94609	3410	01	06001	37.82018974	-122.2643221	Alameda County
231121	Fee-for-Service	1073633632	1073633632	1	1	KHEMET, TANYA M	11/14/2008	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3234 MARYSVILLE BLVD	None	SACRAMENTO	CA	95815	1411	34	06067	38.626371	-121.4322615	Sacramento County
231142	Fee-for-Service	1679584486	1679584486	1	1	KAVANAUGH, ARTHUR F MD	11/1/1999	207K00000X	NA	Other	026	PHYSICIANS	50307	83	Rheumatology	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
231148	Fee-for-Service	1598730640	1598730640	1	1	KAKARLAPUDI, RAMESH K MD	10/1/2000	207L00000X	NA	Other	026	PHYSICIANS	51821	None	None	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
231154	Fee-for-Service	1679078257	1679078257	1	1	KOBAYASHI, BRANDON A MD	6/23/2021	208M00000X	NA	Other	026	PHYSICIANS	164599	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
231175	Fee-for-Service	1376906891	1376906891	1	1	KIERNAN, BRENDAN J MD	8/1/2021	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	172782	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
231223	Fee-for-Service	1700978954	1700978954	1	1	KEARL, YVETTE LIZA MD	12/1/1996	2080P0204X	NA	Other	026	PHYSICIANS	81679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
231251	Fee-for-Service	1932268679	1932268679	1	2	KWON, STEVEN I MD	11/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94776	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
231255	Fee-for-Service	1255488581	1255488581	1	1	KAISER FOUNDATION HEALTH PLA	1/27/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMAN PHAR#291	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
231256	Fee-for-Service	1073744546	1073744546	1	1	KUBOMOTO, SCOTT M MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115254	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
231303	Fee-for-Service	1275855728	1275855728	1	1	KOUSHA-SHOAR, ZOHREH MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126688	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
231311	Fee-for-Service	1700088804	1700088804	1	1	KEVIN FARZIN KIA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5201 HARRY HINES BLVD	None	DALLAS	TX	75235	7708	00	None	32.81161328	-96.83715929	Dallas County
231325	Fee-for-Service	1881035897	1881035897	1	1	KRISTJANSSON, JENNIFER L	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134635	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
231350	Fee-for-Service	1477608271	1477608271	1	1	KAISER FOUNDATION HOSP	1/27/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	BALDWIN PARK	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
231388	Fee-for-Service	1740749837	1740749837	1	1	KOJIMA, NOAH MD	5/22/2024	207R00000X	NA	Other	026	PHYSICIANS	177161	41	Internal Medicine	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
231407	Fee-for-Service	1396003257	1396003257	1	1	KUMAR, TISHANGI MD	2/7/2022	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	139580	None	None	0	In state provider	None	625 S FAIR OAKS AVE	STE 215	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
231435	Fee-for-Service	1548331507	1548331507	1	1	KOYAMA, SANDRA YUKARI	5/22/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65748	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
231480	Fee-for-Service	1144411679	1144411679	1	1	KIM, BRIAN J MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94167	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
231544	Fee-for-Service	1639242977	1639242977	1	1	KIM, JAE H MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52431	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
231552	Fee-for-Service	1093784597	1093784597	1	1	KADDEN, MARK L MD	6/30/1987	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	57198	10	Gastroenterology (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
231601	Fee-for-Service	1427258425	1427258425	1	2	KHALILIFARD, FARIMAH LMFT	3/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
231605	Fee-for-Service	1578022901	1578022901	1	1	KAMALIMOTLAGH, SHARIFEH MD	12/6/2022	207R00000X	NA	Other	026	PHYSICIANS	178934	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
231633	Fee-for-Service	1881153120	1881153120	1	1	KELLY, NICOLE A MD	6/27/2022	390200000X	NA	Other	026	PHYSICIANS	178408	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
231661	Fee-for-Service	1740436278	1740436278	1	1	KUROKI, ROBYN A MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103299	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
231695	Fee-for-Service	1972036697	1972036697	1	1	KIM, JOSHUA E DO	3/30/2021	207P00000X	NA	Other	026	PHYSICIANS	18633	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
231720	Fee-for-Service	1447352414	1447352414	1	1	KHECHOYAN, DAVID Y MD	1/28/2019	2086S0122X	NA	General Surgery	026	PHYSICIANS	-	24	Plastic Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
231722	Fee-for-Service	1124500012	1124500012	1	1	KNAPP, GEORGE S CNP	3/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7740 RANCHO SANTA FE RD	None	CARLSBAD	CA	92009	8685	37	06073	33.08100093	-117.2372485	San Diego County
231772	Fee-for-Service	1174665376	1174665376	1	1	KWOK, VINCENT V MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94169	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
231787	Fee-for-Service	1134230329	1134230329	1	1	KASAWA, JOHN MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	79338	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
231822	Fee-for-Service	1275638801	1275638801	1	1	KALINA,MARK E MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	49274	41	Internal Medicine	0	In state provider	None	7798 STARLING DR	STE 306	SAN DIEGO	CA	92123	2733	37	06073	32.79328051	-117.1554268	San Diego County
231826	Fee-for-Service	1386165314	1386165314	1	1	KARIM, VICTORIA J AU	7/5/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
231830	Fee-for-Service	1639242977	1639242977	1	1	KIM, JAE H MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52431	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
231944	Fee-for-Service	1649902669	1649902669	1	1	KANG, SOO JI CRNA	8/4/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
231949	Fee-for-Service	1720342728	1720342728	1	1	KHAN, SHAFIA A MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132317	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
231960	Fee-for-Service	1548221542	1548221542	1	1	KASAMATSU, GRACE MD	4/10/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79930	40	Pediatrics	0	In state provider	None	2071 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
232006	Fee-for-Service	1447352414	1447352414	1	1	KHECHOYAN, DAVID Y MD	1/28/2019	2086S0122X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
232043	Fee-for-Service	1114946639	1114946639	1	1	KAYE, PETER S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	382 S ARTHUR AVE	None	LOUISVILLE	CO	80027	3094	00	None	39.96537281	-105.1247735	Boulder County
232136	Fee-for-Service	1053762948	1053762948	1	1	KUPPERMANN, DAVID MD	3/9/2021	208800000X	NA	Other	026	PHYSICIANS	171086	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
232194	Fee-for-Service	1811075914	1811075914	1	1	KONDRATIOUK, SVELTANA DO	10/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8546	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
232204	Fee-for-Service	1164165692	1164165692	1	1	KAUR, KIMI OD	5/12/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
232210	Fee-for-Service	1609948447	1609948447	1	1	KOH, SOON-CHURLD MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	56402	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
232213	Fee-for-Service	1659649770	1659649770	1	1	KASULA, PRIYA NAINA R MD	4/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120213	41	Internal Medicine	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
232234	Fee-for-Service	1346770971	1346770971	1	1	KATIKINENI, VEENA MD	4/14/2022	207RR0500X	NA	Other	026	PHYSICIANS	172714	None	None	0	In state provider	None	12677 HESPERIA RD	140	VICTORVILLE	CA	92395	7735	36	06071	34.48148078	-117.2906175	San Bernardino County
232249	Fee-for-Service	1558641688	1558641688	1	1	KULCZYCKI, MICHAEL S DO	2/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12431	66	Emergency Medicine (Urgent Care)	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
232262	Fee-for-Service	1205913159	1205913159	1	1	KUNDA, LARISA D MD	3/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73119	84	Surgery-Head and Neck	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
232292	Fee-for-Service	1104820927	1104820927	1	1	KOSAR, EROL M MD	10/15/2009	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	75877	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4201 TORRANCE BLVD	STE 560	TORRANCE	CA	90503	4583	19	06037	33.8375955	-118.358748	Los Angeles County
232299	Fee-for-Service	1003937954	1003937954	1	1	KARCHIKIAN, SILVA MD	5/29/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40855	41	Internal Medicine	0	In state provider	None	410 W ARDEN AVENUE	SUITE 101	GLENDALE	CA	91203	4004	19	06037	34.15842441	-118.2618749	Los Angeles County
232339	Fee-for-Service	1114005675	1114005675	1	1	KUROSU, CATHERINE J MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50972	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
232341	Fee-for-Service	1265726723	1265726723	1	1	KIRSTEN, JONATHAN A MD	10/10/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	134985	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
232343	Fee-for-Service	1912427501	1912427501	1	1	KING, EBONY D MD	3/18/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159155	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
232361	Fee-for-Service	1730445644	1730445644	1	1	KOTHARI, NISREEN M MD	9/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144488	18	Ophthalmology	0	In state provider	None	1899 W MARCH LANE	None	STOCKTON	CA	95207	6402	39	06077	37.9873599	-121.3290151	San Joaquin County
232369	Fee-for-Service	1588721195	1588721195	1	1	KOLLER,JOHN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 CENTER AVE	STE 102	KODIAK	AK	99615	7306	00	None	57.78893809	-152.4060461	Kodiak Island Borough
232373	Fee-for-Service	1912408386	1912408386	1	1	KHO, ERNANIE CRNA	7/3/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
232385	Fee-for-Service	1104533447	1104533447	1	1	KAZI, MARYAM LMFT	10/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
232392	Fee-for-Service	1437500162	1437500162	1	1	KAM, MAY S DO	11/16/2020	207R00000X	NA	Other	026	PHYSICIANS	16889	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
232422	Fee-for-Service	1245896950	1245896950	1	1	KARMALLY, SERENA DO	7/26/2022	207R00000X	NA	Other	026	PHYSICIANS	19553	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
232434	Fee-for-Service	1457888042	1457888042	1	1	KALKHOFF, STEPHEN M MD	8/24/2024	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	190096	09	Gynecology (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	SUITE 400	LONG BEACH	CA	90806	1553	19	06037	33.809706	-118.189343	Los Angeles County
232441	Fee-for-Service	1417104837	1417104837	1	1	KIM, PAUL J MD	7/20/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	109213	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
232462	Fee-for-Service	1750806865	1750806865	1	1	KO, GRANT N MD PC	1/16/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	49179	36	Psychiatry	0	In state provider	None	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
232538	Fee-for-Service	1417390063	1417390063	1	1	KOTHARI, KATHRYN MD	7/1/2021	207PP0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
232562	Fee-for-Service	1912328584	1912328584	1	1	KARIYA, KARI PT	5/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
232569	Fee-for-Service	1154793297	1154793297	1	1	KAUFMAN, STEPHANIE LMFT	9/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	WOOD THERAPEUTIC SERVICE	215 N SAN MATEO DR	STE 4	SAN MATEO	CA	94401	2674	41	06081	37.56993046	-122.3300299	San Mateo County
232579	Fee-for-Service	1144394586	1144394586	1	1	KIM, DANIEL S MD	12/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87628	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
232581	Fee-for-Service	1811161144	1811161144	1	1	KALIN, AARON M DO	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14239	05	Anesthesiology	0	In state provider	None	726 FOURTH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
232585	Fee-for-Service	1477628634	1477628634	1	1	KOSSMAN, STEVEN MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85236	68	Hematology	0	In state provider	None	5555 RESERVOIR DR	STE 306	SAN DIEGO	CA	92120	5178	37	06073	32.77628471	-117.0563688	San Diego County
232587	Fee-for-Service	1003937954	1003937954	1	1	KARCHIKIAN, SILVA MD	5/29/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40855	01	General Practice	0	In state provider	None	410 W ARDEN AVENUE	SUITE 101	GLENDALE	CA	91203	4004	19	06037	34.15842441	-118.2618749	Los Angeles County
232589	Fee-for-Service	1174029821	1174029821	1	1	KUO, SELENA Z	5/8/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	174239	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
232596	Fee-for-Service	1437206760	1437206760	1	1	KAISER FNDATION HLTH PLN	2/15/2003	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #521	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
232601	Fee-for-Service	1053393017	1053393017	1	1	KABAKIAN, HRAYR A MD	1/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	39877	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
232625	Fee-for-Service	1114005675	1114005675	1	1	KUROSU, CATHERINE J MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50972	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
232674	Fee-for-Service	1437422060	1437422060	1	1	KNAPP, SHANNON E	2/17/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 200	FAIRFIELD	CA	94533	4897	48	06095	38.25812361	-122.0495417	Solano County
232685	Fee-for-Service	1063284172	1063284172	1	1	KHAKALI, MARK JONATHAN	11/8/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9449 CLEMENTINE WAY	None	ELK GROVE	CA	95758	3912	34	06067	38.413197	-121.452048	Sacramento County
232688	Fee-for-Service	1700270287	1700270287	1	1	KERN, HANNAH MD	12/27/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	145918	None	None	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
232698	Fee-for-Service	1013073824	1013073824	1	1	KAPOOR, SUDHIR MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	97433	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
232722	Fee-for-Service	1457888042	1457888042	1	1	KALKHOFF, STEPHEN M MD	8/24/2024	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	190096	15	Obstetrics (D.O. only)	0	In state provider	None	2888 LONG BEACH BLVD	SUITE 400	LONG BEACH	CA	90806	1553	19	06037	33.809706	-118.189343	Los Angeles County
232754	Fee-for-Service	1457517229	1457517229	1	1	KING, KATHLEEN H DO	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10998	08	Family Practice	0	In state provider	None	2210 DEL PASO RD	STE A	SACRAMENTO	CA	95834	9676	34	06067	38.655189	-121.5091575	Sacramento County
232756	Fee-for-Service	1699702316	1699702316	1	1	KHAN, AZIZ U MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	44121	68	Hematology	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
232759	Fee-for-Service	1629011366	1629011366	1	1	KIM, TCHANG J MD	1/1/1979	207L00000X	NA	Other	026	PHYSICIANS	29337	05	Anesthesiology	0	In state provider	None	12832 GARDEN GROVE BLVD	STE 230	GARDEN GROVE	CA	92843	2033	30	06059	33.77433247	-117.908712	Orange County
232858	Fee-for-Service	1619114592	1619114592	1	1	KNIGHT, ANDREW M MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90774	78	Neoplastic Diseases/Oncology	0	In state provider	None	110 LYNCH CREEK WY	STE A	PETALUMA	CA	94954	2337	49	06097	38.25171165	-122.6351052	Sonoma County
232860	Fee-for-Service	1740263052	1740263052	1	1	KELLY IVESTER	3/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1133 COLLEGE AVE	STE C143	MANHATTAN	KS	66502	2751	00	None	39.192381	-96.5996865	Riley County
232869	Fee-for-Service	1215167648	1215167648	1	1	KASI, PASHTOON MD	8/26/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	30	06059	33.65251244	-117.7317885	Orange County
232874	Fee-for-Service	1477628634	1477628634	1	1	KOSSMAN, STEVEN MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85236	78	Neoplastic Diseases/Oncology	0	In state provider	None	5555 RESERVOIR DR	STE 306	SAN DIEGO	CA	92120	5178	37	06073	32.77628471	-117.0563688	San Diego County
232888	Fee-for-Service	1275505562	1275505562	2	1	KHASIGIAN, HARRY A MD	9/11/2014	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	29772	20	Orthopedic Surgery	0	In state provider	None	7551 TIMBERLAKE WAY	SUITE 200	SACRAMENTO	CA	95823	5422	34	06067	38.466225	-121.415958	Sacramento County
232901	Fee-for-Service	1477765162	1477765162	1	1	KLEIN, TARA A MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94389	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
232903	Fee-for-Service	1679860936	1679860936	1	1	KLINGER, JENNIFER L PT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
232940	Fee-for-Service	1417117839	1417117839	1	1	KOTHA, ROSHAN MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106044	41	Internal Medicine	0	In state provider	None	5555 RESERVOIR DR	#309	SAN DIEGO	CA	92120	5193	37	06073	32.77628471	-117.0563688	San Diego County
232971	Fee-for-Service	1568998516	1568998516	1	1	KOLLEFRATH, MATTHEW B MD	8/3/2020	207R00000X	NA	Other	026	PHYSICIANS	163289	41	Internal Medicine	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
232973	Fee-for-Service	1063284172	1063284172	1	1	KHAKALI, MARK JONATHAN	11/8/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9449 CLEMENTINE WAY	None	ELK GROVE	CA	95758	3912	34	06067	38.413197	-121.452048	Sacramento County
232985	Fee-for-Service	1013073824	1013073824	1	1	KAPOOR, SUDHIR MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	97433	41	Internal Medicine	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
233022	Fee-for-Service	1811075633	1811075633	1	1	KADRI, ATTIA S MD	4/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83823	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	365 HAWTHORNE AVE	STE 301	OAKLAND	CA	94609	3113	01	06001	37.82079728	-122.2633226	Alameda County
233023	Fee-for-Service	1679908404	1679908404	1	1	KHAN, HAMMAD O MD INC	5/18/2015	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	92889	41	Internal Medicine	0	In state provider	None	685 N 13TH AVE	STE 11	UPLAND	CA	91786	4963	36	06071	34.10202219	-117.6339091	San Bernardino County
233025	Fee-for-Service	1467814459	1467814459	1	1	KIM, ARAM MD	6/17/2022	2084N0402X	NA	Neurology	026	PHYSICIANS	175657	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
233076	Fee-for-Service	1962480756	1962480756	1	1	KIMBLE K WILLIAM	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY MEDICAL SPECIA	2550 S PARKER RD	STE 206	AURORA	CO	80014	1679	00	None	39.670515	-104.8642785	Arapahoe County
233103	Fee-for-Service	1578086559	1578086559	1	1	KENEDY, SUZANNE CNP	4/15/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10889 WELLWORTH AVE	None	LOS ANGELES	CA	90024	4918	19	06037	34.05707768	-118.4424488	Los Angeles County
233110	Fee-for-Service	1801337241	1801337241	1	1	KURTMEN, DAVID	8/15/2023	208M00000X	NA	Other	026	PHYSICIANS	182938	None	None	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
233114	Fee-for-Service	1043773070	1043773070	1	1	KEPHART, GRANT D CRNA	5/10/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
233125	Fee-for-Service	1396876611	1396876611	1	1	KLAREN, AMANDA F OD	4/28/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
233137	Fee-for-Service	1326030867	1326030867	1	1	KOMROSKY, MELISSA C NP	9/29/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
233149	Fee-for-Service	1316582422	1316582422	1	1	KHALTAR, DULGUUN NP	8/8/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
233155	Fee-for-Service	1215167648	1215167648	1	1	KASI, PASHTOON MD	8/26/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	30	06059	33.65251244	-117.7317885	Orange County
233171	Fee-for-Service	1396057725	1396057725	1	1	KRAMER, RAYMOND D MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48896	01	General Practice	0	In state provider	None	47-923 OASIS ST	None	INDIO	CA	92201	9203	33	06065	33.72305277	-116.220673	Riverside County
233187	Fee-for-Service	1730279233	1730279233	1	1	KEITH LMBIRD MD	4/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 N NEVADA AVE	None	COLORADO SPGS	CO	80907	6819	00	None	38.86574509	-104.8201477	El Paso County
233208	Fee-for-Service	1922323997	1922323997	1	1	KHUU, ANTHONY N MD	10/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	1155 MILL ST	None	RENO	NV	89520	1576	00	None	39.52483792	-119.7968314	Washoe County
233224	Fee-for-Service	1821438649	1821438649	1	1	KOH, CHRISTINA Y MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135030	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
233228	Fee-for-Service	1417117839	1417117839	1	1	KOTHA, ROSHAN MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106044	83	Rheumatology	0	In state provider	None	5555 RESERVOIR DR	#309	SAN DIEGO	CA	92120	5193	37	06073	32.77628471	-117.0563688	San Diego County
233267	Fee-for-Service	1518306802	1518306802	1	1	KHALIFA AL OMRANI, BAKR B MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138506	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
233296	Fee-for-Service	1710338959	1710338959	1	1	KING, STEPHANIE A PSYD	5/31/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	405 ENFRENTE RD	220	NOVATO	CA	94949	7201	21	06041	38.06860017	-122.5397962	Marin County
233299	Fee-for-Service	1306897160	1306897160	1	1	KALLAY, TOM C MD	12/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	71512	40	Pediatrics	0	In state provider	None	1000 W CARSON STREET	None	TORRANCE	CA	90509	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
233309	Fee-for-Service	1679908404	1679908404	1	1	KHAN, HAMMAD O MD INC	5/18/2015	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	92889	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	685 N 13TH AVE	STE 11	UPLAND	CA	91786	4963	36	06071	34.10202219	-117.6339091	San Bernardino County
233341	Fee-for-Service	1033240338	1033240338	1	1	KHORAKIWALA, DURRIYAH PHD	8/14/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
233391	Fee-for-Service	1720440282	1720440282	1	1	KARIM, AZAD S MD	10/18/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	179388	None	None	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
233403	Fee-for-Service	1174676753	1174676753	1	1	KARUMANCHI, SUBBIAN A MD	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152162	45	Nephrology (Renal-Kidney)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
233407	Fee-for-Service	1720032972	1720032972	1	1	KURELLA, MANJULA MD	11/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79151	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
233410	Fee-for-Service	1184966046	1184966046	1	1	KING, MONIQUE C	2/3/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	20790 MADRONA AVE	None	TORRANCE	CA	90503	3777	19	06037	33.84145481	-118.344603	Los Angeles County
233482	Fee-for-Service	1922001635	1922001635	1	1	KLONTX, WILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2727 MCCLELLAND BLVD	None	JOPLIN	MO	64804	1626	00	None	37.06080628	-94.53202788	Jasper County
233496	Fee-for-Service	1952530800	1952530800	1	1	KHAN, SALMAN A MD	8/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108834	41	Internal Medicine	0	In state provider	None	1700 CESAR CHAVEZ AVE	SUITE 3900	LOS ANGELES	CA	90033	2414	19	06037	34.05101259	-118.217259	Los Angeles County
233505	Fee-for-Service	1760824403	1760824403	1	1	KELEHER, EAMON C MD	6/3/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147744	01	General Practice	0	In state provider	None	760 OTAY LAKES RD	None	CHULA VISTA	CA	91910	6915	37	06073	32.64603447	-117.0015068	San Diego County
233519	Fee-for-Service	1194927392	1194927392	1	1	KHAN, PARVEEN MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101696	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3700 VACA VALLEY PARKWAY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
233549	Fee-for-Service	1942511076	1942511076	1	1	KEVIN CARLILE M.D.	11/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	650 S RANDALL RD	None	ALGONQUIN	IL	60102	5944	00	None	42.16631855	-88.33554678	McHenry County
233557	Fee-for-Service	1952300576	1952300576	1	1	KAMRAN,M ALI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 N HILLSIDE	None	WICHITA	KS	67214	0000	00	None	37.695312	-97.29903348	Sedgwick County
233612	Fee-for-Service	1669476206	1669476206	1	1	KIM, YOUNG SOON MD	10/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32590	40	Pediatrics	0	In state provider	None	17507 CRENSHAW BLVD	None	TORRANCE	CA	90504	3403	19	06037	33.871635	-118.326516	Los Angeles County
233639	Fee-for-Service	1972879476	1972879476	1	1	KHAN, MOHAMMAD T MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129226	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
233672	Fee-for-Service	1669410247	1669410247	1	1	KIVELA, PAUL D MD	12/31/1992	207P00000X	NA	Other	026	PHYSICIANS	72039	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
233716	Fee-for-Service	1649685967	1649685967	1	1	KASSIR, MOHAMMAD M MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134558	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
233777	Fee-for-Service	1063569382	1063569382	1	1	KAISER PERMANENTE	1/31/1995	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	1900 E 4TH ST	None	SANTA ANA	CA	92705	3910	30	06059	33.74805463	-117.8400671	Orange County
233806	Fee-for-Service	1922179050	1922179050	2	1	KERN ALLERGY MEDICAL CLINIC	1/8/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1921 18TH ST	None	BAKERSFIELD	CA	93301	4205	15	06029	35.37525954	-119.024586	Kern County
233809	Fee-for-Service	1568431146	1568431146	1	1	KROL, THOMAS C MD	1/1/1982	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	43649	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
233817	Fee-for-Service	1528253572	1528253572	1	1	KRUTZIK, MICHAEL N MD	10/23/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	66632	None	None	0	In state provider	AMC	528 G ST	None	BRAWLEY	CA	92227	2411	13	06025	32.97748458	-115.5329928	Imperial County
233846	Fee-for-Service	1023286325	1023286325	1	1	KASOW, ZACHARY M LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
233849	Fee-for-Service	1457854192	1457854192	1	2	KERN VALLEY HEALTHCARE	3/25/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	4300 BIRCH ST	None	LAKE ISABELLA	CA	93240	9535	15	06029	35.63438473	-118.4065846	Kern County
233864	Fee-for-Service	1417194614	1417194614	1	1	KASPERSKI, DEANNA L	2/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101349	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
233902	Fee-for-Service	1306330063	1306330063	1	1	KAZEMIAN, MINA DO	12/18/2022	207L00000X	NA	Other	026	PHYSICIANS	17621	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
233947	Fee-for-Service	1710938568	1710938568	1	1	KINGHORN, KATHERINE A MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88955	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
233968	Fee-for-Service	1538197876	1538197876	1	1	KEATS, JOHN P MD	10/1/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40092	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	LOMA VISTA AT BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.275366	-119.2577085	Ventura County
233980	Fee-for-Service	1336518323	1336518323	1	1	KAUFMAN, KARIE F LMFT	5/23/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 E AVENUE	STE 4C	CHICO	CA	95926	1628	04	06007	0	0	None
233994	Fee-for-Service	1487790614	1487790614	1	1	KIM, JOANNE J MD	1/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75392	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3625 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1701	38	06075	37.78631844	-122.4538709	San Francisco County
234019	Fee-for-Service	1710481163	1710481163	1	1	KARLIN, ANDREW W MD	8/3/2022	207L00000X	NA	Other	026	PHYSICIANS	163902	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
234065	Fee-for-Service	1538196340	1538196340	1	1	KUWAHARA, JOSEPH D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51415	05	Anesthesiology	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
234075	Fee-for-Service	1750583092	1750583092	1	1	KNOWLES, SUSAN L MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
234080	Fee-for-Service	1174926190	1174926190	1	1	KHALIFIAN, SAM MD	7/15/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	159219	07	Dermatology	0	In state provider	None	200 UCLA MEDICAL PLZ	BLDG 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
234081	Fee-for-Service	1245253772	1245253772	1	1	KELLER, ROBERTA L MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80616	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
234102	Fee-for-Service	1366480634	1366480634	1	1	KRUK, PETER G MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96070	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
234111	Fee-for-Service	1265510002	1265510002	1	1	KUEHNER, GILLIAN MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81068	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
234136	Fee-for-Service	1912955402	1912955402	1	1	KIRBY KARL A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1250 EAST 3900 SOUTH	STE 260	SALT LAKE CITY	UT	84124	0000	00	None	40.68704883	-111.8558593	Salt Lake County
234138	Fee-for-Service	1457854192	1457854192	1	2	KERN VALLEY HEALTHCARE	3/25/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	4300 BIRCH ST	None	LAKE ISABELLA	CA	93240	9535	15	06029	35.63438473	-118.4065846	Kern County
234142	Fee-for-Service	1194707943	1194707943	1	1	KENT R HOOTMAN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING ASSC	1501 S POTOMAC	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
234155	Fee-for-Service	1588655658	1588655658	1	1	KARIYA, ENA MD	5/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87623	08	Family Practice	0	In state provider	None	23512 MADERO	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
234159	Fee-for-Service	1184620866	1184620866	1	1	KLEIN, RYAN M MD	11/20/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61244	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
234304	Fee-for-Service	1366805400	1366805400	1	1	KAMINSKI, PETER A MD	7/16/2019	208M00000X	NA	Other	026	PHYSICIANS	162028	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
234359	Fee-for-Service	1881914604	1881914604	1	1	KITAMURA, GENE MD	8/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	119415	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
234362	Fee-for-Service	1750583092	1750583092	1	1	KNOWLES, SUSAN L MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	83	Rheumatology	1	Border provider	None	1707 W CHARLESTON BLVD	220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
234370	Fee-for-Service	1174926190	1174926190	1	1	KHALIFIAN, SAM MD	7/15/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	159219	41	Internal Medicine	0	In state provider	None	200 UCLA MEDICAL PLZ	BLDG 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
234398	Fee-for-Service	1972583011	1972583011	1	1	KON, KEVIN N MD	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	94-800 UKEE ST	STE 303	WAIPAHU	HI	96797	4044	00	None	21.41257872	-158.0008603	Honolulu County
234405	Fee-for-Service	1194096743	1194096743	1	1	KNOTTS, NICOLE V MD	6/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124373	01	General Practice	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
234413	Fee-for-Service	1376749671	1376749671	1	1	KIME, SUSAN E	6/6/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
234447	Fee-for-Service	1184620866	1184620866	1	1	KLEIN, RYAN M MD	11/20/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61244	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
234500	Fee-for-Service	1356485304	1356485304	2	1	KUNWOO L KIM	4/9/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3130 W OLYMPIC BLVD	STE 150	LOS ANGELES	CA	90006	2484	19	06037	34.05258529	-118.3039795	Los Angeles County
234502	Fee-for-Service	1831107044	1831107044	1	1	KARTALIAN, RAFFI P MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79146	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3801 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	5731	15	06029	35.39450879	-119.0082635	Kern County
234517	Fee-for-Service	1639328982	1639328982	1	1	KISER, ELISA A LMFT	8/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1800 E LAMBERT RD	STE 230	BREA	CA	92821	4399	30	06059	33.9252218	-117.877552	Orange County
234529	Fee-for-Service	1205063054	1205063054	1	1	KU, PATTY C MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114176	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
234542	Fee-for-Service	1063625069	1063625069	1	1	KOUWABUNPAT, PAT T	8/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97918	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
234563	Fee-for-Service	1659049153	1659049153	1	1	KEBEDE, MARTA B	5/2/2022	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
234678	Fee-for-Service	1164447751	1164447751	1	1	KARP, KARYN B CRNA	6/1/2002	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	726 FOURTH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
234698	Fee-for-Service	1851597991	1851597991	1	1	KUPFERMAN, STEVEN B MD	1/11/2008	1223S0112X	NA	Dental Provider	026	PHYSICIANS	97977	04	Otology, Laryngology, Rhinology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
234705	Fee-for-Service	1518399831	1518399831	3	1	KESHAV RX, INC.	9/30/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1307 W 6TH ST	# 107	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
234713	Fee-for-Service	1881083103	1881083103	1	1	KIM, YOO J CRNA	12/9/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
234740	Fee-for-Service	1326541129	1326541129	1	1	KINDE, BENYAM Z MD	3/31/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	163883	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
234754	Fee-for-Service	1497067490	1497067490	1	1	KIM, JOSEPH Y MD	3/7/2019	207P00000X	NA	Other	026	PHYSICIANS	158233	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
234757	Fee-for-Service	1992360366	1992360366	1	1	KWAN, STEPHANIE Y MD	8/1/2024	2085R0001X	NA	Other	026	PHYSICIANS	177183	32	Radiation Therapy (D.O. only)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
234769	Fee-for-Service	1679962179	1679962179	1	1	KIM, JOANNE J OD INC	12/22/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14147 PIPELINE AVE	None	CHINO	CA	91710	5618	36	06071	33.99576275	-117.7151699	San Bernardino County
234774	Fee-for-Service	1972829257	1972829257	1	1	KF SUNRAY LLC	10/12/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3210 WEST PICO BLVD	None	LOS ANGELES	CA	90019	3699	19	06037	34.04717649	-118.312164	Los Angeles County
234801	Fee-for-Service	1346333846	1346333846	1	1	KRIEGER, MARK D MD	6/1/1999	2084N0402X	NA	Neurology	026	PHYSICIANS	78508	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
234802	Fee-for-Service	1003990094	1003990094	1	1	KAHN, CHERYL MD	7/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	54104	30	Radiology	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
234812	Fee-for-Service	1548452220	1548452220	1	1	KNOSKI-KIM, SUSIE H MD	10/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100946	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
234875	Fee-for-Service	1093722829	1093722829	1	1	KLEMEK, JOSEPH MD INC	3/24/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	29543	20	Orthopedic Surgery	0	In state provider	None	16300 SAND CANYON AVE	STE 511	IRVINE	CA	92618	3705	30	06059	33.66115075	-117.7742405	Orange County
234887	Fee-for-Service	1346619319	1346619319	1	1	KITZLER, LISA M	3/21/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
234902	Fee-for-Service	1629049374	1629049374	1	1	KATIMS, LEE M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST MARYS HOSPITAL	901 45TH ST	None	WEST PALM BCH	FL	33407	2413	00	None	26.756073	-80.0626545	Palm Beach County
234910	Fee-for-Service	1659969277	1659969277	1	1	KHALID, HIRA LMFT	3/11/2025	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
234912	Fee-for-Service	1164442000	1164442000	1	1	KHAYALI, MOHAMMAD R MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29943	13	Neurology (M.D. only)	0	In state provider	A PROFESSIONAL CORP	395 N SAN JACINTO ST	STE A	HEMET	CA	92543	3109	33	06065	33.752547	-116.958686	Riverside County
234927	Fee-for-Service	1881694719	1881694719	1	1	KOGUT, KELLY ANN MD PC	10/9/2007	2086S0120X	NA	General Surgery	026	PHYSICIANS	-	85	Surgery-Pediatric	1	Border provider	None	653 N TOWN CENTER DR	STE 507	LAS VEGAS	NV	89144	0519	00	None	36.17975641	-115.3155995	Clark County
234928	Fee-for-Service	1154397164	1154397164	1	1	KELTY, RICHARD H MD	10/3/1991	207ZP0102X	NA	Other	026	PHYSICIANS	39396	22	Pathology (M.D. only)	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
234933	Fee-for-Service	1790709186	1790709186	1	1	KOSEFF, PERRY R DO INC	9/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	4371	08	Family Practice	0	In state provider	None	2037 E 7TH ST	None	LONG BEACH	CA	90804	4590	19	06037	33.77537451	-118.16676	Los Angeles County
234943	Fee-for-Service	1760560486	1760560486	1	1	KATSURA, KEITH W DO	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7832	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
234974	Fee-for-Service	1124550835	1124550835	1	1	KING, KEVIN MD	6/29/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	165926	40	Pediatrics	0	In state provider	None	726 N MEDICAL CTR DR E	STE 209	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
235011	Fee-for-Service	1740432095	1740432095	1	1	KOOTURU, SHRUTHI R MD	5/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115127	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
235029	Fee-for-Service	1780027763	1780027763	1	1	KOO, JAIME MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115337	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
235030	Fee-for-Service	1588168793	1588168793	1	1	KAPLAN, SAMUEL R MD	11/20/2020	207P00000X	NA	Other	026	PHYSICIANS	163634	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
235076	Fee-for-Service	1760464424	1760464424	1	1	KOFFORD,MARK W MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70574	01	General Practice	0	In state provider	DANA POINT URGENT CARE	24582 DEL PRADO	STE H	DANA POINT	CA	92629	3821	30	06059	33.46545653	-117.700956	Orange County
235128	Fee-for-Service	1467433961	1467433961	1	1	KING, WILLIAM Y MD	1/30/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
235144	Fee-for-Service	1780716936	1780716936	1	1	KHOO, ALBERT H MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	98287	08	Family Practice	0	In state provider	None	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
235153	Fee-for-Service	1245317486	1245317486	1	1	KAREN M CARLSON	9/28/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	526 S 9TH AVE	None	SEQUIM	WA	98382	3626	00	None	48.07525986	-123.124012	Clallam County
235186	Fee-for-Service	1457318164	1457318164	1	1	KOPELMAN, WILLIAM J MD	3/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53462	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	WEST HILLS HOSP, ED	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
235199	Fee-for-Service	1134693047	1134693047	1	1	KENNY, CHARLES A LCSW	5/3/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235200	Fee-for-Service	1164442000	1164442000	1	1	KHAYALI, MOHAMMAD R MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29943	34	Urology and Urological Surgery	0	In state provider	A PROFESSIONAL CORP	395 N SAN JACINTO ST	STE A	HEMET	CA	92543	3109	33	06065	33.752547	-116.958686	Riverside County
235234	Fee-for-Service	1619076528	1619076528	1	1	KELLY, HOLLY C MD INC	1/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72149	None	None	0	In state provider	None	4000 CIVIC CENTER DR	STE 205	SAN RAFAEL	CA	94903	5233	21	06041	38.0041783	-122.538861	Marin County
235251	Fee-for-Service	1245348861	1245348861	1	1	KRETZSCHMAR, FREDERICK J	3/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49874	22	Pathology (M.D. only)	0	In state provider	MD	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
235294	Fee-for-Service	1144664590	1144664590	1	1	KIM, MICHELLE J MD	7/23/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	156416	18	Ophthalmology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
235333	Fee-for-Service	1013105725	1013105725	1	1	KELLY, NATE E MD	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	99273	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
235339	Fee-for-Service	1124045927	1124045927	1	1	KAMRA, KOMAL MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74608	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235359	Fee-for-Service	1538499405	1538499405	1	1	KELLY, ELIZABETH A LMFT	5/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
235364	Fee-for-Service	1215151071	1215151071	1	1	KOHLI, AMITPAL S MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	94277	67	Endocrinology	0	In state provider	None	30281 GOLDEN LANTERN	None	LAGUNA NIGUEL	CA	92677	5979	30	06059	33.52255027	-117.6859055	Orange County
235388	Fee-for-Service	1609840826	1609840826	1	1	KELLNER, MARIA MD	12/12/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	88925	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
235459	Fee-for-Service	1780796037	1780796037	1	1	KRAEMER, FREDRIC MD	10/31/1984	207RE0101X	NA	Endocrinology	026	PHYSICIANS	36929	67	Endocrinology	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
235460	Fee-for-Service	1144244690	1144244690	1	1	KIM, TAELL T MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72179	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
235465	Fee-for-Service	1568629889	1568629889	1	1	KIM, TAE K MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124131	08	Family Practice	0	In state provider	None	555 TECHEVAH DR	3W 105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
235469	Fee-for-Service	1053706135	1053706135	1	1	KIM, SARAH MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129894	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
235510	Fee-for-Service	1346751294	1346751294	1	1	KHAKPOUR, NINA LMFT	9/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
235521	Fee-for-Service	1932136199	1932136199	1	1	KELLEY, CARLA A CRNA	6/16/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
235540	Fee-for-Service	1245348861	1245348861	1	1	KRETZSCHMAR, FREDERICK J	3/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49874	42	Nuclear Medicine	0	In state provider	MD	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
235543	Fee-for-Service	1124280672	1124280672	1	1	KANG, EUGENIA MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	106718	02	General Surgery	0	In state provider	None	2700 GRANT STREET	SUITE 316	CONCORD	CA	94520	2272	07	06013	37.98417931	-122.0361585	Contra Costa County
235551	Fee-for-Service	1144228628	1144228628	1	2	KIM, WILLIAM C MD INC	10/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	4201 TORRANCE BLVD	STE 190	TORRANCE	CA	90503	4539	19	06037	33.8375955	-118.358748	Los Angeles County
235565	Fee-for-Service	1013657782	1013657782	1	1	KANE, JAMES LMFT	3/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
235587	Fee-for-Service	1457419210	1457419210	1	1	KAPLAN, EUGENE MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67292	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORPORATION	120 LA CASA VIA	STE 209	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
235612	Fee-for-Service	1659309649	1659309649	1	1	KOEFFLER, HAROLD P MD	4/29/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	35603	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
235617	Fee-for-Service	1053355982	1053355982	1	1	KNAPP, ROLF D DO	10/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	5513	01	General Practice	0	In state provider	None	2540 N SANTIAGO BLVD	None	ORANGE	CA	92867	1862	30	06059	33.83083711	-117.8334144	Orange County
235618	Fee-for-Service	1619057882	1619057882	1	1	KIESTER, PHILLIP D MD	8/31/1989	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	40561	20	Orthopedic Surgery	0	In state provider	None	455 N ROXBURY DR	None	BEVERLY HILLS	CA	90210	5001	19	06037	34.06807822	-118.4069809	Los Angeles County
235627	Fee-for-Service	1780851956	1780851956	1	1	KARSAN, ANAND S MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121472	None	None	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
235630	Fee-for-Service	1689657579	1689657579	2	1	KRAKOW, DEBORAH MD	3/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	57061	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
235643	Fee-for-Service	1306100425	1306100425	1	1	KAUR, GAGANDEEP MD	1/13/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
235646	Fee-for-Service	1427258425	1427258425	1	1	KHALILIFARD, FARIMAH LMFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47756	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
235672	Fee-for-Service	1659532117	1659532117	1	1	KHAN, SALMAN R MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121566	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
235680	Fee-for-Service	1912249400	1912249400	1	1	KIM, ELLEN S MD	8/17/2022	207R00000X	NA	Other	026	PHYSICIANS	167810	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
235688	Fee-for-Service	1154321511	1154321511	1	1	KACHUR, NICHOLAS J CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
235690	Fee-for-Service	1316971039	1316971039	1	1	KELLEY, ELIZABETH W MD	5/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
235696	Fee-for-Service	1386751170	1386751170	1	1	KAHN, JAMES	3/31/1988	207RX0202X	NA	Oncology	026	PHYSICIANS	52303	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
235748	Fee-for-Service	1144244690	1144244690	1	1	KIM, TAELL T MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72179	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
235750	Fee-for-Service	1568629889	1568629889	1	1	KIM, TAE K MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124131	01	General Practice	0	In state provider	None	555 TECHEVAH DR	3W 105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
235760	Fee-for-Service	1841321478	1841321478	1	1	KENNEDY, JOHN A	10/15/1997	156FX1700X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	150 EL CAMINO REAL	STE 101	TUSTIN	CA	92780	3667	30	06059	33.74478	-117.823698	Orange County
235799	Fee-for-Service	1336506781	1336506781	1	1	KELLY, IAN	1/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 E GARVEY AVE N	B2	WEST COVINA	CA	91791	1544	19	06037	34.07280989	-117.8995249	Los Angeles County
235842	Fee-for-Service	1124195789	1124195789	1	1	KALRA, ANKUR OD	5/30/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1615 E PLAZA BLVD	STE 101	NATIONAL CITY	CA	91950	3771	37	06073	32.67670551	-117.0885584	San Diego County
235892	Fee-for-Service	1528115854	1528115854	1	1	KAISER FNDATION HLTH PLN	12/24/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #230	8080 PARKWAY DR	None	LA MESA	CA	91942	2104	37	06073	32.77560706	-117.0231998	San Diego County
235967	Fee-for-Service	1972062271	1972062271	1	1	KILPATRICK, CARMEN F MD	8/30/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180748	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
235971	Fee-for-Service	1346699592	1346699592	1	1	KRICHEVSKIY, OLHA DO	9/25/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21300	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
235987	Fee-for-Service	1295025039	1295025039	1	1	KEIGHLEY, EMBER D MD	5/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122010	01	General Practice	0	In state provider	None	1381 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3314	49	06097	38.62757555	-122.8638141	Sonoma County
235991	Fee-for-Service	1053739029	1053739029	1	1	KWACK, JOSEPH MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139386	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
236021	Fee-for-Service	1316601479	1316601479	1	1	KOROVESHI, HENRI LCSW	2/25/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
236099	Fee-for-Service	1508957382	1508957382	1	1	KOERPER, MARION A MD	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21909	40	Pediatrics	0	In state provider	U C MED CTR	650 MOFFITT HOSP	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.73743268	-122.4331132	San Francisco County
236166	Fee-for-Service	1003077769	1003077769	1	1	KIM, CHARLES DO	2/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12414	05	Anesthesiology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
236168	Fee-for-Service	1467477638	1467477638	1	1	KIM, PETER YUN SOO	12/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48806	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
236172	Fee-for-Service	1023047198	1023047198	2	1	KRISHNAN, SUBBARAYAN MD	6/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54481	41	Internal Medicine	0	In state provider	None	1031 E LATHAM AVENUE	STE 3	HEMET	CA	92543	4425	33	06065	33.7493735	-116.961021	Riverside County
236184	Fee-for-Service	1588720858	1588720858	1	1	KHATIB, MUSTAFA A MD	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92717	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
236190	Fee-for-Service	1811044142	1811044142	1	1	KAISER-PERMANENTE PHCY	12/14/1979	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	160	250 W SAN JOSE AVE	None	CLAREMONT	CA	91711	5207	19	06037	34.08313553	-117.7175385	Los Angeles County
236205	Fee-for-Service	1881636181	1881636181	1	1	KAMEI, ASAO MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32822	41	Internal Medicine	0	In state provider	None	152 PIONEER LN	None	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
236262	Fee-for-Service	1144367921	1144367921	1	1	KIM, JEAN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89809	None	None	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
236279	Fee-for-Service	1063567956	1063567956	1	1	KAISER FOUNDATION HOSPITAL	1/1/1995	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	MENTAL HEALTH CENTER	765 W COLLEGE ST	None	LOS ANGELES	CA	90012	5923	19	06037	34.0661756	-118.2435934	Los Angeles County
236303	Fee-for-Service	1417770330	1417770330	1	1	KARA CONSULTANTCY	1/17/2025	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
236311	Fee-for-Service	1295996205	1295996205	1	1	KWON, YONG K MD	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	109539	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
236320	Fee-for-Service	1174564033	1174564033	2	1	KALRA, TEJINDER M S MD	7/22/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42400	10	Gastroenterology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
236338	Fee-for-Service	1144592205	1144592205	1	1	KHOSRAVIANI, KHASHAYAR MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139927	83	Rheumatology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
236375	Fee-for-Service	1730383019	1730383019	1	1	KUAH, SOLOMON S MD	3/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115819	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
236415	Fee-for-Service	1285720680	1285720680	1	1	KOLIN, TALIA MD	6/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	64713	18	Ophthalmology	0	In state provider	None	13320 RIVERSIDE DR	STE 114	SHERMAN OAKS	CA	91423	2519	19	06037	34.15758348	-118.423233	Los Angeles County
236434	Fee-for-Service	1093809741	1093809741	1	1	KAMRAN, SHAHID MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50261	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
236463	Fee-for-Service	1205932050	1205932050	1	1	KOO, RALPH A MD	8/1/1998	207PE0004X	NA	Other	026	PHYSICIANS	81031	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L ST	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
236509	Fee-for-Service	1568722957	1568722957	1	1	KHWARG, STEVEN G MD	7/22/2013	207W00000X	NA	Ophthalmology	026	PHYSICIANS	47726	18	Ophthalmology	0	In state provider	PROF CORP	201 S ALVARADO ST	STE 325	LOS ANGELES	CA	90057	2354	19	06037	34.06417777	-118.2719543	Los Angeles County
236557	Fee-for-Service	1548289515	1548289515	1	1	KERRIHARD, THOMAS N MD	3/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	85311	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
236561	Fee-for-Service	1174917371	1174917371	1	1	KHANWALKAR, ASHOKE R MD	10/16/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	170474	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
236607	Fee-for-Service	1174564033	1174564033	2	1	KALRA, TEJINDER M S MD	7/22/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42400	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
236643	Fee-for-Service	1609922384	1609922384	1	1	KULUNGOWSKI, ANN M MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
236681	Fee-for-Service	1346457298	1346457298	1	1	KIRKHAM JOHN C. MD	12/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
236697	Fee-for-Service	1205360542	1205360542	1	1	KUMAR, DEEPIKA MD	10/18/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	158314	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
236706	Fee-for-Service	1144359951	1144359951	1	1	KRAJCIN, ANNA M CCC-SLP	10/15/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1849 WILLOW PASS RD.	SUITE 420	CONCORD	CA	94520	2524	07	06013	37.97486759	-122.0377305	Contra Costa County
236710	Fee-for-Service	1265474514	1265474514	1	1	KARAMI, NILGOON MD	3/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	86278	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
236721	Fee-for-Service	1386983138	1386983138	1	1	KOO, SONYA J MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110482	30	Radiology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
236725	Fee-for-Service	1093809741	1093809741	1	1	KAMRAN, SHAHID MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50261	40	Pediatrics	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
236756	Fee-for-Service	1255368643	1255368643	1	1	KAPLAN, DANIEL E MD	10/31/1983	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	52530	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
236759	Fee-for-Service	1033267919	1033267919	1	1	KAISER FOUND HLTH PLAN	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #331	2238 GEARY BLVD	FL 1	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
236808	Fee-for-Service	1063808871	1063808871	1	1	KWONG, SARA J MD	6/9/2020	207ZP0102X	NA	Other	026	PHYSICIANS	158300	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
236811	Fee-for-Service	1285832394	1285832394	1	1	KARUNASIRI, DEEPTHI K MD	7/12/2021	207ZP0101X	NA	Other	026	PHYSICIANS	84014	None	None	0	In state provider	None	1331 W AVENUE J	STE. 202	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
236871	Fee-for-Service	1841224201	1841224201	1	1	KIM, JOSEPH C MD	8/23/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75181	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	# A108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
236887	Fee-for-Service	1912449505	1912449505	1	1	KREGG, CHRISTINE	4/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	558 ABBOTT ST	A	SALINAS	CA	93901	4326	27	06053	36.66276002	-121.6420145	Monterey County
236910	Fee-for-Service	1528153590	1528153590	1	1	KWAN, KAREN Y MD	10/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82798	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
236912	Fee-for-Service	1952890956	1952890956	1	1	KOLANGARA, SHIVA S DO	5/4/2021	207R00000X	NA	Other	026	PHYSICIANS	17927	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
236940	Fee-for-Service	1316924046	1316924046	2	1	KIZZIAR, RONALD MD	1/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
236952	Fee-for-Service	1023594579	1023594579	1	1	KOSTIV, NATHAN M NP	3/6/2020	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
236971	Fee-for-Service	1700878147	1700878147	1	1	KENNEN JR DO, E WILLIAM	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	870 WEATHERWOOD LANE	None	GREENSBURG	PA	15601	0000	00	None	40.28856514	-79.53094259	Westmoreland County
236982	Fee-for-Service	1578943189	1578943189	1	1	KIM, CHERINE H MD	6/30/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	146773	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
237028	Fee-for-Service	1720490352	1720490352	1	1	KIRK, KATY MD	1/22/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
237033	Fee-for-Service	1013365154	1013365154	1	1	KUNG, JASON MD	8/17/2021	207L00000X	NA	Other	026	PHYSICIANS	172486	None	None	0	In state provider	None	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	31	06061	38.73444822	-121.2720033	Placer County
237034	Fee-for-Service	1831658814	1831658814	1	1	KHORSAND, MOHAMMAD DO	7/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19514	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
237052	Fee-for-Service	1033161740	1033161740	1	1	KISTLER, JONATHAN A MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	92358	36	Psychiatry	0	In state provider	None	1465 30TH ST	STE K	SAN DIEGO	CA	92154	3497	37	06073	32.72113554	-117.1302118	San Diego County
237068	Fee-for-Service	1124183025	1124183025	1	1	KUBIS, KENNETH C MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74803	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
237079	Fee-for-Service	1346517240	1346517240	1	1	KANESHIRO, CASEY Y MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125739	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
237080	Fee-for-Service	1083876221	1083876221	1	1	KAZANJIAN, GAREN S CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
237087	Fee-for-Service	1417945627	1417945627	1	1	KALISPELL REGIONAL HOSP	2/9/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	310 SUNNYVIEW LN	None	KALISPELL	MT	59901	3199	00	None	48.214773	-114.3236925	Flathead County
237095	Fee-for-Service	1063808871	1063808871	1	1	KWONG, SARA J MD	6/9/2020	207ZP0102X	NA	Other	026	PHYSICIANS	158300	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
237129	Fee-for-Service	1699823351	1699823351	1	1	KAISER FOUNDATION HEALTH	2/16/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMNTE PHRM #608	4801 COFFEE RD	None	BAKERSFIELD	CA	93308	9424	15	06029	35.403066	-119.0923565	Kern County
237152	Fee-for-Service	1205908969	1205908969	1	1	KROEKER, KRISTIN P MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63997	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6183 N FRESNO ST	STE 101	FRESNO	CA	93710	8611	10	06019	36.82625378	-119.7814317	Fresno County
237199	Fee-for-Service	1528153590	1528153590	1	1	KWAN, KAREN Y MD	10/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82798	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
237224	Fee-for-Service	1700831468	1700831468	1	1	KENNEALLY, GAILA DO	2/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18171	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
237244	Fee-for-Service	1154958247	1154958247	1	1	KUNG, JASON MD	7/21/2023	207R00000X	NA	Other	026	PHYSICIANS	184700	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
237255	Fee-for-Service	1578615795	1578615795	1	1	KIM, SUNG Y MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56086	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
237274	Fee-for-Service	1215956677	1215956677	1	1	KAHN, KATHERINE L MD	8/21/1996	207R00000X	NA	Other	026	PHYSICIANS	54393	41	Internal Medicine	0	In state provider	DEPT OF MEDICINE	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
237286	Fee-for-Service	1922508316	1922508316	1	1	KHAZAEI NEJAD, SALIMEH MD	7/19/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	185014	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
237335	Fee-for-Service	1245538347	1245538347	1	1	KARABEL, ABRAHAM LMFT	7/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
237373	Fee-for-Service	1871767558	1871767558	1	1	KOLLENKARK, KEVIN C CRNA	3/2/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
237376	Fee-for-Service	1417945627	1417945627	1	1	KALISPELL REGIONAL HOSP	2/9/2003	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	310 SUNNYVIEW LN	None	KALISPELL	MT	59901	3199	00	None	48.214773	-114.3236925	Flathead County
237383	Fee-for-Service	1659457174	1659457174	1	1	KANDULA, VITTAL K MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67818	05	Anesthesiology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
237433	Fee-for-Service	1922019512	1922019512	1	1	KWONG, ANDREW	11/30/1984	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	GATEWAY CIRCLE PHARMACY	3133 N BROADWAY	None	LOS ANGELES	CA	90031	2703	19	06037	34.07376983	-118.2079822	Los Angeles County
237441	Fee-for-Service	1750305975	1750305975	1	1	KOENIG, JANE O MD	7/31/1982	174400000X	NA	Other	026	PHYSICIANS	38095	45	Nephrology (Renal-Kidney)	0	In state provider	None	1 SCRIPPS DR	STE 203	SACRAMENTO	CA	95825	6206	34	06067	38.573181	-121.4118135	Sacramento County
237513	Fee-for-Service	1720102197	1720102197	1	1	KUMAR, ANJULI R MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93207	40	Pediatrics	0	In state provider	None	1760 TERMINO AVE	SUITE #300	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
237560	Fee-for-Service	1578657383	1578657383	1	2	KEN ROTH MD & ROLF EHLERS MD	2/25/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES	8765 AERO DRIVE	SUITE 130	SAN DIEGO	CA	92123	1767	37	06073	32.80965252	-117.139383	San Diego County
237593	Fee-for-Service	1033234380	1033234380	1	1	KOLTS, ROSA MARIA LMFT	8/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
237612	Fee-for-Service	1144595000	1144595000	1	1	KIDOKORO, YASUKO MD	9/24/2013	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	32727	22	Pathology (M.D. only)	0	In state provider	None	4282 GENESEE AVE	STE 202	SAN DIEGO	CA	92117	4989	37	06073	32.82092667	-117.1828683	San Diego County
237659	Fee-for-Service	1518911965	1518911965	1	1	KATES, MELANIE M MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	82351	41	Internal Medicine	0	In state provider	None	717 CENTER ST	None	HEALDSBURG	CA	95448	3604	49	06097	38.61783	-122.8707965	Sonoma County
237688	Fee-for-Service	1548462443	1548462443	1	1	KUMAR, SANTHI I MD	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95227	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
237700	Fee-for-Service	1922485192	1922485192	1	1	KARIM, SHEELAN F MD	12/3/2019	207R00000X	NA	Other	026	PHYSICIANS	163266	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
237721	Fee-for-Service	1134623556	1134623556	1	1	KARP, NATHAN C MD	9/13/2023	207RR0500X	NA	Other	026	PHYSICIANS	165847	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
237730	Fee-for-Service	1750305975	1750305975	1	1	KOENIG, JANE O MD	7/31/1982	174400000X	NA	Other	026	PHYSICIANS	38095	41	Internal Medicine	0	In state provider	None	1 SCRIPPS DR	STE 203	SACRAMENTO	CA	95825	6206	34	06067	38.573181	-121.4118135	Sacramento County
237733	Fee-for-Service	1952705238	1952705238	1	1	KOSARI, PEJMAN LMFT	12/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3808 RIVERSIDE DR	SUITE 500	BURBANK	CA	91505	5301	19	06037	34.15252315	-118.3412174	Los Angeles County
237765	Fee-for-Service	1639216815	1639216815	1	1	KIM, JOCELYN T MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	104833	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
237776	Fee-for-Service	1386058014	1386058014	1	1	KHOSRAVI, AMANDA MD	1/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145016	01	General Practice	0	In state provider	None	4900 BARRANCA PKWY	STE 103	IRVINE	CA	92604	8603	30	06059	33.67629075	-117.7956464	Orange County
237804	Fee-for-Service	1720102197	1720102197	1	1	KUMAR, ANJULI R MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93207	10	Gastroenterology (M.D. only)	0	In state provider	None	1760 TERMINO AVE	SUITE #300	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
237829	Fee-for-Service	1922097054	1922097054	1	1	KARAM, JOSEPH A MD	5/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88497	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
237839	Fee-for-Service	1437413648	1437413648	1	1	KHALID, MADIHA MD	9/20/2022	208M00000X	NA	Other	026	PHYSICIANS	179811	None	None	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	95954	2339	49	06097	38.25477	-122.63175	Sonoma County
237859	Fee-for-Service	1356583819	1356583819	1	1	KONDAL, UDIT C MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	120882	08	Family Practice	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
237862	Fee-for-Service	1366513509	1366513509	1	1	KAISER FOUNDATION HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
237895	Fee-for-Service	1144470220	1144470220	1	1	KOCHARIAN, EDWARD MD APC	11/12/2008	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	275 VICTORIA ST	SUITE K	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
237927	Fee-for-Service	1952951311	1952951311	1	1	KEE, HELEN OD	9/6/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
237949	Fee-for-Service	1851352199	1851352199	1	1	KLEIMAN, SHELDON A MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	13604	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
237973	Fee-for-Service	1548462443	1548462443	1	1	KUMAR, SANTHI I MD	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95227	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
238004	Fee-for-Service	1841542651	1841542651	1	1	KILAT, DEANA H CNM	10/26/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	276 INTERNATIONAL CIRLE	None	SANTA CLARA	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara
238024	Fee-for-Service	1316967391	1316967391	1	1	KO, LISA KIT-YI	8/6/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	LISA KIT YI KO OPTOMETRI	618 BLOSSOM HILL RD	STE 100	SAN JOSE	CA	95123	3048	43	06085	37.25052736	-121.8422415	Santa Clara County
238056	Fee-for-Service	1639216815	1639216815	1	1	KIM, JOCELYN T MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	104833	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
238061	Fee-for-Service	1578976221	1578976221	1	1	KOHBODI, GOLENAZ A MD	9/7/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	155368	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
238091	Fee-for-Service	1932234952	1932234952	1	1	KLASSEN, MICHAEL G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69478	20	Orthopedic Surgery	0	In state provider	None	757 PACIFIC ST	None	MONTEREY	CA	93940	2819	27	06053	36.59463401	-121.8978403	Monterey County
238110	Fee-for-Service	1467406330	1467406330	1	1	KHUBESRIAN, MARINA MD	9/2/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77513	08	Family Practice	0	In state provider	None	1505 WILSON TER	STE 160	GLENDALE	CA	91206	4077	19	06037	34.14960934	-118.2313491	Los Angeles County
238152	Fee-for-Service	1366513509	1366513509	1	1	KAISER FOUNDATION HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
238162	Fee-for-Service	1154480770	1154480770	1	1	KAPLAN, WILLIAM I DO	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	5418	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
238182	Fee-for-Service	1093011090	1093011090	1	1	KAUR, NAVJEET MD	10/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127068	None	None	0	In state provider	None	1165 MONTGOMERY AVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
238217	Fee-for-Service	1124754551	1124754551	1	1	KENDALL, JONATHAN LMFT	4/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
238222	Fee-for-Service	1225548530	1225548530	1	1	KIRWA, PENINNAH C	8/8/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13728 HIDDEN RIVER	None	EASTVALE	CA	92880	8901	33	06065	33.96033153	-117.5827437	Riverside County
238262	Fee-for-Service	1639499015	1639499015	1	1	KORBAKIS, GEORGIA MD	5/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129598	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
238275	Fee-for-Service	1679619092	1679619092	1	1	KIM, EDWARD T MD	7/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100042	None	None	0	In state provider	None	112 LA CASA VIA	STE 210	WALNUT CREEK	CA	94598	3011	07	06013	37.91229899	-122.0423696	Contra Costa County
238305	Fee-for-Service	1124561444	1124561444	1	1	KUHN, ROGER LMFT	3/25/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
238324	Fee-for-Service	1730264409	1730264409	1	1	KOWNACKI, ROMAN P MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60635	01	General Practice	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
238325	Fee-for-Service	1417922295	1417922295	1	1	KENT MICHAEL GREWE M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	501 N GRAHAM ST	STE 545	PORTLAND	OR	97227	0000	00	None	45.54285348	-122.671035	Multnomah County
238391	Fee-for-Service	1366906935	1366906935	1	1	KING, JANET F RCP	2/5/2019	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
238394	Fee-for-Service	1003029612	1003029612	1	1	KOTHA, ANNAPOORNA	10/14/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2324 MONTPELIER DR	SUITE 1	SAN JOSE	CA	95116	1612	43	06085	37.3648224	-121.8481115	Santa Clara County
238404	Fee-for-Service	1770731994	1770731994	1	1	KRUGER, NATASHA PHD	10/29/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1925 WINCHESTER BOULEVAR	SUITE 204	CAMPBELL	CA	95008	1038	43	06085	37.28904861	-121.9499866	Santa Clara County
238436	Fee-for-Service	1205925369	1205925369	1	1	KOLLI, SAILAJA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 S KING ST	None	HONOLULU	HI	96813	3009	00	None	21.30218603	-157.8505732	Honolulu County
238440	Fee-for-Service	1093943821	1093943821	1	1	KOOB, JASON W MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128794	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
238490	Fee-for-Service	1215946876	1215946876	1	1	KEHOE, KEATHER A MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	70038	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
238509	Fee-for-Service	1225548530	1225548530	1	1	KIRWA, PENINNAH C	8/8/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13728 HIDDEN RIVER	None	EASTVALE	CA	92880	8901	33	06065	33.96033153	-117.5827437	Riverside County
238519	Fee-for-Service	1932224433	1932224433	1	1	KIM, TERI Y MD	1/4/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94771	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
238536	Fee-for-Service	1144257601	1144257601	1	1	KNOWLTON, ROBERT C MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	48763	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
238557	Fee-for-Service	1639499015	1639499015	1	1	KORBAKIS, GEORGIA MD	5/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129598	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
238559	Fee-for-Service	1225500648	1225500648	1	1	KLIMEK, JESSE PT	8/2/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
238560	Fee-for-Service	1467833467	1467833467	1	1	KRAMER, MELISSA S MD	6/21/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146613	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
238618	Fee-for-Service	1598789737	1598789737	1	1	KIM, HYUNSOO MD	7/5/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67640	41	Internal Medicine	0	In state provider	None	2120 THIBODO RD	STE 120	VISTA	CA	92081	7901	37	06073	33.16745345	-117.2180381	San Diego County
238621	Fee-for-Service	1548263163	1548263163	1	1	KARAMLOU, KASRA MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55442	78	Neoplastic Diseases/Oncology	0	In state provider	None	4721 DALLAS RANCH ROAD	None	ANTIOCH	CA	94531	8811	07	06013	37.97016362	-121.7967323	Contra Costa County
238704	Fee-for-Service	1720184872	1720184872	1	1	KUPPUSWAMY, MALATHY MD	6/30/2021	2084P0805X	NA	Psychiatry	026	PHYSICIANS	65583	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
238726	Fee-for-Service	1598743635	1598743635	1	1	KANNAPPAN, TILLAIKARASI	11/26/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52211	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 OLD RIVER RD	STE 200	BAKERSFIELD	CA	93311	9506	15	06029	35.352648	-119.1122505	Kern County
238728	Fee-for-Service	1871585133	1871585133	1	1	KOHLLS PHARMACY & HOMECARE	5/6/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	INC	5110 L ST	None	OMAHA	NE	68117	1330	00	None	41.21254003	-95.99405699	Douglas County
238769	Fee-for-Service	1396899431	1396899431	1	1	KLING, GREGG DO	4/18/2025	207P00000X	NA	Other	026	PHYSICIANS	14730	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3415 S SEPULVEDA BLVD	STE 1122	LOS ANGELES	CA	90034	6060	19	06037	34.02086527	-118.4235306	Los Angeles County
238780	Fee-for-Service	1780237842	1780237842	1	1	KIM, ROBERT G MD	12/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191543	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
238804	Fee-for-Service	1033208145	1033208145	1	1	KNAPP, JAMES C MD	1/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80371	08	Family Practice	0	In state provider	None	911 E TUOLUMNE RD	None	TURLOCK	CA	95382	1543	50	06099	37.51464851	-120.837933	Stanislaus County
238874	Fee-for-Service	1104190974	1104190974	1	1	KHALEDY, MOHAMMAD C MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121899	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
238905	Fee-for-Service	1548263163	1548263163	1	1	KARAMLOU, KASRA MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55442	68	Hematology	0	In state provider	None	4721 DALLAS RANCH ROAD	None	ANTIOCH	CA	94531	8811	07	06013	37.97016362	-121.7967323	Contra Costa County
238940	Fee-for-Service	1255786422	1255786422	1	1	KIM, GINA F CCC-SLP	6/26/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
238956	Fee-for-Service	1316388606	1316388606	1	1	KHAN, SAMEER S MD	8/2/2019	207L00000X	NA	Other	026	PHYSICIANS	133423	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
238970	Fee-for-Service	1457439358	1457439358	1	1	KANER, JONATHAN J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33866	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
239012	Fee-for-Service	1154947596	1154947596	1	1	KDPK III INC	8/24/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6325 DENNISON ST	None	SAN DIEGO	CA	92122	2401	37	06073	32.85404361	-117.2091615	San Diego County
239020	Fee-for-Service	1518128222	1518128222	1	1	KUMARI, ANITA MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137447	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95381	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
239048	Fee-for-Service	1396242186	1396242186	1	1	KUBLAN, ABDUL R MD	9/21/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173426	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
239054	Fee-for-Service	1568776318	1568776318	1	1	KORENSTEIN, STEVEN J MD	5/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122072	01	General Practice	0	In state provider	None	2280 HARRISON AVENUE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
239122	Fee-for-Service	1891056800	1891056800	1	1	KITLOWSKI, KATHLEEN M PHD	11/9/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27268 VIA INDUSTRIA	None	TEMECULA	CA	92590	3751	33	06065	33.50883542	-117.1833694	Riverside County
239123	Fee-for-Service	1588963243	1588963243	1	1	KWAK, ROBERT T MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127352	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
239192	Fee-for-Service	1558845487	1558845487	1	1	KIM, KELLY A NP	12/6/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
239220	Fee-for-Service	1588628960	1588628960	1	1	KEMPER, CAROL A MD	2/28/1988	207R00000X	NA	Other	026	PHYSICIANS	60294	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
239234	Fee-for-Service	1235251927	1235251927	1	1	KIM, CHRISTINA MD	8/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93542	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
239255	Fee-for-Service	1437729746	1437729746	1	1	KENNISH, ELIZABETH DOULA	3/2/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
239258	Fee-for-Service	1811414097	1811414097	1	1	KEHAL, LOVEPREET K LCSW	4/13/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
239266	Fee-for-Service	1982646741	1982646741	1	1	KAZAZIAN, SHANT MD	10/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94612	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
239277	Fee-for-Service	1922443464	1922443464	1	1	KWAK, YOUNG J MD	1/3/2023	207ND0101X	NA	Dermatology	026	PHYSICIANS	165830	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
239278	Fee-for-Service	1700102977	1700102977	1	1	KAMINKER, JACOB PHD	8/27/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3036 REGENT ST	None	BERKELEY	CA	94705	2551	01	06001	37.85421434	-122.2563471	Alameda County
239319	Fee-for-Service	1699149484	1699149484	1	1	KIM, RACHEL H PHD	11/28/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
239366	Fee-for-Service	1013960475	1013960475	1	1	KAO, JACK S MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	69438	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
239380	Fee-for-Service	1013336072	1013336072	1	1	KWON, CAROLYN MD	5/22/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167254	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
239399	Fee-for-Service	1538343629	1538343629	1	1	KWONG, CHRISTOPHER M MD	1/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108990	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
239450	Fee-for-Service	1487701462	1487701462	1	1	KHAN, SANA U MD	2/4/2020	174400000X	NA	Other	026	PHYSICIANS	79841	30	Radiology	0	In state provider	None	9500 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87471149	-118.1315655	Los Angeles County
239457	Fee-for-Service	1689769176	1689769176	1	1	KHAIROLOMOUR, PEGAH MD	12/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69773	40	Pediatrics	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
239461	Fee-for-Service	1902130016	1902130016	1	1	KARPUS MEDICAL GROUP INC	5/16/2011	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	88169	40	Pediatrics	0	In state provider	None	20251 VENTURA BLVD	STE A	WOODLAND HILLS	CA	91364	2564	19	06037	34.16943968	-118.5752421	Los Angeles County
239491	Fee-for-Service	1477137420	1477137420	1	1	KELLY, MIKAELA MD	7/16/2024	390200000X	NA	Other	026	PHYSICIANS	192095	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
239506	Fee-for-Service	1134189590	1134189590	1	1	KHALSA, PRABHJOT S	12/19/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	66263	13	Neurology (M.D. only)	0	In state provider	None	722 MOWRY AVE	None	FREMONT	CA	94536	4115	01	06001	37.56635225	-121.9749284	Alameda County
239508	Fee-for-Service	1588628960	1588628960	1	1	KEMPER, CAROL A MD	2/28/1988	207R00000X	NA	Other	026	PHYSICIANS	60294	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	RM 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
239555	Fee-for-Service	1285765313	1285765313	1	1	KARUNARATNE, MYTHILLA B NP	10/4/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
239568	Fee-for-Service	1336436930	1336436930	1	1	KHAN, ABDUR R MD	6/3/2018	2085R0204X	NA	Other	026	PHYSICIANS	150680	30	Radiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
239588	Fee-for-Service	1477504249	1477504249	1	1	KENNIS, JACK D MD	5/31/1982	193400000X	NA	Other	026	PHYSICIANS	46843	01	General Practice	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
239599	Fee-for-Service	1295372621	1295372621	1	1	KEEBAN NAM, M.D., INC.	12/9/2019	261QM0850X	NA	Other	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
239626	Fee-for-Service	1710977079	1710977079	1	1	KROUSE, DONALD E MD INC	10/19/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42613	01	General Practice	0	In state provider	None	560 MAIN ST	None	WEAVERVILLE	CA	96093	2460	53	06105	40.73286682	-122.9405831	Trinity County
239656	Fee-for-Service	1992115810	1992115810	1	1	KANNARKAT, VINOD MD INC	9/26/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	103084	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	38780 TRADE CENTER DR	SUITE 1C	PALMDALE	CA	93551	3641	19	06037	34.58685376	-118.1430494	Los Angeles County
239661	Fee-for-Service	1962781658	1962781658	1	1	KLEIN, LINDSAY R MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122891	41	Internal Medicine	0	In state provider	None	2700 GRANT STREET	SUITE 200	CONCORD	CA	94520	2270	07	06013	37.98417931	-122.0361585	Contra Costa County
239666	Fee-for-Service	1952599383	1952599383	1	1	KYLER, RACHEL L MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92614	05	Anesthesiology	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93454	4522	42	06083	34.95426953	-120.427596	Santa Barbara County
239685	Fee-for-Service	1194708412	1194708412	2	1	KRAUS, SUSAN FALZONE MD	2/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83754	08	Family Practice	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
239726	Fee-for-Service	1407237126	1407237126	1	1	KANTOROWSKI, LAURA A PHD	2/25/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	7739	-	NOT APPLICABLE	0	In state provider	None	171 CARLOS DRIVE	None	SAN RAFAEL	CA	94903	2005	21	06041	38.01757315	-122.5347337	Marin County
239811	Fee-for-Service	1326520446	1326520446	1	1	KOORHAN, MARISOL C LCSW	2/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
239817	Fee-for-Service	1013913458	1013913458	3	2	KROGER SPECIALTY PHARMACY CA	3/6/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 LINCOLN WAY	None	GARDEN GROVE	CA	92841	1428	30	06059	33.79835147	-118.0034775	Orange County
239851	Fee-for-Service	1063233831	1063233831	1	1	KACZMAREK, MELINDA A	11/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
239880	Fee-for-Service	1235992629	1235992629	1	1	KAHIU, CHRISTINE NGUNJU	6/17/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8720 NAKOTA WAY	None	SACRAMENTO	CA	95828	5935	34	06067	38.47284	-121.379823	Sacramento County
239887	Fee-for-Service	1477837383	1477837383	1	1	KIM, HYEONGDO DO	10/19/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	11970	39	Preventive (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
239888	Fee-for-Service	1477561876	1477561876	1	1	KRUEGER-KALINSKI, MICHELLE A	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80159	None	None	0	In state provider	MD	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
239905	Fee-for-Service	1194259143	1194259143	1	1	KELLY, BRANDON J MD	7/7/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176108	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
239937	Fee-for-Service	1215059084	1215059084	1	1	KOTOMORI, RICHARD T MD	2/18/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	60376	None	None	0	In state provider	None	6529 RIVERSIDE AVE	SUITE 133	RIVERSIDE	CA	92506	3122	33	06065	33.94754553	-117.3881459	Riverside County
239963	Fee-for-Service	1467941534	1467941534	1	1	KINNICK DIALYSIS LLC	3/6/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1382 LOCUST ST	None	PASADENA	CA	91106	1515	19	06037	34.15063214	-118.121779	Los Angeles County
239975	Fee-for-Service	1376095323	1376095323	1	1	KNELL, CATALAINE	9/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
239976	Fee-for-Service	1326083114	1326083114	1	1	KAN, RANDALL E MD	4/30/1996	207L00000X	NA	Other	026	PHYSICIANS	73739	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
239993	Fee-for-Service	1225202260	1225202260	1	1	KELLER, ALLISON A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
240008	Fee-for-Service	1952472037	1952472037	1	1	KRIPLANI, ANITA MD	10/1/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	51047	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	680	LOS ANGELES	CA	90017	4810	19	06037	34.05362775	-118.2661889	Los Angeles County
240038	Fee-for-Service	1184790305	1184790305	1	1	KOHAN, MARIO A MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34875	08	Family Practice	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
240051	Fee-for-Service	1619172517	1619172517	1	1	KITAYAMA, JONATHAN M MD	11/7/2018	207ZP0102X	NA	Other	026	PHYSICIANS	110389	22	Pathology (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
240071	Fee-for-Service	1184951345	1184951345	1	1	KHADEM, NEDA OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1545 NUTMEG PL	None	COSTA MESA	CA	92626	2500	30	06059	33.6818847	-117.9205121	Orange County
240080	Fee-for-Service	1801129663	1801129663	1	1	KOHLI, SANJIVAN S MD	4/19/2010	207R00000X	NA	Other	026	PHYSICIANS	109968	41	Internal Medicine	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
240115	Fee-for-Service	1023381761	1023381761	1	1	KALAGHICHIAN, KIANA LCSW	3/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	108 ORANGE ST	8	REDLANDS	CA	92373	4719	36	06071	34.056972	-117.182554	San Bernardino County
240128	Fee-for-Service	1073653119	1073653119	1	1	KAR, ASHOK J MD INC	3/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	38390	34	Urology and Urological Surgery	0	In state provider	None	1310 W STEWART DR	STE 402	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
240148	Fee-for-Service	1780852517	1780852517	1	1	KABB, AARON L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	24800 SE STARK ST	None	GRESHAM	OR	97030	3378	00	None	45.516762	-122.4070245	Multnomah County
240168	Fee-for-Service	1235992629	1235992629	1	1	KAHIU, CHRISTINE NGUNJU	6/17/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8720 NAKOTA WAY	None	SACRAMENTO	CA	95828	5935	34	06067	38.47284	-121.379823	Sacramento County
240191	Fee-for-Service	1982631933	1982631933	1	1	KIMCO MEDICAL SUPPLY INC	1/4/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	577 N D ST	STE 113	SAN BERNARDINO	CA	92401	1321	36	06071	34.109613	-117.291874	San Bernardino County
240242	Fee-for-Service	1851431498	1851431498	1	1	KOLZOW, KRISTEN LCSW	7/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
240286	Fee-for-Service	1295129583	1295129583	1	1	KANG, HYUNG K MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144346	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
240289	Fee-for-Service	1174076483	1174076483	1	1	KEKLIKIAN, MARIA NP	3/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
240297	Fee-for-Service	1952472037	1952472037	1	1	KRIPLANI, ANITA MD	10/1/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	51047	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1245 WILSHIRE BLVD	680	LOS ANGELES	CA	90017	4810	19	06037	34.05362775	-118.2661889	Los Angeles County
240321	Fee-for-Service	1831535061	1831535061	1	1	KESSLER, MICHAEL J MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156253	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
240342	Fee-for-Service	1205878634	1205878634	1	1	KHRAISHI, TERRY T OD	7/13/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 TORRANCE BLVD	STE 220	TORRANCE	CA	90503	4537	19	06037	33.8375955	-118.358748	Los Angeles County
240368	Fee-for-Service	1063837060	1063837060	1	1	KURATSU, KAREN CCC-SLP	3/12/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
240373	Fee-for-Service	1023082377	1023082377	1	1	KENNEY, MONICA R MD	6/2/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81628	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
240392	Fee-for-Service	1386622561	1386622561	1	1	KESLER, KIMBERLY M MD	11/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87227	02	General Surgery	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
240402	Fee-for-Service	1447581624	1447581624	1	1	KAZEMI, M MICHAEL MD A	10/11/2011	207R00000X	NA	Other	026	PHYSICIANS	61310	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL CORPORATION	5401 NORRIS CANYON RD	STE 308	SAN RAMON	CA	94583	5408	07	06013	37.77752374	-121.9579277	Contra Costa County
240414	Fee-for-Service	1538188768	1538188768	1	1	KOTEIRA, F ELIAS MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75101	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
240431	Fee-for-Service	1588049415	1588049415	1	1	KENNEDY, SAMANTHA L PHD	12/24/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
240437	Fee-for-Service	1073765400	1073765400	1	1	KWON, STEVEN MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110041	41	Internal Medicine	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
240463	Fee-for-Service	1821540840	1821540840	1	1	KG HOME CARE SERVICES	6/6/2016	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	8383 WILSHIRE BLVD	STE 800	BEVERLY HILLS	CA	90211	2425	19	06037	34.06457438	-118.3736146	Los Angeles County
240481	Fee-for-Service	1285126169	1285126169	1	1	KIGHT, ERIN E	12/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
240572	Fee-for-Service	1932256252	1932256252	1	1	KAISER FND HLTH PLAN	9/18/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARMACY#006	5119 POMONA BLVD	None	E LOS ANGELES	CA	90022	1711	19	06037	34.03350406	-118.154384	Los Angeles County
240586	Fee-for-Service	1952472037	1952472037	1	1	KRIPLANI, ANITA MD	10/1/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	51047	14	Neurological Surgery	0	In state provider	None	1245 WILSHIRE BLVD	680	LOS ANGELES	CA	90017	4810	19	06037	34.05362775	-118.2661889	Los Angeles County
240611	Fee-for-Service	1578676243	1578676243	1	1	KIESEL, ERIN O DO	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7197	01	General Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
240635	Fee-for-Service	1750595252	1750595252	1	1	KAUNISMAKI, YVETTE R MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	27	Psychiatry Neurology (D.O. only)	1	Border provider	None	1240 E 9TH ST	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
240645	Fee-for-Service	1235679366	1235679366	1	1	KHAN, FAHIM U	11/6/2020	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	887 PLUMAS ST.	SUITE A	YUBA CITY	CA	95991	4015	51	06101	39.14161451	-121.6176661	Sutter County
240654	Fee-for-Service	1417477183	1417477183	1	2	KIM, JONG H	6/22/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	163105	-	NOT APPLICABLE	0	In state provider	None	1341 N ESCONDIDO BLVD	None	ESCONDIDO	CA	92026	2507	37	06073	33.14046993	-117.0924096	San Diego County
240666	Fee-for-Service	1306667522	1306667522	1	1	KEKUA, RACHEL	12/30/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
240674	Fee-for-Service	1881070241	1881070241	1	1	KALANTARI, JALIL MD	10/19/2021	390200000X	NA	Other	026	PHYSICIANS	145939	None	None	0	In state provider	None	323 N PRAIRIE AVE	STE 114	INGLEWOOD	CA	90301	4503	19	06037	33.966333	-118.3439975	Los Angeles County
240691	Fee-for-Service	1447581624	1447581624	1	1	KAZEMI, M MICHAEL MD A	10/11/2011	207R00000X	NA	Other	026	PHYSICIANS	61310	29	Pulmonary Diseases (M.D. only)	0	In state provider	MEDICAL CORPORATION	5401 NORRIS CANYON RD	STE 308	SAN RAMON	CA	94583	5408	07	06013	37.77752374	-121.9579277	Contra Costa County
240726	Fee-for-Service	1639263502	1639263502	1	1	KRISHNAMURTHY, SAVITHRI	9/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	25830	01	General Practice	0	In state provider	None	2037 E 7TH ST	None	LONG BEACH	CA	90804	4590	19	06037	33.77537451	-118.16676	Los Angeles County
240736	Fee-for-Service	1144228628	1144228628	1	1	KIM, WILLIAM C MD INC	10/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	701 E 28TH ST	STE 117	LONG BEACH	CA	90806	2772	19	06037	33.80803441	-118.1847137	Los Angeles County
240760	Fee-for-Service	1306420559	1306420559	1	1	KOST, LUKAS MD	10/17/2024	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
240780	Fee-for-Service	1992269310	1992269310	1	1	KG LIMITED LLC	10/8/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	332 E. FOOTHILL BLVD	D	ARCADIA	CA	91006	2535	19	06037	34.15108005	-118.0215856	Los Angeles County
240895	Fee-for-Service	1578676243	1578676243	1	1	KIESEL, ERIN O DO	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7197	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
240967	Fee-for-Service	1215111711	1215111711	1	1	KAYUMI-RASHTI, SAMIRA MD	11/18/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	118015	40	Pediatrics	0	In state provider	None	1430 E MAIN STREET	STE 201	SANTA MARIA	CA	93454	4832	42	06083	34.9528467	-120.4127301	Santa Barbara County
240980	Fee-for-Service	1447581624	1447581624	1	1	KAZEMI, M MICHAEL MD A	10/11/2011	207R00000X	NA	Other	026	PHYSICIANS	61310	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	5401 NORRIS CANYON RD	STE 308	SAN RAMON	CA	94583	5408	07	06013	37.77752374	-121.9579277	Contra Costa County
241008	Fee-for-Service	1225564818	1225564818	1	1	KIM, CHARLES CHOL BAE MD	4/29/2021	208600000X	NA	General Surgery	026	PHYSICIANS	129160	None	None	0	In state provider	None	1131 W 6TH ST	250	ONTARIO	CA	91762	1108	36	06071	34.084404	-117.6717015	San Bernardino County
241014	Fee-for-Service	1639263502	1639263502	1	1	KRISHNAMURTHY, SAVITHRI	9/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	25830	08	Family Practice	0	In state provider	None	2037 E 7TH ST	None	LONG BEACH	CA	90804	4590	19	06037	33.77537451	-118.16676	Los Angeles County
241018	Fee-for-Service	1396795860	1396795860	1	1	KUO, TIMOTHY T MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	73625	10	Gastroenterology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
241040	Fee-for-Service	1366527483	1366527483	1	1	KIDNEY INSTITUTE OF THE	3/4/1987	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DESERT LLC	81715 DOCTOR CARREON BLV	STE B2	INDIO	CA	92201	5564	33	06065	33.7073825	-116.2385415	Riverside County
241051	Fee-for-Service	1588983654	1588983654	1	1	KHAN, WAJIHA MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122976	38	Geriatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
241161	Fee-for-Service	1972559490	1972559490	1	1	KEARNS, SANDRA J PHD	4/16/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
241233	Fee-for-Service	1427130285	1427130285	1	1	KALM, BENJAMIN A.MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MEDICAL DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77069459	-111.8370155	Salt Lake County
241330	Fee-for-Service	1235740309	1235740309	1	1	KNECHT, TAYLOR OT	9/1/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
241339	Fee-for-Service	1699790907	1699790907	1	1	KUPPER, DANIEL A PHD	7/31/1996	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1917 1/2 WESTWOOD BLVD	STE 2	LOS ANGELES	CA	90025	8400	19	06037	34.04770039	-118.4350466	Los Angeles County
241340	Fee-for-Service	1588983654	1588983654	1	1	KHAN, WAJIHA MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122976	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
241382	Fee-for-Service	1659332914	1659332914	1	1	KEEFE, JAMES F MD	12/4/2003	207ZP0102X	NA	Other	026	PHYSICIANS	36906	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
241393	Fee-for-Service	1760589790	1760589790	1	1	KHURRAM, ALI MD	8/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78767	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
241417	Fee-for-Service	1265735013	1265735013	1	1	KOPKO, PATRICIA M MD	8/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75006	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
241459	Fee-for-Service	1043537822	1043537822	1	1	KHADAVI, ALAN O MD APC	3/2/2010	193400000X	NA	Other	026	PHYSICIANS	109088	03	Allergy	0	In state provider	None	2809 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5538	19	06037	33.94599284	-118.2211199	Los Angeles County
241501	Fee-for-Service	1154359586	1154359586	1	1	KTLA PROPERTIES LIMITED	5/1/1978	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PARTNERSHIP	3902 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3304	30	06059	33.80298189	-118.0645798	Orange County
241513	Fee-for-Service	1487792511	1487792511	1	2	KITAJI, JON MD	1/12/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	37680	45	Nephrology (Renal-Kidney)	0	In state provider	None	757 PACIFIC STREET	SUITE D2	MONTEREY	CA	93940	2819	27	06053	36.59463401	-121.8978403	Monterey County
241527	Fee-for-Service	1376929034	1376929034	1	1	KIM, PHILIP OD	5/5/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
241550	Fee-for-Service	1568807212	1568807212	1	1	KIM, BYUNGHEE K DPM	8/9/2017	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 100	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
241557	Fee-for-Service	1811001829	1811001829	1	1	KOHL, JONATHAN M MD	8/21/1996	207L00000X	NA	Other	026	PHYSICIANS	31294	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
241563	Fee-for-Service	1902902976	1902902976	1	1	KHAN, AQEEL S MD	1/1/1996	207P00000X	NA	Other	026	PHYSICIANS	55946	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE A108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
241581	Fee-for-Service	1588123863	1588123863	1	1	KAKISH, DAVID M MD	6/12/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177844	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
241592	Fee-for-Service	1962039826	1962039826	1	1	KAM, BRITTNI N MD	7/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187783	None	None	0	In state provider	None	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
241593	Fee-for-Service	1962841536	1962841536	1	1	KWAK, JIEUN MD	7/3/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143673	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
241595	Fee-for-Service	1992167993	1992167993	1	1	KUNSTADT, ETHAN MD	3/2/2020	207P00000X	NA	Other	026	PHYSICIANS	152529	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
241596	Fee-for-Service	1578618419	1578618419	1	1	KALTENBACH, TONYA R MD	4/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81539	10	Gastroenterology (M.D. only)	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
241626	Fee-for-Service	1043500390	1043500390	1	1	KAR, ROMIT K MD FAAP	7/7/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	131652	None	None	0	In state provider	None	355 PLACENTIA AVE	301	NEWPORT BEACH	CA	92663	3304	30	06059	33.62672719	-117.9312941	Orange County
241640	Fee-for-Service	1306003686	1306003686	1	1	KIM, SOMI OD INC	4/27/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3053 W OLYMPIC BLVD	STE 105	LOS ANGELES	CA	90006	2558	19	06037	34.05266275	-118.3017531	Los Angeles County
241650	Fee-for-Service	1851449466	1851449466	1	1	KAISER PERMANENTE PHCY	7/6/1982	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHCY #107	25965 NORMANDIE AVE	None	HARBOR CITY	CA	90710	3416	19	06037	33.78690131	-118.2975558	Los Angeles County
241666	Fee-for-Service	1114494002	1114494002	1	1	KOELSCH, EMILY L NP	4/14/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
241683	Fee-for-Service	1104846344	1104846344	1	1	KREMER, ARNOLD DO	12/31/1987	207P00000X	NA	Other	026	PHYSICIANS	4242	66	Emergency Medicine (Urgent Care)	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
241706	Fee-for-Service	1083364004	1083364004	1	1	KDPK II INC	10/9/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3739 MILLIKIN AVE	None	SAN DIEGO	CA	92122	2415	37	06073	32.8546395	-117.2075898	San Diego County
241732	Fee-for-Service	1588395875	1588395875	1	1	KOPI, EUNICE S	6/30/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9041 SOLAR POINT DR	None	ROSEVILLE	CA	95747	4466	31	06061	38.77024592	-121.394496	Placer County
241742	Fee-for-Service	1093876377	1093876377	1	1	KESSLER, CHRISTINA	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
241753	Fee-for-Service	1225156482	1225156482	1	1	KIANKHOOY, ARMIN MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130675	33	Thoracic Surgery	0	In state provider	None	1019 S CENTRAL AVE	None	GLENDALE	CA	91204	2210	19	06037	34.13405999	-118.2578839	Los Angeles County
241773	Fee-for-Service	1952571317	1952571317	1	1	KATSUMOTO, TAMIKO R MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87253	83	Rheumatology	0	In state provider	None	400 PANASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
241781	Fee-for-Service	1215075205	1215075205	1	1	KERN, JONATHAN MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52234	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
241791	Fee-for-Service	1841201902	1841201902	1	1	KUMRA, MARILYN D CRNA	3/17/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
241836	Fee-for-Service	1477634632	1477634632	1	1	KUDTARKAR, SANJAY S MD	1/1/1998	174400000X	NA	Other	026	PHYSICIANS	64957	40	Pediatrics	0	In state provider	None	401 E HIGHLAND AVE	STE 552	SAN BERNARDINO	CA	92404	3838	36	06071	34.1358627	-117.2757778	San Bernardino County
241845	Fee-for-Service	1104577634	1104577634	1	1	KUANG, LI CRNA	3/10/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
241881	Fee-for-Service	1326355231	1326355231	1	1	KOHL, KRISTA L PHD	9/27/2022	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
241889	Fee-for-Service	1700991163	1700991163	1	1	KEIR ANDREW BEXAR FOWLER, M.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1650 COWLES ST	None	FAIRBANKS	AK	99701	5999	00	None	64.8310943	-147.7363579	Fairbanks North Star Borough
241924	Fee-for-Service	1184155269	1184155269	1	1	KRUEGER, KRISTEN PT	8/15/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
241930	Fee-for-Service	1740320183	1740320183	1	1	KAY, LYNDA LEE MD	3/1/1995	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	52407	08	Family Practice	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
241942	Fee-for-Service	1427386895	1427386895	1	1	KESSEY, KOFI MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94613	14	Neurological Surgery	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
241943	Fee-for-Service	1649387879	1649387879	1	1	KHALIL, NABIL F MD	11/5/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	41872	01	General Practice	0	In state provider	GARMAR PLAZA MEDICAL CTR	2321 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3006	19	06037	34.01365821	-118.1257857	Los Angeles County
241944	Fee-for-Service	1184995094	1184995094	1	1	KAPTEIN, MATTHEW J MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125084	45	Nephrology (Renal-Kidney)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
241955	Fee-for-Service	1003931502	1003931502	1	1	KELLY, KADETTE CRNA	5/25/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
241974	Fee-for-Service	1891007456	1891007456	1	1	KHERSONSKY, JONATHAN MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119085	05	Anesthesiology	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
241987	Fee-for-Service	1043742950	1043742950	1	1	KOBAYASHI, EDWARD N MD	9/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158801	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
241994	Fee-for-Service	1699983288	1699983288	1	1	KIM, MICHELLE N	5/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	43112 15TH STREET W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
241995	Fee-for-Service	1346340809	1346340809	1	1	KATSKE, FLOYD A MD	6/10/2007	208800000X	NA	Other	026	PHYSICIANS	36408	34	Urology and Urological Surgery	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
242000	Fee-for-Service	1891746665	1891746665	1	1	KOGA, CLAIRE H MD	4/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46669	08	Family Practice	0	In state provider	None	1701 BROOKLYN AVE	STE 230	LOS ANGELES	CA	90033	2464	19	06037	34.040502	-118.191954	Los Angeles County
242020	Fee-for-Service	1588395875	1588395875	1	1	KOPI, EUNICE S	6/30/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9041 SOLAR POINT DR	None	ROSEVILLE	CA	95747	4466	31	06061	38.77024592	-121.394496	Placer County
242027	Fee-for-Service	1801075189	1801075189	1	1	KNOLL, ANDREW N MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93913	31	Roentgenology, Radiology (M.D. only)	0	In state provider	None	330 LEWIS STREET	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
242030	Fee-for-Service	1437241015	1437241015	1	1	KALLAS,ROBIN H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MARTIN LUTHER KING	None	TACOMA	WA	98405	0000	00	None	47.25960844	-122.4534238	Pierce County
242034	Fee-for-Service	1225156482	1225156482	1	1	KIANKHOOY, ARMIN MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130675	02	General Surgery	0	In state provider	None	1019 S CENTRAL AVE	None	GLENDALE	CA	91204	2210	19	06037	34.13405999	-118.2578839	Los Angeles County
242115	Fee-for-Service	1689797375	1689797375	1	1	KHALILI, RAMIN MD PC	6/11/2012	208800000X	NA	Other	026	PHYSICIANS	76811	34	Urology and Urological Surgery	0	In state provider	None	39 CONGRESS	STE 201	PASADENA	CA	91105	3021	19	06037	34.13407645	-118.151226	Los Angeles County
242116	Fee-for-Service	1992141840	1992141840	1	1	KEM, SOKKUNTHAIR NP	10/24/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
242136	Fee-for-Service	1174150791	1174150791	1	1	KLOOR, JACKSON MD	10/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186896	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
242152	Fee-for-Service	1669866232	1669866232	1	1	KELLY, OLIVIA J MD	12/8/2018	207R00000X	NA	Other	026	PHYSICIANS	145069	41	Internal Medicine	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
242184	Fee-for-Service	1679542898	1679542898	2	1	KAHEN, TANAZ MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	79336	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9700 WOODMAN AVE	STE A-10	ARLETA	CA	91331	8040	19	06037	34.24604728	-118.4474624	Los Angeles County
242221	Fee-for-Service	1598712614	1598712614	1	1	KOH, KRISTINE R MD	10/27/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77835	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
242226	Fee-for-Service	1972506277	1972506277	1	1	KENT WINKLER M.D.	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 S THOMPSON ST	None	FLAGSTAFF	AZ	86001	8759	00	None	35.184573	-111.674529	Coconino County
242230	Fee-for-Service	1184995094	1184995094	1	1	KAPTEIN, MATTHEW J MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125084	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
242269	Fee-for-Service	1861696916	1861696916	1	1	KMETZ, KIM B MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
242293	Fee-for-Service	1891746665	1891746665	1	1	KOGA, CLAIRE H MD	4/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46669	10	Gastroenterology (M.D. only)	0	In state provider	None	1701 BROOKLYN AVE	STE 230	LOS ANGELES	CA	90033	2464	19	06037	34.040502	-118.191954	Los Angeles County
242302	Fee-for-Service	1356536585	1356536585	1	1	KHORSAN, REZA MD	6/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101659	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
242309	Fee-for-Service	1417438136	1417438136	1	1	KAUR, BHUPINDER OT	5/17/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
242313	Fee-for-Service	1033425459	1033425459	1	1	KUO, ISABEL MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120346	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
242332	Fee-for-Service	1417136490	1417136490	1	1	KIM, JINA E CRNA	6/26/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
242413	Fee-for-Service	1801039458	1801039458	1	1	KHAN, NADIA P MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119115	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
242415	Fee-for-Service	1992390769	1992390769	1	1	KULEYIN UNLIMITED LLC	3/5/2023	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON	2445 AUGUSTINE DR	150	SANTA CLARA	CA	95054	3032	43	06085	37.3820451	-121.9699444	Santa Clara County
242443	Fee-for-Service	1114091683	1114091683	1	1	KOLBERG, PATRICIA A LMFT	7/24/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 MAIN ST	STE 1D	DIAMOND SPRINGS	CA	95619	9177	09	06017	38.69472998	-120.8155524	El Dorado County
242456	Fee-for-Service	1093133290	1093133290	1	1	KHAN, SANA MD	8/15/2020	207R00000X	NA	Other	026	PHYSICIANS	168289	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
242458	Fee-for-Service	1518233642	1518233642	1	1	KUSHAL PARIKH	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
242500	Fee-for-Service	1477637049	1477637049	1	1	KUO, TERRY MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77602	41	Internal Medicine	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
242512	Fee-for-Service	1093140329	1093140329	1	1	KOVACIK, PHILIP A LCSW	5/23/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
242513	Fee-for-Service	1891485330	1891485330	1	1	KOHLI, SABRINA L NP	9/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11030 BOLLINGER CANYON R	SUITE 250	SAN RAMON	CA	94582	4874	07	06013	37.77383963	-121.9239786	Contra Costa County
242542	Fee-for-Service	1366837502	1366837502	1	1	KITAMURA, KELLIE MD	5/22/2019	207P00000X	NA	Other	026	PHYSICIANS	147417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
242544	Fee-for-Service	1124035969	1124035969	1	1	KAUR, TAJINDER B MD	10/21/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83605	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
242580	Fee-for-Service	1891746665	1891746665	1	1	KOGA, CLAIRE H MD	4/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46669	41	Internal Medicine	0	In state provider	None	1701 BROOKLYN AVE	STE 230	LOS ANGELES	CA	90033	2464	19	06037	34.040502	-118.191954	Los Angeles County
242589	Fee-for-Service	1528257060	1528257060	1	1	KAMJOO, SAMI MD	4/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102003	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
242596	Fee-for-Service	1316980535	1316980535	1	1	KEYNIGSHTEYN, RENA Y MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89143	None	None	0	In state provider	None	7855 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	5344	19	06037	34.0908873	-118.36044	Los Angeles County
242614	Fee-for-Service	1174626238	1174626238	1	1	KRIVAN, DAVID W MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	98603	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
242628	Fee-for-Service	1457511917	1457511917	2	1	KABAN, JORDANA D MD	8/14/2018	207P00000X	NA	Other	026	PHYSICIANS	12828	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
242641	Fee-for-Service	1144547993	1144547993	1	1	KORNFELD, MEREDITH LMFT	9/21/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82995	-	NOT APPLICABLE	0	In state provider	None	1816 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87558576	-122.2622904	Alameda County
242687	Fee-for-Service	1942267992	1942267992	1	1	KIM, DONG S MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	48273	41	Internal Medicine	0	In state provider	None	11441 HEACOCK ST	STE F	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
242739	Fee-for-Service	1316113228	1316113228	1	1	KIMBALL LAEL CHRISTIANSON, M	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	0000	00	None	43.61455048	-116.256231	Ada County
242750	Fee-for-Service	1992095566	1992095566	1	1	KAMATH, MEGAN Y MD	10/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150293	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
242801	Fee-for-Service	1437386000	1437386000	1	1	KUSSMAN, STEVEN R MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128796	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
242841	Fee-for-Service	1376566133	1376566133	1	1	KAWEAH DELTA HLTHCR DIST	4/1/2005	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	602 W WILLOW AVE	STE A	VISALIA	CA	93291	6102	54	06107	36.328473	-119.2979925	Tulare County
242847	Fee-for-Service	1679645154	1679645154	1	1	KIM, MARK J MD	3/31/1991	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	72178	08	Family Practice	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
242849	Fee-for-Service	1336331123	1336331123	1	1	KNOHL, HOWARD R MD INC	1/1/1979	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	12235 BEACH BLVD	STE 110	STANTON	CA	90680	3943	30	06059	33.784425	-117.9930265	Orange County
242886	Fee-for-Service	1659146314	1659146314	1	1	KIRK, SEAN CRNA	5/8/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
242922	Fee-for-Service	1316574452	1316574452	1	1	KULKOFF, CONSTANTINE DO	1/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19557	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
242925	Fee-for-Service	1053366047	1053366047	1	1	KATCHMAN, NEIL D DO	4/29/1994	207P00000X	NA	Other	026	PHYSICIANS	6563	01	General Practice	0	In state provider	None	250 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
242975	Fee-for-Service	1972997427	1972997427	1	1	KLATMAN, KATHRYN A MD	7/10/2020	207L00000X	NA	Other	026	PHYSICIANS	166832	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
242980	Fee-for-Service	1902086028	1902086028	1	1	KALRA, T M MD APC	4/6/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	520 SUPERIOR AVENUE	STE 295	NEWPORT BEACH	CA	92663	3667	30	06059	33.628914	-117.9276525	Orange County
243067	Fee-for-Service	1578119673	1578119673	1	1	KHALIFA, NATALIA LCSW	9/16/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
243082	Fee-for-Service	1912915901	1912915901	1	1	KAHN-ROSE, ROBERT P MD	7/31/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	59791	36	Psychiatry	0	In state provider	None	21820 CRAGGY VIEW ST	None	CHATSWORTH	CA	91311	2909	19	06037	34.25537055	-118.6049901	Los Angeles County
243109	Fee-for-Service	1023189784	1023189784	1	1	KIMMONS, HERBERT C MD	8/24/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48258	40	Pediatrics	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
243119	Fee-for-Service	1033159710	1033159710	1	1	KOEBLE, CAROL J MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	69179	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DR	SUITE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
243126	Fee-for-Service	1124220157	1124220157	1	1	KHANNA, SURABHI A MD	5/28/2023	207RR0500X	NA	Other	026	PHYSICIANS	171517	None	None	0	In state provider	None	25 N 14TH ST	STE 820	SAN JOSE	CA	95112	6215	43	06085	37.34293357	-121.8775187	Santa Clara County
243147	Fee-for-Service	1285789099	1285789099	1	1	KAISER FOUNDATION HOSPITALS	5/12/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10992 SAN DIEGO MISSION	BUILDING 2 STE 3401	SAN DIEGO	CA	92108	2444	37	06073	32.78503881	-117.1020911	San Diego County
243161	Fee-for-Service	1437483088	1437483088	1	1	KOBLAND, DIANA L LAC	12/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
243182	Fee-for-Service	1467446278	1467446278	1	1	KAYAL, INC	4/20/2002	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	442 SUNSET BLVD	None	HAYWARD	CA	94541	3832	01	06001	37.67421974	-122.0975231	Alameda County
243211	Fee-for-Service	1053366047	1053366047	1	1	KATCHMAN, NEIL D DO	4/29/1994	207P00000X	NA	Other	026	PHYSICIANS	6563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
243226	Fee-for-Service	1679093389	1679093389	1	1	KOKA, VAHINI L DO	7/13/2021	207P00000X	NA	Other	026	PHYSICIANS	18823	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
243240	Fee-for-Service	1184885857	1184885857	1	1	KANG, SEONG M MD	5/25/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104123	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
243289	Fee-for-Service	1114914918	1114914918	1	1	KHAN, SALMA S MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54576	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
243299	Fee-for-Service	1104842640	1104842640	1	1	KIM, MYUNG H MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81752	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
243352	Fee-for-Service	1548897960	1548897960	1	1	KUO, WILLIAM	9/17/2024	207L00000X	NA	Other	026	PHYSICIANS	184960	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
243369	Fee-for-Service	1568469732	1568469732	1	1	KUMMER, ROBERT OD	8/25/1975	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1421 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3401	19	06037	34.05409489	-118.3838638	Los Angeles County
243392	Fee-for-Service	1477564474	1477564474	2	1	KANEN, TODD A MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	66159	02	General Surgery	0	In state provider	None	2415 BATH ST	None	SANTA BARBARA	CA	93105	4324	42	06083	34.43190764	-119.7238799	Santa Barbara County
243436	Fee-for-Service	1285789099	1285789099	1	1	KAISER FOUNDATION HOSPITALS	5/12/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10992 SAN DIEGO MISSION	BUILDING 2 STE 3401	SAN DIEGO	CA	92108	2444	37	06073	32.78503881	-117.1020911	San Diego County
243447	Fee-for-Service	1942768254	1942768254	1	1	KARAM, RAYMOND MD	10/20/2023	207R00000X	NA	Other	026	PHYSICIANS	175975	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
243448	Fee-for-Service	1356310502	1356310502	2	1	KAHN, ZEV M MD	11/20/2020	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	25422	04	Otology, Laryngology, Rhinology	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
243456	Fee-for-Service	1407817430	1407817430	1	1	KOPP, FRANZ J MD	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87341	20	Orthopedic Surgery	0	In state provider	None	4060 4TH AVE	STE 700	SAN DIEGO	CA	92103	2121	37	06073	32.75053673	-117.1616539	San Diego County
243475	Fee-for-Service	1194220046	1194220046	1	1	KURT, PATRICK J MD	10/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173812	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
243523	Fee-for-Service	1336534338	1336534338	1	1	KORNSWIET, MATTHEW S DO	6/26/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	17197	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	FLOOR 2	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
243577	Fee-for-Service	1407173149	1407173149	1	1	KOURA, SHAWN S MD	1/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125775	77	Infectious Disease	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
243629	Fee-for-Service	1275611188	1275611188	1	1	KAO, PETER F MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82545	03	Allergy	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
243675	Fee-for-Service	1790724292	1790724292	1	1	KALISH, JOANNE B MD	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14202	41	Internal Medicine	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
243686	Fee-for-Service	1275793846	1275793846	1	1	KAHLON, KANWARPAL S MD	6/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103296	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90045	5631	19	06037	34.06527974	-118.4462792	Los Angeles County
243762	Fee-for-Service	1679079388	1679079388	1	1	KASEM, HALIMAH MD	1/3/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173789	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
243772	Fee-for-Service	1821071986	1821071986	1	1	KHANNA, VIKRAM MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70485	08	Family Practice	0	In state provider	None	1801 TULLY RD	# F	MODESTO	CA	95350	2931	50	06099	37.670814	-121.0122795	Stanislaus County
243778	Fee-for-Service	1255309472	1255309472	2	1	KAPLAN, ROBERT A MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	23572	None	None	0	In state provider	None	3650 SOUTH ST	STE 4	LAKEWOOD	CA	90712	1502	19	06037	33.86019847	-118.149255	Los Angeles County
243807	Fee-for-Service	1841453966	1841453966	1	1	KIM, JEFFREY L MD	9/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116547	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204 B	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
243849	Fee-for-Service	1902988496	1902988496	1	1	KHAI T VU MD MEDICAL CORP	12/26/2006	193400000X	NA	Other	026	PHYSICIANS	68534	None	None	0	In state provider	TION	9940 TALBERT AVE	SUITE 204	FOUNTAIN VALLEY	CA	92708	4019	30	06059	33.70166347	-117.955494	Orange County
243933	Fee-for-Service	1285720680	1285720680	1	2	KOLIN, TALIA MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64713	18	Ophthalmology	0	In state provider	None	4036 WHITTIER BLVD	STE 202	LOS ANGELES	CA	90023	2561	19	06037	34.02390455	-118.1847825	Los Angeles County
243936	Fee-for-Service	1699544981	1699544981	1	1	KIVILA, ALEX MUTUKU	3/19/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1022 W BUTTERCUP LN	None	RIALTO	CA	92376	9948	36	06071	34.10829049	-117.3907845	San Bernardino County
243970	Fee-for-Service	1275793846	1275793846	1	1	KAHLON, KANWARPAL S MD	6/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103296	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90045	5631	19	06037	34.06527974	-118.4462792	Los Angeles County
244036	Fee-for-Service	1457884298	1457884298	1	1	KHERADMAND, SHIVA DO	7/1/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	18822	None	None	0	In state provider	None	25405 HANCOCK AVE.	200	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
244064	Fee-for-Service	1457439184	1457439184	1	1	KOHN, GERALD J MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63674	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
244140	Fee-for-Service	1457419236	1457419236	1	1	KULKARNI, MOHANA S MD	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106999	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
244152	Fee-for-Service	1871811679	1871811679	1	1	KIM, JASON J MD	8/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113649	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
244168	Fee-for-Service	1396004594	1396004594	1	1	KAVEESHVAR, HIRSH DO	11/8/2022	2084S0010X	NA	Neurology	026	PHYSICIANS	15212	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
244169	Fee-for-Service	1770720641	1770720641	1	1	KEAGLE MEDICAL INC	10/23/2008	193400000X	NA	Other	026	PHYSICIANS	64773	24	Plastic Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 601	LOS ANGELES	CA	90017	4810	19	06037	34.05362775	-118.2661889	Los Angeles County
244216	Fee-for-Service	1245268119	1245268119	1	1	KAZAN, CLAYTON DAVID	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80682	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
244225	Fee-for-Service	1699544981	1699544981	1	1	KIVILA, ALEX MUTUKU	3/19/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1022 W BUTTERCUP LN	None	RIALTO	CA	92376	9948	36	06071	34.10829049	-117.3907845	San Bernardino County
244242	Fee-for-Service	1811988496	1811988496	1	1	KRATZ, RICHARD E.	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65340	18	Ophthalmology	0	In state provider	None	14914 SHERMAN WAY	None	VAN NUYS	CA	91405	2113	19	06037	34.20110364	-118.458051	Los Angeles County
244261	Fee-for-Service	1427129345	1427129345	1	1	KLAPMAN, MARVIN H MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	50876	07	Dermatology	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
244264	Fee-for-Service	1275793846	1275793846	1	1	KAHLON, KANWARPAL S MD	6/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103296	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90045	5631	19	06037	34.06527974	-118.4462792	Los Angeles County
244267	Fee-for-Service	1548235823	1548235823	1	1	KUGEL, GREGORY B MD	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54627	30	Radiology	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
244282	Fee-for-Service	1942837216	1942837216	1	1	KIM, STEFFAN H MD	9/26/2023	208M00000X	NA	Other	026	PHYSICIANS	179898	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
244305	Fee-for-Service	1164624813	1164624813	1	1	KEVIN D TRINH MD AND JOHN L	10/17/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	BRAZILL MD A MEDICAL	2323 16TH STREET	SUITE 504	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
244352	Fee-for-Service	1457439184	1457439184	1	1	KOHN, GERALD J MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63674	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
244368	Fee-for-Service	1912404849	1912404849	1	1	KALAWI, ADAM Z MD	4/26/2023	2084N0402X	NA	Neurology	026	PHYSICIANS	164741	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
244379	Fee-for-Service	1912467481	1912467481	1	1	KARR, MATTHEW A DO	8/26/2022	208M00000X	NA	Other	026	PHYSICIANS	20023	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
244411	Fee-for-Service	1073668117	1073668117	1	1	KHAN, SAIRA Y OD	3/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
244416	Fee-for-Service	1538247036	1538247036	1	1	KAN, PATRICK Y MD	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83126	08	Family Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
244424	Fee-for-Service	1578635322	1578635322	1	1	KUMAR, RUMA MD	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77459	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
244426	Fee-for-Service	1023559283	1023559283	1	1	KIMBALL, KERILYN W DO	8/4/2020	171000000X	NA	Other	026	PHYSICIANS	16745	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
244435	Fee-for-Service	1730237629	1730237629	1	1	KIM, SUBIN P OD	12/24/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
244436	Fee-for-Service	1184886780	1184886780	1	1	KIM, CARON R MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111329	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
244445	Fee-for-Service	1104882653	1104882653	1	1	KAISER, THOMAS JOSEPH MD	1/1/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25587	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	45 CASTRO ST	STE 302	SAN FRANCISCO	CA	94114	1029	38	06075	37.76829732	-122.4357056	San Francisco County
244446	Fee-for-Service	1568402477	1568402477	1	1	KENNEDY, MORGAN R PHD	10/6/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 HOEN AVE	None	SANTA ROSA	CA	95405	9407	49	06097	38.441034	-122.665257	Sonoma County
244464	Fee-for-Service	1114987070	1114987070	1	1	KERR, ANNA R MD	11/30/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	73485	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
244495	Fee-for-Service	1073053732	1073053732	1	1	KEYNAN HOBBS NURSING, INC.	3/16/2022	261QM0850X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8900 GROSSMONT BLVD # 4-	None	LA MESA	CA	91941	4047	37	06073	32.77345049	-117.0040635	San Diego County
244523	Fee-for-Service	1124555842	1124555842	1	1	KUON, SUNGJIN DO	8/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18221	08	Family Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
244537	Fee-for-Service	1275707879	1275707879	1	1	KEVIN J BIELAMOWICZ	10/18/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
244555	Fee-for-Service	1184776569	1184776569	1	1	KIM, SAM K MD	5/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81401	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
244583	Fee-for-Service	1366622193	1366622193	1	1	KELLY, VICTORIA M MD	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105305	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
244584	Fee-for-Service	1851919617	1851919617	1	1	KIMERA, MARTIN K	8/13/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1648 N BRIGANTINE LN	None	VILLA PARK	CA	92867	4058	30	06059	33.8148671	-117.8311876	Orange County
244592	Fee-for-Service	1639161425	1639161425	1	1	KATHERINE R STRELICH, M.D	11/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10123 SE MARKET ST	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
244594	Fee-for-Service	1164740676	1164740676	1	1	KAZURA, PETER R MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
244622	Fee-for-Service	1851385223	1851385223	1	1	KABBANI, SAMER MD	6/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	74135	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2332 23RD ST	None	EUREKA	CA	95501	3231	12	06023	40.78684548	-124.1425485	Humboldt County
244642	Fee-for-Service	1194810655	1194810655	1	1	KETCHUM, DARCY C MD	10/28/1993	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	59735	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2999 REGENT ST	STE 301	BERKELEY	CA	94705	2118	01	06001	37.85592021	-122.2566436	Alameda County
244656	Fee-for-Service	1225236516	1225236516	1	2	KASARJIAN, JULIE K MD	9/14/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	98419	-	NOT APPLICABLE	0	In state provider	None	1100 NORTH D ST	None	SAN BERNARDINO	CA	92410	3425	36	06071	34.119711	-117.291936	San Bernardino County
244658	Fee-for-Service	1417450263	1417450263	1	1	KANG, BRIAN H MD	8/25/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	175339	None	None	0	In state provider	None	345 HALCYON RD	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
244667	Fee-for-Service	1447239090	1447239090	1	1	KOGAN, ROBERT L. MD	8/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	63330	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
244698	Fee-for-Service	1346623451	1346623451	1	1	KAUR, SUKHDIP MD	11/17/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
244775	Fee-for-Service	1629126594	1629126594	1	1	KAZIMIROFF, PAUL B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33025	13	Neurology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
244777	Fee-for-Service	1497855639	1497855639	1	1	KAMBIZ, ASHOORZADEH DO	12/27/2007	207R00000X	NA	Other	026	PHYSICIANS	8930	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
244798	Fee-for-Service	1114460920	1114460920	1	1	KHACHTOURIANS, LUCINE L LMFT	9/4/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
244803	Fee-for-Service	1124339114	1124339114	1	1	KAO, WEI-MING MD	8/8/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	183263	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
244811	Fee-for-Service	1265623524	1265623524	1	1	KRUTZIK, RAMONA A MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70812	67	Endocrinology	0	In state provider	None	528 G ST	None	BRAWLEY	CA	92227	2411	13	06025	32.97748458	-115.5329928	Imperial County
244812	Fee-for-Service	1740368455	1740368455	1	1	KINNEY, WALTER K MD	10/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37006	41	Internal Medicine	0	In state provider	None	187 40TH STREET WAY	None	OAKLAND	CA	94611	5210	01	06001	37.82658235	-122.2545416	Alameda County
244824	Fee-for-Service	1104106780	1104106780	1	1	KAFFKA, MARIAH D LCSW	10/8/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4129 MAIN	202	RIVERSIDE	CA	92501	3662	33	06065	33.97869946	-117.3766533	Riverside County
244852	Fee-for-Service	1124212667	1124212667	1	1	KUNIYOSHI, JEREMY K MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76172	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
244863	Fee-for-Service	1306824420	1306824420	1	1	KERN COUNTY NEUROLOGICAL	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GRP INC	1705 28TH ST	None	BAKERSFIELD	CA	93301	1902	15	06029	35.38477999	-119.0215335	Kern County
244872	Fee-for-Service	1851919617	1851919617	1	1	KIMERA, MARTIN K	8/13/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1648 N BRIGANTINE LN	None	VILLA PARK	CA	92867	4058	30	06059	33.8148671	-117.8311876	Orange County
244880	Fee-for-Service	1164740676	1164740676	1	1	KAZURA, PETER R MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
244895	Fee-for-Service	1891747390	1891747390	1	1	KAPLON, RICHARD J MD	2/15/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86404	02	General Surgery	0	In state provider	None	3941 J ST	STE 270	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
244914	Fee-for-Service	1700182805	1700182805	1	1	KEHDY LAI, HIBA LMFT	10/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR BU	368	PALM DESERT	CA	92211	6226	33	06065	33.75833451	-116.3114325	Riverside County
244923	Fee-for-Service	1194827782	1194827782	1	1	KUJMANIAN LEON, MD	7/14/2010	207RE0101X	NA	Endocrinology	026	PHYSICIANS	64159	41	Internal Medicine	0	In state provider	None	607 N CENTRAL AVE	STE 304	GLENDALE	CA	91203	1836	19	06037	34.153974	-118.2579675	Los Angeles County
244974	Fee-for-Service	1174978571	1174978571	1	1	KRAFT, ELIZABETH MD	9/26/2022	390200000X	NA	Other	026	PHYSICIANS	171595	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245011	Fee-for-Service	1790999670	1790999670	1	1	KHAN, MEHREEN M MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114760	41	Internal Medicine	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.4876781	-122.2249265	San Mateo County
245033	Fee-for-Service	1932389327	1932389327	1	1	KIM, DANIEL S MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24477	05	Anesthesiology	0	In state provider	None	12900A GARDEN GROVE BLVD	STE 122	GARDEN GROVE	CA	92843	2016	30	06059	33.77433148	-117.9075735	Orange County
245053	Fee-for-Service	1295929636	1295929636	1	1	KIM, KI S MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	35050	25	Physical Medicine and Rehabilitation	0	In state provider	None	192 BEACON ST	None	S SAN FRANCISCO	CA	94080	6913	41	06081	37.63966055	-122.4022905	San Mateo County
245078	Fee-for-Service	1952311821	1952311821	2	1	KING, JOHN D MD	12/9/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	19146	85	Surgery-Pediatric	0	In state provider	None	18411 CLARK ST	STE 302	TARZANA	CA	91356	3571	19	06037	34.16981538	-118.5337442	Los Angeles County
245091	Fee-for-Service	1427726835	1427726835	1	1	KIM, PAUL Y PT	9/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14682 CENTRAL AVE	None	CHINO	CA	91710	9505	36	06071	33.986601	-117.689039	San Bernardino County
245140	Fee-for-Service	1083885040	1083885040	1	1	KARL R KNUDSEN MD PC	4/2/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2200 BRYANT WILLIAMS DR	STE 1	KLAMATH FALLS	OR	97601	1121	00	None	42.25198664	-121.7841082	Klamath County
245162	Fee-for-Service	1063404572	1063404572	1	1	KISTNER, JR. ROBERT L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
245171	Fee-for-Service	1558487611	1558487611	1	1	KOKOT, NIELS MD	5/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84940	None	None	0	In state provider	None	1520 SAN PABLO STREET	SUITE 4600	LOS ANGELES	CA	90033	5330	19	06037	34.06269295	-118.2030006	Los Angeles County
245173	Fee-for-Service	1568975290	1568975290	1	1	KAWEAH DELTA HEALTH CARE DIS	8/13/2018	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	54	06107	36.359649	-119.331567	Tulare County
245207	Fee-for-Service	1194827782	1194827782	1	1	KUJMANIAN LEON, MD	7/14/2010	207RE0101X	NA	Endocrinology	026	PHYSICIANS	64159	67	Endocrinology	0	In state provider	None	607 N CENTRAL AVE	STE 304	GLENDALE	CA	91203	1836	19	06037	34.153974	-118.2579675	Los Angeles County
245235	Fee-for-Service	1033164892	1033164892	1	1	KITAJIMA, TINA D MD	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68088	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
245241	Fee-for-Service	1457854192	1457854192	1	1	KERN VALLEY HEALTHCARE	11/26/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4300 BIRCH ST	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63438473	-118.4065846	Kern County
245260	Fee-for-Service	1396307039	1396307039	1	1	KIM, CATHY M NP	3/18/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
245300	Fee-for-Service	1730462771	1730462771	1	1	KARIMU, MOSHOOD B MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 N TOWN CENTER DRIVE	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
245304	Fee-for-Service	1780952176	1780952176	1	1	KONING, JEFFREY L MD	6/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122071	30	Radiology	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
245309	Fee-for-Service	1730297854	1730297854	1	1	KIM, MELODY M MD	5/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61231	36	Psychiatry	0	In state provider	None	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
245313	Fee-for-Service	1396182887	1396182887	1	1	KANNAN, NEETA MD	5/1/2018	390200000X	NA	Other	026	PHYSICIANS	135169	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
245319	Fee-for-Service	1578936035	1578936035	1	1	KEYS, JENIQUE B CNM	10/21/2019	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
245332	Fee-for-Service	1336374123	1336374123	1	1	KIM, JANET MD	6/5/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	123752	18	Ophthalmology	0	In state provider	None	5991 E SPRING ST	None	LONG BEACH	CA	90808	3752	19	06037	33.81062147	-118.1154555	Los Angeles County
245365	Fee-for-Service	1952311821	1952311821	2	1	KING, JOHN D MD	12/9/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	19146	20	Orthopedic Surgery	0	In state provider	None	18411 CLARK ST	STE 302	TARZANA	CA	91356	3571	19	06037	34.16981538	-118.5337442	Los Angeles County
245384	Fee-for-Service	1801960513	1801960513	1	1	KAISER FOUNDATION HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
245391	Fee-for-Service	1336409226	1336409226	1	1	KOKKINIDES, MARIA Z DO	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14144	41	Internal Medicine	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
245507	Fee-for-Service	1063831857	1063831857	1	1	KWOK, JANET Y MD	6/19/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	139288	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
245526	Fee-for-Service	1457854192	1457854192	1	1	KERN VALLEY HEALTHCARE	3/6/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4300 BIRCH ST	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63438473	-118.4065846	Kern County
245532	Fee-for-Service	1710908082	1710908082	1	1	KOIFMAN, KHAIM MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	34756	05	Anesthesiology	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
245572	Fee-for-Service	1285835454	1285835454	1	1	KOHLI, NITA MD	1/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104864	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
245584	Fee-for-Service	1720097066	1720097066	1	1	KOHORN, LISA A MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70187	22	Pathology (M.D. only)	0	In state provider	None	280 S MAIN ST	None	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
245612	Fee-for-Service	1245318989	1245318989	1	1	KLUG, RAPHAEL M DO	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7648	20	Orthopedic Surgery	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
245631	Fee-for-Service	1619527876	1619527876	1	1	K.C.H. COUNSELING INC.	9/26/2019	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24520 HAWTHORNE BLVD.	220	TORRANCE	CA	90505	6848	19	06037	33.79879508	-118.3510187	Los Angeles County
245635	Fee-for-Service	1083726905	1083726905	1	2	KOH, SANDY S	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	34583	None	None	0	In state provider	None	3419 TYLER AVE	None	EL MONTE	CA	91731	3103	19	06037	34.07081311	-118.0360305	Los Angeles County
245653	Fee-for-Service	1952311821	1952311821	2	1	KING, JOHN D MD	12/9/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	19146	40	Pediatrics	0	In state provider	None	18411 CLARK ST	STE 302	TARZANA	CA	91356	3571	19	06037	34.16981538	-118.5337442	Los Angeles County
245679	Fee-for-Service	1700207941	1700207941	1	1	KIM, YOUNG-MIN MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127211	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
245753	Fee-for-Service	1427103829	1427103829	1	1	KAYE, MARTIN I MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
245802	Fee-for-Service	1972829000	1972829000	1	1	KATSNELSON, SVETLANA MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135028	67	Endocrinology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
245813	Fee-for-Service	1457854192	1457854192	1	1	KERN VALLEY HEALTHCARE	11/26/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4300 BIRCH ST	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63438473	-118.4065846	Kern County
245814	Fee-for-Service	1487318739	1487318739	1	1	KIRKPATRICK, JORDAN LMFT	1/26/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3820 AUBURN BLVD.	SUITE 100	SACRAMENTO	CA	95821	2069	34	06067	38.639583	-121.3754985	Sacramento County
245821	Fee-for-Service	1295730471	1295730471	1	1	KAISER, JOSEPH W. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	15520 19 MILE RD	STE 480	CLINTON TWP	MI	48038	6332	00	None	42.61249099	-82.96818269	Macomb County
245823	Fee-for-Service	1689935751	1689935751	1	1	KERN, CHRISTOPHER R DO	4/26/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	17948	41	Internal Medicine	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
245830	Fee-for-Service	1659428977	1659428977	1	1	KAISER PERMANENTE	4/5/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY #113	3900 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2000	19	06037	33.78982251	-118.1462265	Los Angeles County
245861	Fee-for-Service	1841475019	1841475019	1	1	KHIN, LAY L MD	7/24/2019	207R00000X	NA	Other	026	PHYSICIANS	160054	41	Internal Medicine	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
245915	Fee-for-Service	1003201666	1003201666	1	1	KROGUE, JUSTIN D MD	7/31/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	146997	20	Orthopedic Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
245926	Fee-for-Service	1902067507	1902067507	1	1	KALLICHANDA, NATHASH MD	12/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88370	22	Pathology (M.D. only)	0	In state provider	None	19951 MARINER AVE	STE 155	TORRANCE	CA	90503	1738	19	06037	33.85129396	-118.3504889	Los Angeles County
245944	Fee-for-Service	1023045515	1023045515	1	1	KAUFMAN, SETH A MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89849	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
246039	Fee-for-Service	1528672052	1528672052	1	1	KATZ, SARAH N NP	3/11/2022	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11800 WILSHIRE BLVD	None	LOS ANGELES	CA	90025	6606	19	06037	34.0475456	-118.4632671	Los Angeles County
246083	Fee-for-Service	1205077385	1205077385	1	1	KAO, LUKE S MD INC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	32679	34	Urology and Urological Surgery	0	In state provider	None	10230 ARTESIA BLVD	STE 105	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
246085	Fee-for-Service	1801391446	1801391446	1	1	KUMAR, PUNEET B MD	4/2/2021	208M00000X	NA	Other	026	PHYSICIANS	165948	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
246115	Fee-for-Service	1952698516	1952698516	1	1	KYLE K CHONG M.D.	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
246208	Fee-for-Service	1780145524	1780145524	1	1	KWON, DAVID H DO	9/27/2022	207R00000X	NA	Other	026	PHYSICIANS	19484	None	None	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
246247	Fee-for-Service	1831251495	1831251495	1	1	KATELLA MEDICAL GRP INC	10/7/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	KATELLA MULTI-SPECIALTY	9876 KATELLA AVE	None	ANAHEIM	CA	92804	6418	30	06059	33.80305103	-117.9606595	Orange County
246254	Fee-for-Service	1962724187	1962724187	1	1	KUMAR, VASANTH K MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32885	41	Internal Medicine	0	In state provider	None	2105 BEVERLY BLVD	SUITE 205	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
246255	Fee-for-Service	1497064521	1497064521	1	2	KIOKA, MUTSUMI JOHN MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
246303	Fee-for-Service	1841547015	1841547015	1	1	KARR, ANDREA M	5/3/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2001 SOLAR DR	STE 150	OXNARD	CA	93036	0680	56	06111	34.22025454	-119.1449192	Ventura County
246320	Fee-for-Service	1003075037	1003075037	1	1	KESELMAN, INNA MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111883	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLZ	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
246386	Fee-for-Service	1740830389	1740830389	1	1	KENDALL INDIVIDUAL, FAMILY A	5/14/2024	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	APISTS	1622 4TH ST	None	SANTA ROSA	CA	95404	4020	49	06097	38.448162	-122.6995335	Sonoma County
246395	Fee-for-Service	1912949132	1912949132	1	1	KIM, RICHARD T MD	9/7/2005	207RC0200X	NA	Other	026	PHYSICIANS	51931	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
246416	Fee-for-Service	1427586940	1427586940	1	1	KLUBNICK, JENNA A	9/4/2022	208M00000X	NA	Other	026	PHYSICIANS	180369	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
246456	Fee-for-Service	1245080522	1245080522	1	1	KETH, ELAINA AU	10/21/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
246483	Fee-for-Service	1669845673	1669845673	1	1	KRACK, JENNIFER E	8/14/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
246501	Fee-for-Service	1376860387	1376860387	1	1	KIM, SARAH C MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119152	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
246507	Fee-for-Service	1700091519	1700091519	1	1	KING, SHURONDA CRNA	4/19/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
246519	Fee-for-Service	1366404576	1366404576	1	1	KNIGHT,PATRICE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 GOVERNORS DR SW	None	HUNTSVILLE	AL	35801	5123	00	None	34.71989554	-86.58362279	Madison County
246534	Fee-for-Service	1831251495	1831251495	1	1	KATELLA MEDICAL GRP INC	10/7/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	KATELLA MULTI-SPECIALTY	9876 KATELLA AVE	None	ANAHEIM	CA	92804	6418	30	06059	33.80305103	-117.9606595	Orange County
246542	Fee-for-Service	1952648156	1952648156	1	1	KHAN, JAHANZEB A MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145170	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
246551	Fee-for-Service	1194586123	1194586123	1	1	KAUR, NAVINDER NP	1/30/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	10	06019	36.80840238	-119.8594473	Fresno County
246552	Fee-for-Service	1760456503	1760456503	1	1	KAI, HABER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
246609	Fee-for-Service	1053731869	1053731869	1	1	KEMKAR, SNEHA A MD	11/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139853	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
246659	Fee-for-Service	1700964566	1700964566	1	1	KIM, LENA H MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79209	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1580 VALENCIA ST	STE 506	SAN FRANCISCO	CA	94110	4418	38	06075	37.74746923	-122.4202583	San Francisco County
246673	Fee-for-Service	1740830389	1740830389	1	1	KENDALL INDIVIDUAL, FAMILY A	5/14/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	APISTS	1622 4TH ST	None	SANTA ROSA	CA	95404	4020	49	06097	38.448162	-122.6995335	Sonoma County
246684	Fee-for-Service	1912949132	1912949132	1	1	KIM, RICHARD T MD	9/7/2005	207RC0200X	NA	Other	026	PHYSICIANS	51931	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
246690	Fee-for-Service	1740860691	1740860691	1	1	KAPOOR, KOMAL MD	7/24/2024	207R00000X	NA	Other	026	PHYSICIANS	192467	41	Internal Medicine	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
246710	Fee-for-Service	1760939318	1760939318	1	1	KIRK, ANDREA E PHD	12/11/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	309 S. MAIN ST.	None	SEBASTOPOL	CA	95472	4208	49	06097	38.39997858	-122.8230216	Sonoma County
246716	Fee-for-Service	1407467954	1407467954	1	1	KAN, ADA PT	11/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2280 DIAMOND BLVD	320	CONCORD	CA	94520	5775	07	06013	37.97715317	-122.0605709	Contra Costa County
246721	Fee-for-Service	1144236399	1144236399	1	1	KATO, STEPHEN K MD	12/29/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	35767	40	Pediatrics	0	In state provider	None	10251 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6719	19	06037	33.87290452	-118.1154735	Los Angeles County
246729	Fee-for-Service	1104840586	1104840586	1	2	KOSTICK, BARBARA MD	7/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24535	01	General Practice	0	In state provider	None	2190 PERALTA BLVD	None	FREMONT	CA	94536	3965	01	06001	37.56234759	-121.9893955	Alameda County
246734	Fee-for-Service	1881628212	1881628212	1	1	KRISHNAN, SHREE J MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136907	45	Nephrology (Renal-Kidney)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
246758	Fee-for-Service	1962543157	1962543157	1	1	KILLAM, SONIA R OT	4/26/2020	225XN1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
246772	Fee-for-Service	1578754602	1578754602	1	1	KANG, ILHO MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86835	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
246785	Fee-for-Service	1144375056	1144375056	1	5	KAISER FOUNDATION HOSPITALS	5/14/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6640 ALTON PKWY	None	IRVINE	CA	92618	3734	30	06059	33.65911992	-117.7737909	Orange County
246786	Fee-for-Service	1376860387	1376860387	1	1	KIM, SARAH C MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119152	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
246801	Fee-for-Service	1629041082	1629041082	1	1	KING, HOLLIS H DO	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	4976	01	General Practice	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
246816	Fee-for-Service	1225080708	1225080708	1	1	KARACA, TIMUR J MD	7/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86322	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
246821	Fee-for-Service	1396409678	1396409678	1	1	KRUG, CORBIN E LCSW	3/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
246941	Fee-for-Service	1811274186	1811274186	1	2	KAYIIRA, MARGARET N	8/2/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	18259 ARIAL WAY	None	SANTA CLARITA	CA	91350	5791	19	06037	34.44102068	-118.4568107	Los Angeles County
246968	Fee-for-Service	1114620895	1114620895	1	1	KEALSA TRANSPORTATION SERVIC	4/17/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13772 FONTANELLE PL	None	SAN DIEGO	CA	92128	4741	37	06073	32.9698116	-117.079733	San Diego County
247021	Fee-for-Service	1750812939	1750812939	1	1	KAUR, SUBHPALJIT MD	6/22/2022	207R00000X	NA	Other	026	PHYSICIANS	164442	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
247091	Fee-for-Service	1750452512	1750452512	1	1	KEARNS, DONALD B MD	8/24/2004	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	42381	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	3030 BERGER AVE	STE 402	SAN DIEGO	CA	92123	4228	37	06073	32.79859767	-117.1508677	San Diego County
247164	Fee-for-Service	1821574492	1821574492	1	1	KNOTTS, KAYLA R OD	10/15/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	54	06107	36.332757	-119.288682	Tulare County
247165	Fee-for-Service	1639195860	1639195860	1	1	KAHRAMAN, LEVENT MD	3/31/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
247173	Fee-for-Service	1477537439	1477537439	1	1	KIEF-GARCIA, MONIKA L MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	45836	30	Radiology	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
247212	Fee-for-Service	1881771855	1881771855	1	1	KITTLE, VONDA L	7/10/2000	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	VONDA'S AUDIOLOGICAL SRV	5776 N DEWOLF AVE	None	CLOVIS	CA	93619	9234	10	06019	36.819882	-119.6421165	Fresno County
247225	Fee-for-Service	1437437266	1437437266	1	1	KLEINMAN, SUSAN M LCSW	4/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	930 EUCLID ST #202	None	SANTA MONICA	CA	90403	4623	19	06037	34.02963565	-118.4941219	Los Angeles County
247229	Fee-for-Service	1811274186	1811274186	1	2	KAYIIRA, MARGARET N	8/2/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	18259 ARIAL WAY	None	SANTA CLARITA	CA	91350	5791	19	06037	34.44102068	-118.4568107	Los Angeles County
247253	Fee-for-Service	1689677205	1689677205	1	1	KAUL, ANITA MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46693	68	Hematology	0	In state provider	None	227 W JANSS RD	STE 330	THOUSAND OAKS	CA	91360	1871	56	06111	34.20611691	-118.883861	Ventura County
247324	Fee-for-Service	1750495545	1750495545	1	1	KURTZMAN, JAMES T MD	5/26/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74134	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
247385	Fee-for-Service	1194767459	1194767459	1	1	KONCHIGERI, RAVI H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74716	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
247396	Fee-for-Service	1598896268	1598896268	1	1	KWIATKOWSKI, SCOTT W DO	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11602	None	None	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
247419	Fee-for-Service	1396804662	1396804662	1	1	KHAN, TARIQ A MD	4/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101538	41	Internal Medicine	0	In state provider	None	36485 INDIAN VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.631929	-117.273816	Riverside County
247468	Fee-for-Service	1609329291	1609329291	1	1	KAZANDJIAN, DZOVAK PSYD	9/23/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30423 CANWOOD ST	SUITE 138	AGOURA HILLS	CA	91301	4315	19	06037	34.14710182	-118.7842501	Los Angeles County
247477	Fee-for-Service	1144264201	1144264201	1	1	KRAMMER, BRADLEY A MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2610 UHRMANN ROAD	None	KLAMATH FALLS	OR	97601	1123	00	None	42.25167494	-121.7867299	Klamath County
247493	Fee-for-Service	1679763635	1679763635	1	2	KISHBAUGH, GRETCHEN PHD	1/3/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1330 LINCOLN AVE	STE 304A	SAN RAFAEL	CA	94901	2120	21	06041	37.97629089	-122.5226851	Marin County
247541	Fee-for-Service	1689677205	1689677205	1	1	KAUL, ANITA MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46693	41	Internal Medicine	0	In state provider	None	227 W JANSS RD	STE 330	THOUSAND OAKS	CA	91360	1871	56	06111	34.20611691	-118.883861	Ventura County
247577	Fee-for-Service	1952414542	1952414542	1	1	KIRKPATRICK,RYAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST	None	SALEM	OR	97301	0000	00	None	44.933211	-123.0355125	Marion County
247599	Fee-for-Service	1952756207	1952756207	1	1	KATZ, JONATHAN E MD	6/1/2022	208800000X	NA	Other	026	PHYSICIANS	175654	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
247610	Fee-for-Service	1487715983	1487715983	1	1	KRAMER, JOEL H PHD	5/22/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
247621	Fee-for-Service	1649245051	1649245051	1	1	KRILL, JULIANNA E PT	1/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
247651	Fee-for-Service	1821552357	1821552357	1	1	KURUDIMOVA, ALLA LMFT	11/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	1501 CORPORATE WAY	200	SACRAMENTO	CA	95831	3887	34	06067	38.492604	-121.5201645	Sacramento County
247781	Fee-for-Service	1235123357	1235123357	1	1	KUIKEN, DANIEL A MD	5/31/1986	207L00000X	NA	Other	026	PHYSICIANS	36977	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
247798	Fee-for-Service	1982061230	1982061230	1	1	KO, ARA MD	7/6/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	139859	85	Surgery-Pediatric	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
247825	Fee-for-Service	1669453247	1669453247	1	1	KUBAL, WAYNE S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
247830	Fee-for-Service	1689677205	1689677205	1	1	KAUL, ANITA MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46693	78	Neoplastic Diseases/Oncology	0	In state provider	None	227 W JANSS RD	STE 330	THOUSAND OAKS	CA	91360	1871	56	06111	34.20611691	-118.883861	Ventura County
247837	Fee-for-Service	1407809304	1407809304	1	2	KUDRIMOTI, HERMANT S MD	8/23/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	54482	13	Neurology (M.D. only)	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
247844	Fee-for-Service	1528084738	1528084738	1	1	KRAMER, DAVID MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	20106	30	Radiology	0	In state provider	None	25 N 14TH ST	STE 150	SAN JOSE	CA	95112	6218	43	06085	37.34293357	-121.8775187	Santa Clara County
247883	Fee-for-Service	1891528097	1891528097	1	1	KINZEL, JASON LMFT	1/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
247929	Fee-for-Service	1194896043	1194896043	1	1	KHEITER, AHMED MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89639	41	Internal Medicine	0	In state provider	None	555 TACHEVAH DRIVE	2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
247940	Fee-for-Service	1073617361	1073617361	1	1	KEOUGH, KENNETH LMFT	8/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1625 6TH AVE	None	OAKLAND	CA	94606	2478	01	06001	37.7966701	-122.250772	Alameda County
247945	Fee-for-Service	1447295308	1447295308	1	1	KOVACIK, R DAVID MD	7/17/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84709	None	None	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
247949	Fee-for-Service	1720432453	1720432453	1	1	KHAN, NADIR Z MD	5/6/2019	390200000X	NA	Other	026	PHYSICIANS	158336	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
247951	Fee-for-Service	1053088849	1053088849	1	1	KIM, MIN NP	1/31/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1331 W. AVE J	STE 101A	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
247993	Fee-for-Service	1225218720	1225218720	1	1	KIRRANE,JEANNETTE A	5/23/2019	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
248020	Fee-for-Service	1295774602	1295774602	1	1	KNOTT, PETER R NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248035	Fee-for-Service	1306954599	1306954599	1	1	KELLER, EARLENE A LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	13951 MONO WAY	None	SONORA	CA	95370	2807	55	06109	37.9783557	-120.3393376	Tuolumne County
248041	Fee-for-Service	1831330638	1831330638	1	1	KALRA, SMITA K MD	8/11/2020	208M00000X	NA	Other	026	PHYSICIANS	168909	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
248043	Fee-for-Service	1982135034	1982135034	1	1	KUNKEL, EMILY K MD	7/31/2023	208600000X	NA	General Surgery	026	PHYSICIANS	187971	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
248056	Fee-for-Service	1861563785	1861563785	1	1	KONO, MICHIYUKI MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76904	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
248100	Fee-for-Service	1861407728	1861407728	1	1	KOHLER, MARTHA L LCSW	12/13/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
248104	Fee-for-Service	1669491197	1669491197	1	1	KAPLAN, LINDA	6/30/1989	2084N0400X	NA	Neurology	026	PHYSICIANS	67672	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
248108	Fee-for-Service	1104212083	1104212083	1	1	KANJIYA, SHREY M MD	7/14/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	168099	None	None	0	In state provider	None	4955 VAN NUYS BLVD	STE 615	SHERMAN OAKS	CA	91403	1839	19	06037	34.160805	-118.4487295	Los Angeles County
248199	Fee-for-Service	1891055349	1891055349	1	1	KOROLYOV, ALEKSEY MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141941	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
248216	Fee-for-Service	1790892115	1790892115	1	1	KIM, JOSEPH S MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	52950	41	Internal Medicine	0	In state provider	None	3000 W OLYMPIC BLVD	STE 202	LOS ANGELES	CA	90006	2588	19	06037	34.05260947	-118.3003335	Los Angeles County
248221	Fee-for-Service	1871646182	1871646182	1	1	KALLAH, ANDREA M MD	7/28/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69647	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	FLOOR 2	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
248244	Fee-for-Service	1316344138	1316344138	1	1	KHAN, TANZIM DPM	4/16/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
248250	Fee-for-Service	1487993176	1487993176	1	1	KIDNEY AND HYPERTENSION	9/14/2015	193400000X	NA	Other	026	PHYSICIANS	88861	41	Internal Medicine	0	In state provider	CONSULTANTS	18546 ROSCOE BLVD	STE 110	NORTHRIDGE	CA	91324	4667	19	06037	34.22069869	-118.537684	Los Angeles County
248283	Fee-for-Service	1841352663	1841352663	1	1	KIM, JIM C MD INC	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67383	None	None	0	In state provider	None	2203 17TH ST	None	BAKERSFIELD	CA	93301	3604	15	06029	35.37431634	-119.0272969	Kern County
248300	Fee-for-Service	1205597309	1205597309	1	1	KITHUKU, DAVID	3/2/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	27497 COYOTE MESA DRIVE	None	CORONA	CA	92883	7907	33	06065	33.7199216	-117.4174427	Riverside County
248302	Fee-for-Service	1215948690	1215948690	1	1	KRISHNAN, AMRITA Y MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82241	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
248339	Fee-for-Service	1285608265	1285608265	1	1	KLETSCHER, BRUCE A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
248353	Fee-for-Service	1134385271	1134385271	1	1	KURBAN, WILLIAM MD	12/4/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	153798	None	None	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
248367	Fee-for-Service	1821240938	1821240938	1	1	KHOURY, SHAHIRA S MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53416	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
248418	Fee-for-Service	1801319116	1801319116	1	1	KORDI, KIMBERLY V LCSW	2/22/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
248422	Fee-for-Service	1285712885	1285712885	1	1	KHOURI, ISSA A MD	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78545	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
248442	Fee-for-Service	1295315042	1295315042	1	1	KANG, KEIKO M MD	8/13/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
248447	Fee-for-Service	1659520088	1659520088	1	1	KEENE, TRACY L LMFT	12/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
248453	Fee-for-Service	1659441822	1659441822	1	1	KANJI, JASON MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	89292	36	Psychiatry	0	In state provider	None	3171 LOS FELIZ BLVD	STE 200	LOS ANGELES	CA	90039	1536	19	06037	34.12369709	-118.2682266	Los Angeles County
248489	Fee-for-Service	1922499961	1922499961	1	1	KHALEDY, PALITA OT	11/1/2018	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
248494	Fee-for-Service	1114181534	1114181534	1	1	KANSAL, KARI J MD	6/12/2018	2086X0206X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
248501	Fee-for-Service	1356928048	1356928048	1	1	KALRA, ARIANNE D	5/4/2023	390200000X	NA	Other	026	PHYSICIANS	20470	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
248519	Fee-for-Service	1871858399	1871858399	1	1	KONG, MARIANNA MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127607	01	General Practice	0	In state provider	None	1001 POTRERO AVE	ROOM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
248529	Fee-for-Service	1922170752	1922170752	1	1	KENDRICK, MONICA E MD	4/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86279	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
248537	Fee-for-Service	1073692083	1073692083	1	1	KRISHNA, GOPAL G MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	36123	41	Internal Medicine	0	In state provider	None	917 BLANCO CIR	None	SALINAS	CA	93901	4446	27	06053	36.65433288	-121.6377316	Monterey County
248539	Fee-for-Service	1487993176	1487993176	1	1	KIDNEY AND HYPERTENSION	9/14/2015	193400000X	NA	Other	026	PHYSICIANS	88861	45	Nephrology (Renal-Kidney)	0	In state provider	CONSULTANTS	18546 ROSCOE BLVD	STE 110	NORTHRIDGE	CA	91324	4667	19	06037	34.22069869	-118.537684	Los Angeles County
248551	Fee-for-Service	1780662569	1780662569	1	1	KUHLS, DEBORAH A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	89	Surgery-Traumatic	1	Border provider	KUHLS, DEBORAH A MD	2040 W CHARLESTON BLVD	STE 601	LAS VEGAS	NV	89102	2245	00	None	36.1589735	-115.168095	Clark County
248577	Fee-for-Service	1487693685	1487693685	1	1	KRAMER, PAUL H MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	44030	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12840 RIVERSIDE DR	STE 300A	VALLEY VILLAGE	CA	91607	3327	19	06037	34.15759054	-118.4129775	Los Angeles County
248588	Fee-for-Service	1205597309	1205597309	1	1	KITHUKU, DAVID	3/2/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	27497 COYOTE MESA DRIVE	None	CORONA	CA	92883	7907	33	06065	33.7199216	-117.4174427	Riverside County
248590	Fee-for-Service	1215948690	1215948690	1	1	KRISHNAN, AMRITA Y MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82241	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
248602	Fee-for-Service	1538447677	1538447677	1	1	KARAM, DAVID CHRISTOPHER MD	11/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113390	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	3RD FLOOR	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
248640	Fee-for-Service	1245060185	1245060185	1	1	KAUR, SUPREET CRNA	12/13/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
248642	Fee-for-Service	1679736854	1679736854	1	1	KIM, ALICE M DO	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12182	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4053 LONE TREE WAY	STE 101	ANTIOCH	CA	94531	6208	07	06013	37.97569499	-121.800733	Contra Costa County
248679	Fee-for-Service	1396953733	1396953733	1	1	KALINDJIAN, KRIKOR I MD	1/17/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	1300 N VERMONT AVE	# 807	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
248698	Fee-for-Service	1265796783	1265796783	1	1	KESSLER, NICOLE M LCSW	4/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15 WILLIAMSBURG LN	STE A	CHICO	CA	95926	5520	04	06007	39.75295903	-121.8548475	Butte County
248703	Fee-for-Service	1285839779	1285839779	1	1	KULKARNI, SONALI P MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95238	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248704	Fee-for-Service	1588856710	1588856710	1	1	KWOK, KAY M MD	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93475	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3650 E SOUTH ST	STE 403	LAKEWOOD	CA	90712	1504	19	06037	33.8601747	-118.1494013	Los Angeles County
248728	Fee-for-Service	1124182902	1124182902	1	1	KAISER FOUNDATION HOSPITALS	1/22/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10180 SE SUNNYSIDE RD	None	CLACKAMAS	OR	97015	8970	00	None	45.43128	-122.5613205	Clackamas County
248730	Fee-for-Service	1205152956	1205152956	1	1	KARNEZIS, STELLIOS MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112377	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
248759	Fee-for-Service	1497380356	1497380356	1	1	KIM, HELEN O CNP	4/8/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
248813	Fee-for-Service	1316460215	1316460215	1	1	KANDOLA, SAMANJIT K MD	4/4/2024	207R00000X	NA	Other	026	PHYSICIANS	170070	None	None	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
248824	Fee-for-Service	1073692083	1073692083	1	1	KRISHNA, GOPAL G MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	36123	45	Nephrology (Renal-Kidney)	0	In state provider	None	917 BLANCO CIR	None	SALINAS	CA	93901	4446	27	06053	36.65433288	-121.6377316	Monterey County
248864	Fee-for-Service	1386687424	1386687424	1	1	KIRSCHNER, HEATHER S DO	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9530	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
248879	Fee-for-Service	1215948690	1215948690	1	1	KRISHNAN, AMRITA Y MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82241	01	General Practice	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
248909	Fee-for-Service	1336208966	1336208966	1	1	KATRAGADDA, RAMA D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33127	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
248916	Fee-for-Service	1831382738	1831382738	1	1	KLEIN, BERNARD J	11/30/1988	207R00000X	NA	Other	026	PHYSICIANS	61659	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
248963	Fee-for-Service	1558548255	1558548255	1	1	KINGSLEY, JEFFREY D MD	4/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103298	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
248994	Fee-for-Service	1720138373	1720138373	1	1	KANG, GRACE C OD	11/21/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
249002	Fee-for-Service	1033476262	1033476262	1	1	KEMMERLY, THOMAS M MD	8/2/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	128828	None	None	0	In state provider	None	40404 CALIFORNIA OAKS RD	STE C	MURRIETA	CA	92562	5786	33	06065	33.57857707	-117.1998797	Riverside County
249092	Fee-for-Service	1134685852	1134685852	1	1	KOUZI, SARAH LMFT	10/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
249152	Fee-for-Service	1356434989	1356434989	1	1	KAIMAL, ANJALI J MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94610	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
249182	Fee-for-Service	1922546829	1922546829	1	1	KHALAFI, FARBOD PSYD	3/25/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
249186	Fee-for-Service	1366966368	1366966368	1	1	KHREIS, TARIQ MD	5/16/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	-	68	Hematology	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
249206	Fee-for-Service	1932300829	1932300829	1	1	KUSUMOTO, RURIKO OD	12/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 CRAVEN ROAD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
249210	Fee-for-Service	1235174111	1235174111	1	1	KUBASKA, SAMANTHA M MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79054	30	Radiology	0	In state provider	None	1100 N TUSTIN AVE	None	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
249253	Fee-for-Service	1619985868	1619985868	1	1	KHATAMI, MANOOCHEHR MD	12/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	37551	36	Psychiatry	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
249254	Fee-for-Service	1477996916	1477996916	1	1	KINNEY, AARON M MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137937	01	General Practice	0	In state provider	None	8170 LAGUNA BLVD	SUITE 101	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
249339	Fee-for-Service	1619452158	1619452158	1	1	KUEHNER, MEGAN M NP	10/7/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
249341	Fee-for-Service	1790207231	1790207231	1	1	KWON, SANGIL PHD	10/28/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HEALTH	473 EAST CARNEGIE DR.	STE. 200	SAN BERNARDINO	CA	92408	0000	36	06071	34.0683677	-117.2746246	San Bernardino County
249360	Fee-for-Service	1154858314	1154858314	1	1	KRISHNASAMY, SHALINI MD	10/7/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
249388	Fee-for-Service	1346276359	1346276359	1	1	KARNAZE, DEAN S MD	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	29427	13	Neurology (M.D. only)	0	In state provider	UCSD NEURO MED GRP	545 E CLEVELAND ST	STE B	STOCKTON	CA	95204	5535	39	06077	37.97379447	-121.2893338	San Joaquin County
249392	Fee-for-Service	1952367815	1952367815	1	1	KOTH, LAURA L MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64672	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
249410	Fee-for-Service	1629726609	1629726609	1	1	KULKIN, JAMI M LMFT	11/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
249411	Fee-for-Service	1194054858	1194054858	1	1	KHAN, SIDRAH MD	11/3/2021	208M00000X	NA	Other	026	PHYSICIANS	115674	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
249473	Fee-for-Service	1366966368	1366966368	1	1	KHREIS, TARIQ MD	5/16/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
249505	Fee-for-Service	1639283286	1639283286	1	1	KELLY, CAROLYN D NP	11/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249547	Fee-for-Service	1740543024	1740543024	1	1	KENNETH MARTIN	9/8/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 MATTHEW ST	None	MARIETTA	OH	45750	1635	00	None	39.4305237	-81.4649715	Washington County
249558	Fee-for-Service	1508092230	1508092230	1	1	KIM, JOY M DPM	7/25/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2141 N HARBOR BLVD	SUITE 25000	FULLERTON	CA	92835	3616	30	06059	33.89443025	-117.9288328	Orange County
249569	Fee-for-Service	1780737809	1780737809	1	1	KAW, ROSE OD	9/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
249635	Fee-for-Service	1649761149	1649761149	1	1	KAUFMAN, KATIE J	3/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
249656	Fee-for-Service	1326005489	1326005489	1	1	KELLAR, ROBERT J JR MD	1/26/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	22741	01	General Practice	0	In state provider	A MEDICAL CORP	918 S FAIRMONT AVE	None	LODI	CA	95240	5119	39	06077	38.122173	-121.285821	San Joaquin County
249668	Fee-for-Service	1124010483	1124010483	1	1	KOLTUN, WILLIAM D MD	12/4/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	30767	-	NOT APPLICABLE	0	In state provider	None	2410 E ST	None	SAN DIEGO	CA	92102	2024	37	06073	32.71479744	-117.142202	San Diego County
249680	Fee-for-Service	1952367815	1952367815	1	1	KOTH, LAURA L MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64672	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
249689	Fee-for-Service	1730248956	1730248956	1	1	KANE, LAURIE A MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142486	67	Endocrinology	0	In state provider	None	1500 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12736888	-118.257777	Los Angeles County
249694	Fee-for-Service	1134387954	1134387954	1	1	KENG, ELSA LMFT	8/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
249706	Fee-for-Service	1215297080	1215297080	1	1	KIM, BRADFORD J MD	1/10/2023	2086X0206X	NA	General Surgery	026	PHYSICIANS	183668	None	None	0	In state provider	None	320 W 6TH ST	None	CORONA	CA	92882	3349	33	06065	33.87571825	-117.5695868	Riverside County
249713	Fee-for-Service	1659404937	1659404937	1	1	KORLEY, FREDERICK K MD	7/12/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
249772	Fee-for-Service	1073556064	1073556064	2	1	KOTHANDARAMAN, PREMA MD	1/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82019	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	51 N 5TH AVENUE	SUITE 204	ARCADIA	CA	91006	3711	19	06037	34.1412293	-118.0205477	Los Angeles County
249778	Fee-for-Service	1093963712	1093963712	1	3	KELLY, KEVIN R MD	9/29/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	143303	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
249791	Fee-for-Service	1194753517	1194753517	1	1	KILLEEN, JAMES D MD	1/1/1982	208600000X	NA	General Surgery	026	PHYSICIANS	33507	02	General Surgery	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
249838	Fee-for-Service	1710253638	1710253638	1	1	KHAGI, YULIAN	6/4/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	135306	68	Hematology	0	In state provider	None	200 N ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
249858	Fee-for-Service	1760877146	1760877146	1	1	KUNG, EVAN C MD	12/13/2021	207L00000X	NA	Other	026	PHYSICIANS	148453	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
249865	Fee-for-Service	1023011038	1023011038	1	1	KABAR, MICHAEL N MD	5/19/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53581	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
249881	Fee-for-Service	1295267821	1295267821	1	1	KRICHILSKY, LEOR MD	12/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157752	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249893	Fee-for-Service	1073179529	1073179529	1	1	KAKAIYA, ROSHNI DO	2/22/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19485	08	Family Practice	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
249898	Fee-for-Service	1962692236	1962692236	1	1	KHAYALI, SALMA MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112451	None	None	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
249939	Fee-for-Service	1720310204	1720310204	1	1	KING, DONITA M LMFT	6/1/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 PROVIDENCE MINE RD	STE 103E	NEVADA CITY	CA	95959	2937	29	06057	39.24969422	-121.0286134	Nevada County
249965	Fee-for-Service	1952367815	1952367815	1	1	KOTH, LAURA L MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64672	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
249977	Fee-for-Service	1770889792	1770889792	1	1	KHAN, AMER M MD	4/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119084	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
249982	Fee-for-Service	1225236516	1225236516	1	1	KASARJIAN, JULIE K MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98419	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
250008	Fee-for-Service	1316909831	1316909831	1	1	KEANE, CHRISTOPHER W MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86553	None	None	0	In state provider	None	1328 TWENTY SECOND ST	None	SANTA MONICA	CA	90404	0000	19	06037	34.03122319	-118.4797185	Los Angeles County
250068	Fee-for-Service	1871082263	1871082263	1	1	KIM, YOEL MD	7/22/2022	390200000X	NA	Other	026	PHYSICIANS	164357	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
250126	Fee-for-Service	1710253638	1710253638	1	1	KHAGI, YULIAN	6/4/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	135306	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
250152	Fee-for-Service	1023011038	1023011038	1	1	KABAR, MICHAEL N MD	5/19/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53581	36	Psychiatry	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
250163	Fee-for-Service	1063468346	1063468346	1	1	KASHANI, HOUMAN M MD	9/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84361	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
250169	Fee-for-Service	1124263959	1124263959	1	1	KAISER FOUNDATION HEALTH	1/16/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #120	1301 PINOLE VALLEY RD.	1ST FLR.	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
250191	Fee-for-Service	1780769828	1780769828	1	1	KOSCHE, KATHLEEN A LCSW	12/3/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4510 E PACIFIC COAST	STE 120	LONG BEACH	CA	90804	6939	19	06037	33.78815204	-118.1400821	Los Angeles County
250201	Fee-for-Service	1952511214	1952511214	1	1	KARIMI, AFSHIN MD	7/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96518	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
250230	Fee-for-Service	1245986876	1245986876	1	1	KAVISH PRAJAPATI INC.	3/9/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3045 WILSON RD	None	BAKERSFIELD	CA	93304	5317	15	06029	35.3321517	-119.037271	Kern County
250328	Fee-for-Service	1508083098	1508083098	1	1	KIM, ALEX H DPM	6/15/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
250329	Fee-for-Service	1518339936	1518339936	2	1	KELLEY, TESIA L LMFT	8/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17740 HONEYCOMB LN	None	VICTORVILLE	CA	92395	5182	36	06071	34.50225468	-117.2763696	San Bernardino County
250336	Fee-for-Service	1992083711	1992083711	1	1	KHAW, JENNIFER R LMFT	6/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
250370	Fee-for-Service	1154749034	1154749034	1	1	KIMOTO, MARYANN DO	9/4/2019	207RR0500X	NA	Other	026	PHYSICIANS	17280	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
250438	Fee-for-Service	1083740708	1083740708	1	1	KIM, HENRY Y MD	3/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77410	25	Physical Medicine and Rehabilitation	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
250444	Fee-for-Service	1306334644	1306334644	1	1	KEBELO, YILMA K DPM	8/3/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
250462	Fee-for-Service	1811185523	1811185523	1	1	KO, CHRISTINE FUE Y OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	35149 NEWARK BLVD	STE C	NEWARK	CA	94560	1219	01	06001	37.54922953	-122.0470727	Alameda County
250465	Fee-for-Service	1790829554	1790829554	1	1	KOBYLINSKI, SABINA M DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5233	08	Family Practice	0	In state provider	None	24411 HEALTH CENTER DR	STE 510	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
250474	Fee-for-Service	1457545774	1457545774	1	1	KIRKMAN, MATTHEW G MD	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104416	18	Ophthalmology	0	In state provider	None	2830 W MAIN ST	None	VISALIA	CA	93291	4331	54	06107	36.330093	-119.3222565	Tulare County
250476	Fee-for-Service	1215111232	1215111232	1	1	KIM, BRIAN MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131367	10	Gastroenterology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
250485	Fee-for-Service	1922050137	1922050137	1	1	KAJI, DEVONNA MD	2/1/2002	208800000X	NA	Other	026	PHYSICIANS	57238	34	Urology and Urological Surgery	0	In state provider	None	9300 VALLEY CHILDREN PL	None	MADERA	CA	93638	0000	20	06039	36.88437894	-119.8003484	Madera County
250529	Fee-for-Service	1295001972	1295001972	1	1	KEITH CHAN	9/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	0000	00	None	47.44115887	-122.2138846	King County
250546	Fee-for-Service	1831694660	1831694660	1	1	KAZBEROUK, ALEXANDER D MD	6/9/2022	208M00000X	NA	Other	026	PHYSICIANS	165392	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
250566	Fee-for-Service	1205198140	1205198140	1	1	KOMSAN, EHAB A DO	7/5/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	13418	36	Psychiatry	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
250578	Fee-for-Service	1720601800	1720601800	1	1	KRUMHOLT, JEREMY MD	4/30/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
250589	Fee-for-Service	1285657189	1285657189	1	1	KRAUT, JEFFREY M MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	21238	40	Pediatrics	0	In state provider	None	510 CYPRESS ST	STE D	FORT BRAGG	CA	95437	5411	23	06045	39.43260152	-123.798942	Mendocino County
250612	Fee-for-Service	1033597885	1033597885	1	1	KHEDER, KEVIN MD	10/20/2020	207RC0200X	NA	Other	026	PHYSICIANS	150282	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
250651	Fee-for-Service	1598824252	1598824252	1	1	KIM, DIANE MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60719	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
250659	Fee-for-Service	1154749034	1154749034	1	1	KIMOTO, MARYANN DO	9/4/2019	207RR0500X	NA	Other	026	PHYSICIANS	17280	83	Rheumatology	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
250663	Fee-for-Service	1023382934	1023382934	1	1	KWONG, ELAINE MD	10/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119087	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 480	SACRAMENTO	CA	95861	5126	34	06067	38.572803	-121.4685	Sacramento County
250725	Fee-for-Service	1083740708	1083740708	1	1	KIM, HENRY Y MD	3/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77410	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
250759	Fee-for-Service	1750548467	1750548467	1	1	KIM, BO Y LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	11441 HEACOCK ST	STE B 2	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
250765	Fee-for-Service	1215111232	1215111232	1	1	KIM, BRIAN MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131367	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
250770	Fee-for-Service	1770012684	1770012684	1	1	KUBALA, MEGHAN M MD	8/23/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	162673	None	None	0	In state provider	None	1745 ELDENA WAY	None	MODESTO	CA	95350	3568	50	06099	37.669986	-120.9869565	Stanislaus County
250772	Fee-for-Service	1922050137	1922050137	1	1	KAJI, DEVONNA MD	2/1/2002	208800000X	NA	Other	026	PHYSICIANS	57238	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDREN PL	None	MADERA	CA	93638	0000	20	06039	36.88437894	-119.8003484	Madera County
250774	Fee-for-Service	1477551505	1477551505	1	1	KATZ, CANDACE R MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70552	03	Allergy	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
250776	Fee-for-Service	1922636430	1922636430	1	1	KORN, RYAN E MD	9/1/2024	207P00000X	NA	Other	026	PHYSICIANS	184971	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
250795	Fee-for-Service	1043735970	1043735970	1	1	KELLY, MEGAN E PSY	10/30/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250798	Fee-for-Service	1104243062	1104243062	1	1	KUMRA, SHIVANI MD	4/14/2020	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
250860	Fee-for-Service	1346865409	1346865409	1	1	KIM, SOLOMON DPM	8/1/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	110 NEW STINE RD	None	BAKERSFIELD	CA	93309	2605	15	06029	35.35333762	-119.0610348	Kern County
250908	Fee-for-Service	1962458752	1962458752	1	1	KHALIL, TAHER M ATTIA MD	3/1/1998	207RN0300X	NA	Nephrology	026	PHYSICIANS	62790	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
250937	Fee-for-Service	1144389701	1144389701	1	1	KOH PHYSICAL THERAPY, INC.	10/28/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9080 IRVINE CENTER DRIVE	None	IRVINE	CA	92618	4658	30	06059	33.63644038	-117.7392454	Orange County
250947	Fee-for-Service	1326381468	1326381468	1	1	KELESHIAN, HAGOP J DO	10/2/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22902	08	Family Practice	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
250950	Fee-for-Service	1730102476	1730102476	1	1	KADRI, MUNAF M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61215	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
250952	Fee-for-Service	1336386507	1336386507	1	1	KNOLL, CHERISH C PSYD	10/3/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
250972	Fee-for-Service	1104181098	1104181098	1	1	KIM, CINDY B Y MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131823	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
250988	Fee-for-Service	1548337462	1548337462	1	1	KAMB, CARL R MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84583	20	Orthopedic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
251012	Fee-for-Service	1730616145	1730616145	1	1	KIM, ALICE J DPM	10/5/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
251059	Fee-for-Service	1306156153	1306156153	1	1	KIM, DANIEL H MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114296	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
251080	Fee-for-Service	1811680648	1811680648	1	1	K PRIME HOME LLC	8/9/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	24302 BARK ST	None	LAKE FOREST	CA	92630	5227	30	06059	33.60955267	-117.6954202	Orange County
251086	Fee-for-Service	1295703320	1295703320	1	1	KAMAJIAN, STEVEN D, D.O.	5/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	4674	08	Family Practice	0	In state provider	None	2103 MONTROSE AVE	STE E	MONTROSE	CA	91020	1546	19	06037	34.206831	-118.224702	Los Angeles County
251089	Fee-for-Service	1295026482	1295026482	1	1	KOSHKARYAN, VAHAN MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114175	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	STE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
251112	Fee-for-Service	1336696772	1336696772	1	1	KELLY, KATHY A LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
251125	Fee-for-Service	1497808414	1497808414	1	1	KRIER, MICHAEL J MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	100295	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
251170	Fee-for-Service	1821231093	1821231093	1	1	KLAUSMEYER, MELISSA A MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	97850	46	Hand Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
251183	Fee-for-Service	1528018777	1528018777	1	1	KASIRAJAN, KARTHIKESHWAR MD	9/15/2018	2086S0129X	NA	General Surgery	026	PHYSICIANS	152828	02	General Surgery	0	In state provider	None	1082 GLENDON AVE	None	LOS ANGELES	CA	90024	2908	19	06037	34.06109265	-118.4443071	Los Angeles County
251239	Fee-for-Service	1730102476	1730102476	1	1	KADRI, MUNAF M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61215	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
251303	Fee-for-Service	1851601819	1851601819	1	1	KIM, JENNIFER S NP	12/18/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
251332	Fee-for-Service	1780147751	1780147751	1	1	KHULLAR, NIDHI DO	12/13/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20200	None	None	0	In state provider	None	100A SAN PABLO TOWNE CTR	None	SAN PABLO	CA	94806	0000	07	06013	37.95446487	-122.3326626	Contra Costa County
251347	Fee-for-Service	1710108618	1710108618	1	1	KAUK, JUSTIN R MD	9/24/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	2	Out of state provider	None	7715 SAN JACINTO PL	SUITE 100	PLANO	TX	75024	3215	00	None	33.08178962	-96.79728648	Collin County
251358	Fee-for-Service	1801215694	1801215694	1	1	KHALIGHI, MISHA L MD	8/18/2017	390200000X	NA	Other	026	PHYSICIANS	140775	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
251375	Fee-for-Service	1295026482	1295026482	1	1	KOSHKARYAN, VAHAN MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114175	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4955 VAN NUYS BLVD	STE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
251382	Fee-for-Service	1225700388	1225700388	1	1	KELLER, TESS LMFT	6/12/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	822 G ST	STE 4	ARCATA	CA	95521	6247	12	06023	40.86821305	-124.0859305	Humboldt County
251386	Fee-for-Service	1346424991	1346424991	1	1	KURZMAN, PHILIP S MD	8/31/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	108585	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94909	1702	21	06041	37.9469952	-122.5373892	Marin County
251412	Fee-for-Service	1497808414	1497808414	1	1	KRIER, MICHAEL J MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	100295	10	Gastroenterology (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
251418	Fee-for-Service	1992917587	1992917587	1	1	KALKSTEIN, JONATHAN M MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	92871	36	Psychiatry	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
251423	Fee-for-Service	1184676116	1184676116	1	1	KRISTOFOR D NORLAND MD	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1035 116TH AVE NE	None	BELLEVUE	WA	98004	4604	00	None	47.620296	-122.1856955	King County
251427	Fee-for-Service	1912548652	1912548652	1	1	KARIM, SOFIA A LCSW	2/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
251485	Fee-for-Service	1659811362	1659811362	1	1	KLOKE, WENDY LCSW	3/8/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
251488	Fee-for-Service	1033558275	1033558275	1	1	KRIOGHLIAN, SEBOUH P DO	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13897	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
251546	Fee-for-Service	1275920258	1275920258	1	1	KWOCK, CHRISTINA L MD	9/15/2022	208600000X	NA	General Surgery	026	PHYSICIANS	174858	None	None	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
251547	Fee-for-Service	1063464089	1063464089	1	1	KAAKI, BILAL R MD	7/23/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	89191	None	None	0	In state provider	None	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
251564	Fee-for-Service	1558700922	1558700922	1	1	KERSCH, KRISTOPHER J MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109211	22	Pathology (M.D. only)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	2395	19	06037	34.05358988	-118.2661119	Los Angeles County
251587	Fee-for-Service	1891170825	1891170825	1	1	KHAN, MOHAMMAD SAUD MD	9/4/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
251619	Fee-for-Service	1295579282	1295579282	1	1	KAPLAN, BESS	7/17/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1827 KNOLL DR	None	VENTURA	CA	93003	7321	56	06111	34.25641704	-119.2199387	Ventura County
251654	Fee-for-Service	1124050844	1124050844	1	1	KALLAPUR, SUHAS G MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149272	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
251698	Fee-for-Service	1467436691	1467436691	1	1	KLEINER, HARRY DO	9/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G ST	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
251711	Fee-for-Service	1699139444	1699139444	1	1	KHAMBATY, LUBENA MD	4/25/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	159662	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
251719	Fee-for-Service	1043264583	1043264583	1	1	KIM, HUBERT T MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81680	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	STE A632	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251720	Fee-for-Service	1023388501	1023388501	1	1	KAHN, REBECCA LMFT	7/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10944 ROSE AVE	#7	LOS ANGELES	CA	90034	5385	19	06037	34.02345692	-118.4196108	Los Angeles County
251739	Fee-for-Service	1427337708	1427337708	1	1	KIM, JISANG MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123568	41	Internal Medicine	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
251767	Fee-for-Service	1033267984	1033267984	1	1	KAISER PERM PHCY #279	12/16/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
251784	Fee-for-Service	1083692669	1083692669	1	1	KASSABIAN, GARBIS MD	1/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79982	41	Internal Medicine	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
251809	Fee-for-Service	1063414290	1063414290	1	1	KAMPS, BARBARA S CRNA	8/19/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1311 S MILLER ST	STE 100	SANTA MARIA	CA	93454	6900	42	06083	34.93818375	-120.4316485	Santa Barbara County
251837	Fee-for-Service	1629268537	1629268537	1	1	KOWALSKI, ADAM E MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119675	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
251845	Fee-for-Service	1609805894	1609805894	1	1	KATRAGADDA, CHANDRIKA	2/27/1996	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6001 TRUXTUN AVE	STE 160	BAKERSFIELD	CA	93309	0693	15	06029	35.36252236	-119.072932	Kern County
251846	Fee-for-Service	1861478422	1861478422	1	1	KUO, SAMUEL S MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42858	01	General Practice	0	In state provider	None	1088 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22407506	-119.3370995	Tulare County
251866	Fee-for-Service	1265464374	1265464374	1	1	KUMAR, SIDDHARTHA MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54200	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
251880	Fee-for-Service	1326788530	1326788530	1	1	KAUR, MANPARBODH MD	9/19/2024	207P00000X	NA	Other	026	PHYSICIANS	189628	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
251892	Fee-for-Service	1437243102	1437243102	1	1	KNIGHT, JASON M MD	8/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70791	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
251899	Fee-for-Service	1306866850	1306866850	1	1	KEUSHKERIAN, SIMON M MD	3/31/1987	208600000X	NA	General Surgery	026	PHYSICIANS	44451	02	General Surgery	0	In state provider	None	1710 BROOKLYN AVE	STE 225	LOS ANGELES	CA	90033	2439	19	06037	34.040502	-118.191954	Los Angeles County
251961	Fee-for-Service	1770762239	1770762239	1	1	KERN COUNTY MENTAL HEALTH	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	DEPARTMENT	315 EAST 18TH STREET	None	BAKERSFIELD	CA	93305	5610	15	06029	35.37490666	-118.998982	Kern County
252011	Fee-for-Service	1578778221	1578778221	1	1	KEMP, STAN W LMFT	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
252033	Fee-for-Service	1366448060	1366448060	1	1	KUO, JEFFREY MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68170	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
252070	Fee-for-Service	1083692669	1083692669	1	1	KASSABIAN, GARBIS MD	1/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79982	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
252073	Fee-for-Service	1659899664	1659899664	1	1	KERN, MARY K CNM	7/7/2018	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1353 OLD TEMESCAL ROAD	None	CORONA	CA	92881	7262	33	06065	33.85386752	-117.537732	Riverside County
252077	Fee-for-Service	1174537559	1174537559	1	1	KEARNEY, ROBERT E MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87029	24	Plastic Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
252081	Fee-for-Service	1306038070	1306038070	1	1	KWAAN, ROBERT P MD	2/28/2008	207R00000X	NA	Other	026	PHYSICIANS	93316	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
252118	Fee-for-Service	1558505453	1558505453	1	1	KARAKASH, SCARLETT D MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149362	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
252138	Fee-for-Service	1023212487	1023212487	1	1	KIM, DOLLY B MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106331	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
252139	Fee-for-Service	1871517110	1871517110	1	1	KIM, PAUL E	1/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	63939	None	None	0	In state provider	None	8352 CLAIREMONT MESA BLV	STE A	SAN DIEGO	CA	92111	1302	37	06073	32.835114	-117.1454355	San Diego County
252188	Fee-for-Service	1518948108	1518948108	1	1	KUMAR, SANJAY MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104866	20	Orthopedic Surgery	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
252205	Fee-for-Service	1891919700	1891919700	1	1	KO, YOUNG J MD AMC	9/23/2008	207R00000X	NA	Other	026	PHYSICIANS	39814	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	44215 15TH ST W	STE 303	LANCASTER	CA	93534	4007	19	06037	34.68666415	-118.1568572	Los Angeles County
252225	Fee-for-Service	1649255068	1649255068	1	1	KING, THOMAS H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62320	38	Geriatrics	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
252271	Fee-for-Service	1346781762	1346781762	1	1	KATEBIAN, BEHROD B MD	9/27/2021	207L00000X	NA	Other	026	PHYSICIANS	157446	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
252308	Fee-for-Service	1053336420	1053336420	1	1	KEITINA DONAHUE-LUNSFORD DO	11/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 HOSPITAL DR	None	HURRICANE	WV	25526	9202	00	None	38.45165654	-81.95139799	Putnam County
252321	Fee-for-Service	1982775144	1982775144	1	1	KLING, KAREN M MD	5/31/1995	208600000X	NA	General Surgery	026	PHYSICIANS	53583	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
252349	Fee-for-Service	1427377324	1427377324	1	1	KAUR, MANDEEP CRNA	6/19/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
252352	Fee-for-Service	1144428418	1144428418	1	1	KIM, GENIE L MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98094	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
252373	Fee-for-Service	1790163756	1790163756	1	1	KOTAMARTI, KEVIN R MD	3/30/2023	207L00000X	NA	Other	026	PHYSICIANS	183799	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
252376	Fee-for-Service	1134442080	1134442080	1	1	KRAKORA, EDITA MD	6/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110314	08	Family Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
252456	Fee-for-Service	1013338367	1013338367	1	1	KWAN, AMY MD	9/24/2024	208M00000X	NA	Other	026	PHYSICIANS	129177	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
252457	Fee-for-Service	1912392846	1912392846	1	1	KAMNETZ, JOSHUA L MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153698	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
252466	Fee-for-Service	1457408783	1457408783	1	1	KAISER FOUNDATION CPP	2/3/1997	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY 251	300 PULLMAN ST	# G	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
252492	Fee-for-Service	1891919700	1891919700	1	1	KO, YOUNG J MD AMC	9/23/2008	207R00000X	NA	Other	026	PHYSICIANS	39814	41	Internal Medicine	0	In state provider	None	44215 15TH ST W	STE 303	LANCASTER	CA	93534	4007	19	06037	34.68666415	-118.1568572	Los Angeles County
252501	Fee-for-Service	1871837575	1871837575	1	1	KAO, HSING-LU LMFT	2/5/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 W FIRST ST	STE 346	CLAREMONT	CA	91711	4742	19	06037	34.09450024	-117.7183344	Los Angeles County
252514	Fee-for-Service	1649255068	1649255068	1	1	KING, THOMAS H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62320	07	Dermatology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
252521	Fee-for-Service	1932119815	1932119815	1	1	KIM, JANET S MD	8/31/1994	207R00000X	NA	Other	026	PHYSICIANS	53915	None	None	0	In state provider	None	10833 LE CONTE AVE	STE 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
252599	Fee-for-Service	1861771677	1861771677	1	1	KELLY, JUDY C LMFT	9/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	224 W GRAHAM AVE	None	LAKE ELSINORE	CA	92530	3740	33	06065	33.66853666	-117.3296688	Riverside County
252604	Fee-for-Service	1841671153	1841671153	1	1	KNEZEVIC, ALEXANDER MD	11/17/2019	207R00000X	NA	Other	026	PHYSICIANS	161631	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
252683	Fee-for-Service	1063590164	1063590164	1	1	KORN, PAUL C MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63484	41	Internal Medicine	0	In state provider	None	2160 APPIAN WAY	STE 200	PINOLE	CA	94564	2565	07	06013	37.99585174	-122.3021549	Contra Costa County
252746	Fee-for-Service	1356489181	1356489181	1	1	KALRA, ARUN K MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51926	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
252789	Fee-for-Service	1124002100	1124002100	1	1	KLEIN, ANDREW S MD	7/31/1987	174400000X	NA	Other	026	PHYSICIANS	61130	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
252792	Fee-for-Service	1023287786	1023287786	1	1	KWON, YONG MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109539	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
252797	Fee-for-Service	1346733581	1346733581	1	1	KATELL, JOSHUA LCSW	10/20/2023	106S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
252836	Fee-for-Service	1366710865	1366710865	1	1	KING, NATHAN A DO	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12517	01	General Practice	0	In state provider	None	1600 E CITRUS AVE	None	REDLANDS	CA	92374	4802	36	06071	34.05557272	-117.1468659	San Bernardino County
252889	Fee-for-Service	1881798312	1881798312	1	1	KIM,JOSEPHINE T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	WOMENS MEDICAL CARE	1005 DIVISION ST	None	PRESCOTT	AZ	86301	0000	00	None	34.560702	-112.4793	Yavapai County
252926	Fee-for-Service	1609979871	1609979871	1	1	KARIPPOT, ANOOP MD	12/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54071	36	Psychiatry	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
252968	Fee-for-Service	1003128695	1003128695	1	1	KARETI, VINAYATA M DO	2/6/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	14986	41	Internal Medicine	0	In state provider	None	44105 15TH STREET WEST	UNITS 401/3/5/7	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
252972	Fee-for-Service	1063590164	1063590164	1	1	KORN, PAUL C MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63484	08	Family Practice	0	In state provider	None	2160 APPIAN WAY	STE 200	PINOLE	CA	94564	2565	07	06013	37.99585174	-122.3021549	Contra Costa County
252977	Fee-for-Service	1356538631	1356538631	1	1	KENIG, KATHRYN C	6/10/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
253035	Fee-for-Service	1356489181	1356489181	1	1	KALRA, ARUN K MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51926	78	Neoplastic Diseases/Oncology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
253071	Fee-for-Service	1407047913	1407047913	1	1	KARNA COLBY	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
253108	Fee-for-Service	1124219456	1124219456	1	1	KIM, MICHELLE M MD	7/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103033	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1778	19	06037	34.06373445	-118.443537	Los Angeles County
253135	Fee-for-Service	1386982239	1386982239	1	1	KLONCZ, NICOLE M LMFT	8/18/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118701	-	NOT APPLICABLE	0	In state provider	None	109 MARGARET LANE	None	GRASS VALLEY	CA	95945	5211	29	06057	39.22903923	-121.0461317	Nevada County
253141	Fee-for-Service	1265467708	1265467708	1	1	KALLO, JANET R MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	58290	22	Pathology (M.D. only)	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
253195	Fee-for-Service	1760792170	1760792170	1	1	KAPADIA, MOHAMMED MINHAS N M	7/7/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	116504	36	Psychiatry	0	In state provider	D	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
253222	Fee-for-Service	1245673227	1245673227	1	1	KHOURY, LOREN DO	8/24/2022	207R00000X	NA	Other	026	PHYSICIANS	16881	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
253305	Fee-for-Service	1538370861	1538370861	1	1	KHAN, IRFAN A MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	85387	41	Internal Medicine	0	In state provider	None	161 AVENIDA VAQUERO	None	SAN CLEMENTE	CA	92672	3601	30	06059	33.44373814	-117.6431813	Orange County
253315	Fee-for-Service	1427475821	1427475821	1	1	KAUSEN, BRITTANY MD	3/31/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	138373	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
253323	Fee-for-Service	1295062925	1295062925	1	1	KASTENDIEK, JAMES S MD	5/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109966	36	Psychiatry	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
253324	Fee-for-Service	1467563833	1467563833	1	1	KNAPP, DAVID A MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87382	41	Internal Medicine	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
253357	Fee-for-Service	1194703348	1194703348	1	1	KEEFE, DANIEL T MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87336	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
253376	Fee-for-Service	1821019753	1821019753	1	1	KELSO, CHRISTINE G MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99718	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
253402	Fee-for-Service	1093717472	1093717472	1	2	KROMHOUT, AARON MD	10/14/2024	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88432	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1551 BISHOP ST STE B240	None	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
253441	Fee-for-Service	1568881555	1568881555	1	1	KIM, TYSON MD	9/19/2019	207WX0120X	NA	Ophthalmology	026	PHYSICIANS	164743	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
253446	Fee-for-Service	1760471049	1760471049	1	1	KYURAN ANN CHOE, MD	6/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
253453	Fee-for-Service	1366511925	1366511925	1	1	KING, SUZANNE D	7/27/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1623 STARR DR	None	YUBA CITY	CA	95993	2670	51	06101	39.14354298	-121.6452123	Sutter County
253482	Fee-for-Service	1528165958	1528165958	1	1	KLIMA, ROGER R MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48124	02	General Surgery	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
253483	Fee-for-Service	1639246473	1639246473	1	1	KIM, DIANNE H MD	3/13/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	88431	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
253486	Fee-for-Service	1902056245	1902056245	1	1	KUNKEL, DAVID C MD	9/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111550	10	Gastroenterology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
253535	Fee-for-Service	1366405276	1366405276	1	1	KENT, DOLORES R MD	6/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35258	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	251 TURN PIKE DRIVE	None	FOLSOM	CA	95630	8098	34	06067	38.654946	-121.170537	Sacramento County
253573	Fee-for-Service	1770548091	1770548091	1	1	KIM, MATTHEW J MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67704	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
253583	Fee-for-Service	1609210749	1609210749	1	1	KENTON ASCHE	2/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1311 N MILDRED RD	None	CORTEZ	CO	81321	2231	00	None	37.36196474	-108.5727346	Montezuma County
253592	Fee-for-Service	1538370861	1538370861	1	1	KHAN, IRFAN A MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	85387	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	161 AVENIDA VAQUERO	None	SAN CLEMENTE	CA	92672	3601	30	06059	33.44373814	-117.6431813	Orange County
253613	Fee-for-Service	1972661296	1972661296	1	1	KOTLARCYZK, JAROSLAW J MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53430	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
253615	Fee-for-Service	1871167346	1871167346	1	1	KAKAR, ARIAN CNP	6/3/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10400 NORWALK BLVD	STE 100	SANTA FE SPRINGS	CA	90670	3856	19	06037	33.94152	-118.0726905	Los Angeles County
253633	Fee-for-Service	1720379100	1720379100	1	1	KIM, SAMUEL C M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123812	18	Ophthalmology	0	In state provider	None	11370 ANDERSON STREET	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
253638	Fee-for-Service	1235128273	1235128273	1	1	KUNZELMAN, LORI D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7400 E OSBORN RD	None	SCOTTSDALE	AZ	85251	6432	00	None	33.488748	-111.9225285	Maricopa County
253650	Fee-for-Service	1609442052	1609442052	1	1	KOMARIZADEH, AEMAD DO	2/23/2024	390200000X	NA	Other	026	PHYSICIANS	21758	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
253656	Fee-for-Service	1144593005	1144593005	1	2	KHALILI, MICHAEL MD	9/22/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145007	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
253671	Fee-for-Service	1811197973	1811197973	1	1	KAPILA, RISHI R MD	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99074	41	Internal Medicine	0	In state provider	None	1180 EAST SHAW AVE	STE 125	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
253678	Fee-for-Service	1326378779	1326378779	1	1	KUO, CALVIN C MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110484	20	Orthopedic Surgery	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
253696	Fee-for-Service	1578794129	1578794129	1	1	KANG, KRIS S NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
253710	Fee-for-Service	1770598104	1770598104	1	1	KENMORE MERCY HOSPITAL	3/3/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2950 ELMWOOD AVE	None	KENMORE	NY	14217	1390	00	None	42.977664	-78.8793435	Erie County
253746	Fee-for-Service	1912002106	1912002106	1	1	KHURANA, RAHUL MD	9/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87255	18	Ophthalmology	0	In state provider	None	2485 HOSPITAL DR	None	MOUNTAIN VIEW	CA	94040	4123	43	06085	37.368918	-122.081761	Santa Clara County
253819	Fee-for-Service	1902062151	1902062151	1	1	KATOUZIAN, TAHER DO	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12692	41	Internal Medicine	0	In state provider	None	43112 15TH STREET W	None	FONTANA	CA	92335	6720	36	06071	34.16692663	-117.4587535	San Bernardino County
253821	Fee-for-Service	1427221415	1427221415	1	1	KO, HONG-KI S MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109356	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
253837	Fee-for-Service	1528479318	1528479318	1	1	KIRSCH, HANNAH L MD	9/28/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	141501	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
253851	Fee-for-Service	1154384303	1154384303	1	1	KARPOUZAS, GEORGE A MD	2/1/1999	207RR0500X	NA	Other	026	PHYSICIANS	63587	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
253874	Fee-for-Service	1053350231	1053350231	1	1	KELLEY, ANN S MD	5/6/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	58702	78	Neoplastic Diseases/Oncology	0	In state provider	None	500 E ESPLANADE DR	STE 740	OXNARD	CA	93036	0514	56	06111	34.22877446	-119.1713365	Ventura County
253915	Fee-for-Service	1922568252	1922568252	1	1	KLINGMAN, LAUREN MD	1/21/2025	207P00000X	NA	Other	026	PHYSICIANS	181702	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
253984	Fee-for-Service	1467651083	1467651083	1	1	KARAMICHALIS, IOANNIS MD	6/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75612	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
254025	Fee-for-Service	1710081088	1710081088	1	1	KHAN, SHAHEEN MD	6/12/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50433	40	Pediatrics	0	In state provider	None	1111 W 4TH ST	None	MADERA	CA	93637	4474	20	06039	36.95563823	-120.0735861	Madera County
254038	Fee-for-Service	1700530037	1700530037	1	1	KARIUKI, ZIPPORAH W	3/18/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	614 S VICTORY BLVD	APT C	BURBANK	CA	91502	2497	19	06037	34.16936253	-118.311455	Los Angeles County
254121	Fee-for-Service	1750595682	1750595682	1	1	KELIDDARI, FARHAD MD	3/26/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	80767	30	Radiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
254137	Fee-for-Service	1154384303	1154384303	1	1	KARPOUZAS, GEORGE A MD	2/1/1999	207RR0500X	NA	Other	026	PHYSICIANS	63587	83	Rheumatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
254147	Fee-for-Service	1265504583	1265504583	1	1	KIM, ALEX P DO	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	8742	10	Gastroenterology (M.D. only)	0	In state provider	None	870 SHASTA ST	SUITE 200	YUBA CITY	CA	95991	4117	51	06101	39.14204	-121.6161711	Sutter County
254152	Fee-for-Service	1972971430	1972971430	1	1	KITAY, DEBORAH L LMFT	7/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	512 MAIN STREET	SUITE 2	EL SEGUNDO	CA	90245	4664	19	06037	33.92258115	-118.415961	Los Angeles County
254162	Fee-for-Service	1053350231	1053350231	1	1	KELLEY, ANN S MD	5/6/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	58702	68	Hematology	0	In state provider	None	500 E ESPLANADE DR	STE 740	OXNARD	CA	93036	0514	56	06111	34.22877446	-119.1713365	Ventura County
254167	Fee-for-Service	1467868703	1467868703	1	1	KERWIN, GARRETT J CRNA	2/23/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
254184	Fee-for-Service	1821301292	1821301292	1	1	KOONTZ, NICHOLAS R LMFT	10/26/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
254277	Fee-for-Service	1265510952	1265510952	1	1	KANZ, JONATHAN J DO	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9194	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
254315	Fee-for-Service	1720041858	1720041858	1	1	KHORRAM, OMID A MD	2/28/1992	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48465	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
254325	Fee-for-Service	1700530037	1700530037	1	1	KARIUKI, ZIPPORAH W	3/18/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	614 S VICTORY BLVD	APT C	BURBANK	CA	91502	2497	19	06037	34.16936253	-118.311455	Los Angeles County
254357	Fee-for-Service	1033293006	1033293006	1	1	KINSOLVING, MAURICE D MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	58411	41	Internal Medicine	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
254365	Fee-for-Service	1578597779	1578597779	1	1	KESALA, ADRIAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7435 W TALCOTT AVE	None	CHICAGO	IL	60631	3707	00	None	41.98844808	-87.81251188	Cook County
254389	Fee-for-Service	1225123045	1225123045	1	1	KAMHOLZ, BARBARA A MD	2/8/2015	2084P0805X	NA	Psychiatry	026	PHYSICIANS	89202	36	Psychiatry	0	In state provider	None	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
254420	Fee-for-Service	1235808916	1235808916	1	1	KAMANA, ELIUD M CRNA	4/28/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
254466	Fee-for-Service	1265504948	1265504948	1	1	KINNEY, PAUL R PT	7/17/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
254469	Fee-for-Service	1578915666	1578915666	1	1	KAHLON, NIMAR PAL K MD	8/24/2022	207R00000X	NA	Other	026	PHYSICIANS	164247	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
254547	Fee-for-Service	1184702722	1184702722	1	1	KRONISH, DANIEL P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31171	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
254575	Fee-for-Service	1336227974	1336227974	1	1	KIM, JINWOO M MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77029	70	Clinic (mixed specialty)	0	In state provider	None	4150 V ST	FL 2	SACRAMENTO	CA	95817	1460	34	06067	38.556081	-121.4570475	Sacramento County
254609	Fee-for-Service	1962769679	1962769679	1	1	KAWATA, HIRO MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135761	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
254626	Fee-for-Service	1316250491	1316250491	1	1	KEERTHIPALA, KANCHANA MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124127	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
254697	Fee-for-Service	1093251779	1093251779	1	1	KUALA-GILBERT, KEHAU K LCSW	4/2/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3525 PRESLEY AVE	None	RIVERSIDE	CA	92507	4453	33	06065	33.978609	-117.3469995	Riverside County
254698	Fee-for-Service	1164401535	1164401535	1	2	KEVIN WIESMANN M.D.	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	725 S WAHANNA RD	None	SEASIDE	OR	97138	7735	00	None	45.99034686	-123.9131204	Clatsop County
254759	Fee-for-Service	1801183975	1801183975	1	1	KAO, ELAINE OD	9/2/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17617 PIONEER BLVD	None	ARTESIA	CA	90701	4008	19	06037	33.87077683	-118.0823775	Los Angeles County
254820	Fee-for-Service	1003926197	1003926197	2	1	KHURANA, BALJEET MD	5/15/2009	2084P0804X	NA	Psychiatry	026	PHYSICIANS	36661	36	Psychiatry	0	In state provider	None	2220 E FRUIT ST	STE 216	SANTA ANA	CA	92701	4459	30	06059	33.75277851	-117.8354745	Orange County
254863	Fee-for-Service	1336227974	1336227974	1	1	KIM, JINWOO M MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77029	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4150 V ST	FL 2	SACRAMENTO	CA	95817	1460	34	06067	38.556081	-121.4570475	Sacramento County
254867	Fee-for-Service	1235192691	1235192691	1	1	KARANIKKIS, CHRISTOS A DO	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	9149	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE DRIVE	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
254894	Fee-for-Service	1801948930	1801948930	1	1	KAMBHAM, NEERAJA MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55068	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
254986	Fee-for-Service	1780620328	1780620328	1	1	KHAVARIAN, BAHAREH B MD	1/8/2008	207R00000X	NA	Other	026	PHYSICIANS	79841	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
255006	Fee-for-Service	1861437519	1861437519	1	1	KOMAS, BARBARA MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	61861	08	Family Practice	0	In state provider	None	860 JAMACHA RD	None	EL CAJON	CA	92019	6206	37	06073	32.78430676	-116.9279962	San Diego County
255014	Fee-for-Service	1962704734	1962704734	1	1	KHARAZI, ALEXANDRA MD	8/5/2019	208600000X	NA	General Surgery	026	PHYSICIANS	162449	02	General Surgery	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
255017	Fee-for-Service	1821551953	1821551953	1	1	KAUR, GAGANPREET NP	4/21/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	39	06077	38.02415455	-121.2934722	San Joaquin County
255036	Fee-for-Service	1609119031	1609119031	1	1	KORNBLIT, ADVA MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137893	41	Internal Medicine	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
255037	Fee-for-Service	1164745725	1164745725	1	1	KIM, NAMEE C MD	7/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117278	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
255049	Fee-for-Service	1699396887	1699396887	1	1	KOOPS, EMILY J OT	6/15/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	805 E WALNUT AVE	None	LOMPOC	CA	93436	7027	42	06083	34.64061286	-120.4487303	Santa Barbara County
255051	Fee-for-Service	1033234380	1033234380	1	2	KOLTS, ROSA MARIA LMFT	3/8/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E. ABBEYFIELD STREE	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
255054	Fee-for-Service	1073846747	1073846747	1	1	KIEL, RICHARD G MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	109756	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2335 E KASHIAN LANE	STE 240	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
255060	Fee-for-Service	1720234024	1720234024	1	1	KUMAR, PIYUSH MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131556	01	General Practice	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
255066	Fee-for-Service	1518085380	1518085380	1	1	KOHN, JOSETTE G MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64758	08	Family Practice	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
255110	Fee-for-Service	1235380189	1235380189	1	1	KAISER FOUNDATION HEALTH	2/10/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #187	1183 E. FOOTHILL BLVD.	1ST FLR.	UPLAND	CA	91786	4049	36	06071	34.10724648	-117.6359175	San Bernardino County
255128	Fee-for-Service	1275073603	1275073603	1	1	KRATOS HOME HEALTH CARE INC	4/6/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8345 RESEDA BLVD	STE 212	NORTHRIDGE	CA	91324	5942	19	06037	34.222005	-118.5360975	Los Angeles County
255130	Fee-for-Service	1386870889	1386870889	1	1	KREYDIN, EVGENIY I MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133167	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
255139	Fee-for-Service	1841267614	1841267614	1	1	KAHLON, RAMIT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13921 W GRAND AVE	STE 502	SURPRISE	AZ	85374	2439	00	None	33.646986	-112.3619625	Maricopa County
255168	Fee-for-Service	1790135739	1790135739	1	1	KWOK, AMY Y MD	11/4/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165022	08	Family Practice	0	In state provider	None	1755 COURT STREET	None	REDDING	CA	96001	1721	45	06089	40.58041248	-122.3945221	Shasta County
255182	Fee-for-Service	1912943911	1912943911	1	1	KREIL, ERNI A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	43962	41	Internal Medicine	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
255226	Fee-for-Service	1235524851	1235524851	1	1	KIM, HEIDI C OD	7/18/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
255253	Fee-for-Service	1760042915	1760042915	1	1	KOREATOWN SENIOR CENTER LLC	9/3/2020	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	3400 OLYMPIC BLVD	None	LOS ANGELES	CA	90019	2122	19	06037	34.05261031	-118.3124979	Los Angeles County
255256	Fee-for-Service	1265103907	1265103907	1	1	KINNEY, TARYN M LMFT	6/12/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
255262	Fee-for-Service	1013132901	1013132901	1	1	KHAN, ZAFAR S MD AMC	2/23/2005	193200000X	NA	Other	026	PHYSICIANS	85906	20	Orthopedic Surgery	0	In state provider	None	11160 WARNER AVE	STE 311	FOUNTAIN VALLEY	CA	92708	0455	30	06059	33.71630854	-117.934317	Orange County
255266	Fee-for-Service	1023255858	1023255858	1	1	KADALIKATTIL THOMAS, MATHEW	6/20/2024	207P00000X	NA	Other	026	PHYSICIANS	156152	41	Internal Medicine	0	In state provider	MD	250 NORTH 1ST STREET	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
255268	Fee-for-Service	1730260910	1730260910	1	1	KIM, HEE B MD	3/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42386	40	Pediatrics	0	In state provider	None	1998 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92405	4116	36	06071	34.1334	-117.289677	San Bernardino County
255270	Fee-for-Service	1568474732	1568474732	1	1	KULBER, DAVID ALAN MD	6/21/2000	174400000X	NA	Other	026	PHYSICIANS	66502	01	General Practice	0	In state provider	None	4849 VAN NUYS BLVD	STE 102	SHERMAN OAKS	CA	91403	2117	19	06037	34.159113	-118.4487465	Los Angeles County
255309	Fee-for-Service	1952327355	1952327355	1	1	KARODY, RAMESH MD	3/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	39790	41	Internal Medicine	0	In state provider	RAMESH KARODY MD INC	6860 BROCKTON AVE	STE 11	RIVERSIDE	CA	92506	3816	33	06065	33.948999	-117.396722	Riverside County
255323	Fee-for-Service	1023604519	1023604519	1	1	KITCH, HANNAH J PT	2/25/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2815 MAIN ST.,	SUITE 205	CORONA	CA	92882	0000	33	06065	33.84741266	-117.570694	Riverside County
255352	Fee-for-Service	1396774436	1396774436	1	1	KWUN, PEGGY MD	4/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80768	36	Psychiatry	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
255360	Fee-for-Service	1639283617	1639283617	1	1	KAHN, SUSAN R LMFT	5/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4240 LOST HILLS ROAD	UNIT 2501	CALABASAS HILLS	CA	91301	5387	19	06037	34.1377239	-118.7057735	Los Angeles County
255406	Fee-for-Service	1396139515	1396139515	1	1	KWON, DANIEL H MD	7/9/2021	207RH0000X	NA	Hematology	026	PHYSICIANS	146273	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255418	Fee-for-Service	1164893913	1164893913	1	1	KAWK, JONG MUN	1/12/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
255425	Fee-for-Service	1558822932	1558822932	1	1	KAZEROUNI, KAYVAN K MD	8/15/2022	390200000X	NA	Other	026	PHYSICIANS	179748	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
255468	Fee-for-Service	1235218926	1235218926	1	1	KIM, WAN J MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78825	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
255469	Fee-for-Service	1437618105	1437618105	1	1	KAISER FOUNDATION HEALTH PLA	4/28/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	568	12761 SCHABARUM	PLAZA LEVEL RM 1100	IRWINDALE	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
255492	Fee-for-Service	1760975379	1760975379	1	1	KAZIM, ERUM MD	10/3/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173847	None	None	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
255531	Fee-for-Service	1851959720	1851959720	1	1	KYI ZIN M.D., INC.	12/24/2024	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1850 E 8TH STREET	None	DAVIS	CA	95616	2502	57	06113	38.55331005	-121.7285704	Yolo County
255540	Fee-for-Service	1235314576	1235314576	1	1	KIM, YAN S MD	12/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104147	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
255544	Fee-for-Service	1245238922	1245238922	1	1	KAZMOUZ, SAFWAN MD	4/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65580	38	Geriatrics	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
255555	Fee-for-Service	1225334360	1225334360	1	1	KENYON, KEITH E JR MD INC	3/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	30715	18	Ophthalmology	0	In state provider	None	201 S ALVARADO STREET	SUITE 406	LOS ANGELES	CA	90057	2320	19	06037	34.06417777	-118.2719543	Los Angeles County
255584	Fee-for-Service	1376711572	1376711572	1	1	KNEISEL, CHRISTINE M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
255595	Fee-for-Service	1952327355	1952327355	1	1	KARODY, RAMESH MD	3/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	39790	66	Emergency Medicine (Urgent Care)	0	In state provider	RAMESH KARODY MD INC	6860 BROCKTON AVE	STE 11	RIVERSIDE	CA	92506	3816	33	06065	33.948999	-117.396722	Riverside County
255597	Fee-for-Service	1346396512	1346396512	1	1	KAHN, DAVID M MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	82057	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
255616	Fee-for-Service	1710960687	1710960687	1	1	KAREN E ASPRY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	593 EDDY ST	None	PROVIDENCE	RI	02905	0000	00	None	41.81122992	-71.40713931	Providence County
255630	Fee-for-Service	1396132460	1396132460	1	1	KEEHNER, JOCELYN E MD	6/10/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	160871	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255645	Fee-for-Service	1841511631	1841511631	1	1	KHORSANDI, AMIN MD INC	5/31/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2222 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90404	2304	19	06037	34.03052319	-118.4776873	Los Angeles County
255649	Fee-for-Service	1154411858	1154411858	1	1	KLENCK, ROBERT E MD	8/26/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	60894	20	Orthopedic Surgery	0	In state provider	None	959 E WALNUT ST	SUITE 220	PASADENA	CA	91106	5363	19	06037	34.14962102	-118.1305187	Los Angeles County
255655	Fee-for-Service	1962172106	1962172106	1	1	KIDIKIAN, ALINE NP	1/10/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1501 SUPERIOR AVE	205	NEWPORT BEACH	CA	92663	3640	30	06059	33.62918676	-117.9305675	Orange County
255688	Fee-for-Service	1568881571	1568881571	1	1	KOTWANI, PRASHANT MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139736	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255698	Fee-for-Service	1104904879	1104904879	1	1	KEENLY, LISA D MD	5/10/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74471	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
255699	Fee-for-Service	1093995706	1093995706	1	1	KRIEGSTEIN, ARNOLD R MD	12/5/2007	2084N0400X	NA	Neurology	026	PHYSICIANS	44979	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255706	Fee-for-Service	1013478999	1013478999	1	1	KU, ERIC MD	9/10/2024	2085R0001X	NA	Other	026	PHYSICIANS	182542	30	Radiology	0	In state provider	None	1144 COFFEE RD	None	MODESTO	CA	95355	4205	50	06099	37.659627	-120.9756125	Stanislaus County
255717	Fee-for-Service	1467416362	1467416362	1	1	KRAMER, RICHARD J MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	25161	04	Otology, Laryngology, Rhinology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
255781	Fee-for-Service	1396810370	1396810370	1	1	KHAN, MOHAMMAD H MD	3/8/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	35408	10	Gastroenterology (M.D. only)	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
255806	Fee-for-Service	1467804922	1467804922	1	1	KITAMATA-WONG, BRITNEY OD	1/6/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255818	Fee-for-Service	1043888092	1043888092	1	1	KAY, EMILY A AU	9/16/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
255829	Fee-for-Service	1235314576	1235314576	1	1	KIM, YAN S MD	12/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104147	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
255832	Fee-for-Service	1245238922	1245238922	1	1	KAZMOUZ, SAFWAN MD	4/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65580	01	General Practice	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
255834	Fee-for-Service	1811251614	1811251614	1	1	KEVIN WONG	1/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
255864	Fee-for-Service	1649478694	1649478694	1	1	KRAMER, ROBIN F NP	3/21/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255895	Fee-for-Service	1700074036	1700074036	1	1	KLEIN, LISA M LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
255932	Fee-for-Service	1841511631	1841511631	1	1	KHORSANDI, AMIN MD INC	5/31/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2222 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90404	2304	19	06037	34.03052319	-118.4776873	Los Angeles County
255950	Fee-for-Service	1588762538	1588762538	1	1	KRISHNAMOORTHI, K MD	3/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70897	41	Internal Medicine	0	In state provider	None	1401 SPANOS CT	STE 111	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
255975	Fee-for-Service	1730221730	1730221730	1	1	KHARIT, TATYANA MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	88429	36	Psychiatry	0	In state provider	None	11303 W WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
255977	Fee-for-Service	1174671002	1174671002	1	1	KOENIG, CONSTANCE R CRNA	5/26/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
255978	Fee-for-Service	1992329627	1992329627	1	1	KOBA PSYCHOLOGICAL SERVICES	1/14/2022	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	PC	2309 PACIFIC COAST	STE 202	HERMOSA BEACH	CA	90254	2751	19	06037	33.87101437	-118.3948248	Los Angeles County
255998	Fee-for-Service	1467416362	1467416362	1	1	KRAMER, RICHARD J MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	25161	10	Gastroenterology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
256000	Fee-for-Service	1679909170	1679909170	1	1	KITTS, EMILY M LMFT	5/1/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	115A TOWN AND COUNTRY DR	None	DANVILLE	CA	94526	3960	07	06013	37.81399962	-121.9986978	Contra Costa County
256034	Fee-for-Service	1962899096	1962899096	1	1	KAO, STEVEN MD	6/12/2020	111NR0200X	NA	Other	026	PHYSICIANS	145928	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
256045	Fee-for-Service	1053997726	1053997726	1	1	KILLMOND, KATHERINE A MD	6/27/2024	390200000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
256067	Fee-for-Service	1396810370	1396810370	1	1	KHAN, MOHAMMAD H MD	3/8/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	35408	41	Internal Medicine	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
256088	Fee-for-Service	1144240961	1144240961	1	1	KATSAROS, EMMANUEL P DO	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	6857	41	Internal Medicine	0	In state provider	None	795 E SECOND STREET	SUITE 5	PONOMA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
256094	Fee-for-Service	1306186861	1306186861	1	1	KAPILESHWARKAR, YAMINI S MD	7/30/2021	2080P0203X	NA	Other	026	PHYSICIANS	171969	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
256107	Fee-for-Service	1336177229	1336177229	1	1	KARP, MICHAEL S MD	9/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75098	None	None	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
256153	Fee-for-Service	1558070599	1558070599	1	1	KIST, TYLER D PT	1/22/2025	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	521 E ELDER ST	SUITE 106/107	FALLBROOK	CA	92028	3081	37	06073	33.38015149	-117.246267	San Diego County
256201	Fee-for-Service	1477727352	1477727352	1	1	KEFALOPOULOS, GUS W MD	8/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101632	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
256221	Fee-for-Service	1023471224	1023471224	1	1	KORNBLATT, ALLISON MD	9/1/2019	2279E0002X	NA	Other	026	PHYSICIANS	158412	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
256250	Fee-for-Service	1831356708	1831356708	1	1	KOGAN, GREGORY A DO	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9419	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	#8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
256265	Fee-for-Service	1992329627	1992329627	1	1	KOBA PSYCHOLOGICAL SERVICES	1/14/2022	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	PC	2309 PACIFIC COAST	STE 202	HERMOSA BEACH	CA	90254	2751	19	06037	33.87101437	-118.3948248	Los Angeles County
256274	Fee-for-Service	1841685922	1841685922	1	1	KELLEY, NIRVAIR S MD DO	9/23/2019	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
256278	Fee-for-Service	1316402456	1316402456	1	1	KENNEY, SARA LMFT	5/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 S. B ST.	None	SAN MATEO	CA	94401	4053	41	06081	37.56539871	-122.3222584	San Mateo County
256297	Fee-for-Service	1477572030	1477572030	1	1	KARLAMANGLA, ARUN S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64543	None	None	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
256332	Fee-for-Service	1295804052	1295804052	1	1	KIM, JOSEPH MD	9/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82485	02	General Surgery	0	In state provider	None	1328 22ND ST	FL 3	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
256341	Fee-for-Service	1114555810	1114555810	1	1	KO, MICHELLE E MD	12/13/2022	390200000X	NA	Other	026	PHYSICIANS	19608	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
256344	Fee-for-Service	1225218522	1225218522	1	1	KATUKOTA, VIJAYA K MD	7/1/1984	207R00000X	NA	Other	026	PHYSICIANS	38220	None	None	0	In state provider	None	12555 CENTRAL AVE	STE B	CHINO	CA	91710	3569	36	06071	34.025247	-117.6892645	San Bernardino County
256376	Fee-for-Service	1144240961	1144240961	1	1	KATSAROS, EMMANUEL P DO	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	6857	83	Rheumatology	0	In state provider	None	795 E SECOND STREET	SUITE 5	PONOMA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
256392	Fee-for-Service	1962863720	1962863720	1	1	KWON, RACHEL PSYD	3/16/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23 CORPORATE PLAZA DR	STE 150	NEWPORT BEACH	CA	92660	7908	30	06059	33.6090297	-117.8748261	Orange County
256423	Fee-for-Service	1649354309	1649354309	1	1	KINI, DIVYA MD	12/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	74472	41	Internal Medicine	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
256436	Fee-for-Service	1467682260	1467682260	1	2	KAUR, JAGDEEP MD	5/2/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	170263	-	NOT APPLICABLE	0	In state provider	None	13386 MARENGO RD	None	GALT	CA	95632	8429	34	06067	38.26647	-121.2836535	Sacramento County
256441	Fee-for-Service	1205893856	1205893856	1	1	KARLINER, LEAH S MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68409	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
256486	Fee-for-Service	1215136221	1215136221	1	1	KEMPIAK, STEPHAN J MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102166	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
256489	Fee-for-Service	1598703787	1598703787	1	1	KAMAL, AHMAD MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72850	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
256509	Fee-for-Service	1063831048	1063831048	1	1	KUANG, HUI C NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
256521	Fee-for-Service	1295800837	1295800837	1	2	KAISER FOUNDATION HOSPITAL	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	HACIENDA BUILDING	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
256551	Fee-for-Service	1992329627	1992329627	1	1	KOBA PSYCHOLOGICAL SERVICES	1/14/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PC	2309 PACIFIC COAST	STE 202	HERMOSA BEACH	CA	90254	2751	19	06037	33.87101437	-118.3948248	Los Angeles County
256581	Fee-for-Service	1376718254	1376718254	1	1	KWIATKOWSKI, MERCEDES K MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131196	36	Psychiatry	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
256617	Fee-for-Service	1295804052	1295804052	1	1	KIM, JOSEPH MD	9/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82485	78	Neoplastic Diseases/Oncology	0	In state provider	None	1328 22ND ST	FL 3	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
256621	Fee-for-Service	1972645083	1972645083	1	1	KANJI, RAHIM	6/9/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	910-1/2 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1602	19	06037	34.0604988	-118.3835767	Los Angeles County
256640	Fee-for-Service	1427079250	1427079250	1	1	KING, WILLIAM D MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	71878	-	NOT APPLICABLE	0	In state provider	None	3756 SANTA ROSALIA DRIVE	SUITE 617	LOS ANGELES	CA	90008	3606	19	06037	34.00888336	-118.3389334	Los Angeles County
256654	Fee-for-Service	1801955026	1801955026	1	1	KAPILA, YAGYA V	5/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54459	None	None	0	In state provider	None	501 S SHORE CENTER WEST	SUITE 103F	ALAMEDA	CA	94501	5759	01	06001	37.75884896	-122.2528366	Alameda County
256659	Fee-for-Service	1699090522	1699090522	1	1	KIM, HANA DO	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12011	01	General Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
256664	Fee-for-Service	1821797960	1821797960	1	1	KAYE, TREVOR S PT	10/12/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8135 SARATOGA WAY	STE 200	EL DORADO HILLS	CA	95762	4590	09	06017	38.65291812	-121.0731598	El Dorado County
256671	Fee-for-Service	1457887895	1457887895	1	1	KASSAI, SHABNAM S PSYD	3/7/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
256724	Fee-for-Service	1225052459	1225052459	1	1	KUMAR, ASHIM V MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80341	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
256728	Fee-for-Service	1568534212	1568534212	1	1	KOCH, MONIKA A MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66441	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
256741	Fee-for-Service	1891745881	1891745881	1	1	KRANZ, MARC MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
256759	Fee-for-Service	1306152756	1306152756	1	1	KANG, JUNG Y MD	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120841	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
256813	Fee-for-Service	1871869339	1871869339	1	1	KISHAN, AMAR U MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128333	30	Radiology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
256852	Fee-for-Service	1609923929	1609923929	1	1	KAISER FDN HLTH PLAN INC	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY #606	8800 MING AVE	None	BAKERSFIELD	CA	93311	1308	15	06029	35.33987154	-119.1000429	Kern County
256898	Fee-for-Service	1689239055	1689239055	1	1	KAUR, PAWANDEEP NP	11/10/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	782 MEDICAL CENTER DR E	SUITE 101	CLOVIS	CA	93611	6890	10	06019	36.84379626	-119.6609117	Fresno County
257019	Fee-for-Service	1497933220	1497933220	1	1	KLEYNBERG MED CLNC INC	8/30/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	KLEYNBERG, LEONID D MD	6221 WILSHIRE BLVD	STE 504	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
257051	Fee-for-Service	1518195643	1518195643	1	1	KEET, KEVIN R MD	10/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108252	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	None	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
257056	Fee-for-Service	1710033246	1710033246	1	1	KASHEFI, CAROL MD	9/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89848	34	Urology and Urological Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
257081	Fee-for-Service	1871869339	1871869339	1	1	KISHAN, AMAR U MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128333	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
257105	Fee-for-Service	1962715854	1962715854	1	1	KIERSEY, KRISTEN D	6/24/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2575 E BIDWELL ST	STE 100	FOLSOM	CA	95630	6445	34	06067	38.658888	-121.1303835	Sacramento County
257141	Fee-for-Service	1396522892	1396522892	1	1	KANGAROO CARE BIRTH SERVICES	11/2/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
257152	Fee-for-Service	1346201159	1346201159	1	1	KEYSER PETER F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	933 RED APPLE RD	STE C	WENATCHEE	WA	98801	0000	00	None	47.4079405	-120.322728	Chelan County
257220	Fee-for-Service	1447868773	1447868773	1	1	KERSTETTER, COURTNEY L PT	9/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
257226	Fee-for-Service	1225442023	1225442023	1	1	KEYSER, ANDREW R MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149936	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
257231	Fee-for-Service	1689844813	1689844813	1	1	KAWANKAR, SANJAY S	9/18/2007	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1750 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90035	4602	19	06037	34.04559008	-118.3765503	Los Angeles County
257281	Fee-for-Service	1467484550	1467484550	1	1	KATZ, STEVEN G MD	9/20/1991	2086S0129X	NA	General Surgery	026	PHYSICIANS	32823	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10 CONGRESS ST	STE 504	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
257296	Fee-for-Service	1164405882	1164405882	1	1	KUBBA, SAMIR V MD	5/25/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71807	78	Neoplastic Diseases/Oncology	0	In state provider	None	401 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3803	36	06071	34.1358627	-117.2757778	San Bernardino County
257335	Fee-for-Service	1598922320	1598922320	1	1	KUO, ALLEN MD	6/2/2014	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	110790	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
257346	Fee-for-Service	1528202553	1528202553	1	1	KIM, DAVID C MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	99314	24	Plastic Surgery	0	In state provider	None	2601 E MAIN STREET	SUITE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
257367	Fee-for-Service	1023085867	1023085867	1	1	KAPALI, MALATHY MD	9/22/2008	174400000X	NA	Other	026	PHYSICIANS	53415	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
257392	Fee-for-Service	1619301579	1619301579	1	1	KOTHAPALLI, NAGA MD	2/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146693	36	Psychiatry	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
257421	Fee-for-Service	1093717472	1093717472	1	1	KROMHOUT, AARON MD	3/13/2008	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88432	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1941 JOHNSON AVE	STE 202	SAN LUIS OBISPO	CA	93401	4154	40	06079	35.27804785	-120.649711	San Luis Obispo County
257422	Fee-for-Service	1215422902	1215422902	1	1	KEUNG, SAMANTHA MSW LCSW	9/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8291 UTICA AVE	102	RANCHO CUCAMONGA	CA	91730	3800	36	06071	34.10254043	-117.5711583	San Bernardino County
257458	Fee-for-Service	1366731622	1366731622	1	1	KNOERNSCHILD, DENNIS R MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137739	05	Anesthesiology	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
257474	Fee-for-Service	1639814239	1639814239	1	1	KEAMY-MINOR, EMILY E MD	4/16/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
257525	Fee-for-Service	1164626594	1164626594	1	1	KRZYZANIAK, MICHAEL J MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146490	02	General Surgery	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
257582	Fee-for-Service	1164405882	1164405882	1	1	KUBBA, SAMIR V MD	5/25/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71807	68	Hematology	0	In state provider	None	401 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3803	36	06071	34.1358627	-117.2757778	San Bernardino County
257596	Fee-for-Service	1477994101	1477994101	1	1	KILIC, SENA F MD	4/1/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
257608	Fee-for-Service	1174801328	1174801328	1	1	KAI L SHARBONO	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	217 W CATALDO AVE	None	SPOKANE	WA	99201	2217	00	None	47.665782	-117.4152105	Spokane County
257609	Fee-for-Service	1780666560	1780666560	1	1	KELLEY, WILLIAM R MD	12/25/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	51795	30	Radiology	0	In state provider	None	1401 BAILEY AVE	None	NEEDLES	CA	92363	3103	36	06071	34.832997	-114.618293	San Bernardino County
257610	Fee-for-Service	1417698903	1417698903	1	1	KHATTAB, MOEMEN	9/10/2024	390200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
257662	Fee-for-Service	1740349372	1740349372	1	1	KOKA, VIDHYALAKSHMI V MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	60821	01	General Practice	0	In state provider	None	1695 S SAN JACINTO AVE	STE A	SAN JACINTO	CA	92583	5181	33	06065	33.770961	-116.954649	Riverside County
257677	Fee-for-Service	1841502390	1841502390	1	1	KASPAR, JOSEPH F PHD	1/5/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
257722	Fee-for-Service	1386861862	1386861862	1	1	KAPLAN, LESLIE A MD	7/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62361	40	Pediatrics	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
257727	Fee-for-Service	1912351180	1912351180	1	1	KLEPPER, ARIELLE L MD	8/21/2019	208M00000X	NA	Other	026	PHYSICIANS	152544	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
257746	Fee-for-Service	1093957474	1093957474	1	1	KREINER, SHAWN M MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118510	40	Pediatrics	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
257801	Fee-for-Service	1134141583	1134141583	1	1	KATZ, KENNETH A MD	11/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101448	07	Dermatology	0	In state provider	None	200 W ARBOR DRIVE	# 8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
257843	Fee-for-Service	1821048141	1821048141	1	1	KIRSCHEN, DAVID G OD	11/17/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	428 S BREA BLVD	None	BREA	CA	92821	5301	30	06059	33.91384656	-117.9017632	Orange County
257844	Fee-for-Service	1255373874	1255373874	1	1	KINCANNON, WILLIAM N MD	1/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	5519	40	Pediatrics	0	In state provider	None	2403 CASTILLO ST	STE 202	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
257860	Fee-for-Service	1447877253	1447877253	1	1	KUZAVA, SIERRA E PHD	1/10/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
257909	Fee-for-Service	1467545558	1467545558	1	1	KREBEL, STEVEN R MD	5/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
257931	Fee-for-Service	1891264461	1891264461	1	1	KELLOGG, BRIAN E LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
258013	Fee-for-Service	1124381181	1124381181	1	1	KHAN, NILOUFER MD	3/6/2023	207RH0000X	NA	Hematology	026	PHYSICIANS	184738	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
258046	Fee-for-Service	1588296180	1588296180	1	2	KNOWLEDGE ENLIGHTENS YOU	7/1/2020	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ATTN: SAN LEANDRO	16244 CAROLYN STREET	None	SAN LEANDRO	CA	94578	1429	01	06001	37.70289897	-122.1102323	Alameda County
258055	Fee-for-Service	1376109108	1376109108	1	1	KANG, BRYAN OT	11/11/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
258097	Fee-for-Service	1033485859	1033485859	1	1	KHOSLA, ANKAJ MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146782	41	Internal Medicine	0	In state provider	None	890 W STETSON AVE	STE B	HEMET	CA	92543	7311	33	06065	33.72939753	-116.9797995	Riverside County
258133	Fee-for-Service	1689784449	1689784449	1	1	KHALILI, RAMIN MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76811	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
258148	Fee-for-Service	1427240977	1427240977	1	1	KESLOW, KERRI M MD	9/21/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	100592	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
258253	Fee-for-Service	1457942070	1457942070	1	1	KRANDA, ARIEL D AU	11/12/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	13121 PHILADELPHIA ST	None	WHITTIER	CA	90601	4302	19	06037	33.97912551	-118.0353645	Los Angeles County
258280	Fee-for-Service	1073777934	1073777934	1	1	KANARD, ROBERT C MD	2/8/2018	2086S0120X	NA	General Surgery	026	PHYSICIANS	84875	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
258291	Fee-for-Service	1528151016	1528151016	1	1	KILPATRICK, WILLIAM MD	8/1/1984	207P00000X	NA	Other	026	PHYSICIANS	34846	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9500 S BROADWAY	None	LOS ANGELES	CA	90003	4053	19	06037	33.949935	-118.2781105	Los Angeles County
258294	Fee-for-Service	1891881660	1891881660	1	1	KRENG, VIRANY M MD	12/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81008	08	Family Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
258307	Fee-for-Service	1417096959	1417096959	1	1	KOROSTOFF, LESLIE J MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96824	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2625 W ALAMEDA	STE 412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
258322	Fee-for-Service	1679545164	1679545164	1	1	KHAWAJA, IMRAN R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
258384	Fee-for-Service	1003691049	1003691049	1	1	KAUR, NAVJOT NP	3/14/2024	390200000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9802 STOCKDALE HWY	STE 102	BAKERSFIELD	CA	93311	3653	15	06029	35.3544067	-119.1113372	Kern County
258388	Fee-for-Service	1588793962	1588793962	1	1	KURN, SIDNEY J MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	32827	13	Neurology (M.D. only)	0	In state provider	None	95 MONTGOMERY DR	STE 102	SANTA ROSA	CA	95404	6617	49	06097	38.442357	-122.704641	Sonoma County
258492	Fee-for-Service	1588634513	1588634513	1	1	KORSAND, SID S MD	6/18/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49591	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
258526	Fee-for-Service	1518943281	1518943281	1	1	KALANITHI PAUL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3269	00	None	35.220006	-114.0380145	Mohave County
258614	Fee-for-Service	1073245494	1073245494	1	1	KWONG, THEODORE A PT	10/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
258631	Fee-for-Service	1104892264	1104892264	1	1	KAZEMI, MAHMOOD R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77962	67	Endocrinology	0	In state provider	None	5401 NORRIS CANYON RD	STE 108	SAN RAMON	CA	94583	5406	07	06013	37.77752374	-121.9579277	Contra Costa County
258634	Fee-for-Service	1861436925	1861436925	1	1	KERN, MICHAEL P MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41569	08	Family Practice	0	In state provider	None	3100 TELEGRAPH AVE	None	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
258719	Fee-for-Service	1841788502	1841788502	1	1	KADERI, TAMANA MD	11/8/2022	207RC0200X	NA	Other	026	PHYSICIANS	166165	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
258729	Fee-for-Service	1376038406	1376038406	1	1	KHAKSHOOY, DANIEL MD	8/4/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173916	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
258744	Fee-for-Service	1467958843	1467958843	1	1	KOCHAKZADEH, KATAYON DO	1/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19134	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
258751	Fee-for-Service	1114293800	1114293800	1	1	KAMANGAR, FARANAK MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126556	07	Dermatology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
258764	Fee-for-Service	1649387390	1649387390	1	1	KRAMER, JESSE M MD	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	64435	07	Dermatology	0	In state provider	None	2126 EUREKA WAY	None	REDDING	CA	96001	0427	45	06089	40.58661765	-122.4029863	Shasta County
258783	Fee-for-Service	1114094018	1114094018	1	1	KILLEEN, JEANNE L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29283	18	Ophthalmology	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
258784	Fee-for-Service	1245380062	1245380062	1	1	KLEINSINGER, FREDRICK MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	22594	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
258790	Fee-for-Service	1801024476	1801024476	1	1	KOUCH, JOHN MD	5/11/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145212	08	Family Practice	0	In state provider	None	717 CENTER ST	None	HEALDSBURG	CA	95448	3604	49	06097	38.61783	-122.8707965	Sonoma County
258818	Fee-for-Service	1164401535	1164401535	1	1	KEVIN WIESMANN M.D.	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
258843	Fee-for-Service	1033443940	1033443940	1	1	KERWIN, CHRISTINA M	11/28/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
258888	Fee-for-Service	1376725085	1376725085	1	1	KEI-CHUEN J LAU, MD, INC	6/27/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	10802 COLLEGE PLACE	None	CERRITOS	CA	90703	1579	19	06037	33.88484554	-118.102932	Los Angeles County
258944	Fee-for-Service	1003047796	1003047796	1	1	KELLY FITZPATRICK, D.O	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3300 HEALTHPLEX PKWY	None	NORMAN	OK	73072	9749	00	None	35.26033774	-97.48938026	Cleveland County
258948	Fee-for-Service	1427022482	1427022482	1	1	KIM, LESLIE H MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	41605	01	General Practice	0	In state provider	None	28991 FRONT ST	STE 104	TEMECULA	CA	92590	2858	33	06065	33.48432994	-117.1438082	Riverside County
259007	Fee-for-Service	1134365539	1134365539	1	1	KANE, SAUNDRA E LMFT	1/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2431 W MARCH LN	STE 210	STOCKTON	CA	95207	8211	39	06077	37.985267	-121.3372349	San Joaquin County
259052	Fee-for-Service	1164727251	1164727251	1	1	KASRAVI, FAZLOLLAH B MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115332	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
259081	Fee-for-Service	1144470568	1144470568	1	1	KHALIL, DANIEL R MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143526	34	Urology and Urological Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
259097	Fee-for-Service	1265819163	1265819163	1	1	KWON, YONG HWAN MD	2/1/2018	207P00000X	NA	Other	026	PHYSICIANS	146206	66	Emergency Medicine (Urgent Care)	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
259108	Fee-for-Service	1750483327	1750483327	1	1	KURDI, BACHAR MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69719	41	Internal Medicine	0	In state provider	None	11100 WARNER AVE	STE 256	FOUNTAIN VALLEY	CA	92708	7502	30	06059	33.716291	-117.9355051	Orange County
259118	Fee-for-Service	1144547993	1144547993	1	2	KORNFELD, MEREDITH LMFT	3/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
259141	Fee-for-Service	1790289320	1790289320	1	1	KIENER, ALEXANDER J MD	7/22/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173920	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
259154	Fee-for-Service	1407191018	1407191018	1	1	KOPPY, ALICIA	10/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
259176	Fee-for-Service	1730344912	1730344912	1	1	KANG, CELESTE Y MD	10/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111146	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
259185	Fee-for-Service	1932593217	1932593217	1	1	KATIE VALENTINO	11/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5841 S MARYLAND AVE	None	CHICAGO	IL	60637	1443	00	None	41.788431	-87.60489252	Cook County
259227	Fee-for-Service	1013131705	1013131705	1	1	KWAK, STEVE K MD	7/19/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	105407	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
259268	Fee-for-Service	1457494015	1457494015	1	1	KEATING, JOHN L MD	8/24/2004	174400000X	NA	Other	026	PHYSICIANS	43506	05	Anesthesiology	0	In state provider	None	425 W JUNIPERO ST	STE 3	SANTA BARBARA	CA	93105	4294	42	06083	34.42973253	-119.7249544	Santa Barbara County
259270	Fee-for-Service	1831266261	1831266261	1	1	KAPLAN, JUAN B MD	5/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	31146	34	Urology and Urological Surgery	0	In state provider	None	850 S ATLANTIC BLVD	STE 302	MONTEREY PARK	CA	91754	4729	19	06037	34.05097684	-118.1379979	Los Angeles County
259271	Fee-for-Service	1720400740	1720400740	1	1	KEEHR, BARBARA	5/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
259283	Fee-for-Service	1720089618	1720089618	1	1	KIM, YOUNGMI P NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1630 E MAIN ST	None	EL CAJON	CA	92021	5204	37	06073	32.80766827	-116.9222044	San Diego County
259298	Fee-for-Service	1659958361	1659958361	1	1	KAFASHZADEH, DARIUSH MD	4/11/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
259330	Fee-for-Service	1942354907	1942354907	1	1	KEEGAN, LORI M LCSW	7/29/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96830	-	NOT APPLICABLE	0	In state provider	None	301 E 13TH STREET	SUITE A	MERCED	CA	95341	6211	24	06047	37.29248035	-120.4730619	Merced County
259381	Fee-for-Service	1740800671	1740800671	1	1	KAUR, KARANJOT	4/5/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
259384	Fee-for-Service	1730748401	1730748401	1	1	KOGA, ERIC DPM	5/25/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 100	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
259392	Fee-for-Service	1750483327	1750483327	1	1	KURDI, BACHAR MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69719	67	Endocrinology	0	In state provider	None	11100 WARNER AVE	STE 256	FOUNTAIN VALLEY	CA	92708	7502	30	06059	33.716291	-117.9355051	Orange County
259424	Fee-for-Service	1457533630	1457533630	1	1	KIEDROWSKI, CHAD E LMFT	8/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
259435	Fee-for-Service	1316564594	1316564594	1	1	KINNEY, MELIZA Q LCSW	11/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
259478	Fee-for-Service	1760735542	1760735542	1	1	KAMDAR, ADITI B MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154988	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
259488	Fee-for-Service	1184063604	1184063604	1	1	KHASIGIAN, HARRY A AMC	5/1/2001	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	29772	20	Orthopedic Surgery	0	In state provider	None	7551 TIMBERLAKE WAY	SUITE 200	SACRAMENTO	CA	95823	5422	34	06067	38.466225	-121.415958	Sacramento County
259498	Fee-for-Service	1992259626	1992259626	1	1	KANDA, MIYUKI LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
259506	Fee-for-Service	1285926196	1285926196	1	1	KUNELLIS, JOSHUA A MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126108	01	General Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
259524	Fee-for-Service	1619362928	1619362928	1	1	KADRI, OMAR M MD	10/18/2021	390200000X	NA	Other	026	PHYSICIANS	170865	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
259541	Fee-for-Service	1568745925	1568745925	1	1	KANER, RYAN J PSYD	12/12/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
259555	Fee-for-Service	1548288194	1548288194	1	1	KAYVANFAR, JAMES F MD	8/31/1993	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	72876	20	Orthopedic Surgery	0	In state provider	None	24318 WALNUT ST	None	NEWHALL	CA	91321	2924	19	06037	34.37860819	-118.5291073	Los Angeles County
259596	Fee-for-Service	1326270224	1326270224	1	1	KIM, JEONG A	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105883	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
259611	Fee-for-Service	1285088492	1285088492	1	1	KASMAN, ALEX MD	8/19/2022	208800000X	NA	Other	026	PHYSICIANS	158009	None	None	0	In state provider	None	2911 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98821335	-121.978125	Santa Cruz County
259625	Fee-for-Service	1801157235	1801157235	1	1	KERZUMA, SANTA DO	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13912	41	Internal Medicine	0	In state provider	None	1550 N INDIAN CANYON DR	None	PALM SPRINGS	CA	95336	4932	33	06065	33.84404748	-116.5455227	Riverside County
259646	Fee-for-Service	1750497244	1750497244	1	1	KASHNOW, ERIC J MD	6/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76735	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
259661	Fee-for-Service	1649340654	1649340654	1	1	KOEPPEL, MARTIN P MD	12/4/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	20968	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
259665	Fee-for-Service	1992335897	1992335897	1	1	KITABJIAN, SUSANNA H NP	2/24/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
259702	Fee-for-Service	1639751969	1639751969	1	1	KAPLAN-SANTOS, HEATHER	11/7/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30211 AVENIDA DE LAS BAN	None	RANCHO SANTA MARG	CA	92688	9268	30	06059	33.63454768	-117.6033128	Orange County
259710	Fee-for-Service	1619145174	1619145174	1	1	KUMAGAI, KEVIN E	1/16/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7117 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
259711	Fee-for-Service	1063453306	1063453306	1	1	KUCZKOWSKI,KRZYSZTOF MD	11/29/2000	207L00000X	NA	Other	026	PHYSICIANS	73507	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
259740	Fee-for-Service	1831114669	1831114669	1	1	KUNJU, AYSHA MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135445	41	Internal Medicine	0	In state provider	None	200 MUIR DRIVE	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
259761	Fee-for-Service	1578759296	1578759296	1	1	KANG, SUKHDIP K MD	1/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112240	41	Internal Medicine	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
259835	Fee-for-Service	1790725752	1790725752	1	1	KRISHNAMURTHY, C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44250	36	Psychiatry	0	In state provider	None	18523 CORWIN RD	STE H	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
259846	Fee-for-Service	1487650966	1487650966	1	1	KLAPPER, ELLEN B MD	7/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62356	22	Pathology (M.D. only)	0	In state provider	None	200 NORTH ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
259859	Fee-for-Service	1104924356	1104924356	1	1	KITAMURA, KEIKO OD	4/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 DISCOVERY PLAZA	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
259883	Fee-for-Service	1336485218	1336485218	1	1	KERN RADIOLOGY MEDICAL GROUP	12/9/2013	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9330 STOCKDALE HWY	SUITE 100	BAKERSFIELD	CA	93311	3614	15	06029	35.35452946	-119.106351	Kern County
259919	Fee-for-Service	1265430946	1265430946	1	1	KITTS, DAVID G MD	9/1/2001	208600000X	NA	General Surgery	026	PHYSICIANS	59846	33	Thoracic Surgery	0	In state provider	None	10956 DONNER PASS RD	STE 210	TRUCKEE	CA	96161	4888	29	06057	39.32625521	-120.2012059	Nevada County
259972	Fee-for-Service	1295779197	1295779197	1	1	KHOURI, SAMI M MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60690	41	Internal Medicine	0	In state provider	None	1580 CREEKSIDE DR	STE 260	FOLSOM	CA	95630	3889	34	06067	38.668914	-121.148028	Sacramento County
260011	Fee-for-Service	1104834472	1104834472	1	1	KLEIN, STUART D MD	12/30/1997	207RA0401X	NA	Other	026	PHYSICIANS	45289	41	Internal Medicine	0	In state provider	None	9951 CARMEL MOUNTAIN RD	# E3	SAN DIEGO	CA	92129	2890	37	06073	32.96074553	-117.1126881	San Diego County
260022	Fee-for-Service	1750319794	1750319794	1	1	KERN RADIOLOGY MED GRP	8/8/1990	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
260023	Fee-for-Service	1407881576	1407881576	1	1	KANAR, COLIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1855 VETERANS PARK DR	STE 101	NAPLES	FL	34109	0446	00	None	26.27140368	-81.78212885	Collier County
260027	Fee-for-Service	1427194596	1427194596	1	1	KEMPS, VIVIAN A LCSW	8/6/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BLDG C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
260046	Fee-for-Service	1578759296	1578759296	1	1	KANG, SUKHDIP K MD	1/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112240	45	Nephrology (Renal-Kidney)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
260074	Fee-for-Service	1871679340	1871679340	1	1	KEREKES, ERIK G MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75390	10	Gastroenterology (M.D. only)	0	In state provider	None	2880 ATLANTIC AVE	STE 100	LONG BEACH	CA	90806	1739	19	06037	33.809382	-118.185001	Los Angeles County
260166	Fee-for-Service	1700171691	1700171691	1	1	KUMAR, AVISHEK MD	11/27/2017	193200000X	NA	Other	026	PHYSICIANS	145824	78	Neoplastic Diseases/Oncology	0	In state provider	None	4500 BROCKTON AVE	STE 107	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
260196	Fee-for-Service	1336208958	1336208958	1	1	KIM, JOUNG-HE K MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	26055	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
260207	Fee-for-Service	1265430946	1265430946	1	1	KITTS, DAVID G MD	9/1/2001	208600000X	NA	General Surgery	026	PHYSICIANS	59846	02	General Surgery	0	In state provider	None	10956 DONNER PASS RD	STE 210	TRUCKEE	CA	96161	4888	29	06057	39.32625521	-120.2012059	Nevada County
260248	Fee-for-Service	1720321078	1720321078	1	1	KOKOSINSKI, EDWARD M DO	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14466	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
260296	Fee-for-Service	1245348994	1245348994	1	1	KAWANO, DAVID K MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	53807	01	General Practice	0	In state provider	None	1 BAYWOOD AVE	STE 6	SAN MATEO	CA	94402	1537	41	06081	37.56513159	-122.3284067	San Mateo County
260299	Fee-for-Service	1104834472	1104834472	1	1	KLEIN, STUART D MD	12/30/1997	207RA0401X	NA	Other	026	PHYSICIANS	45289	08	Family Practice	0	In state provider	None	9951 CARMEL MOUNTAIN RD	# E3	SAN DIEGO	CA	92129	2890	37	06073	32.96074553	-117.1126881	San Diego County
260302	Fee-for-Service	1922010388	1922010388	1	1	KARCHIKIAN, SILVA MD	4/8/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	40855	01	General Practice	0	In state provider	None	520 E BROADWAY BLVD	None	GLENDALE	CA	91205	4912	19	06037	34.14630672	-118.2492813	Los Angeles County
260325	Fee-for-Service	1548437809	1548437809	1	1	KRAUSE, RACHAEL I MD	6/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102002	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
260395	Fee-for-Service	1063689727	1063689727	1	1	KORNIK, RACHEL I MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122073	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
260408	Fee-for-Service	1104242080	1104242080	1	1	KONG, BENJAMIN J PT	6/24/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
260421	Fee-for-Service	1679625008	1679625008	1	1	KAO, JUDY Y OD	10/16/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
260422	Fee-for-Service	1770097362	1770097362	1	1	KIM, JI A CRNA	12/7/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
260437	Fee-for-Service	1194257626	1194257626	1	1	KAO, LESLIEANN S MD	10/17/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
260454	Fee-for-Service	1700171691	1700171691	1	1	KUMAR, AVISHEK MD	11/27/2017	193200000X	NA	Other	026	PHYSICIANS	145824	68	Hematology	0	In state provider	None	4500 BROCKTON AVE	STE 107	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
260477	Fee-for-Service	1346246261	1346246261	1	1	KELSEYVILLE FIRE PRO DIS	12/14/1990	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4020 MAIN ST	None	KELSEYVILLE	CA	95451	7410	17	06033	38.97777225	-122.8371601	Lake County
260497	Fee-for-Service	1265430946	1265430946	1	1	KITTS, DAVID G MD	9/1/2001	208600000X	NA	General Surgery	026	PHYSICIANS	59846	01	General Practice	0	In state provider	None	10956 DONNER PASS RD	STE 210	TRUCKEE	CA	96161	4888	29	06057	39.32625521	-120.2012059	Nevada County
260522	Fee-for-Service	1992902050	1992902050	1	1	KESLER, MARINA N	7/8/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
260530	Fee-for-Service	1083787980	1083787980	1	1	KAZMOUZ, GHASSAN	10/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66439	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	STE W304	PALM SPRINGS	CA	92262	4809	33	06065	33.839505	-116.5455735	Riverside County
260570	Fee-for-Service	1073111779	1073111779	1	1	KADLEC, KIRSTEN E CRNA	10/13/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
260628	Fee-for-Service	1467441527	1467441527	1	1	KIM, JOHN S	5/3/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
260635	Fee-for-Service	1134625866	1134625866	1	1	KIMBALL, SAVANNAH R MD	7/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163699	None	None	0	In state provider	None	824 E CARSON ST	SUITE 203	CARSON	CA	90745	2262	19	06037	33.83159904	-118.2605506	Los Angeles County
260651	Fee-for-Service	1447722103	1447722103	1	1	KELLER, CARLA K RCP	4/27/2020	2279P1006X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
260665	Fee-for-Service	1174801344	1174801344	1	1	KIM, DANIEL MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122585	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
260692	Fee-for-Service	1942338769	1942338769	1	1	KASSIS, ADRIENNE P MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99717	08	Family Practice	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
260697	Fee-for-Service	1720135056	1720135056	1	1	KAISER FOUND HLTH PLAN	11/18/1981	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
260713	Fee-for-Service	1811197544	1811197544	1	1	KIM, TRISHA M MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98004	30	Radiology	0	In state provider	None	400 PARNASSUS AVENUE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
260724	Fee-for-Service	1194257626	1194257626	1	1	KAO, LESLIEANN S MD	10/17/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
260727	Fee-for-Service	1033743893	1033743893	1	1	KULJIAN, GARRETT A	5/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25495 MEDICAL CENTER DR.	SUITE 304	MURRIETA	CA	92562	0000	33	06065	33.55804188	-117.1834064	Riverside County
260741	Fee-for-Service	1154527927	1154527927	1	1	KAR, ASHOK J MD INC	10/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	38390	34	Urology and Urological Surgery	0	In state provider	None	1310 W STEWART DR	STE 402	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
260742	Fee-for-Service	1700171691	1700171691	1	1	KUMAR, AVISHEK MD	11/27/2017	193200000X	NA	Other	026	PHYSICIANS	145824	41	Internal Medicine	0	In state provider	None	4500 BROCKTON AVE	STE 107	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
260771	Fee-for-Service	1487094579	1487094579	1	1	KHAN, FAEZA F MD	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149560	40	Pediatrics	0	In state provider	None	589 LOS COCHES ST	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
260829	Fee-for-Service	1588869879	1588869879	1	1	KYLE, SHARON M	7/6/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
260862	Fee-for-Service	1689100158	1689100158	1	1	KIMBROUGH, DREW E	12/7/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
260901	Fee-for-Service	1477904506	1477904506	1	1	KEDARISETTY, SURAJ MD	7/2/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	171667	None	None	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
260913	Fee-for-Service	1255500690	1255500690	1	1	KARTONO, ALLOYSIUS MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105403	25	Physical Medicine and Rehabilitation	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
260932	Fee-for-Service	1033308358	1033308358	1	1	KHONDKARYAN, ANI N MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107994	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	92335	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
260976	Fee-for-Service	1225425606	1225425606	1	1	KIMURA, BRAD H MD	2/13/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	149752	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
261013	Fee-for-Service	1194257626	1194257626	1	1	KAO, LESLIEANN S MD	10/17/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
261023	Fee-for-Service	1215022967	1215022967	1	1	KAW JR, HENRY R MD	11/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95068	08	Family Practice	0	In state provider	None	3130 S HARBOR BLVD	STE 250	SANTA ANA	CA	92704	6824	30	06059	33.70467057	-117.919705	Orange County
261036	Fee-for-Service	1518042514	1518042514	1	1	KRAUSS, RONALD M MD	4/21/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	25813	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
261069	Fee-for-Service	1144601386	1144601386	1	1	KHAN, MAHEEN Q MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	177885	None	None	0	In state provider	None	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
261119	Fee-for-Service	1154498087	1154498087	1	1	KIM, SUE H MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74611	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
261187	Fee-for-Service	1437659778	1437659778	1	1	KANG, YOUNG IL	8/4/2023	207R00000X	NA	Other	026	PHYSICIANS	179014	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
261190	Fee-for-Service	1477008704	1477008704	1	1	KING, AUDREY PT	4/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
261200	Fee-for-Service	1417942178	1417942178	1	1	KIJEWSKI, VICKI J MD	8/20/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
261205	Fee-for-Service	1790855625	1790855625	1	1	KAWASHIRI, DAVID Y MD	4/23/1996	207R00000X	NA	Other	026	PHYSICIANS	77100	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	STE 601	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
261223	Fee-for-Service	1265955256	1265955256	1	1	KALAW, ALLAN B NP	9/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
261269	Fee-for-Service	1295099497	1295099497	1	1	KOSIV, KATHERINE A MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155624	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
261288	Fee-for-Service	1891739108	1891739108	1	1	KAISERMAN, DONALD MD	2/2/1983	2084N0400X	NA	Neurology	026	PHYSICIANS	26455	13	Neurology (M.D. only)	0	In state provider	None	100 S VINCENT AVE	None	WEST COVINA	CA	91790	2902	19	06037	34.0702257	-117.926681	Los Angeles County
261289	Fee-for-Service	1962865931	1962865931	1	1	KHALID, AHMER MD	8/3/2020	208M00000X	NA	Other	026	PHYSICIANS	156934	08	Family Practice	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
261293	Fee-for-Service	1255774824	1255774824	1	1	KAUR, GURVINDER	1/29/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	191814	None	None	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
261316	Fee-for-Service	1043779986	1043779986	1	1	KIM, UNJA CNM	10/11/2022	363LW0102X	NA	Nurse Practitioner	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
261321	Fee-for-Service	1114094067	1114094067	1	1	KERR, RONALD G MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	34415	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
261351	Fee-for-Service	1881814259	1881814259	1	1	KAZAZIAN, RAFFI MD	9/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98003	08	Family Practice	0	In state provider	None	301 S FAIR OAKS AVE	SUITE 300	PASADENA	CA	91105	2561	19	06037	34.140348	-118.1504565	Los Angeles County
261369	Fee-for-Service	1538176755	1538176755	1	1	KUMAR, PARUL P MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70486	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
261372	Fee-for-Service	1003556440	1003556440	1	1	KARMEN-TUOHY, SAVANNAH MD	1/25/2025	207R00000X	NA	Other	026	PHYSICIANS	190185	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
261384	Fee-for-Service	1912931197	1912931197	1	1	KOBE, CHRIS DC	6/21/1996	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4221 SHASTA DAM BLVD	None	SHASTA LAKE	CA	96019	9423	45	06089	40.68073292	-122.3702587	Shasta County
261389	Fee-for-Service	1598784811	1598784811	1	1	KHALIL, NAGY MD, INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56258	01	General Practice	0	In state provider	None	1557 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2551	19	06037	33.97477752	-118.246176	Los Angeles County
261392	Fee-for-Service	1881845238	1881845238	1	1	KANE, JUSTIN T MD	2/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103884	24	Plastic Surgery	0	In state provider	None	863 N DOUGLAS ST	STE 100	EL SEGUNDO	CA	90245	2801	19	06037	33.92830583	-118.3831669	Los Angeles County
261394	Fee-for-Service	1922186725	1922186725	1	1	KAGHAZWALA, YASMEEN S MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68168	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
261396	Fee-for-Service	1154479947	1154479947	1	1	KAISER FDN LTH PLAN INC	7/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PHARMACY 220	400 CRAVEN RD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
261402	Fee-for-Service	1346308459	1346308459	1	1	KIRK, MICHAEL O II	3/13/2007	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	405 REDCLIFF DR	STE 100	REDDING	CA	96002	0160	45	06089	40.57465323	-122.3639452	Shasta County
261440	Fee-for-Service	1225533664	1225533664	1	1	KANE, LEWIS DPM	10/19/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
261444	Fee-for-Service	1265431241	1265431241	1	1	KEAMY, MITCHELL F MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	6130 ELTON AVE	None	LAS VEGAS	NV	89107	2538	00	None	36.17198653	-115.225452	Clark County
261465	Fee-for-Service	1336201995	1336201995	1	1	KONDRASHOV, DIMITRIY G	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92439	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
261493	Fee-for-Service	1083773055	1083773055	1	1	KADZE, RUSLANA MD INC	3/4/2004	193400000X	NA	Other	026	PHYSICIANS	73273	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5525 ETIWANDA AVE	SUITE 228	TARZANA	CA	91356	6157	19	06037	34.17046451	-118.5308463	Los Angeles County
261503	Fee-for-Service	1801188669	1801188669	1	1	KHAN, IMAD R MD	1/23/2025	2084A2900X	NA	Neurology	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
261553	Fee-for-Service	1831385202	1831385202	1	1	KOCH, FRANCIS H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22349	01	General Practice	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
261576	Fee-for-Service	1891739108	1891739108	1	1	KAISERMAN, DONALD MD	2/2/1983	2084N0400X	NA	Neurology	026	PHYSICIANS	26455	14	Neurological Surgery	0	In state provider	None	100 S VINCENT AVE	None	WEST COVINA	CA	91790	2902	19	06037	34.0702257	-117.926681	Los Angeles County
261594	Fee-for-Service	1154360709	1154360709	1	1	KEVIN SIPPRELL, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 S MAPLE ST	None	WACONIA	MN	55387	0000	00	None	44.843139	-93.79078701	Carver County
261651	Fee-for-Service	1326184524	1326184524	1	1	KHAN, ABID H MD	10/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53806	41	Internal Medicine	0	In state provider	None	160 E ARTESIA ST	STE 255	POMONA	CA	91767	2921	19	06037	34.07556833	-117.7507835	Los Angeles County
261704	Fee-for-Service	1528173960	1528173960	1	1	KOLLISCH, NANCY R MD	7/31/1981	174400000X	NA	Other	026	PHYSICIANS	44466	77	Infectious Disease	0	In state provider	None	8008 FROST ST	STE 200	SAN DIEGO	CA	92123	4207	37	06073	32.80027859	-117.1524832	San Diego County
261723	Fee-for-Service	1134243439	1134243439	1	1	KAKARLA, SUDHIR P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79473	None	None	0	In state provider	None	152 PIONEER LN	STE C	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
261726	Fee-for-Service	1366290462	1366290462	1	1	KERN SURGICAL ASSOCIATES INC	7/29/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	2521 G ST	None	BAKERSFIELD	CA	93301	2811	15	06029	35.382393	-119.0223575	Kern County
261741	Fee-for-Service	1144232034	1144232034	1	1	KOO, SUSAN	10/31/1995	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1850 E 8TH ST	None	DAVIS	CA	95616	2502	57	06113	38.55331005	-121.7285704	Yolo County
261774	Fee-for-Service	1336114370	1336114370	1	2	KHAJAVI, NOSRAT DO	1/17/2017	207L00000X	NA	Other	026	PHYSICIANS	6223	05	Anesthesiology	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
261815	Fee-for-Service	1518988344	1518988344	1	1	KIM, JOY B MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86479	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
261831	Fee-for-Service	1831112259	1831112259	1	1	KOHANI, ROYA MD	3/1/1998	207R00000X	NA	Other	026	PHYSICIANS	64593	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
261839	Fee-for-Service	1053505636	1053505636	1	1	KUO, MINGGEN T MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107462	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12462 PUTNAM STREET	SUITE 208	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
261861	Fee-for-Service	1215099767	1215099767	1	1	KEATING, RICHARD M MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56710	83	Rheumatology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
261865	Fee-for-Service	1063449403	1063449403	1	1	KAR, SAIBAL MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63816	None	None	0	In state provider	None	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06593048	-118.2708351	Los Angeles County
261875	Fee-for-Service	1760805576	1760805576	1	1	KOMPANIEZ, KARI L MD	12/8/2017	390200000X	NA	Other	026	PHYSICIANS	145523	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
261879	Fee-for-Service	1528015203	1528015203	1	1	KALMAN, LESLIE P MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	49888	-	NOT APPLICABLE	0	In state provider	None	1735 ENTERPRISE DR	BLDG 1 STE 105A	FAIRFIELD	CA	94533	6822	48	06095	38.24294683	-122.060841	Solano County
261931	Fee-for-Service	1881128957	1881128957	1	1	KALINOSKI, THOMAS M MD	9/30/2020	207R00000X	NA	Other	026	PHYSICIANS	159230	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
261988	Fee-for-Service	1093718462	1093718462	1	1	KHERADPOUR, RABIN MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63649	41	Internal Medicine	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
262000	Fee-for-Service	1164486429	1164486429	1	1	KARDAN, FARAMARZ MD	3/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61678	41	Internal Medicine	0	In state provider	None	27800 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6410	30	06059	33.55952733	-117.6645199	Orange County
262020	Fee-for-Service	1013095736	1013095736	1	1	KABIR, SYEDA M MD	3/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74606	36	Psychiatry	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
262050	Fee-for-Service	1912345307	1912345307	1	1	KHARE, MANASWITHA MD	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140062	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
262070	Fee-for-Service	1316379712	1316379712	1	1	KAMEL, KAMEL MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139116	01	General Practice	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
262085	Fee-for-Service	1831423847	1831423847	1	1	KELLEY, MICHELLE LCSW	4/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41690 ENTERPRISE CIR N	SUITE 230	TEMECULA	CA	92590	5660	33	06065	33.51949343	-117.1693521	Riverside County
262104	Fee-for-Service	1538106372	1538106372	1	1	KINGSTON, JESSICA M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70367	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
262127	Fee-for-Service	1053505636	1053505636	1	1	KUO, MINGGEN T MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107462	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	12462 PUTNAM STREET	SUITE 208	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
262166	Fee-for-Service	1568854230	1568854230	1	1	KNUTSEN, ASHLEY M CCC-SLP	9/16/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
262195	Fee-for-Service	1932433836	1932433836	1	1	KEZIRIAN, JESSICA W PT	11/1/2018	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
262294	Fee-for-Service	1316336746	1316336746	1	1	KARAM, KAREN D LCSW	9/27/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	704 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.188881	-120.6695385	Calaveras County
262302	Fee-for-Service	1699716936	1699716936	1	1	KENNETH BRAIT MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
262326	Fee-for-Service	1609018480	1609018480	1	1	KING, KEVIN LMFT	9/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5800 HANNUM AVE	105	CULVER CITY	CA	90230	6553	19	06037	33.98724995	-118.3858338	Los Angeles County
262334	Fee-for-Service	1326195645	1326195645	1	1	KAISER FOUND HLTH PLAN	9/16/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHCY	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
262336	Fee-for-Service	1750327235	1750327235	1	1	KHAN, KHALID B MD INC	8/8/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62486	None	None	0	In state provider	None	13425 INGLEWOOD AVE	None	HAWTHORNE	CA	90250	5727	19	06037	33.9105813	-118.3613146	Los Angeles County
262337	Fee-for-Service	1154381689	1154381689	1	1	KEMP KRISTIAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5475 SOUTH 500 EAST	None	OGDEN	UT	84405	6905	00	None	41.16449014	-111.9686412	Weber County
262361	Fee-for-Service	1730148271	1730148271	1	1	KLAMATH OPHTHALMOLOGY PC	10/1/2009	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	2640 BIEHN STREET	SUITE 3	KLAMATH FALLS	OR	97601	1181	00	None	42.2454811	-121.7916325	Klamath County
262401	Fee-for-Service	1144222571	1144222571	1	1	KIAN, HOMAN MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90772	08	Family Practice	0	In state provider	None	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
262415	Fee-for-Service	1053505636	1053505636	1	1	KUO, MINGGEN T MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107462	41	Internal Medicine	0	In state provider	None	12462 PUTNAM STREET	SUITE 208	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
262416	Fee-for-Service	1205135530	1205135530	1	1	KAPLAN, JENNIFER A MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123935	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
262435	Fee-for-Service	1255419743	1255419743	1	1	KHAN, RAKHSHI MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94559	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
262444	Fee-for-Service	1609227859	1609227859	1	1	KWETE, GRACIA MD	8/12/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
262448	Fee-for-Service	1861826695	1861826695	1	1	KANE, VICTORIA A PT	9/16/2020	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
262458	Fee-for-Service	1750431219	1750431219	1	1	KENDALL, ADAM R MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91533	08	Family Practice	0	In state provider	None	1164 NORUMBEGA DRIVE	None	MONROVIA	CA	91016	1831	19	06037	34.16143717	-117.9790379	Los Angeles County
262476	Fee-for-Service	1285865675	1285865675	1	1	KHEIWA, AHMED A MD	9/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142019	40	Pediatrics	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
262496	Fee-for-Service	1164046058	1164046058	1	1	KARP, ELIZABETH PHD	11/23/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
262497	Fee-for-Service	1083935332	1083935332	1	1	KAUR, NAVPREET MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135921	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
262547	Fee-for-Service	1861411324	1861411324	1	1	KO, DERECK H RN	5/9/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
262552	Fee-for-Service	1174696587	1174696587	1	1	KING, JEFFREY M MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42949	08	Family Practice	0	In state provider	None	935 N GEM ST	None	TULARE	CA	93274	2127	54	06107	36.22107814	-119.3398789	Tulare County
262596	Fee-for-Service	1245307156	1245307156	1	1	KHONA, DIMPLE K MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73746	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
262608	Fee-for-Service	1336221969	1336221969	1	1	KIM, CHAN H MD	10/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	30732	13	Neurology (M.D. only)	0	In state provider	None	14350 WHITTIER BLVD	STE 320	WHITTIER	CA	90605	2153	19	06037	33.95501294	-118.0185665	Los Angeles County
262615	Fee-for-Service	1881653400	1881653400	1	1	KAYE, SUSAN CNP	12/9/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
262643	Fee-for-Service	1871780098	1871780098	1	1	KONG, JIANG-TI MD	11/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93727	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
262646	Fee-for-Service	1730400375	1730400375	1	1	KARRIS, BIANCA C MD	1/23/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	147124	36	Psychiatry	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
262649	Fee-for-Service	1730148271	1730148271	1	1	KLAMATH OPHTHALMOLOGY PC	10/1/2009	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	1	Border provider	None	2640 BIEHN STREET	SUITE 3	KLAMATH FALLS	OR	97601	1181	00	None	42.2454811	-121.7916325	Klamath County
262665	Fee-for-Service	1598774457	1598774457	1	1	KARNANI, BINA R MD	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76210	08	Family Practice	0	In state provider	None	2702 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
262685	Fee-for-Service	1275563207	1275563207	1	1	KHORRAMI, PAYMAN MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	73031	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	SUITE 1108	LOS ANGELES	CA	90067	2021	19	06037	34.05887194	-118.4122914	Los Angeles County
262727	Fee-for-Service	1932197894	1932197894	1	1	KENJIROU OHASHI MD	6/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
262735	Fee-for-Service	1508972753	1508972753	1	1	KIETZMAN, ROBIN M PHD	1/22/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21015	-	NOT APPLICABLE	0	In state provider	None	447 N EL MOLINO AVE	None	PASADENA	CA	91101	1403	19	06037	34.15365596	-118.1370318	Los Angeles County
262751	Fee-for-Service	1407902166	1407902166	1	1	KRALL, AUDREY MD	2/8/2015	282NC0060X	NA	Hospitals	026	PHYSICIANS	61957	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
262764	Fee-for-Service	1285865675	1285865675	1	1	KHEIWA, AHMED A MD	9/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142019	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
262771	Fee-for-Service	1568751584	1568751584	1	1	KHUU, LINH H MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127070	41	Internal Medicine	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
262796	Fee-for-Service	1053534610	1053534610	1	1	KIM, PETER K MD	3/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67819	13	Neurology (M.D. only)	0	In state provider	None	2950 SYCAMORE DR	STE 303	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
262818	Fee-for-Service	1982681227	1982681227	1	1	KIM, DAVE T MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61680	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90017	3907	19	06037	34.05270508	-118.2641005	Los Angeles County
262884	Fee-for-Service	1427284215	1427284215	1	1	KEIHANIAN, SARA MD	2/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135418	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
262885	Fee-for-Service	1245307156	1245307156	1	1	KHONA, DIMPLE K MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73746	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
262891	Fee-for-Service	1053933101	1053933101	1	1	KYAN, JOHN	10/17/2023	207R00000X	NA	Other	026	PHYSICIANS	183505	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
262921	Fee-for-Service	1003868027	1003868027	1	2	KHOURY, BILL J MD	4/30/2017	207P00000X	NA	Other	026	PHYSICIANS	63305	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
262937	Fee-for-Service	1033734868	1033734868	1	1	KUMAR, SHAMEEKA K NP	6/27/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
262950	Fee-for-Service	1821736539	1821736539	1	1	KUMAR, SANJEEV MD	6/9/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	176932	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
262969	Fee-for-Service	1255008520	1255008520	1	1	KASHMIRA CORPORATION	10/25/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29645 RANCHO CALIFORNIA	129	TEMECULA	CA	92591	5285	33	06065	33.50627123	-117.1431728	Riverside County
262970	Fee-for-Service	1275563207	1275563207	1	1	KHORRAMI, PAYMAN MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	73031	10	Gastroenterology (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	SUITE 1108	LOS ANGELES	CA	90067	2021	19	06037	34.05887194	-118.4122914	Los Angeles County
262980	Fee-for-Service	1235210097	1235210097	1	1	KHANKARI, KISHORE B MD	10/23/2023	207R00000X	NA	Other	026	PHYSICIANS	168344	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
263001	Fee-for-Service	1528134558	1528134558	1	1	KERENDI, FAROUGH MD INC	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	40018	01	General Practice	0	In state provider	None	6360 WILSHIRE BLVD	STE 414	LOS ANGELES	CA	90048	5601	19	06037	34.06363617	-118.3676811	Los Angeles County
263009	Fee-for-Service	1710292073	1710292073	1	1	KHANGURA, HARBINDER S MD	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120940	05	Anesthesiology	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
263016	Fee-for-Service	1518379429	1518379429	1	1	KAUR, AMANJOT MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
263017	Fee-for-Service	1528351053	1528351053	1	1	KANG, STEPHANIE W DO	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13245	41	Internal Medicine	0	In state provider	None	450 EAST ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
263018	Fee-for-Service	1679787766	1679787766	1	1	KIM, MOON J NP	12/1/1998	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2675 W OLYMPIC BLVD	STE 207	LOS ANGELES	CA	90006	2880	19	06037	34.05243942	-118.2907458	Los Angeles County
263039	Fee-for-Service	1528419348	1528419348	1	1	KAMANTIGUE, ACE M NP	10/1/2018	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1101 BRYAN AVE	STE E	TUSTIN	CA	92780	4401	30	06059	33.74272355	-117.8149529	Orange County
263043	Fee-for-Service	1508997420	1508997420	1	1	KELLY, MICHAEL P MD	9/29/2021	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	100116	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
263054	Fee-for-Service	1285865675	1285865675	1	1	KHEIWA, AHMED A MD	9/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142019	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
263058	Fee-for-Service	1922033620	1922033620	1	1	KUO, RAYMOND HAHN MD	11/16/2007	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	78920	30	Radiology	0	In state provider	None	293 S MAIN ST	STE 100	ORANGE	CA	92868	3826	30	06059	33.7842	-117.8672725	Orange County
263074	Fee-for-Service	1700381191	1700381191	1	1	KIZHAKKEPAT PISHARAM, JAYASR	1/20/2022	207R00000X	NA	Other	026	PHYSICIANS	176015	None	None	0	In state provider	EE MD	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
263084	Fee-for-Service	1053534610	1053534610	1	1	KIM, PETER K MD	3/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67819	79	Neurology-Child	0	In state provider	None	2950 SYCAMORE DR	STE 303	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
263169	Fee-for-Service	1891747564	1891747564	1	1	KADELL, BARBARA M MD	7/31/1984	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	10000	30	Radiology	0	In state provider	UCLA, DEPT OF RAD SCI	CENTER FOR HLTH SCIENCES	None	LOS ANGELES	CA	90024	0000	19	06037	0	0	None
263170	Fee-for-Service	1427374149	1427374149	1	1	KHAN, SOBIYA W DO	3/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12093	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 WEST JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
263171	Fee-for-Service	1427284215	1427284215	1	1	KEIHANIAN, SARA MD	2/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135418	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
263200	Fee-for-Service	1336593391	1336593391	1	1	KIM, PETER E MD	7/1/2021	390200000X	NA	Other	026	PHYSICIANS	158981	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
263217	Fee-for-Service	1518319235	1518319235	1	1	KUCH, JORDAN LMFT	9/28/2020	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
263222	Fee-for-Service	1952633323	1952633323	1	1	KOHAN, JAMES JACK MD LLC	10/30/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	54757	None	None	0	In state provider	None	2658 DEL MAR HEIGHTS RD	SUITE 358	DEL MAR	CA	92014	3100	37	06073	32.94943745	-117.2452763	San Diego County
263311	Fee-for-Service	1841366770	1841366770	1	1	KENNEDY, NEIL MD	7/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97631	30	Radiology	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
263329	Fee-for-Service	1982963997	1982963997	1	1	KOSKI, REBECCA LMFT	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8605 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4109	19	06037	34.088062	-118.3791834	Los Angeles County
263344	Fee-for-Service	1528150109	1528150109	1	1	KILGORE, DAVID B MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58409	01	General Practice	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
263380	Fee-for-Service	1760840318	1760840318	1	1	KRAUS, CLINT M DO	8/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19953	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
263384	Fee-for-Service	1841213899	1841213899	1	1	KATZ, MICHAEL A MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77114	41	Internal Medicine	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
263388	Fee-for-Service	1487831665	1487831665	1	1	KOJIAN, BEDROS MD INC	5/1/2001	261Q00000X	NA	Other	026	PHYSICIANS	33708	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 W STEWART DR	STE 308	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
263393	Fee-for-Service	1023716461	1023716461	1	1	KNOL, STEPHANIE BIRTH DOULA	7/16/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
263413	Fee-for-Service	1396029443	1396029443	1	1	KIM, CHRISTEN YUNAH	11/28/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1390 WEST H STREET	SUITE F	OAKDALE	CA	95361	3529	50	06099	37.75817442	-120.8617244	Stanislaus County
263415	Fee-for-Service	1952892861	1952892861	1	1	KKA HOME HEALTH CARE, INC	7/6/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	UNIT 213	NORTH HILLS	CA	91343	4354	19	06037	34.232355	-118.467768	Los Angeles County
263421	Fee-for-Service	1962631168	1962631168	1	1	KHILNANI, MAHESH M NP	5/15/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
263436	Fee-for-Service	1164838884	1164838884	1	1	KIONG, YITIAN TIMOTHY MD	5/22/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	160048	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
263493	Fee-for-Service	1396828554	1396828554	1	1	KONG-THEIN, LORNA MD APC	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51913	40	Pediatrics	0	In state provider	None	207 S SANTA ANITA AVE	STE 330	SAN GABRIEL	CA	91776	1154	19	06037	34.10120583	-118.1065375	Los Angeles County
263546	Fee-for-Service	1497098719	1497098719	1	1	KREYMER, YELENA MD	12/21/2018	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
263590	Fee-for-Service	1396721114	1396721114	1	1	KHURTSIDZE,GREGORY G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1706 WASHINGTON WAY	None	LONGVIEW	WA	98632	0000	00	None	46.13849482	-122.940236	Cowlitz County
263601	Fee-for-Service	1144064510	1144064510	1	1	KM HEALTHCARE INC	7/2/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	612 W DUARTE RD	#102	ARCADIA	CA	91007	9221	19	06037	34.12647805	-118.051994	Los Angeles County
263636	Fee-for-Service	1023412475	1023412475	1	1	KAO, DANIEL J NP	4/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
263640	Fee-for-Service	1235992769	1235992769	1	1	KHURANA, MONIKA RCP	3/11/2024	2279P1005X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
263649	Fee-for-Service	1356358329	1356358329	1	1	KOWALESKI, STEVEN L MD	3/31/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40827	40	Pediatrics	0	In state provider	None	2510 WEBSTER ST	None	BERKELEY	CA	94705	2504	01	06001	37.85564794	-122.2560479	Alameda County
263668	Fee-for-Service	1851895452	1851895452	1	1	KUO, ANDREW MD	6/24/2022	207L00000X	NA	Other	026	PHYSICIANS	163771	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
263673	Fee-for-Service	1841213899	1841213899	1	1	KATZ, MICHAEL A MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77114	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
263695	Fee-for-Service	1558505321	1558505321	1	1	KIM, DAVID D MD	2/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91389	68	Hematology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
263699	Fee-for-Service	1033286182	1033286182	1	1	KIM, SINJOO T MD	2/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68034	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
263795	Fee-for-Service	1760628911	1760628911	1	1	KAISER FOUNDATION HEALTH	9/16/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #563	12801 CROSSROADS PKWY S	None	CITY OF INDUSTRY	CA	91746	3506	19	06037	34.0289395	-118.024533	Los Angeles County
263822	Fee-for-Service	1629503180	1629503180	1	1	KESSACK, JOSHUA DO	7/8/2024	207P00000X	NA	Other	026	PHYSICIANS	21000	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
263832	Fee-for-Service	1912008442	1912008442	1	1	KITT, VICTOR V MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	41263	04	Otology, Laryngology, Rhinology	0	In state provider	None	1902 B ST	None	BAKERSFIELD	CA	93301	3526	15	06029	35.37632105	-119.0280894	Kern County
263870	Fee-for-Service	1922197185	1922197185	1	1	KAWAI, STANLEY OD	5/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10502 KATELLA AVE	None	ANAHEIM	CA	92804	6528	30	06059	33.80291728	-117.9500175	Orange County
263914	Fee-for-Service	1003178088	1003178088	1	1	KHAN, KASHIF T MD	9/1/2019	207L00000X	NA	Other	026	PHYSICIANS	153565	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
263924	Fee-for-Service	1780858761	1780858761	1	1	KAUFMAN, JOHN F MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99669	30	Radiology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
263959	Fee-for-Service	1588616783	1588616783	1	1	KIRBY, AMY B MD	3/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184671	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
263964	Fee-for-Service	1093799660	1093799660	1	1	KASTEN, JEFF S NP	6/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
263971	Fee-for-Service	1073720462	1073720462	1	1	KONG, HAI O	3/3/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	511 N VICTORY BLVD	None	BURBANK	CA	91502	1737	19	06037	34.17860123	-118.3190001	Los Angeles County
263983	Fee-for-Service	1558505321	1558505321	1	1	KIM, DAVID D MD	2/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91389	78	Neoplastic Diseases/Oncology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
263987	Fee-for-Service	1366798886	1366798886	1	1	KAO, JULIE OD	5/20/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1015 S NOGALES STREET	#109	ROWLAND HEIGHTS	CA	91748	1309	19	06037	33.99637543	-117.8884823	Los Angeles County
263990	Fee-for-Service	1033286182	1033286182	1	1	KIM, SINJOO T MD	2/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68034	45	Nephrology (Renal-Kidney)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
264012	Fee-for-Service	1760558126	1760558126	1	1	KIM, SOMI OD	9/15/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3053 W OLYMPIC BLVD	STE 105	LOS ANGELES	CA	90006	2558	19	06037	34.05266275	-118.3017531	Los Angeles County
264052	Fee-for-Service	1336310515	1336310515	1	1	KATKURI, KIRTHI R MD	6/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112924	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
264077	Fee-for-Service	1568487866	1568487866	1	1	KALEITA, THOMAS A PHD	3/1/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
264083	Fee-for-Service	1811145428	1811145428	1	2	KODZIC, ANA PHD	11/25/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SERVICE	895 AEROVISTA PL	106	SAN LUIS OBISPO	CA	93401	8725	40	06079	35.24285786	-120.6403241	San Luis Obispo County
264109	Fee-for-Service	1508177221	1508177221	1	1	KANG, TERRY S MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142718	18	Ophthalmology	0	In state provider	None	1246 E ARROW HIGHWAY	SUITE A	UPLAND	CA	91786	4955	36	06071	34.09974849	-117.634842	San Bernardino County
264119	Fee-for-Service	1386633618	1386633618	1	1	KATZ, MARILYN DO	6/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	471 N CENTRAL AVE	None	UPLAND	CA	91786	4219	36	06071	34.099308	-117.689689	San Bernardino County
264197	Fee-for-Service	1386625952	1386625952	1	1	KAISER, KIRK ALAN MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	555 N ARLINGTON AVE	None	RENO	NV	89503	4723	00	None	39.53124039	-119.8188498	Washoe County
264216	Fee-for-Service	1215063466	1215063466	1	1	KELMAN, ARIELLA MD	9/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72587	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
264223	Fee-for-Service	1639533532	1639533532	1	1	KAYALI, IBRAHEEM MD	9/8/2022	208600000X	NA	General Surgery	026	PHYSICIANS	180933	None	None	0	In state provider	None	2656 EDITH AVE	None	REDDING	CA	96001	3030	45	06089	40.57073094	-122.3974088	Shasta County
264248	Fee-for-Service	1427117092	1427117092	1	1	KIM, JANE H MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89663	24	Plastic Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
264296	Fee-for-Service	1124019971	1124019971	1	1	KUO, FRANCIS, E OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1108 MISSION ST	None	SANTA CRUZ	CA	95060	3527	44	06087	36.97045021	-122.0367624	Santa Cruz County
264370	Fee-for-Service	1306355698	1306355698	1	1	KIM, SANDRA Y CNP	1/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
264383	Fee-for-Service	1700870102	1700870102	2	1	KELEKAR, DILIP R MD	8/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	37290	20	Orthopedic Surgery	0	In state provider	None	18523 CORWIN RD	STE D	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
264411	Fee-for-Service	1619908944	1619908944	1	1	KALRA, JAGJEET S MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	44804	41	Internal Medicine	0	In state provider	0	530 W EATON AVE	STE C	TRACY	CA	95376	3454	39	06077	37.74328351	-121.433886	San Joaquin County
264443	Fee-for-Service	1447811047	1447811047	1	1	KIM, MICHAEL J MD	4/25/2024	207P00000X	NA	Other	026	PHYSICIANS	186161	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
264462	Fee-for-Service	1457636292	1457636292	1	1	KARRUMI, CHRISTOPHER MD	4/15/2019	207P00000X	NA	Other	026	PHYSICIANS	159947	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
264466	Fee-for-Service	1477656932	1477656932	1	1	KUMAR, VIKRAM R MD	12/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90318	40	Pediatrics	0	In state provider	None	311 W I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
264467	Fee-for-Service	1558651885	1558651885	1	1	KIM, DONALD Y DO	5/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14643	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264536	Fee-for-Service	1700848397	1700848397	1	2	KROSNER, SETH M MD	9/1/1998	2086S0129X	NA	General Surgery	026	PHYSICIANS	84478	02	General Surgery	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
264537	Fee-for-Service	1720135049	1720135049	1	1	KAISER PERMANENTE PHRM	3/3/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#323	12001 W WASHINGTON BLVD	None	LOS ANGELES	CA	90066	5801	19	06037	33.99760695	-118.4228296	Los Angeles County
264598	Fee-for-Service	1821301532	1821301532	1	1	KATHERINE BROWN	1/29/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
264611	Fee-for-Service	1326101445	1326101445	1	1	KAKISHIBA, KAREN W MD	1/31/1991	207RA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	56087	40	Pediatrics	0	In state provider	None	810 RICHLAND RD	None	YUBA CITY	CA	95991	6200	51	06101	39.1181022	-121.6228659	Sutter County
264634	Fee-for-Service	1992700876	1992700876	1	1	KRPAN, JOHN B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	6983	08	Family Practice	0	In state provider	None	1300 KURT DR	STE 105	ANGELS CAMP	CA	95222	0000	05	06009	38.07476917	-120.5364629	Calaveras County
264649	Fee-for-Service	1780678706	1780678706	1	1	KONDOVSKI, SACHO R MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	6077	01	General Practice	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
264653	Fee-for-Service	1922354828	1922354828	1	1	KIM, SAMUEL W MD	5/2/2019	208600000X	NA	General Surgery	026	PHYSICIANS	160112	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
264674	Fee-for-Service	1104249283	1104249283	1	1	KLEYMAN, ELEONORA MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127416	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
264676	Fee-for-Service	1386116911	1386116911	1	1	KSHEVATZKY, ERIN M RCP	5/11/2020	2278G1100X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
264677	Fee-for-Service	1619044518	1619044518	1	1	KANTER, MICHAEL H MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	47085	None	None	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
264678	Fee-for-Service	1538694914	1538694914	1	1	KANG, JUNGMIN NP	1/2/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
264698	Fee-for-Service	1619908944	1619908944	1	1	KALRA, JAGJEET S MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	44804	29	Pulmonary Diseases (M.D. only)	0	In state provider	0	530 W EATON AVE	STE C	TRACY	CA	95376	3454	39	06077	37.74328351	-121.433886	San Joaquin County
264702	Fee-for-Service	1386792307	1386792307	1	1	KRAININ, JOSEPH G MD	12/31/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93853	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
264718	Fee-for-Service	1629462791	1629462791	1	2	KARAMYAN, NUNE MD	4/28/2023	207R00000X	NA	Other	026	PHYSICIANS	167932	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
264750	Fee-for-Service	1467587139	1467587139	1	1	KHAN, SHALLA S MD	8/14/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9839	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
264804	Fee-for-Service	1205653631	1205653631	1	1	KWONG, RACHEL CNP	2/10/2025	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2777 LONG BEACH BLVD	STE 200	LONG BEACH	CA	90806	1513	19	06037	33.80734327	-118.189472	Los Angeles County
264823	Fee-for-Service	1700848397	1700848397	1	2	KROSNER, SETH M MD	9/1/1998	2086S0129X	NA	General Surgery	026	PHYSICIANS	84478	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
264824	Fee-for-Service	1063699668	1063699668	1	1	KOPELMAN, TODD G PHD	3/20/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
264855	Fee-for-Service	1760831796	1760831796	1	1	KAHLER, DIANE E PT	8/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 S CHAPARRAL CT	150	ANAHEIM	CA	92808	2237	30	06059	33.86492127	-117.7445525	Orange County
264856	Fee-for-Service	1649488545	1649488545	1	1	KAVALI, ASHA MD	2/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	54328	30	Radiology	0	In state provider	None	1801 E MARCH LANE	SUITE A130	STOCKTON	CA	95210	6650	39	06077	38.00315652	-121.2868715	San Joaquin County
264863	Fee-for-Service	1366519100	1366519100	1	1	KAWAMOTO, DIANE H OD	1/24/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9834 GENESEE AVE	STE 114	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
264886	Fee-for-Service	1306861729	1306861729	1	1	KURISU, MICHAEL J DO	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9217	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
264948	Fee-for-Service	1598025165	1598025165	1	1	KING, LOREN PHD	8/8/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	325 W HOSPITALITY LANE	None	SAN BERNARDINO	CA	92408	3243	36	06071	34.0658995	-117.29034	San Bernardino County
264970	Fee-for-Service	1104907559	1104907559	1	1	KILBURN, JEREMY P MD	12/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	1707 W CHARLESTON BLVD	STE 220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
264984	Fee-for-Service	1285898932	1285898932	1	1	KUSMIERSKI, ANYA S LMFT	5/31/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
265000	Fee-for-Service	1336378371	1336378371	1	1	KIM, JAMES T MD	5/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121180	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
265006	Fee-for-Service	1023180841	1023180841	1	1	KHAN, NAUREEN MD	1/25/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77746	36	Psychiatry	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
265031	Fee-for-Service	1447558747	1447558747	1	1	KIM, DEBORAH N MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115676	40	Pediatrics	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
265044	Fee-for-Service	1205103082	1205103082	1	1	KATZ, JASON J LMFT	3/19/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8271 MELROSE AVE	SUITE 110	LOS ANGELES	CA	90046	6800	19	06037	34.08372747	-118.3696965	Los Angeles County
265050	Fee-for-Service	1043693146	1043693146	1	1	KAUR, SIMRANJIT MD	6/1/2021	207R00000X	NA	Other	026	PHYSICIANS	155849	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
265081	Fee-for-Service	1730271099	1730271099	1	1	KHODADADI, ARBI	7/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	83304	None	None	0	In state provider	None	959 E WALNUT ST	STE 120	PASADENA	CA	91106	5364	19	06037	34.14962102	-118.1305187	Los Angeles County
265098	Fee-for-Service	1649579038	1649579038	1	1	KRAINSKI, FELIX MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148376	41	Internal Medicine	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
265110	Fee-for-Service	1639169592	1639169592	1	1	KAUFMAN, DAVID M MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77831	None	None	0	In state provider	None	126 S FLORAL ST	None	VISALIA	CA	93291	6259	54	06107	36.329472	-119.295558	Tulare County
265115	Fee-for-Service	1487929857	1487929857	1	1	KENIGSBERG, DEBORAH M PSYD	5/25/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25406	-	NOT APPLICABLE	0	In state provider	PSYD	5675 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4712	19	06037	34.05742688	-118.3532118	Los Angeles County
265177	Fee-for-Service	1760644843	1760644843	1	1	KIM, IVAN I MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116735	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
265195	Fee-for-Service	1376558239	1376558239	1	1	KUNAMNENI, BASAVA P MD	9/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51232	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	420 W ACACIA ST	STE 18	STOCKTON	CA	95203	2441	39	06077	37.96135715	-121.2996632	San Joaquin County
265210	Fee-for-Service	1699833327	1699833327	1	1	KIM, BACK K MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49641	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3545 WILSHIRE BLVD	STE 247	LOS ANGELES	CA	90010	2389	19	06037	34.0617575	-118.301985	Los Angeles County
265272	Fee-for-Service	1932763638	1932763638	1	1	KIM, BOJEONG DO	1/2/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20388	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
265300	Fee-for-Service	1396204285	1396204285	1	1	KOPATZ, CHRISTINA K MD	10/4/2024	208600000X	NA	General Surgery	026	PHYSICIANS	177481	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
265303	Fee-for-Service	1730186354	1730186354	1	1	KUSHAL, DHAN D MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
265316	Fee-for-Service	1386055853	1386055853	1	1	KIM, JASON DO	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
265323	Fee-for-Service	1619905437	1619905437	1	1	KARPMAN, GERALD N MD	1/1/1979	207N00000X	NA	Dermatology	026	PHYSICIANS	29766	07	Dermatology	0	In state provider	None	2438 N PONDEROSA DR	STE C105	CAMARILLO	CA	93010	2369	56	06111	34.24219545	-119.0227012	Ventura County
265324	Fee-for-Service	1841429404	1841429404	1	1	KIM. ALEXANDER S MD	6/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125086	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
265340	Fee-for-Service	1851329874	1851329874	1	1	KHAN, ZAFAR S MD	6/22/2009	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	85906	20	Orthopedic Surgery	0	In state provider	None	11160 WARNER AVE	STE 311	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
265367	Fee-for-Service	1588217236	1588217236	1	1	KAISER FOUNDATION HEALTH PLA	10/11/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	051	1021 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.728255	-121.290405	Placer County
265376	Fee-for-Service	1235424284	1235424284	1	1	KATO, KAMBRIE Y MD	5/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124371	30	Radiology	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
265384	Fee-for-Service	1649579038	1649579038	1	1	KRAINSKI, FELIX MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148376	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
265399	Fee-for-Service	1013027465	1013027465	1	1	KIM, DONG S MD INC	4/12/2012	207R00000X	NA	Other	026	PHYSICIANS	48273	41	Internal Medicine	0	In state provider	None	11441 HEACOCK ST	SUITE F	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
265474	Fee-for-Service	1669424586	1669424586	1	1	KHANOYAN, SIRVARD MD	10/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80900	08	Family Practice	0	In state provider	None	801 S CHEVY CHASE DR	STE 230	GLENDALE	CA	91205	4436	19	06037	34.136757	-118.2396195	Los Angeles County
265496	Fee-for-Service	1699833327	1699833327	1	1	KIM, BACK K MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49641	42	Nuclear Medicine	0	In state provider	None	3545 WILSHIRE BLVD	STE 247	LOS ANGELES	CA	90010	2389	19	06037	34.0617575	-118.301985	Los Angeles County
265497	Fee-for-Service	1861550840	1861550840	1	1	KUAN, TING-KUO CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2691 HOSTETTER RD	None	SAN JOSE	CA	95132	2227	43	06085	37.39809512	-121.8695627	Santa Clara County
265520	Fee-for-Service	1659495026	1659495026	1	1	KUMAR, DEVINDER MD	12/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101352	41	Internal Medicine	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
265537	Fee-for-Service	1417062597	1417062597	1	1	KASHIMA, KARIN K LCSW	8/20/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1151 DOVE ST	STE 295	NEWPORT BEACH	CA	92660	2843	30	06059	33.66079655	-117.8652168	Orange County
265566	Fee-for-Service	1437564457	1437564457	1	1	KOSMADAKIS, KELSEY A NP	6/28/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
265575	Fee-for-Service	1932131257	1932131257	1	1	KATZ, ANDREW J MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81324	None	None	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
265588	Fee-for-Service	1730186354	1730186354	1	1	KUSHAL, DHAN D MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	68	Hematology	1	Border provider	None	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
265650	Fee-for-Service	1013297712	1013297712	1	1	KANG, SAE J MD	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116825	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
265659	Fee-for-Service	1134326697	1134326697	1	1	KARETI, GAUTAM B MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124208	13	Neurology (M.D. only)	0	In state provider	None	42135 10TH ST WEST	SUITE 301	LANCASTER	CA	93534	6093	19	06037	34.648533	-118.1477975	Los Angeles County
265665	Fee-for-Service	1053483867	1053483867	1	1	KORIS, NEIL H MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51031	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
265679	Fee-for-Service	1265638035	1265638035	1	1	KINZLER, DAMIEN W DO	10/1/2021	207P00000X	NA	Other	026	PHYSICIANS	18326	None	None	0	In state provider	None	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
265703	Fee-for-Service	1033377965	1033377965	1	1	KIRAN, ANEETA R MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96783	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
265716	Fee-for-Service	1952368508	1952368508	1	1	KIM, YOUNG SHIN MD	7/11/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	85720	None	None	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
265719	Fee-for-Service	1114165362	1114165362	1	1	KLASSETT, BRANDON Z OT	12/6/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12411 SLAUSON AVE	STE H	WHITTIER	CA	90606	2835	19	06037	33.96028839	-118.0529975	Los Angeles County
265747	Fee-for-Service	1306473467	1306473467	1	1	KHACHATRYAN, MERI DO	5/1/2024	207R00000X	NA	Other	026	PHYSICIANS	20826	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
265773	Fee-for-Service	1801107511	1801107511	1	1	KHUDATYAN, HRACH MD INC	8/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60871	08	Family Practice	0	In state provider	None	134 N GLENDALE AVE	None	GLENDALE	CA	91206	4451	19	06037	34.1476757	-118.2466135	Los Angeles County
265785	Fee-for-Service	1295741429	1295741429	1	1	KELTON, FRANKLIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 E MARSHALL ST	# Q	WEST CHESTER	PA	19380	4412	00	None	39.972996	-75.6018225	Chester County
265804	Fee-for-Service	1285713917	1285713917	1	1	KIM, SUNMEE L MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84660	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
265824	Fee-for-Service	1356331904	1356331904	1	1	KENT J STOCK MD	3/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	955 RIBAUT RD	None	BEAUFORT	SC	29901	1068	00	None	32.416929	-80.68852154	Beaufort County
265893	Fee-for-Service	1114337946	1114337946	1	1	KUO, RICKY L LAC	8/14/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3940 4TH AVE	STE 320-1	SAN DIEGO	CA	92103	3193	37	06073	32.74912549	-117.161641	San Diego County
265940	Fee-for-Service	1184759227	1184759227	1	2	KELLY & SCOTTS CARE HOME	7/1/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1324 5TH PL	None	DELANO	CA	93215	3001	15	06029	35.76424152	-119.2391595	Kern County
265959	Fee-for-Service	1972022465	1972022465	1	1	KEENAN, AMBER R NP	12/1/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1100 PEAR TREE LN	None	NAPA	CA	94558	6446	28	06055	38.32087983	-122.2946228	Napa County
265981	Fee-for-Service	1588110423	1588110423	1	1	KWAN, CHANGYOW MD	7/8/2024	390200000X	NA	Other	026	PHYSICIANS	187362	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
265997	Fee-for-Service	1154406718	1154406718	1	1	KIENLE, GEORGE S DO	1/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8454	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
266007	Fee-for-Service	1700028131	1700028131	1	1	KANI, KIMIA K MD	12/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123113	None	None	0	In state provider	None	43731 15TH ST WEST	None	LANCASTER	CA	93534	4785	19	06037	34.67731742	-118.1564784	Los Angeles County
266023	Fee-for-Service	1639272750	1639272750	1	1	KEET, ROBERT B MD	10/17/1975	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	31017	41	Internal Medicine	0	In state provider	None	9053 SOQUEL DR	None	APTOS	CA	95003	4034	44	06087	36.97568478	-121.8906978	Santa Cruz County
266036	Fee-for-Service	1992965768	1992965768	1	1	KAGAN, DAVID B MD	10/26/2010	207R00000X	NA	Other	026	PHYSICIANS	113476	None	None	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
266045	Fee-for-Service	1891718649	1891718649	1	1	KAWEAH DELTA HEALTH CARE	5/16/2002	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	623 W WILLOW AVE	None	VISALIA	CA	93291	4716	54	06107	36.328077	-119.298519	Tulare County
266051	Fee-for-Service	1275504995	1275504995	1	2	KERENDIAN, JOSEPH MD INC	9/26/1994	193400000X	NA	Other	026	PHYSICIANS	75439	18	Ophthalmology	0	In state provider	None	8641 WILSHIRE BLVD	STE 312	BEVERLY HILLS	CA	90211	2921	19	06037	34.06614972	-118.3798912	Los Angeles County
266053	Fee-for-Service	1811350473	1811350473	1	1	KHINE, ANNIKA K MD	7/1/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	150543	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
266074	Fee-for-Service	1528119435	1528119435	1	1	KRISHNAMOORTHI MD INC	3/23/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A PROFESSIONAL MEDICAL C	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	50	06099	37.66353653	-120.9564675	Stanislaus County
266089	Fee-for-Service	1053654673	1053654673	1	1	KOGER, MATTHEW B MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141952	None	None	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
266099	Fee-for-Service	1861572513	1861572513	1	1	KIM, NAM U MD	6/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81797	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
266156	Fee-for-Service	1730103748	1730103748	1	1	KIM, LEONARD D MD	11/30/1995	207L00000X	NA	Other	026	PHYSICIANS	80429	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
266166	Fee-for-Service	1104807676	1104807676	1	1	KIM, SUSAN MD	6/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87629	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
266224	Fee-for-Service	1295180222	1295180222	1	1	KATTENHORN, JORDAN S MD	7/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151618	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
266227	Fee-for-Service	1841555976	1841555976	1	1	KLEBANOV, YEVGENY MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126559	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
266245	Fee-for-Service	1700927415	1700927415	1	1	KAMEL, HESHAM MD	11/3/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150039	None	None	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
266291	Fee-for-Service	1245245703	1245245703	1	1	KENDALL MUSTON ROGERS MD	11/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
266303	Fee-for-Service	1083754170	1083754170	1	1	KITZES, ALEXANDER J PHD	11/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
266321	Fee-for-Service	1588648653	1588648653	1	1	KIMBALL, MICHAEL P MD	10/31/1992	174400000X	NA	Other	026	PHYSICIANS	76060	20	Orthopedic Surgery	0	In state provider	None	8929 UNIVERSITY CENTER L	STE 201	SAN DIEGO	CA	92122	1008	37	06073	32.87036657	-117.2263573	San Diego County
266330	Fee-for-Service	1891718649	1891718649	1	1	KAWEAH DELTA HEALTH CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	623 W WILLOW AVE	None	VISALIA	CA	93291	4716	54	06107	36.328077	-119.298519	Tulare County
266332	Fee-for-Service	1932606852	1932606852	1	1	KAGECHE, FRANCIS M	8/30/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3122 HUNTSMAN DRIVE	None	SACRAMENTO	CA	95826	4243	34	06067	38.55942	-121.3501275	Sacramento County
266360	Fee-for-Service	1528119435	1528119435	1	1	KRISHNAMOORTHI MD INC	1/16/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	A PROFESSIONAL MEDICAL C	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	50	06099	37.66353653	-120.9564675	Stanislaus County
266409	Fee-for-Service	1164895520	1164895520	1	1	KOLIN, ELLIOT S MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	60634	30	Radiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
266451	Fee-for-Service	1285637298	1285637298	1	1	KHAIRA, DIVIS K MD	2/8/2015	207RH0003X	NA	Oncology	026	PHYSICIANS	38947	41	Internal Medicine	0	In state provider	None	1940 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
266459	Fee-for-Service	1801939053	1801939053	1	1	KNIGHT, ANGELA M MFT	4/15/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	17	06033	39.03772106	-122.9223338	Lake County
266465	Fee-for-Service	1841635869	1841635869	1	1	KIME, AARON MD	2/1/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	136799	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
266535	Fee-for-Service	1144375056	1144375056	1	1	KAISER FOUNDATION HOSPITALS	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
266561	Fee-for-Service	1437179736	1437179736	1	1	KOCH, CHRISTIAN A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83415	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
266580	Fee-for-Service	1649246562	1649246562	1	1	KO, VINCENT MD	4/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97917	22	Pathology (M.D. only)	0	In state provider	None	177 RIVERSIDE AVE	None	NEWPORT BEACH	CA	92663	4120	30	06059	33.62131101	-117.9237292	Orange County
266594	Fee-for-Service	1801139068	1801139068	1	1	KIM, LYDIA R MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150150	07	Dermatology	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
266611	Fee-for-Service	1750347316	1750347316	1	1	KHORASHADI, FARHAD MD	7/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75718	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
266617	Fee-for-Service	1932606852	1932606852	1	1	KAGECHE, FRANCIS M	8/30/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3122 HUNTSMAN DRIVE	None	SACRAMENTO	CA	95826	4243	34	06067	38.55942	-121.3501275	Sacramento County
266639	Fee-for-Service	1710978713	1710978713	1	1	KOLBA, KAREN S MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	59530	83	Rheumatology	0	In state provider	None	607 PLAZA DR	STE A	SANTA MARIA	CA	93454	6945	42	06083	34.9373489	-120.4279501	Santa Barbara County
266645	Fee-for-Service	1528119435	1528119435	1	1	KRISHNAMOORTHI MD INC	5/21/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	A PROFESSIONAL MEDICAL C	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	50	06099	37.66353653	-120.9564675	Stanislaus County
266658	Fee-for-Service	1861566184	1861566184	1	1	KLEIN, JENNIFER M MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85449	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
266666	Fee-for-Service	1023186236	1023186236	1	1	KINGTON, MICHAEL LMFT	2/26/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
266714	Fee-for-Service	1124311238	1124311238	1	1	KELLER, ZAIHLEEN S MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125039	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
266716	Fee-for-Service	1366427510	1366427510	1	1	KIM, RICHARD MD	2/18/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83441	08	Family Practice	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
266721	Fee-for-Service	1003359555	1003359555	1	1	KEITH EBILANE, M.D., INC.	6/27/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	13429 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5803	19	06037	33.91025923	-118.352777	Los Angeles County
266733	Fee-for-Service	1144406273	1144406273	1	1	KUNITZ, GRETCHEN E MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	47367	41	Internal Medicine	0	In state provider	None	2621 SHADELANDS DRIVE	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
266737	Fee-for-Service	1285637298	1285637298	1	1	KHAIRA, DIVIS K MD	2/8/2015	207RH0003X	NA	Oncology	026	PHYSICIANS	38947	68	Hematology	0	In state provider	None	1940 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
266739	Fee-for-Service	1740286384	1740286384	1	1	KUETTEL, KEVIN D MD	8/24/2004	174400000X	NA	Other	026	PHYSICIANS	44004	41	Internal Medicine	0	In state provider	None	6888 LINCOLN AVE	STE K	BUENA PARK	CA	90620	4107	30	06059	33.83179254	-118.013031	Orange County
266746	Fee-for-Service	1710165303	1710165303	1	1	KARNCHANASORN, SOPHANA MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134081	41	Internal Medicine	0	In state provider	None	2710 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
266754	Fee-for-Service	1629149521	1629149521	1	1	KEWALRAMANI, C H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25579	41	Internal Medicine	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
266763	Fee-for-Service	1396759536	1396759536	1	1	KHAN, MAHMOOD A MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75616	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
266778	Fee-for-Service	1316030927	1316030927	1	1	KEMALYAN, NATHAN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	501 N GRAHAM ST	STE 555	PORTLAND	OR	97227	2007	00	None	45.54285348	-122.671035	Multnomah County
266782	Fee-for-Service	1962741132	1962741132	1	1	KORN, WILLIAM M LCSW	4/18/2016	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2001 SANTA MONICA BLVD	STE 860W	SANTA MONICA	CA	90404	2189	19	06037	34.02891163	-118.4797466	Los Angeles County
266788	Fee-for-Service	1194761486	1194761486	1	1	KASSINOVE, ANDREW S MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73936	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	0000	33	06065	33.70620698	-116.2339008	Riverside County
266804	Fee-for-Service	1871911289	1871911289	1	1	KUOY, EDWARD MD	5/5/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	139790	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
266810	Fee-for-Service	1306876123	1306876123	1	1	KHORRAMI, SHAHRAM MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111325	41	Internal Medicine	0	In state provider	None	9655 MONTE VISTA AVE	#402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
266821	Fee-for-Service	1144375056	1144375056	1	3	KAISER FOUNDATION HOSPITALS	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
266864	Fee-for-Service	1952473761	1952473761	1	1	KIRSCH, CANDACE MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	57060	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
266905	Fee-for-Service	1447605209	1447605209	1	1	KUMAR, PALAK MD	6/28/2019	390200000X	NA	Other	026	PHYSICIANS	158108	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
266932	Fee-for-Service	1952458556	1952458556	1	1	KALMAN, PHILIP B MD	7/3/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	28039	08	Family Practice	0	In state provider	None	1349 MAIN STREET	None	NEWMAN	CA	95360	1326	50	06099	37.31496518	-121.0225535	Stanislaus County
267005	Fee-for-Service	1679550123	1679550123	1	1	KULICK, DANIEL L MD	12/31/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	47622	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1300 N VERMONT AVE	# 610	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
267013	Fee-for-Service	1699789792	1699789792	1	1	KIMBER, NANCY D MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65877	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10861 CHERRY ST	SUITE 206	LOS ALAMITOS	CA	90720	5407	30	06059	33.80465174	-118.0680053	Orange County
267019	Fee-for-Service	1285637298	1285637298	1	1	KHAIRA, DIVIS K MD	2/8/2015	207RH0003X	NA	Oncology	026	PHYSICIANS	38947	78	Neoplastic Diseases/Oncology	0	In state provider	None	1940 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
267035	Fee-for-Service	1982822805	1982822805	1	1	KUMBHANI, SHILPA R MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99559	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	BOX 0648	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267036	Fee-for-Service	1982946034	1982946034	1	1	KETIKIAN, VARDANUSH MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147604	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
267064	Fee-for-Service	1831620301	1831620301	1	1	KARVONEN, KAYLA MD	1/17/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	160198	None	None	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
267103	Fee-for-Service	1346565942	1346565942	1	1	KIM SEON J MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124886	41	Internal Medicine	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
267111	Fee-for-Service	1518032226	1518032226	1	1	KAISER FOUNDATION HOSPITALS	11/4/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	01	06001	37.60846354	-122.0715526	Alameda County
267122	Fee-for-Service	1366506206	1366506206	1	1	KANG, DAVID M MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	73548	02	General Surgery	0	In state provider	None	950 STOCKTON ST	STE 388	SAN FRANCISCO	CA	94108	1618	38	06075	37.79469747	-122.4079497	San Francisco County
267127	Fee-for-Service	1023446960	1023446960	1	1	KADRY, JOSE	1/22/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
267149	Fee-for-Service	1922159086	1922159086	1	1	KRISTIN BAER-KARTCH MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 E 1ST ST	None	DULUTH	MN	55805	2107	00	None	46.79665306	-92.08754275	St. Louis County
267208	Fee-for-Service	1043366149	1043366149	1	1	KERNER, DAVID J PHD	12/12/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
267214	Fee-for-Service	1154610517	1154610517	1	1	KLEINMAN, SARA H MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135454	03	Allergy	0	In state provider	None	10833 LE CONTE AVENUE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
267255	Fee-for-Service	1306690789	1306690789	1	1	KRAFT, NICHOLE NP	7/8/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1005 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6913	38	06075	37.78499871	-122.4213851	San Francisco County
267313	Fee-for-Service	1891997011	1891997011	1	1	KO, IRIS P MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	110533	05	Anesthesiology	0	In state provider	None	900 SOUTH ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
267393	Fee-for-Service	1518032226	1518032226	1	1	KAISER FOUNDATION HOSPITALS	11/4/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	01	06001	37.60846354	-122.0715526	Alameda County
267405	Fee-for-Service	1043487317	1043487317	1	1	KELESIDIS, THEODOROS MD	4/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106957	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
267408	Fee-for-Service	1376674390	1376674390	1	1	KRUEGER, PHILIP MD	8/7/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	87975	None	None	0	In state provider	None	901 CAMPUS DR	STE 111	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
267412	Fee-for-Service	1912517707	1912517707	1	1	KIM, HEAWON OD	10/26/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
267415	Fee-for-Service	1316011612	1316011612	1	1	KAROUKIAN, ROBERT MD	12/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	71279	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
267416	Fee-for-Service	1700889532	1700889532	1	1	KENDALL, KENNETH RICHARD	12/1/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 N H ST	None	LOMPOC	CA	93436	4521	42	06083	34.64936471	-120.4577269	Santa Barbara County
267485	Fee-for-Service	1942388707	1942388707	1	1	KENIA, NEELESH J MD	10/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87969	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
267490	Fee-for-Service	1851683684	1851683684	1	1	KALBASI, ANUSHA MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143472	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE B265	LOS ANGELES	CA	90095	0001	19	06037	34.065126	-118.446237	Los Angeles County
267492	Fee-for-Service	1457986952	1457986952	1	1	KOSHLAP, KARL F NP	4/6/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
267497	Fee-for-Service	1154610517	1154610517	1	1	KLEINMAN, SARA H MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135454	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVENUE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
267518	Fee-for-Service	1336130525	1336130525	1	1	KIM, CHRISTIAN K MD	7/30/1996	207W00000X	NA	Ophthalmology	026	PHYSICIANS	83836	18	Ophthalmology	0	In state provider	None	380 TESCONI CT	None	SANTA ROSA	CA	95401	4653	49	06097	38.447631	-122.7345885	Sonoma County
267546	Fee-for-Service	1992872550	1992872550	1	1	KPADUWA, STELLA O MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56261	40	Pediatrics	0	In state provider	None	10408 VACCO ST	STE B	EL MONTE	CA	91733	3350	19	06037	34.04727908	-118.0442754	Los Angeles County
267588	Fee-for-Service	1497503130	1497503130	1	1	KSK NURSING CORPORATION	6/11/2024	261Q00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1875 W. REDONDO BEACH BL	SUITE 308	GARDENA	CA	90247	3641	19	06037	33.8879044	-118.3111113	Los Angeles County
267652	Fee-for-Service	1811145428	1811145428	1	1	KODZIC, ANA PHD	12/7/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24967	-	NOT APPLICABLE	0	In state provider	None	6500 MORRO ROAD	SUITE D	ATASCADERO	CA	93422	4142	40	06079	35.48364845	-120.6655946	San Luis Obispo County
267654	Fee-for-Service	1881267383	1881267383	1	1	KAPOYAN, GOHAR PT	11/8/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
267698	Fee-for-Service	1952575342	1952575342	1	1	KOHANZADEH, SOM MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95627	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
267763	Fee-for-Service	1144475070	1144475070	1	1	KINDER, KATHY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2640	00	None	39.08455286	-94.57578107	Jackson County
267780	Fee-for-Service	1154610517	1154610517	1	1	KLEINMAN, SARA H MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135454	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVENUE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
267806	Fee-for-Service	1104385392	1104385392	1	1	KIM, BRENDAN J MD	12/27/2022	207R00000X	NA	Other	026	PHYSICIANS	178719	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
267808	Fee-for-Service	1427342963	1427342963	1	1	KHIN, MAUNG M MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115675	41	Internal Medicine	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
267821	Fee-for-Service	1861143752	1861143752	1	1	KUO, AMY Y NP	9/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
267826	Fee-for-Service	1508408899	1508408899	1	1	KIM, EUNSUN NP	4/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
267836	Fee-for-Service	1295809572	1295809572	1	1	KIM, MICHAEL M MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84299	05	Anesthesiology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
267842	Fee-for-Service	1043849979	1043849979	1	1	KURGHINYAN, HOVHANNES MD	7/24/2023	207R00000X	NA	Other	026	PHYSICIANS	184041	None	None	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
267855	Fee-for-Service	1548605843	1548605843	1	1	KHAN, FAHAD MD	8/20/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	163142	None	None	0	In state provider	None	233 LEWIS ST	None	SAN DIEGO	CA	92103	2122	37	06073	32.75182998	-117.1624746	San Diego County
267876	Fee-for-Service	1639193303	1639193303	1	1	KHEMARA FAM MED CLNC INC	6/11/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1533 ALAMITOS AVE	None	LONG BEACH	CA	90813	2214	19	06037	33.78694633	-118.1766533	Los Angeles County
267878	Fee-for-Service	1841291408	1841291408	1	2	KANSAL, TAPEESH MD	11/14/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52158	-	NOT APPLICABLE	0	In state provider	None	81-557 DR CARREON BLVD	SUITE C-10	INDIO	CA	92201	5517	33	06065	33.70743317	-116.2302643	Riverside County
267885	Fee-for-Service	1861654881	1861654881	1	1	KANSARA, PRANAV P MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114871	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
267887	Fee-for-Service	1538629936	1538629936	1	1	KLONOFF, ALEXANDER N MD	9/15/2022	207R00000X	NA	Other	026	PHYSICIANS	177588	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
267888	Fee-for-Service	1043740194	1043740194	1	1	KAMINSKY, YANA LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
267899	Fee-for-Service	1831123447	1831123447	1	1	KLAY, LEONARD J MD	5/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8890	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3325 CHANATE ROAD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
267909	Fee-for-Service	1174870067	1174870067	1	1	KIM MCMANUS, OLIVIA S MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120194	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
267911	Fee-for-Service	1124460191	1124460191	1	1	KAISER FOUNDATION HEALTH	3/10/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN INC	5250 LANKERSHIM BLVD	FLOOR 9	NORTH HOLLYWOOD	CA	91601	3190	19	06037	34.1665161	-118.3755868	Los Angeles County
267913	Fee-for-Service	1396109914	1396109914	1	1	KANE, KEVIN MD	8/6/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	152798	10	Gastroenterology (M.D. only)	0	In state provider	None	300 FRANK H OGAWA	STE 450	OAKLAND	CA	94612	2037	01	06001	37.80542149	-122.2710615	Alameda County
267922	Fee-for-Service	1801329883	1801329883	1	1	KINASZ, KATHRYN R MD	3/25/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157456	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
267982	Fee-for-Service	1760101836	1760101836	1	1	KYURUMYAN, LILIT NP	1/28/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2701 W ALAMEDA AVE	SUITE 507	BURBANK	CA	91505	4411	19	06037	34.15751343	-118.3303715	Los Angeles County
267988	Fee-for-Service	1225666746	1225666746	1	1	KAHALIARDABILI, PEGAH MD	4/8/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	184188	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
267996	Fee-for-Service	1497764757	1497764757	1	1	KESTEN, DENISE E LCSW	6/9/2005	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	311 FOREST AVE	STE B1	PACIFIC GROVE	CA	93950	3367	27	06053	36.61923487	-121.9185555	Monterey County
268031	Fee-for-Service	1952356933	1952356933	1	1	KONG, LYNN R MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83707	68	Hematology	0	In state provider	None	1700 N ROSE AVE	STE 320	OXNARD	CA	93030	7648	56	06111	34.21746	-119.155545	Ventura County
268032	Fee-for-Service	1952542169	1952542169	1	1	KHAN, FARAZ A MD	8/1/2018	2086S0120X	NA	General Surgery	026	PHYSICIANS	156443	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
268057	Fee-for-Service	1861138505	1861138505	1	1	KOOKOOTSEDES MEDICAL PC	5/24/2022	207RR0500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	25401 CABOT RD	STE 101	LAGUNA HILLS	CA	92653	5524	30	06059	33.59334249	-117.6748702	Orange County
268059	Fee-for-Service	1508272253	1508272253	1	1	KIM, STELLA S OD	3/2/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1246 E ARROW HWY	STE A	UPLAND	CA	91786	4955	36	06071	34.09974849	-117.634842	San Bernardino County
268065	Fee-for-Service	1659508190	1659508190	1	1	KOVACH, ALEXANDRA E MD	8/10/2020	207ZP0213X	NA	Other	026	PHYSICIANS	168549	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
268066	Fee-for-Service	1174055958	1174055958	1	1	KHORFAN, KAMAL MD	6/29/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	169880	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
268069	Fee-for-Service	1477580595	1477580595	1	1	KRAUS, JAMES A MD	7/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91537	08	Family Practice	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
268074	Fee-for-Service	1639118185	1639118185	1	1	KAPLAN, DAVID J DPM	9/5/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	39 N SAN MATEO DRIVE	#4	SAN MATEO	CA	94401	2832	41	06081	37.56748642	-122.327359	San Mateo County
268085	Fee-for-Service	1578653465	1578653465	2	1	KING, BRYAN H MD	1/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	53708	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268102	Fee-for-Service	1376610303	1376610303	1	1	KHOSSOUSSI, FARHAD MD	4/30/1994	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51487	36	Psychiatry	0	In state provider	None	324 N PALM DR	UNIT 103	BEVERLY HILLS	CA	90210	4187	19	06037	34.07323886	-118.3922193	Los Angeles County
268181	Fee-for-Service	1104826114	1104826114	1	1	KARA VILLAREAL M.D.	12/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3815 E BELL RD	STE 2200	PHOENIX	AZ	85032	2139	00	None	33.638571	-111.9990015	Maricopa County
268212	Fee-for-Service	1376952812	1376952812	1	1	KWOK, JAMES W DO	4/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14929	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
268236	Fee-for-Service	1881887636	1881887636	1	1	KASSIS, LISA LMFT	2/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9 SILMARK COURT	None	SACRAMENTO	CA	95831	4823	34	06067	38.484639	-121.546737	Sacramento County
268259	Fee-for-Service	1073128666	1073128666	1	1	KARATHI, CHRISTINE N	10/9/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2877 S BUENA VISTA AVE	None	CORONA	CA	92882	7541	33	06065	33.84794632	-117.582007	Riverside County
268314	Fee-for-Service	1952356933	1952356933	1	1	KONG, LYNN R MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83707	78	Neoplastic Diseases/Oncology	0	In state provider	None	1700 N ROSE AVE	STE 320	OXNARD	CA	93030	7648	56	06111	34.21746	-119.155545	Ventura County
268316	Fee-for-Service	1952542169	1952542169	1	1	KHAN, FARAZ A MD	8/1/2018	2086S0120X	NA	General Surgery	026	PHYSICIANS	156443	85	Surgery-Pediatric	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
268355	Fee-for-Service	1235217118	1235217118	1	1	KENNEY, SEAN P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	575 S 70TH ST	STE 405	LINCOLN	NE	68510	2471	00	None	40.808151	-96.62516802	Lancaster County
268367	Fee-for-Service	1578653465	1578653465	2	1	KING, BRYAN H MD	1/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	53708	26	Psychiatry (child)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268374	Fee-for-Service	1710035613	1710035613	1	1	KUTSUNIS, ANGELA D DO	3/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6079	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	STE 360	LA MESA	CA	91942	6103	37	06073	32.78442148	-117.0073814	San Diego County
268398	Fee-for-Service	1992882955	1992882955	1	1	KNAPIK, STEVEN M	6/1/2001	207R00000X	NA	Other	026	PHYSICIANS	63020	None	None	0	In state provider	CARE DISTRICT	42002 FOX FARM RD	None	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24855001	-116.8860153	San Bernardino County
268415	Fee-for-Service	1609194612	1609194612	1	2	KAUFMAN, JOHN D MD INC	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	35644	None	None	0	In state provider	None	23861 MCBEAN PKWY	STE E30	VALENCIA	CA	91355	2077	19	06037	34.39567343	-118.5542698	Los Angeles County
268419	Fee-for-Service	1174130942	1174130942	1	1	KAWEAH DELTA HEALTH CARE	4/30/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1000 N MOONEY BLVD	None	TULARE	CA	93274	2417	54	06107	36.22495061	-119.312829	Tulare County
268465	Fee-for-Service	1851852446	1851852446	1	1	KHURANA, NEHARIKA MD	12/19/2022	207R00000X	NA	Other	026	PHYSICIANS	180621	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
268483	Fee-for-Service	1366902405	1366902405	1	1	KEHAL, GURSIMRAN S MD	10/31/2022	390200000X	NA	Other	026	PHYSICIANS	19794	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
268494	Fee-for-Service	1508271701	1508271701	1	1	KOCA, EMRE	8/15/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
268504	Fee-for-Service	1811958408	1811958408	1	1	KRENENBERGER, BRETT	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S CLARK STREET	None	BUTTE	MT	94160	0000	00	None	46.00840837	-112.5461616	Silver Bow County
268522	Fee-for-Service	1235719501	1235719501	1	1	KRAGEL, EMILY	6/28/2024	390200000X	NA	Other	026	PHYSICIANS	191138	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
268542	Fee-for-Service	1073128666	1073128666	1	1	KARATHI, CHRISTINE N	10/9/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2877 S BUENA VISTA AVE	None	CORONA	CA	92882	7541	33	06065	33.84794632	-117.582007	Riverside County
268591	Fee-for-Service	1356908602	1356908602	1	1	KAUR, AVNEET DPM	2/22/2024	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
268598	Fee-for-Service	1952356933	1952356933	1	1	KONG, LYNN R MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83707	41	Internal Medicine	0	In state provider	None	1700 N ROSE AVE	STE 320	OXNARD	CA	93030	7648	56	06111	34.21746	-119.155545	Ventura County
268618	Fee-for-Service	1841229655	1841229655	1	1	KAMEL, NAWAL N F MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34963	40	Pediatrics	0	In state provider	None	7400 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	3011	34	06067	38.700774	-121.271373	Sacramento County
268640	Fee-for-Service	1730384546	1730384546	1	1	KWOK, SCOTT H MD	7/11/2011	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	100601	30	Radiology	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
268679	Fee-for-Service	1316354475	1316354475	1	1	KIRK, MICHAEL E PHD	6/2/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
268701	Fee-for-Service	1174592547	1174592547	1	1	KHAN, NASSER U MD	7/12/2005	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51938	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5945 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0610	15	06029	35.36322921	-119.0706029	Kern County
268704	Fee-for-Service	1174130942	1174130942	1	1	KAWEAH DELTA HEALTH CARE	4/30/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1000 N MOONEY BLVD	None	TULARE	CA	93274	2417	54	06107	36.22495061	-119.312829	Tulare County
268780	Fee-for-Service	1568568889	1568568889	1	1	KIHICZAK, NAKIA I MD	11/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88216	07	Dermatology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
268787	Fee-for-Service	1992332878	1992332878	1	1	KIM, SURIN A MD	8/31/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183209	None	None	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
268837	Fee-for-Service	1740007202	1740007202	1	1	KLIEBE, NOELLE	10/23/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	04	06007	0	0	None
268843	Fee-for-Service	1588742167	1588742167	1	1	KAMAL, NASIR MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75990	08	Family Practice	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
268863	Fee-for-Service	1811433055	1811433055	1	1	KUHL, STACY A NP	11/26/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
268885	Fee-for-Service	1619080520	1619080520	1	1	KATHLEEN S GOETZ,MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	747 BROADWAY	None	SEATTLE	WA	98122	4379	00	None	47.608326	-122.3207985	King County
268895	Fee-for-Service	1609212273	1609212273	1	1	KARAMZADEH DASHTI, NOOSHIN	6/29/2021	207ZP0102X	NA	Other	026	PHYSICIANS	171555	None	None	0	In state provider	MD	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
268900	Fee-for-Service	1841229655	1841229655	1	1	KAMEL, NAWAL N F MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34963	01	General Practice	0	In state provider	None	7400 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	3011	34	06067	38.700774	-121.271373	Sacramento County
268925	Fee-for-Service	1669825667	1669825667	1	1	KOO, ANITA	11/2/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	835 THIRD AVE	SUITE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
268956	Fee-for-Service	1720160179	1720160179	1	1	KOLLA, RAJASEKHAR MD	10/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169363	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
269012	Fee-for-Service	1164466488	1164466488	1	1	KOLBERG, GORDON I BCO	1/1/1979	335E00000X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	9663 TIERRA GRANDE ST	STE 201	SAN DIEGO	CA	92126	4570	37	06073	32.89501952	-117.1213425	San Diego County
269048	Fee-for-Service	1487929857	1487929857	1	2	KENIGSBERG, DEBORAH M PSYD	6/19/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30200 AGOURA RD	SUITE 190	AGOURA HILLS	CA	91301	5434	19	06037	34.14513267	-118.7821377	Los Angeles County
269054	Fee-for-Service	1083796601	1083796601	1	1	KONG, SHANNON L CCC-SLP	6/7/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 GREGORY LANE	SUITE 280	PLEASANT HILL	CA	94523	3339	07	06013	37.94794183	-122.0649162	Contra Costa County
269091	Fee-for-Service	1235200098	1235200098	1	1	KIM, JANE J MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51620	67	Endocrinology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
269095	Fee-for-Service	1598127912	1598127912	1	1	KEPHART, DONALD MD	9/11/2023	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	152566	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
269101	Fee-for-Service	1467751685	1467751685	1	1	KAPLAN, JONATHAN R M MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116333	20	Orthopedic Surgery	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
269111	Fee-for-Service	1902573322	1902573322	1	1	KRIVICKAS, DYLAN M PT	10/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25136 HANCOCK AVE	STE A	MURRIETA	CA	92562	5944	33	06065	33.56788654	-117.1824198	Riverside County
269124	Fee-for-Service	1780732701	1780732701	1	1	KLARISTENFELD, DANIEL D	5/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93651	02	General Surgery	0	In state provider	MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
269169	Fee-for-Service	1912079666	1912079666	1	1	KATO, JAN P MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80921	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
269204	Fee-for-Service	1851485056	1851485056	1	1	KIM, KEVIN B MD	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129039	78	Neoplastic Diseases/Oncology	0	In state provider	None	2100 WEBSTER STREET	SUITE 326	SAN FRANCISCO	CA	94115	2378	38	06075	37.7904826	-122.4324477	San Francisco County
269208	Fee-for-Service	1538425772	1538425772	1	1	KEITH, ASHEENA L MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141551	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
269216	Fee-for-Service	1811920242	1811920242	1	1	KHEMICHIAN, SARO MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90035	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
269241	Fee-for-Service	1801946629	1801946629	1	1	KELVIN, MARJORIE MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76587	08	Family Practice	0	In state provider	None	16319 THIRD ST	None	GUERNEVILLE	CA	95446	0000	49	06097	38.50256994	-122.9992051	Sonoma County
269286	Fee-for-Service	1902817711	1902817711	1	1	KRAMER, KATHLEEN E MD	6/1/1999	207N00000X	NA	Dermatology	026	PHYSICIANS	68951	07	Dermatology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
269293	Fee-for-Service	1407914575	1407914575	1	1	KUBLER, PETRA H	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
269319	Fee-for-Service	1134375330	1134375330	1	1	KOSTYK, AMANDA G MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110212	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
269347	Fee-for-Service	1558449165	1558449165	1	1	KEY, LISA M MD	11/20/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83475	41	Internal Medicine	0	In state provider	None	2001 UNION ST	STE 300	SAN FRANCISCO	CA	94123	4108	38	06075	37.7974427	-122.432532	San Francisco County
269369	Fee-for-Service	1235200098	1235200098	1	1	KIM, JANE J MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51620	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
269375	Fee-for-Service	1639336043	1639336043	1	1	KIM, PAUL D MD	9/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111653	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO RD	STE 308	SAN DIEGO	CA	92120	5268	37	06073	32.77684978	-117.055137	San Diego County
269401	Fee-for-Service	1487612560	1487612560	1	1	KHONSARI, FERAIDOUN MD	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	31098	34	Urology and Urological Surgery	0	In state provider	None	1140 W LA VETA AVE	STE 500	ORANGE	CA	92868	4227	30	06059	33.7802984	-117.8651669	Orange County
269439	Fee-for-Service	1194741272	1194741272	1	1	KANG, DAE-WOOK	5/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79486	41	Internal Medicine	0	In state provider	None	2066 CLARMAR WAY	STE B	SAN JOSE	CA	95128	1715	43	06085	37.32626867	-121.9353305	Santa Clara County
269485	Fee-for-Service	1891072906	1891072906	1	1	KANETA, RACHEL K OD	12/3/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	38039 MARTHA AVE	STE 200	FREMONT	CA	94536	3815	01	06001	37.56067484	-121.992217	Alameda County
269493	Fee-for-Service	1487061834	1487061834	1	1	KHAN, ABDULLAH MD	6/19/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	148163	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
269508	Fee-for-Service	1881688380	1881688380	1	1	KLINE, LYNETTE OD	6/6/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	510 CYPRESS ST	STE A	FORT BRAGG	CA	95437	5411	23	06045	39.43260152	-123.798942	Mendocino County
269511	Fee-for-Service	1861180705	1861180705	1	1	KARANJA, LEAH WANJIKU	7/21/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	664 DAPHNE LN	None	LEMOORE	CA	93245	4930	16	06031	36.30496479	-119.7677959	Kings County
269538	Fee-for-Service	1124256383	1124256383	1	1	KHAN, MUBEEN M MD	8/25/2019	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
269541	Fee-for-Service	1801957386	1801957386	1	1	KAMIN, JOSHUA M	4/30/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9702 VENICE BLVD	STE A	CULVER CITY	CA	90232	2717	19	06037	34.02421719	-118.3970702	Los Angeles County
269549	Fee-for-Service	1518227057	1518227057	1	1	KUMBUM-8 INC	7/19/2016	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1024 N SEPULVEDA BLVD	None	LOS ANGELES	CA	90049	2105	19	06037	34.0821023	-118.4734395	Los Angeles County
269580	Fee-for-Service	1689664492	1689664492	1	1	KEEFFE, BRIAN G MD	4/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69588	41	Internal Medicine	0	In state provider	None	2 BON AIR RD	STE 200	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
269626	Fee-for-Service	1952577728	1952577728	1	1	KIND AND TOTAL HEALTH SYSTEM	7/29/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	71751	01	General Practice	0	In state provider	INC	409 W MAIN STREET	None	ALHAMBRA	CA	91801	3433	19	06037	34.0930305	-118.1314728	Los Angeles County
269681	Fee-for-Service	1720018575	1720018575	1	1	KEH, HAN J OD	4/17/2008	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2690 EAST BIDWELL ST	STE 500	FOLSOM	CA	95630	6432	34	06067	38.657646	-121.1251905	Sacramento County
269717	Fee-for-Service	1114991106	1114991106	1	1	KULIYEV, FUAD MD	8/27/2012	207R00000X	NA	Other	026	PHYSICIANS	74368	41	Internal Medicine	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
269730	Fee-for-Service	1598852816	1598852816	1	1	KIM, PAUL HANSU	9/7/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 W 6TH ST	STE 101	CORONA	CA	92882	6508	33	06065	33.87811444	-117.5920508	Riverside County
269744	Fee-for-Service	1194566166	1194566166	1	1	KYELULA, AIDA SAIDI	6/25/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	629 CARDIFF	None	IRVINE	CA	92606	0879	30	06059	33.68861335	-117.8056804	Orange County
269752	Fee-for-Service	1154340099	1154340099	1	1	KENDALL, CAROL A CNP	5/10/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
269771	Fee-for-Service	1487061834	1487061834	1	1	KHAN, ABDULLAH MD	6/19/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	148163	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
269778	Fee-for-Service	1740766633	1740766633	1	1	KHAZAEI, ELHAM	2/13/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
269790	Fee-for-Service	1861180705	1861180705	1	1	KARANJA, LEAH WANJIKU	7/21/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	664 DAPHNE LN	None	LEMOORE	CA	93245	4930	16	06031	36.30496479	-119.7677959	Kings County
269856	Fee-for-Service	1922551936	1922551936	1	1	KRUSE, CARYN L LPCC	7/26/2019	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	521 W CITRUS AVE	None	REDLANDS	CA	92373	4625	36	06071	34.0560682	-117.1887598	San Bernardino County
269916	Fee-for-Service	1316918857	1316918857	1	1	KNEIBLER, BONNIE MD	10/31/1984	207P00000X	NA	Other	026	PHYSICIANS	50636	08	Family Practice	0	In state provider	None	3201 DEL PASO BLVD	None	SACRAMENTO	CA	95815	1505	34	06067	38.626893	-121.4264385	Sacramento County
269954	Fee-for-Service	1255953568	1255953568	1	1	KNAYSI, ASHLEY A CNP	9/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	511 N HOLLYWOOD WAY	None	BURBANK	CA	91505	3406	19	06037	34.15985598	-118.3431272	Los Angeles County
269962	Fee-for-Service	1841291408	1841291408	1	1	KANSAL, TAPEESH MD	1/23/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	52158	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
270012	Fee-for-Service	1669955712	1669955712	1	1	KIERNAN, HEIDI LMFT	5/1/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
270014	Fee-for-Service	1205296621	1205296621	1	1	KULAWIK, CALLIE M PSYD	4/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
270025	Fee-for-Service	1194566166	1194566166	1	1	KYELULA, AIDA SAIDI	6/25/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	629 CARDIFF	None	IRVINE	CA	92606	0879	30	06059	33.68861335	-117.8056804	Orange County
270044	Fee-for-Service	1245241934	1245241934	1	1	KAHN, JEFFERY S MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	69772	36	Psychiatry	0	In state provider	None	9201 BIG HORN BLVD	SUITE 160	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
270046	Fee-for-Service	1427106236	1427106236	1	1	KANG, JIMMY Y MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	75273	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
270055	Fee-for-Service	1386177533	1386177533	1	1	KHOSHREZA, HALEH MD	1/19/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175701	None	None	0	In state provider	None	26538 MOULTON PARKWAY	SUITE 38E	LAGUNA HILLS	CA	92653	8232	30	06059	33.57744684	-117.702553	Orange County
270148	Fee-for-Service	1194917534	1194917534	1	1	KRANSDORF, EVAN P MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116087	41	Internal Medicine	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3103	19	06037	34.06550726	-118.3775199	Los Angeles County
270159	Fee-for-Service	1740675271	1740675271	1	1	KATO, NICOLE M DO	1/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	235 W 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
270208	Fee-for-Service	1184299109	1184299109	1	1	KANDOLA, MICHAEL NP	1/16/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	50	06099	37.66353653	-120.9564675	Stanislaus County
270213	Fee-for-Service	1104881481	1104881481	1	1	KORBER, TIMOTHY E MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58497	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
270264	Fee-for-Service	1285843979	1285843979	1	1	KANJANAUTHAI, SOMSUPHA MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	103083	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
270290	Fee-for-Service	1326138009	1326138009	1	1	KOSNETT, MICHAEL J MD	3/31/1989	207R00000X	NA	Other	026	PHYSICIANS	61812	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
270294	Fee-for-Service	1093941171	1093941171	1	1	KABOLIZADEH, PEYMAN MD	8/17/2020	2085R0001X	NA	Other	026	PHYSICIANS	152224	32	Radiation Therapy (D.O. only)	0	In state provider	None	18111 BROOKHURST ST	LL0300	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
270323	Fee-for-Service	1427106236	1427106236	1	1	KANG, JIMMY Y MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	75273	10	Gastroenterology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
270340	Fee-for-Service	1356683049	1356683049	1	1	KUYKENDALL, DAVID G MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2410 FIRE MESA STREET	180	LAS VEGAS	NV	89128	9017	00	None	36.20533596	-115.2575074	Clark County
270349	Fee-for-Service	1730232372	1730232372	1	1	KANTOR, PHYLLIS B CRNA	1/1/2003	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
270409	Fee-for-Service	1851444384	1851444384	1	1	KIM, ROBERT P MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73505	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
270500	Fee-for-Service	1811331473	1811331473	1	1	KUEI, JENNIFER K MD	8/5/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150288	40	Pediatrics	0	In state provider	None	210 N GARFIELD AVE	SUITE 316	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
270518	Fee-for-Service	1467028373	1467028373	1	1	KAHANA, ANNE M CNP	3/9/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26891 ALISO CREEK RD	None	ALISO VIEJO	CA	92656	3392	30	06059	33.5723715	-117.7235968	Orange County
270543	Fee-for-Service	1285843979	1285843979	1	1	KANJANAUTHAI, SOMSUPHA MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	103083	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
270561	Fee-for-Service	1861810145	1861810145	1	1	KHAN, SUHAIL MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128672	01	General Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
270655	Fee-for-Service	1144375056	1144375056	1	4	KAISER FOUNDATION HOSPITALS	8/23/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3440 EAST LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.852105	-117.8444835	Orange County
270656	Fee-for-Service	1871757211	1871757211	1	1	KNECHEL, NANCY A NP	6/9/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
270667	Fee-for-Service	1275105413	1275105413	1	1	KAMMES, REBECCA R LMFT	9/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
270697	Fee-for-Service	1235225558	1235225558	1	1	KELLER, JON L	10/18/2010	207ZP0102X	NA	Other	026	PHYSICIANS	88732	70	Clinic (mixed specialty)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95602	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
270700	Fee-for-Service	1285884106	1285884106	1	1	KOSSLER, ANDREA L MD	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121372	18	Ophthalmology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
270766	Fee-for-Service	1780096644	1780096644	1	1	KEFFLER-ROA, NICHELE D	9/26/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
270814	Fee-for-Service	1811984446	1811984446	1	1	KASHINO, DEAN SHOJI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35500	08	Family Practice	0	In state provider	None	1667 DOMINICAN WAY	STE 134	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
270932	Fee-for-Service	1144375056	1144375056	1	4	KAISER FOUNDATION HOSPITALS	8/23/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3440 EAST LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.852105	-117.8444835	Orange County
270975	Fee-for-Service	1235225558	1235225558	1	1	KELLER, JON L	10/18/2010	207ZP0102X	NA	Other	026	PHYSICIANS	88732	22	Pathology (M.D. only)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95602	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
270984	Fee-for-Service	1578891628	1578891628	1	1	KIM, SUNGHEE NP	2/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
271045	Fee-for-Service	1801891734	1801891734	1	1	KIM, DONALD D MD	9/30/1991	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	58622	20	Orthopedic Surgery	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
271072	Fee-for-Service	1346485919	1346485919	1	1	KARANDISH, KAVEH MD	12/21/2021	207R00000X	NA	Other	026	PHYSICIANS	168905	None	None	0	In state provider	None	5350 MADISON AVENUE	None	SACRAMENTO	CA	95841	3169	34	06067	38.66031	-121.339125	Sacramento County
271098	Fee-for-Service	1902826480	1902826480	1	1	KARIM, HALIMA A MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92522	13	Neurology (M.D. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
271140	Fee-for-Service	1881018398	1881018398	1	1	KATAN, RAMSEY OD INC	5/20/2014	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	28401 DATE PALM DR	UNIT B	CATHEDRAL CITY	CA	92234	4908	33	06065	33.84161603	-116.4584599	Riverside County
271146	Fee-for-Service	1205074929	1205074929	1	1	KANG, ELIZABETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4214 E SOUTHCROSS BLVD	None	SAN ANTONIO	TX	78222	3723	00	None	29.37474943	-98.41185093	Bexar County
271166	Fee-for-Service	1225594781	1225594781	1	1	KASTEN, JULIE A LMFT	6/10/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
271173	Fee-for-Service	1134299522	1134299522	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN FRANCISCO	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
271182	Fee-for-Service	1831396936	1831396936	1	1	KHANNA, KAJAL MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99313	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
271186	Fee-for-Service	1588731434	1588731434	1	1	KOE, KWOCK K MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	48894	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
271202	Fee-for-Service	1316231954	1316231954	1	2	KUCHARSKI, JACLYN D MD	2/14/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	124877	01	General Practice	0	In state provider	None	204 EAST BEACH STREET	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
271252	Fee-for-Service	1235225558	1235225558	1	1	KELLER, JON L	10/18/2010	207ZP0102X	NA	Other	026	PHYSICIANS	88732	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95602	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
271280	Fee-for-Service	1700175684	1700175684	1	1	KANG, YUNA MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125579	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
271334	Fee-for-Service	1174083547	1174083547	1	1	KALRA, AMIT DO	9/28/2023	207RS0012X	NA	Other	026	PHYSICIANS	21147	None	None	0	In state provider	None	1801 E MARCH LN	STE C310	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
271360	Fee-for-Service	1346583556	1346583556	1	1	KIM, JOYCE	1/30/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVENUE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
271368	Fee-for-Service	1750565529	1750565529	1	1	KRUPITSKAYA, YELENA MD	5/25/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	95966	68	Hematology	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
271375	Fee-for-Service	1962877977	1962877977	1	1	KAPLAN, INES NP	10/10/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
271385	Fee-for-Service	1972596120	1972596120	1	1	KIM, CATHERINE C MD	8/10/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55929	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2876 SYCAMORE DR	STE 200	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
271400	Fee-for-Service	1861662314	1861662314	1	1	KENSINGER, NESTOR L LMFT	3/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
271411	Fee-for-Service	1831115054	1831115054	1	1	KESHEN, TAMIR H MD	11/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87958	None	None	0	In state provider	None	2403 CASTILLO ST	STE 202	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
271426	Fee-for-Service	1205813532	1205813532	1	1	KALISETTI, DAMAYANTHI MD	4/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87495	41	Internal Medicine	0	In state provider	None	1258 CONCANNON BLVD	None	LIVERMORE	CA	94550	6002	01	06001	37.6609605	-121.7789055	Alameda County
271468	Fee-for-Service	1922568542	1922568542	1	1	KEEFE, KATHERINE MD	7/15/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
271544	Fee-for-Service	1013027390	1013027390	1	1	KOHTZ, JANET E OD	9/22/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6700 INDIANA AVENUE	SUITE 155	RIVERSIDE	CA	92506	4225	33	06065	33.94397483	-117.3905469	Riverside County
271570	Fee-for-Service	1033683719	1033683719	1	1	KEARNS, MARK J MD	4/3/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	158916	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
271599	Fee-for-Service	1982116026	1982116026	2	1	KIRKMAN, LALITA P LAC	8/30/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1780 FREMONT BLVD	#C	SEASIDE	CA	93955	3629	27	06053	36.61486798	-121.8425401	Monterey County
271624	Fee-for-Service	1922183045	1922183045	1	1	KIDNEY INSTITUTE AT	3/25/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	EISENHOWER MEDICAL CTR	39000 BOB HOPE DR	# 103	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
271630	Fee-for-Service	1497999502	1497999502	1	1	KHIN, MAY M MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107700	41	Internal Medicine	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
271631	Fee-for-Service	1184883415	1184883415	1	1	KANSAL, NAMITA G	2/8/2015	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	100883	None	None	0	In state provider	None	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
271644	Fee-for-Service	1750565529	1750565529	1	1	KRUPITSKAYA, YELENA MD	5/25/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	95966	78	Neoplastic Diseases/Oncology	0	In state provider	None	2571 PARK AVE	None	CONCORD	CA	94520	1901	07	06013	37.98410885	-122.0337521	Contra Costa County
271677	Fee-for-Service	1609924406	1609924406	1	1	KULIEV, EMIN MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69382	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
271711	Fee-for-Service	1780086397	1780086397	1	1	KOH MEDICAL INC	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117951	01	General Practice	0	In state provider	None	350 HAWTHORNE AVE	STE G116	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
271736	Fee-for-Service	1538523030	1538523030	1	1	KHOSRAVI, ARYA MD	11/1/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	156085	None	None	0	In state provider	None	1595 SOQUEL DR	STE 411	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
271741	Fee-for-Service	1245534528	1245534528	1	1	KUMAR, KARAN R MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126765	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
271750	Fee-for-Service	1154092757	1154092757	1	1	KIM, KEVIN	11/4/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	15758 LA FORGE ST	None	WHITTIER	CA	90603	2334	19	06037	33.94071657	-117.9935592	Los Angeles County
271809	Fee-for-Service	1437698065	1437698065	1	1	KAGOMA, YOAN Y MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147534	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271913	Fee-for-Service	1063676815	1063676815	1	1	KIM-RYUJIN, JUNE	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
271927	Fee-for-Service	1548646425	1548646425	1	1	KEMPER, JOSHUA L CRNA	4/27/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
271960	Fee-for-Service	1386982239	1386982239	1	2	KLONCZ, NICOLE M LMFT	9/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
271973	Fee-for-Service	1275529422	1275529422	1	1	KUENSTLE, DAVID C MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75742	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
271974	Fee-for-Service	1063590974	1063590974	1	1	KUMAR, VINOD MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74137	41	Internal Medicine	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
272026	Fee-for-Service	1881978682	1881978682	1	1	KHALSA, SUKH DEV SINGH NP	9/14/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
272038	Fee-for-Service	1811738974	1811738974	1	1	KAUR, PAWANJOT OD	6/27/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1575 B STREET	None	HAYWARD	CA	94541	3017	01	06001	37.67905755	-122.072805	Alameda County
272059	Fee-for-Service	1144558453	1144558453	1	1	KIANG, YIH-TING T OD	5/16/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	138 N MILPITAS BLVD	None	MILPITAS	CA	95035	4401	43	06085	37.43348259	-121.8999829	Santa Clara County
272062	Fee-for-Service	1962628933	1962628933	1	1	KING, CARL L PHD	8/31/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 BARRINGTON	STE 204	LOS ANGELES	CA	90025	5363	19	06037	34.03672191	-118.4500156	Los Angeles County
272103	Fee-for-Service	1245905918	1245905918	1	1	KNOWLES, KELLY PT	3/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
272153	Fee-for-Service	1528009305	1528009305	1	1	KHOURY, JULIE A	5/28/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1820 MARRON RD	STE 102	CARLSBAD	CA	92008	1177	37	06073	33.17711559	-117.3396763	San Diego County
272198	Fee-for-Service	1093979866	1093979866	1	1	KIM, JINAH MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104414	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
272247	Fee-for-Service	1275529422	1275529422	1	1	KUENSTLE, DAVID C MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75742	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
272294	Fee-for-Service	1548279029	1548279029	1	1	KATZMAN, TODD H MD	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	56022	20	Orthopedic Surgery	0	In state provider	None	1532 BROOKHOLLOW DR	STE B	SANTA ANA	CA	92705	5440	30	06059	33.71523255	-117.8484005	Orange County
272307	Fee-for-Service	1992729008	1992729008	1	1	KAUFMAN, JENNIFER L MD	11/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	72303	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
272313	Fee-for-Service	1811335607	1811335607	1	1	KALLEPALLI, ANITA MD	12/26/2017	208M00000X	NA	Other	026	PHYSICIANS	150289	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
272362	Fee-for-Service	1194727305	1194727305	1	1	KHALIFE ROUILLARD, NORMA PT	11/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8790 CUYAMACA ST.	SUITE A	SANTEE	CA	92071	4295	37	06073	32.83583009	-116.9839098	San Diego County
272425	Fee-for-Service	1538504360	1538504360	1	1	KIMBERLY NICHELSON	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5321 MEADOW LANE CT	None	SHEFFIELD VLG	OH	44035	0600	00	None	41.42060545	-82.0741365	Lorain County
272441	Fee-for-Service	1568546620	1568546620	1	1	KRYSTAL, ANDREW D MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143390	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
272448	Fee-for-Service	1760989636	1760989636	1	1	KHAMMAHAVONG, GARY MD	1/1/2022	207P00000X	NA	Other	026	PHYSICIANS	175022	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
272453	Fee-for-Service	1780820795	1780820795	1	1	KODURU, SUNAINA MD	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99558	41	Internal Medicine	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6253	07	06013	37.98252	-121.8030615	Contra Costa County
272471	Fee-for-Service	1467638395	1467638395	1	1	KVM MEDICAL SUPPLY INC	5/5/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	KVM MEDICAL SUPPLY INC	11026 VICTORY BLVD	SUITE A	NORTH HOLLYWOOD	CA	91606	3720	19	06037	34.18666655	-118.3713525	Los Angeles County
272474	Fee-for-Service	1861856338	1861856338	1	1	KENNEDY, VANESSA E MD	9/23/2022	207RH0000X	NA	Hematology	026	PHYSICIANS	150948	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
272484	Fee-for-Service	1649376823	1649376823	1	1	KOO, EDWARD Y MD	1/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	75721	01	General Practice	0	In state provider	None	1001 SNEATH LN	STE 206	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
272503	Fee-for-Service	1518296888	1518296888	1	1	KANKA, KRISTIN C DO	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10440	02	General Surgery	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
272508	Fee-for-Service	1811905227	1811905227	1	1	KEELEN, GREGORY M DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1441 N BECKLEY AVE	None	DALLAS	TX	75203	1201	00	None	32.76063	-96.8257485	Dallas County
272513	Fee-for-Service	1881282002	1881282002	1	2	KYRA CARE INC	1/7/2021	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4448 EAGLE ROCK BLVD	G	LOS ANGELES	CA	90041	3512	19	06037	34.12550387	-118.2193928	Los Angeles County
272517	Fee-for-Service	1275529422	1275529422	1	1	KUENSTLE, DAVID C MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75742	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
272527	Fee-for-Service	1144426636	1144426636	1	1	KNOPICK, CHRISTOPHER R MD	10/11/2010	208800000X	NA	Other	026	PHYSICIANS	112242	34	Urology and Urological Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
272562	Fee-for-Service	1992872691	1992872691	1	1	KEDDINGTON, JOAN OD	5/30/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1615 E PLAZA BLVD	STE 101	NATIONAL CITY	CA	91950	3771	37	06073	32.67670551	-117.0885584	San Diego County
272574	Fee-for-Service	1902013741	1902013741	1	1	KIM, SANG JO LAC	3/2/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	12402 INDUSTRIAL BLVD	SUITE B2	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
272575	Fee-for-Service	1154958981	1154958981	1	1	KOTSYUBKO, NICHOLAS MD	6/11/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	185004	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
272577	Fee-for-Service	1568404200	1568404200	1	1	KOKKALERA, UTHAIAH P MD	8/19/2008	208600000X	NA	General Surgery	026	PHYSICIANS	100600	02	General Surgery	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
272589	Fee-for-Service	1497018410	1497018410	1	1	KHAN, AHMED F MD	6/3/2019	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	161223	08	Family Practice	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
272617	Fee-for-Service	1659943249	1659943249	1	1	KATSURA, YANA LMFT	6/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	970 CAMERADO DRIVE	SUITE #200	CAMERON PARK	CA	95682	7769	09	06017	38.68796248	-120.9882223	El Dorado County
272631	Fee-for-Service	1104844703	1104844703	1	1	KRISHNAN, ANAND MD	10/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87885	34	Urology and Urological Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
272644	Fee-for-Service	1518264647	1518264647	1	1	KANG, DANIEL MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119615	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	90054	0559	30	06059	33.78674051	-117.8888713	Orange County
272708	Fee-for-Service	1649255845	1649255845	1	1	KOCH, ROBERT B MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134952	20	Orthopedic Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
272709	Fee-for-Service	1568546620	1568546620	1	1	KRYSTAL, ANDREW D MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143390	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
272714	Fee-for-Service	1124803374	1124803374	1	1	KYTE, ERIKA	4/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
272721	Fee-for-Service	1477608271	1477608271	1	3	KAISER FOUNDATION HOSP	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	BALDWIN PARK	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
272754	Fee-for-Service	1861544090	1861544090	1	1	KWONG, JAN MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88218	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
272773	Fee-for-Service	1003863069	1003863069	1	1	KIM, YOUNG S MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68660	22	Pathology (M.D. only)	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
272780	Fee-for-Service	1306861950	1306861950	1	1	KIPPS, THOMAS J MD	1/1/1982	207RH0003X	NA	Oncology	026	PHYSICIANS	43229	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
272785	Fee-for-Service	1447394812	1447394812	1	1	KHAN, SHAHID O MD	3/28/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	51486	-	NOT APPLICABLE	0	In state provider	None	44900 N 60TH ST W	None	LANCASTER	CA	93536	7618	19	06037	34.6976943	-118.2365888	Los Angeles County
272787	Fee-for-Service	1356704522	1356704522	1	1	KHAN, AMEERA K MD	1/26/2021	208M00000X	NA	Other	026	PHYSICIANS	163328	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
272799	Fee-for-Service	1306435805	1306435805	1	1	KANEKO, NAOKI MD	2/25/2021	2085R0204X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
272821	Fee-for-Service	1427256403	1427256403	1	1	KIRBY, ERIC OT	3/31/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
272865	Fee-for-Service	1184826372	1184826372	1	1	KING, KARA O MD	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113131	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
272888	Fee-for-Service	1801149018	1801149018	1	1	KO, YOHAN LAC	5/2/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	222 N MOUNTAIN AVE STE 1	None	UPLAND	CA	91786	5733	36	06071	34.096401	-117.6700615	San Bernardino County
272913	Fee-for-Service	1538245550	1538245550	1	1	KALES, HELEN C MD	1/15/2020	2084P0805X	NA	Psychiatry	026	PHYSICIANS	162483	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
272916	Fee-for-Service	1730197955	1730197955	1	1	KELLY, ALBERT M DO	7/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8453	05	Anesthesiology	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
272918	Fee-for-Service	1336567031	1336567031	1	1	KALLINI, JOSEPH MD	4/9/2020	111NR0200X	NA	Other	026	PHYSICIANS	149472	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
272929	Fee-for-Service	1124035266	1124035266	1	1	KEMPERT, PAMELA MD	5/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	35851	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
272962	Fee-for-Service	1770593014	1770593014	1	1	KENNETH C BALL M.D.	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 N STATE ST	None	JACKSON	MS	39216	4500	00	None	32.33121732	-90.17553957	Hinds County
272969	Fee-for-Service	1780795476	1780795476	1	1	KELLAWON, JOYCE P MD	5/26/2020	207R00000X	NA	Other	026	PHYSICIANS	54522	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
272971	Fee-for-Service	1205922093	1205922093	1	1	KRAM, JERROLD A MD	1/25/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	21316	29	Pulmonary Diseases (M.D. only)	0	In state provider	PERALTA HOSP	430 WILLOW ST	None	ALAMEDA	CA	94501	6130	01	06001	37.75883085	-122.255467	Alameda County
272972	Fee-for-Service	1629262258	1629262258	1	1	KING, JUSTIN B MD	11/3/2009	208600000X	NA	General Surgery	026	PHYSICIANS	89447	02	General Surgery	0	In state provider	None	655 EUCLID AVE	None	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
272975	Fee-for-Service	1235583493	1235583493	1	1	KHAN, ABDULHALIM MD	12/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157947	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
273020	Fee-for-Service	1023560968	1023560968	1	1	KING, BRANDON M PT	3/15/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
273085	Fee-for-Service	1568752111	1568752111	1	1	KIM, SUEANN MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152898	36	Psychiatry	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
273087	Fee-for-Service	1477590438	1477590438	1	1	KATZ, RICHARD	10/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
273106	Fee-for-Service	1801848429	1801848429	1	1	KIM, CHRISTINE H MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72401	30	Radiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
273123	Fee-for-Service	1770952103	1770952103	1	1	KIRK, JAMIE K LMFT	1/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
273148	Fee-for-Service	1063722239	1063722239	1	1	KAPLAN, RACHEL M LMFT	6/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	115 LIBERTY ST	STE 5	PETALUMA	CA	94952	2320	49	06097	38.23380158	-122.6433482	Sonoma County
273169	Fee-for-Service	1619080215	1619080215	1	1	KONA, SUDHAKAR K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34736	38	Geriatrics	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 102	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
273184	Fee-for-Service	1619224557	1619224557	1	1	KAUFFMAN, JANE Y MD PC	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51293	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8733 BEVERLY BLVD	SUITE 312	WEST HOLLYWOOD	CA	90048	1843	19	06037	34.07688048	-118.3815765	Los Angeles County
273198	Fee-for-Service	1124035266	1124035266	1	1	KEMPERT, PAMELA MD	5/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	35851	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
273237	Fee-for-Service	1205922093	1205922093	1	1	KRAM, JERROLD A MD	1/25/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	21316	41	Internal Medicine	0	In state provider	PERALTA HOSP	430 WILLOW ST	None	ALAMEDA	CA	94501	6130	01	06001	37.75883085	-122.255467	Alameda County
273241	Fee-for-Service	1306003132	1306003132	1	1	KATSMAN, DIANA MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112485	None	None	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
273308	Fee-for-Service	1740486323	1740486323	1	1	KAUSHIK, AARTI MD	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108892	30	Radiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
273334	Fee-for-Service	1407145675	1407145675	1	1	KNEBEL, ROBERT J MD	4/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124418	30	Radiology	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
273345	Fee-for-Service	1871081182	1871081182	1	1	KUCHIBHATLA, RAMYA MD	1/9/2020	390200000X	NA	Other	026	PHYSICIANS	164986	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
273412	Fee-for-Service	1225398324	1225398324	1	1	KUCAVIKOVA-FILLIPPELLI, KATA	11/11/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RINA LCSW	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
273441	Fee-for-Service	1619080215	1619080215	1	1	KONA, SUDHAKAR K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34736	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 102	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
273454	Fee-for-Service	1588058556	1588058556	1	1	KERN, TYLER A MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144525	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
273508	Fee-for-Service	1205922093	1205922093	1	1	KRAM, JERROLD A MD	1/25/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	21316	01	General Practice	0	In state provider	PERALTA HOSP	430 WILLOW ST	None	ALAMEDA	CA	94501	6130	01	06001	37.75883085	-122.255467	Alameda County
273520	Fee-for-Service	1730324740	1730324740	1	1	KELLY, JOHN D	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123809	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
273571	Fee-for-Service	1811421316	1811421316	1	1	KUNITAKE, RYAN C MD	3/9/2021	207P00000X	NA	Other	026	PHYSICIANS	158693	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
273597	Fee-for-Service	1073951190	1073951190	1	1	KIM, MICHAEL J DPM	5/6/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15315 FAIRFIELD RANCH RO	SUITE 220	CHINO HILLS	CA	91709	8836	36	06071	33.97340322	-117.6922495	San Bernardino County
273633	Fee-for-Service	1083698617	1083698617	1	1	KAYSEN, GEORGE A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33653	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
273640	Fee-for-Service	1427092907	1427092907	1	1	KAPLAN, ANDREW W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
273649	Fee-for-Service	1568697308	1568697308	1	1	KIM, DEBORAH S	3/7/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
273661	Fee-for-Service	1063925493	1063925493	1	1	KINDRED CARE INC	12/26/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26500 AGOURA ROAD	STE 111	CALABASAS	CA	91302	3562	19	06037	34.14389046	-118.6995212	Los Angeles County
273697	Fee-for-Service	1861059206	1861059206	1	1	KOHL, KEENA M MD	8/10/2023	207L00000X	NA	Other	026	PHYSICIANS	187352	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
273708	Fee-for-Service	1619080215	1619080215	1	1	KONA, SUDHAKAR K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34736	08	Family Practice	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 102	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
273780	Fee-for-Service	1851475131	1851475131	1	1	KANG, HELEN MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81525	41	Internal Medicine	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
273786	Fee-for-Service	1912177882	1912177882	1	1	KOHLI, KAPIL MD	8/4/2021	208M00000X	NA	Other	026	PHYSICIANS	172456	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
273789	Fee-for-Service	1578986428	1578986428	1	1	KAMELYA HOME HEALTH	8/11/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	3835 AVOCADO BLVD	SUITE 260	LA MESA	CA	91941	8524	37	06073	32.748741	-116.9619745	San Diego County
273800	Fee-for-Service	1396887741	1396887741	1	1	KENDRICK,BRADLEY T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	950 N 19TH	STE 202	ABILENE	TX	79601	0000	00	None	32.47157828	-99.73045719	Taylor County
273833	Fee-for-Service	1073713962	1073713962	1	1	KINTANAR, AGNES C B MD	8/12/1998	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	38376	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1292 W MILL ST	STE 105	SAN BERNARDINO	CA	92410	2500	36	06071	34.09216953	-117.313173	San Bernardino County
273863	Fee-for-Service	1073755278	1073755278	1	1	KIRIMIS, EVANGELIA K MD	4/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99632	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
273929	Fee-for-Service	1962463604	1962463604	1	1	KWONG, CARL K OD	10/8/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	781 VALLEJO ST	None	SAN FRANCISCO	CA	94133	3834	38	06075	37.79840018	-122.4100366	San Francisco County
273943	Fee-for-Service	1205091261	1205091261	1	1	KAISER FOUNDATION HEALTH	2/9/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENTE #156	1301 CALIFORNIA ST	None	REDLANDS	CA	92374	2910	36	06071	34.07159807	-117.2263378	San Bernardino County
273962	Fee-for-Service	1295878825	1295878825	1	1	KESWANI, ANITA MD	9/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49177	03	Allergy	0	In state provider	None	1900 PENNSYLVANIA AVE	STE D	FAIRFIELD	CA	94533	3642	48	06095	38.26281855	-122.049874	Solano County
273967	Fee-for-Service	1255374732	1255374732	1	1	KESSINGER, TODD A MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68824	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
273980	Fee-for-Service	1780616623	1780616623	1	1	KAHAN, FRED J MD	1/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	59494	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
273990	Fee-for-Service	1164500054	1164500054	1	1	KHOSHABA, NAHRIN G MD	10/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84015	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
273994	Fee-for-Service	1386402824	1386402824	1	1	KAUR, SANDEEP NP	7/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
274054	Fee-for-Service	1750469466	1750469466	1	1	KAGAN, JAMES A MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	70928	18	Ophthalmology	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
274055	Fee-for-Service	1740664762	1740664762	1	1	KUMQUAT HOLDINGS, LLC	12/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	515 CENTINELA AVENUE	None	INGLEWOOD	CA	90302	3215	19	06037	33.97316451	-118.3498716	Los Angeles County
274091	Fee-for-Service	1972692531	1972692531	1	1	KHURANA, SNEH MD	10/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42221	40	Pediatrics	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
274093	Fee-for-Service	1538704127	1538704127	1	1	KO, YI-JAU OT	6/10/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
274099	Fee-for-Service	1073713962	1073713962	1	1	KINTANAR, AGNES C B MD	8/12/1998	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	38376	41	Internal Medicine	0	In state provider	None	1292 W MILL ST	STE 105	SAN BERNARDINO	CA	92410	2500	36	06071	34.09216953	-117.313173	San Bernardino County
274120	Fee-for-Service	1073748620	1073748620	1	1	KIM, JAYON MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
274136	Fee-for-Service	1205910916	1205910916	1	1	KAREN J JONES MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 MADISON ST	STE 700	SEATTLE	WA	98104	3599	00	None	47.60953436	-122.3245882	King County
274147	Fee-for-Service	1205493608	1205493608	1	1	KARAPETIANS, NATALIE MD	12/29/2022	163WM0705X	NA	Other	026	PHYSICIANS	178929	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
274154	Fee-for-Service	1447493564	1447493564	1	1	KHOE, MICHELLE M MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116236	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
274177	Fee-for-Service	1124202437	1124202437	1	1	KALIKA, IRINA MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102217	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
274198	Fee-for-Service	1659394328	1659394328	1	1	KUHN, MICHEAL A MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	47809	40	Pediatrics	0	In state provider	None	800 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3123	33	06065	33.85979137	-117.5527252	Riverside County
274251	Fee-for-Service	1083119424	1083119424	1	1	KRIGER, STEPHEN J DPM	5/5/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5565 GROSSMONT CENTER DR	SUITE 510	LA MESA	CA	91942	3024	37	06073	32.77978322	-117.0094766	San Diego County
274314	Fee-for-Service	1003902164	1003902164	2	1	KOBRINE, STEVEN E MD	8/29/2018	207P00000X	NA	Other	026	PHYSICIANS	53606	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
274324	Fee-for-Service	1174215008	1174215008	1	1	KWAN, CANDICE N	12/11/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2339 W HAMMER LN	STE K	STOCKTON	CA	95209	2368	39	06077	38.02138826	-121.344545	San Joaquin County
274361	Fee-for-Service	1073713962	1073713962	1	1	KINTANAR, AGNES C B MD	8/12/1998	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	38376	08	Family Practice	0	In state provider	None	1292 W MILL ST	STE 105	SAN BERNARDINO	CA	92410	2500	36	06071	34.09216953	-117.313173	San Bernardino County
274384	Fee-for-Service	1164613147	1164613147	1	1	KWONG, ANGELA O MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98364	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
274450	Fee-for-Service	1063423242	1063423242	1	1	KORIN, ALEXANDRA M MD	12/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56024	08	Family Practice	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
274495	Fee-for-Service	1558716704	1558716704	1	1	KILIAN, KAITLIN E CNP	9/3/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274560	Fee-for-Service	1700992534	1700992534	1	1	KIM, DAVID O MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42356	10	Gastroenterology (M.D. only)	0	In state provider	None	3440 LOMITA BLVD	STE 446	TORRANCE	CA	90505	4825	19	06037	33.81328127	-118.3452927	Los Angeles County
274581	Fee-for-Service	1326682519	1326682519	1	2	KADOUR AND HATTAR INC	12/5/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1973 FOOTHILL PKWY	BLDG F, STE 106	CORONA	CA	92881	4110	33	06065	33.83172462	-117.530378	Riverside County
274582	Fee-for-Service	1154853190	1154853190	1	1	KNUDSON-FITZPATRICK, TESS W	3/7/2022	207R00000X	NA	Other	026	PHYSICIANS	160785	None	None	0	In state provider	MD	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
274599	Fee-for-Service	1780948752	1780948752	1	1	KANG, ANN H MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137171	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
274706	Fee-for-Service	1932170362	1932170362	1	1	KIMBALL SANDS FUIKS MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2900 W OKLAHOMA AVE	None	MILWAUKEE	WI	53215	4330	00	None	42.98858952	-87.950682	Milwaukee County
274736	Fee-for-Service	1033478474	1033478474	1	1	KELLN, RYAN A DO	8/14/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13324	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
274762	Fee-for-Service	1366496085	1366496085	1	1	KIM, SYLVIA H MD	4/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89640	None	None	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
274776	Fee-for-Service	1740821768	1740821768	1	1	KIM, YOON YOUNG LMFT	1/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
274787	Fee-for-Service	1306999040	1306999040	1	1	KONKOFF, HERBERT J MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	19242	34	Urology and Urological Surgery	0	In state provider	None	1721 SCOTT ST	GROUND FLOOR	SAN FRANCISCO	CA	94115	3003	38	06075	37.78598942	-122.438323	San Francisco County
274807	Fee-for-Service	1184888471	1184888471	1	1	KING, ALICIA L DO	4/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9735	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
274823	Fee-for-Service	1700992534	1700992534	1	1	KIM, DAVID O MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42356	41	Internal Medicine	0	In state provider	None	3440 LOMITA BLVD	STE 446	TORRANCE	CA	90505	4825	19	06037	33.81328127	-118.3452927	Los Angeles County
274882	Fee-for-Service	1255431300	1255431300	1	1	KIM,YUN JIN MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62158	18	Ophthalmology	0	In state provider	None	3920 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	3303	19	06037	34.06166351	-118.312092	Los Angeles County
274914	Fee-for-Service	1336146281	1336146281	1	1	KOVALOWSTJOHN, KAREN A MD	3/26/2021	207RR0500X	NA	Other	026	PHYSICIANS	170197	None	None	0	In state provider	None	8329 BRIMHALL RD	SUITE 801	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
274972	Fee-for-Service	1801195029	1801195029	1	1	KESHAVA, HARI B MD	8/25/2020	390200000X	NA	Other	026	PHYSICIANS	169384	02	General Surgery	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
274977	Fee-for-Service	1174551006	1174551006	1	1	KORN, BOBBY S MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81749	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
274979	Fee-for-Service	1962864793	1962864793	1	1	KAJBAF, JASON A DO	4/1/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	16176	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
274993	Fee-for-Service	1033478474	1033478474	1	1	KELLN, RYAN A DO	8/14/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13324	20	Orthopedic Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
275009	Fee-for-Service	1225186059	1225186059	1	1	KAISER FNDATION HLTH PLN	3/22/2002	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERM PHARM #357	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
275109	Fee-for-Service	1568573400	1568573400	1	1	KLINGMAN, JEFFREY MD	4/30/1991	2084N0400X	NA	Neurology	026	PHYSICIANS	42222	13	Neurology (M.D. only)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
275110	Fee-for-Service	1508000530	1508000530	1	2	KHORASHADI, AFAGH MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	62101	None	None	0	In state provider	None	22 ODYSSEY	230	IRVINE	CA	92618	7700	30	06059	33.66719598	-117.7642461	Orange County
275146	Fee-for-Service	1386673457	1386673457	1	1	KHUSH, KIRAN K MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76368	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
275164	Fee-for-Service	1154386118	1154386118	1	1	KENNETH S KNOX M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
275173	Fee-for-Service	1114756160	1114756160	1	1	KAMRON A FARIBA DO INC	2/12/2025	193400000X	NA	Other	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	415 W ROUTE 66	STE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
275177	Fee-for-Service	1134579196	1134579196	1	1	KROSS, JONATHAN NP	12/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
275183	Fee-for-Service	1366546798	1366546798	1	1	KOCSIS, TAMAS S MD	12/31/1994	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52069	01	General Practice	0	In state provider	None	67 EVANS RD	None	WOFFORD HEIGHTS	CA	93285	9640	15	06029	35.70661847	-118.4580008	Kern County
275214	Fee-for-Service	1881632271	1881632271	1	1	KAYE, DOUGLAS E MD	8/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71280	40	Pediatrics	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
275215	Fee-for-Service	1750469508	1750469508	1	1	KANG,CHARLES M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67761	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
275225	Fee-for-Service	1407823867	1407823867	1	1	KATHERINE L. BENSCHING MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OREGON HEALTH & SCIENCE	3181 SW SAM JACKSON PRK	None	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
275238	Fee-for-Service	1003980616	1003980616	1	1	KOTA, APARNA MD	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80471	40	Pediatrics	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
275255	Fee-for-Service	1538789508	1538789508	1	1	KORIPELLA, PRADEEP C MD	10/6/2023	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
275259	Fee-for-Service	1063918308	1063918308	1	1	KAUFMAN, SARAH K MD	7/7/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	167114	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
275356	Fee-for-Service	1144223819	1144223819	1	1	KEARNS, MICHAEL J MD	10/31/1985	207P00000X	NA	Other	026	PHYSICIANS	46894	04	Otology, Laryngology, Rhinology	0	In state provider	None	1350 S ELISEO DR	None	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
275429	Fee-for-Service	1598039760	1598039760	1	1	KLEIN, CHELSEA A PT	12/16/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1180 W. OLIVE AVE	SUITE I	MERCED	CA	95348	1900	24	06047	37.31910454	-120.4885665	Merced County
275441	Fee-for-Service	1457919417	1457919417	1	1	KODUKULA, KAMALA LMFT	11/12/2024	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
275463	Fee-for-Service	1225079304	1225079304	1	1	KESHAVACHARYA, SHANTHALA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72398	05	Anesthesiology	0	In state provider	MD	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
275480	Fee-for-Service	1427403658	1427403658	1	1	KAYUPOV, ERDAN MD	7/15/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171970	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
275491	Fee-for-Service	1487653085	1487653085	1	1	KLEIN, ROBERT I. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
275501	Fee-for-Service	1306928262	1306928262	1	1	KIKANI, DIVYAKANT J MD	8/14/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	34717	36	Psychiatry	0	In state provider	None	1800 WESTERN AVE	STE 404	SAN BERNARDINO	CA	92411	1355	36	06071	34.1315778	-117.3182453	San Bernardino County
275527	Fee-for-Service	1609815455	1609815455	1	1	KHALILI, LILI LCSW	5/9/2006	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	17772 IRVINE BLVD	STE 102-5	TUSTIN	CA	92780	3233	30	06059	33.74824746	-117.8220736	Orange County
275540	Fee-for-Service	1538249701	1538249701	1	1	KAZZI, AMIN ANTOINE	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	74204	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
275566	Fee-for-Service	1881030484	1881030484	1	1	KHASHAYAR MOHEBALI MD A MEDI	2/24/2022	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CAL CORPORATION	21 TAMAL VISTA BLVD	103	CORTE MADERA	CA	94925	1130	21	06041	37.93173997	-122.5179353	Marin County
275572	Fee-for-Service	1033156435	1033156435	1	1	KRISHNASAMI, PUSHPA MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55741	01	General Practice	0	In state provider	None	1717 S MAIN ST	None	MILPITAS	CA	95035	6756	43	06085	37.40594287	-121.9029593	Santa Clara County
275595	Fee-for-Service	1942242961	1942242961	1	1	KIM, ALEXANDER J	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71618	None	None	0	In state provider	None	477 N EL CAMINO REAL	STE C200	ENCINITAS	CA	92024	1354	37	06073	33.05700866	-117.262449	San Diego County
275598	Fee-for-Service	1588910103	1588910103	1	1	KWOK, JEFFREY D	10/29/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
275615	Fee-for-Service	1144223819	1144223819	1	1	KEARNS, MICHAEL J MD	10/31/1985	207P00000X	NA	Other	026	PHYSICIANS	46894	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1350 S ELISEO DR	None	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
275682	Fee-for-Service	1083012579	1083012579	1	1	KEY, JULIE A LMFT	11/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2020 COFFEE ROAD	STE A5	MODESTO	CA	95355	9487	50	06099	37.672569	-120.9757125	Stanislaus County
275721	Fee-for-Service	1306367354	1306367354	1	1	KASIR, RAFID MD	7/5/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176364	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
275725	Fee-for-Service	1194143149	1194143149	1	1	KAO, CHRISTINE DO	5/17/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	15483	40	Pediatrics	0	In state provider	None	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
275726	Fee-for-Service	1093151565	1093151565	1	1	KELLER, SUZANNE C NP	3/11/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	801 SANTA FE WAY	None	SHAFTER	CA	93263	3158	15	06029	35.49142021	-119.260004	Kern County
275751	Fee-for-Service	1851380992	1851380992	1	1	KAJANI, SIKANDER MD	2/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	44729	41	Internal Medicine	0	In state provider	None	18350 ROSCOE BLVD	STE 218	NORTHRIDGE	CA	91325	4153	19	06037	34.22071855	-118.5341175	Los Angeles County
275752	Fee-for-Service	1336220201	1336220201	1	1	KAY, ALEXANDER W MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114759	41	Internal Medicine	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
275758	Fee-for-Service	1306928262	1306928262	1	1	KIKANI, DIVYAKANT J MD	8/14/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	34717	01	General Practice	0	In state provider	None	1800 WESTERN AVE	STE 404	SAN BERNARDINO	CA	92411	1355	36	06071	34.1315778	-117.3182453	San Bernardino County
275765	Fee-for-Service	1780841510	1780841510	1	1	KIRAMIJYAN, SARKIS MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	110211	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	152 PIONEER LANE	SUITE D	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
275805	Fee-for-Service	1366634180	1366634180	1	1	KARETI, APARNA L MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100639	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	969 PLUMAS ST	None	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
275814	Fee-for-Service	1164878955	1164878955	1	1	KIM, IAN H CRNA	12/17/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
275817	Fee-for-Service	1215431374	1215431374	1	1	KROJANKER, ELAN D MD	9/8/2023	390200000X	NA	Other	026	PHYSICIANS	165950	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
275940	Fee-for-Service	1811035801	1811035801	2	1	KT PLAZA PHARMACY INC	7/25/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	928 S WESTERN AVE	STE 110	LOS ANGELES	CA	90006	1009	19	06037	34.055145	-118.3090505	Los Angeles County
275947	Fee-for-Service	1023286549	1023286549	1	1	KUPERMAN, RACHEL A MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98948	13	Neurology (M.D. only)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
276004	Fee-for-Service	1336220201	1336220201	1	1	KAY, ALEXANDER W MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114759	77	Infectious Disease	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
276033	Fee-for-Service	1821464298	1821464298	1	1	KUSS, KELLEY M	1/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 E STATE ST	M-B	REDLANDS	CA	92373	0001	33	06065	34.0564015	-117.178776	San Bernardino County
276051	Fee-for-Service	1124115639	1124115639	1	1	KELLY, DANIEL P MD	1/18/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46390	40	Pediatrics	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
276052	Fee-for-Service	1841314408	1841314408	1	1	KIM, PAUL K OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	BRADSHAW OPTOMETRY CORP	3557 BRADSHAW RD	STE 2E	SACRAMENTO	CA	95827	3373	34	06067	38.557701	-121.3340535	Sacramento County
276059	Fee-for-Service	1972857159	1972857159	1	1	KIM, ANDREW H MD	5/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120214	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
276081	Fee-for-Service	1902067218	1902067218	1	1	KRIEZELMAN, JUSTIN D MD	12/20/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
276086	Fee-for-Service	1043771033	1043771033	1	1	KWON, STEVE MD	6/13/2023	207L00000X	NA	Other	026	PHYSICIANS	186772	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
276129	Fee-for-Service	1942333141	1942333141	1	1	KASSEL, DAVID M MD	6/30/1982	207P00000X	NA	Other	026	PHYSICIANS	43890	66	Emergency Medicine (Urgent Care)	0	In state provider	None	610 FREDERICK ST	None	SANTA CRUZ	CA	95062	2203	44	06087	36.97965731	-122.0042799	Santa Cruz County
276131	Fee-for-Service	1255940805	1255940805	1	1	KOMMIDI, APOORVA MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	186519	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
276144	Fee-for-Service	1265510051	1265510051	1	1	KUBOTA, DEREK S MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68662	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
276158	Fee-for-Service	1306228010	1306228010	1	1	KING, JOHN D MD	9/1/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	178411	None	None	0	In state provider	None	25455 BARTON RD	101B 102B 104B 106B 108B	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
276197	Fee-for-Service	1023286549	1023286549	1	1	KUPERMAN, RACHEL A MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98948	79	Neurology-Child	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
276248	Fee-for-Service	1730264177	1730264177	1	1	KEARNEY, MICHAEL K MD	12/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97340	41	Internal Medicine	0	In state provider	None	PUEBLO AT BATH ST	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
276251	Fee-for-Service	1396750055	1396750055	1	1	KURRA, PRATAP S MD	6/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	43255	05	Anesthesiology	0	In state provider	DR KURRA INC	520 W I ST	None	LOS BANOS	CA	93635	3419	24	06047	37.06346603	-120.8593647	Merced County
276257	Fee-for-Service	1336220201	1336220201	1	1	KAY, ALEXANDER W MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114759	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
276286	Fee-for-Service	1215997747	1215997747	1	1	KOLBER,SHARON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1050 E SOUTH TEMPLE	None	SALT LAKE CTY	UT	84102	1507	00	None	40.76933651	-111.8610765	Salt Lake County
276301	Fee-for-Service	1275781668	1275781668	1	1	KAHN, ANDREW H MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107457	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
276325	Fee-for-Service	1649396888	1649396888	1	1	KUNG, JINNY Y CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1717 E DATE PL	None	SAN BERNARDINO	CA	92404	4428	36	06071	34.14094893	-117.2500411	San Bernardino County
276326	Fee-for-Service	1265498836	1265498836	1	1	KIPPER, SAMUEL L MD	1/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	34500	None	None	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
276343	Fee-for-Service	1083897573	1083897573	1	1	KIM, SERAN MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102810	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
276368	Fee-for-Service	1811698905	1811698905	1	1	KIM, ELEASE CRNA	10/31/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
276386	Fee-for-Service	1558532762	1558532762	1	2	KREBS, MELISSA MD	1/19/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	100079	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
276395	Fee-for-Service	1982659322	1982659322	2	1	KALEKA, VIRENDER S MD	1/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	43546	01	General Practice	0	In state provider	None	141 N CLARK STREET	SUITE A	FRESNO	CA	93701	2124	10	06019	36.744102	-119.7860465	Fresno County
276397	Fee-for-Service	1407898646	1407898646	1	1	KHALIL, SHERIF F MD	7/30/1993	207R00000X	NA	Other	026	PHYSICIANS	52212	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
276415	Fee-for-Service	1700273323	1700273323	1	1	KALATHIL, SHEILA MD	10/31/2022	207R00000X	NA	Other	026	PHYSICIANS	179765	None	None	0	In state provider	None	480 4TH AVE	STE 409	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
276426	Fee-for-Service	1962812255	1962812255	1	1	KAUR, NAVNEET MD	2/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147065	08	Family Practice	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
276433	Fee-for-Service	1013908979	1013908979	1	1	KELLY,JAMES D II MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69868	20	Orthopedic Surgery	0	In state provider	None	2351 CLAY ST	STE 510	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
276458	Fee-for-Service	1316057243	1316057243	1	1	KIM, GENE W	3/27/2004	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E MAIN ST	None	SAN JACINTO	CA	92583	4228	33	06065	33.78386623	-116.9586772	Riverside County
276473	Fee-for-Service	1104993914	1104993914	1	1	KUMAR, VATSALA MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42575	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
276491	Fee-for-Service	1639146699	1639146699	1	1	KAMAL, HEBA S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68946	22	Pathology (M.D. only)	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
276513	Fee-for-Service	1538393962	1538393962	1	1	KING, JOHN D MD INC	7/1/1998	193400000X	NA	Other	026	PHYSICIANS	19146	20	Orthopedic Surgery	0	In state provider	None	18840 VENTURA BLVD	SUITE 204	TARZANA	CA	91356	6340	19	06037	34.17204394	-118.5442921	Los Angeles County
276549	Fee-for-Service	1427581016	1427581016	1	1	KIM, DANIEL K DPM	8/21/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3031 W MARCH LN	STE 310	STOCKTON	CA	95219	6562	39	06077	37.9842796	-121.3494311	San Joaquin County
276555	Fee-for-Service	1245892397	1245892397	1	1	KENNEDY, DEVON OD	10/28/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	SUITE P-25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
276568	Fee-for-Service	1003964917	1003964917	1	1	KING, RANDEL R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39642	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
276577	Fee-for-Service	1659355410	1659355410	1	1	KING, KELLY A MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
276635	Fee-for-Service	1497875025	1497875025	1	1	KAWESCH, GARY M MD	3/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66681	18	Ophthalmology	0	In state provider	None	798 WINCHESTER BLVD	None	SAN JOSE	CA	95128	2928	43	06085	37.313361	-121.9499825	Santa Clara County
276669	Fee-for-Service	1215981436	1215981436	1	1	KEITH PEREIRA, MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
276688	Fee-for-Service	1255513123	1255513123	1	1	KONO, KIMBERLY T PHD	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22817	-	NOT APPLICABLE	0	In state provider	None	1930 MARKET ST	None	SAN FRANCISCO	CA	94102	6228	38	06075	37.77037155	-122.4255051	San Francisco County
276737	Fee-for-Service	1487602108	1487602108	1	1	KOKKONEN, JANA S MD	1/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	74178	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
276739	Fee-for-Service	1306069463	1306069463	1	1	KIM, HOLLY H MD	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94274	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
276751	Fee-for-Service	1427413939	1427413939	1	1	KIM, SUNKYEOM LAC	1/8/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	680 WILSHIRE PL	UNIT 312	LOS ANGELES	CA	90005	3950	19	06037	34.060581	-118.2877945	Los Angeles County
276756	Fee-for-Service	1003892282	1003892282	1	1	KASHKOULI, POURIA MD	8/27/2007	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	92888	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
276826	Fee-for-Service	1831141282	1831141282	1	1	KARTCHNER, KEVIN E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	1309	00	None	43.61455048	-116.256231	Ada County
276848	Fee-for-Service	1225598691	1225598691	1	1	KIM, BONNIE Y MD	7/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176888	None	None	0	In state provider	None	726 N MEDICAL CTR DR E	STE 209	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
276890	Fee-for-Service	1316100563	1316100563	1	1	KOLLHOFF, DAVID M MD	11/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122892	34	Urology and Urological Surgery	0	In state provider	None	2330 WEST COVELL BLVD	None	DAVIS	CA	95616	5658	57	06113	38.56097929	-121.7800614	Yolo County
276894	Fee-for-Service	1528600558	1528600558	1	1	KEVIN M CASEY MD APMC	2/15/2023	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ALISTS	2621 DE LA VINA ST	STE 204	SANTA BARBARA	CA	93105	3823	42	06083	34.43503648	-119.7247588	Santa Barbara County
276935	Fee-for-Service	1205193414	1205193414	1	1	KING, EMILY C MD	10/1/2020	390200000X	NA	Other	026	PHYSICIANS	130174	None	None	0	In state provider	None	4440 BROCKTON AVE	STE 410, 420 & 430	RIVERSIDE	CA	92501	4068	33	06065	33.97764104	-117.3838896	Riverside County
276986	Fee-for-Service	1891216180	1891216180	1	1	KASSAR, NATALIE C OD	6/29/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1280 S VICTORIA AVE	STE 100	VENTURA	CA	93003	6550	56	06111	34.26344767	-119.2119344	Ventura County
277005	Fee-for-Service	1851449599	1851449599	1	1	KAISER FOUND HLTH PLAN	11/14/1986	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHCY	400 MUIR RD	None	MARTINEZ	CA	94553	0000	07	06013	37.99387772	-122.108207	Contra Costa County
277008	Fee-for-Service	1477661825	1477661825	1	1	KHOKHAR, ANWAR MD	4/22/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
277014	Fee-for-Service	1629482443	1629482443	1	1	KENNEY, STEVEN G DO	9/20/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	14261	20	Orthopedic Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
277034	Fee-for-Service	1679645410	1679645410	1	1	KORDOUNI, MOHAMMAD R MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94391	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
277042	Fee-for-Service	1568813723	1568813723	1	1	KWOK, KEVIN OD	9/4/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3300 EAST SOUTH STREET	STE 105	LONG BEACH	CA	90805	4579	19	06037	33.86018093	-118.1537163	Los Angeles County
277083	Fee-for-Service	1740392208	1740392208	1	1	KY, NGUYEN DPM	3/17/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	660 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1931	43	06085	37.34260528	-121.8769383	Santa Clara County
277090	Fee-for-Service	1417959628	1417959628	1	1	KASSAR, NAIM S MD	2/14/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	41008	None	None	0	In state provider	None	315 E ALOSTA AVE	STE 201	GLENDORA	CA	91740	6257	19	06037	34.1288686	-117.8608708	Los Angeles County
277121	Fee-for-Service	1366594160	1366594160	1	1	KYAW, TIN TIN MD	6/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85138	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
277128	Fee-for-Service	1932497914	1932497914	1	1	KRAUSHAAR, VIT D MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127695	66	Emergency Medicine (Urgent Care)	0	In state provider	None	75 NIELSON STREET	EM DEPT	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
277142	Fee-for-Service	1164459061	1164459061	1	1	KNISTER, JAMES R MD	9/30/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	62093	30	Radiology	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
277206	Fee-for-Service	1447854625	1447854625	1	1	KURIA, RUTH W	12/11/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	34964 MIDDLECOFF CT.	None	BEAUMONT	CA	92223	7420	33	06065	33.9603224	-117.0504718	Riverside County
277227	Fee-for-Service	1740943174	1740943174	1	1	KHANAL, ANU CNP	2/1/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6995 WALNUT GROVE DR	None	MORGAN HILL	CA	95037	4440	43	06085	37.12807817	-121.6364502	Santa Clara County
277228	Fee-for-Service	1346028735	1346028735	1	1	KIM, ISABEL MD	11/4/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	190107	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
277254	Fee-for-Service	1992029599	1992029599	1	2	KWON, EDWARD MD	4/8/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	120642	None	None	0	In state provider	None	3630 E. IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
277276	Fee-for-Service	1811016561	1811016561	1	1	KNEASS, ZACHARY T MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125381	84	Surgery-Head and Neck	0	In state provider	None	2023 W VISTA WAY	STE J	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
277283	Fee-for-Service	1235557679	1235557679	1	1	KIM, YOOREE MD	9/21/2022	207P00000X	NA	Other	026	PHYSICIANS	154622	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
277325	Fee-for-Service	1013579952	1013579952	1	1	KOCHER, ALEXANDRA E CNP	3/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18785 BROOKHURST STREET	STE 101	FOUNTAIN VALLEY	CA	92708	7300	30	06059	33.68987636	-117.9542321	Orange County
277330	Fee-for-Service	1205015708	1205015708	1	1	KIM, JANET H MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101879	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
277377	Fee-for-Service	1477698686	1477698686	1	2	KERN COUNTY MEDICAL CLINIC,I	3/13/2023	207K00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	NC.	2323 16TH STREET	SUITE 108	BAKERSFIELD	CA	93301	3453	15	06029	35.37238027	-119.0288508	Kern County
277398	Fee-for-Service	1053756080	1053756080	1	1	KAUR, MANPREET LMFT	7/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
277409	Fee-for-Service	1184900037	1184900037	1	1	KOBAYASHI OPTOMETRIC INC	1/14/2015	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13161 MINDANAO WAY	SUITE D6A	MARINA DEL REY	CA	90292	6307	19	06037	33.98496412	-118.4375544	Los Angeles County
277415	Fee-for-Service	1619293446	1619293446	1	1	KUNG, ROBERT D MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124375	10	Gastroenterology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
277429	Fee-for-Service	1275613655	1275613655	1	1	KARUBIAN, FREDERICK J MD	5/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	42957	41	Internal Medicine	0	In state provider	INC	2001 SANTA MONICA BLVD	STE 765W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
277433	Fee-for-Service	1669677837	1669677837	1	1	KHAZAEI NEZHAD, ALI MD	12/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108351	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
277452	Fee-for-Service	1447854625	1447854625	1	1	KURIA, RUTH W	12/11/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	34964 MIDDLECOFF CT.	None	BEAUMONT	CA	92223	7420	33	06065	33.9603224	-117.0504718	Riverside County
277493	Fee-for-Service	1679611750	1679611750	1	1	KIRK, RICHARD F H MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	23530	36	Psychiatry	0	In state provider	None	395 W NAPA STREET	#3	SONOMA	CA	95476	6548	49	06097	38.29262096	-122.4655646	Sonoma County
277496	Fee-for-Service	1972950277	1972950277	1	1	KELSEY, JOHN G MD	10/4/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	153107	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
277510	Fee-for-Service	1104966654	1104966654	1	1	KIM, DAVID DONGYOUNG MD	5/11/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	81419	01	General Practice	0	In state provider	None	1045 ATLANTIC AVE	STE 708	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
277522	Fee-for-Service	1023865326	1023865326	1	1	KINDFUL RESTORATION	6/28/2024	101YA0400X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	7344 MAGNOLIA AVE	110	RIVERSIDE	CA	92504	3819	33	06065	33.94309059	-117.4063922	Riverside County
277523	Fee-for-Service	1811016561	1811016561	1	1	KNEASS, ZACHARY T MD	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125381	04	Otology, Laryngology, Rhinology	0	In state provider	None	2023 W VISTA WAY	STE J	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
277528	Fee-for-Service	1750930707	1750930707	1	1	KEH, MONICA ABIGAIL A NP	5/15/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
277589	Fee-for-Service	1912165010	1912165010	1	1	KHOJABEKYAN, MARINE MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117448	08	Family Practice	0	In state provider	None	1600 E CITRUS AVE	SUITE A	REDLANDS	CA	92374	4270	36	06071	34.05557272	-117.1468659	San Bernardino County
277597	Fee-for-Service	1356821060	1356821060	1	1	KOO, KATHRYN H PHD	5/27/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4605 BARRANCA PARKWAY	101E	IRVINE	CA	92604	1727	30	06059	33.67863338	-117.7997794	Orange County
277633	Fee-for-Service	1114999570	1114999570	1	1	KIM, WOONG R MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131598	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
277660	Fee-for-Service	1265157663	1265157663	1	1	KWAN, HORACE PT	1/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
277673	Fee-for-Service	1275613655	1275613655	1	1	KARUBIAN, FREDERICK J MD	5/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	42957	45	Nephrology (Renal-Kidney)	0	In state provider	INC	2001 SANTA MONICA BLVD	STE 765W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
277703	Fee-for-Service	1851376917	1851376917	1	1	KAYAL, ANAS MD	6/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112450	45	Nephrology (Renal-Kidney)	0	In state provider	None	10670 WEXFORD ST	None	SAN DIEGO	CA	92131	3940	37	06073	32.93893186	-117.0982186	San Diego County
277715	Fee-for-Service	1326276585	1326276585	1	1	KNUDSEN, PETER R MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118509	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
277717	Fee-for-Service	1700164944	1700164944	1	1	KIERSTEAD, PETER A MD	10/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124129	41	Internal Medicine	0	In state provider	None	3610 ATLANTIC AVE	None	LONG BEACH	CA	90807	3418	19	06037	33.822621	-118.185002	Los Angeles County
277742	Fee-for-Service	1255471744	1255471744	1	1	KAVOUKJIAN, HAIKOUHI H	2/28/1990	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	C/O COMFORT CARE	5220 SANTA MONICA BLVD	STE D	LOS ANGELES	CA	90029	1234	19	06037	34.0907695	-118.304154	Los Angeles County
277756	Fee-for-Service	1104966654	1104966654	1	1	KIM, DAVID DONGYOUNG MD	5/11/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	81419	10	Gastroenterology (M.D. only)	0	In state provider	None	1045 ATLANTIC AVE	STE 708	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
277765	Fee-for-Service	1811457658	1811457658	1	1	KAUR, KOMALPREET MD	1/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177090	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
277786	Fee-for-Service	1659448595	1659448595	1	1	KELLERMAN, CHARLES A MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36236	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
277888	Fee-for-Service	1568556462	1568556462	1	1	KEYS, CHRISTOPHER J MD	8/31/1993	207L00000X	NA	Other	026	PHYSICIANS	71107	05	Anesthesiology	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
277922	Fee-for-Service	1265580864	1265580864	1	1	KAISER FOUNDATION HLTH	10/11/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY #1	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
277963	Fee-for-Service	1417116302	1417116302	1	1	KATIE JULIA NADEAU MD	6/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
277965	Fee-for-Service	1679786818	1679786818	1	1	KESSLER, JONATHAN M MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101695	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
278012	Fee-for-Service	1033391909	1033391909	1	1	KIM, MICHELLE J MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108256	30	Radiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
278016	Fee-for-Service	1598291437	1598291437	2	1	KUBELDIS, NATHAN R DO	4/28/2023	207R00000X	NA	Other	026	PHYSICIANS	18559	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
278070	Fee-for-Service	1659577062	1659577062	1	1	KING, TERESA M	7/9/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2030 SUTTER PL	STE 1000	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
278084	Fee-for-Service	1972906568	1972906568	1	2	KLEINER, ZENAIDA LMFT	2/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1720 E LOS ANGELES AVE	237	SIMI VALLEY	CA	93065	2033	56	06111	34.2716455	-118.7653635	Ventura County
278095	Fee-for-Service	1396205738	1396205738	1	1	KAMINSKY, OLIVIA MD	8/1/2023	207L00000X	NA	Other	026	PHYSICIANS	182514	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
278109	Fee-for-Service	1790075331	1790075331	1	1	KIM, SARAH S MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126173	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
278144	Fee-for-Service	1427114081	1427114081	1	1	KUMATA, WENDY M OD	7/6/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1280 S VICTORIA AVE	STE 100	VENTURA	CA	93003	6550	56	06111	34.26344767	-119.2119344	Ventura County
278153	Fee-for-Service	1225128119	1225128119	1	1	KURATANI, JOHN D MD	12/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50744	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
278180	Fee-for-Service	1801839246	1801839246	1	1	KENNEDY, CASEY M MD	10/31/1993	207R00000X	NA	Other	026	PHYSICIANS	73379	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
278184	Fee-for-Service	1548665862	1548665862	1	1	KAMLA, MICHELLE LCSW	3/25/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3 GOVERNORS LN	A	CHICO	CA	95926	5503	04	06007	39.75542195	-121.8587226	Butte County
278297	Fee-for-Service	1164730784	1164730784	1	1	KLOTZLE, JAMES T LMFT	3/11/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	90273	-	NOT APPLICABLE	0	In state provider	None	831 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09030767	-117.7353578	Los Angeles County
278322	Fee-for-Service	1730683269	1730683269	1	1	KIM, JASON MD	7/8/2023	207L00000X	NA	Other	026	PHYSICIANS	180515	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
278363	Fee-for-Service	1346338381	1346338381	1	1	KASSABIAN, ARMEN A MD	9/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96289	34	Urology and Urological Surgery	0	In state provider	None	2701 W ALAMEDA AVE	STE 506	BURBANK	CA	91505	4410	19	06037	34.15751343	-118.3303715	Los Angeles County
278364	Fee-for-Service	1649706532	1649706532	1	1	KAYMEN, EMILY MD	8/29/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	170041	None	None	0	In state provider	None	9090 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
278367	Fee-for-Service	1194853663	1194853663	1	1	KANAKARAJ, SEAN MD	3/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	73175	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
278375	Fee-for-Service	1356367809	1356367809	1	1	KABBESH, MOHAMMAD J MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54090	41	Internal Medicine	0	In state provider	None	632 WEST GIBSON RD	None	WOODLAND	CA	95695	5143	57	06113	38.66314048	-121.794696	Yolo County
278386	Fee-for-Service	1922094101	1922094101	1	1	KATZ, DAN MD	12/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77332	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
278392	Fee-for-Service	1972990265	1972990265	1	1	KHERA, SATINDERPAL S MD	10/26/2020	390200000X	NA	Other	026	PHYSICIANS	145770	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
278396	Fee-for-Service	1225128119	1225128119	1	1	KURATANI, JOHN D MD	12/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50744	13	Neurology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
278404	Fee-for-Service	1225340680	1225340680	1	1	KATO, DEVIN T MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118552	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
278425	Fee-for-Service	1255453213	1255453213	1	1	KANEKO-HUTTON, PATRICIA K OT	4/26/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
278427	Fee-for-Service	1639111743	1639111743	1	1	KLEIN, NEAL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 E MCDOWELL RD	None	PHOENIX	AZ	85006	2612	00	None	33.4657137	-112.0721664	Maricopa County
278466	Fee-for-Service	1962068551	1962068551	1	1	KADABA, VIKARAN MD	9/18/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	190240	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
278474	Fee-for-Service	1467476598	1467476598	2	1	KHAMIS, SHERIF	5/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	43374	None	None	0	In state provider	None	7257 OWENSMOUTH AVE	STE A	CANOGA PARK	CA	91303	1321	19	06037	34.20270201	-118.6015969	Los Angeles County
278480	Fee-for-Service	1568047801	1568047801	1	1	KAVEH, KAMERON R LMFT	3/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
278486	Fee-for-Service	1922425974	1922425974	1	1	KALUZHNY, PETRINA MD	1/4/2018	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	145644	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
278509	Fee-for-Service	1528115417	1528115417	1	1	KAMDAR, BIREN B MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126170	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA	# 365	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
278511	Fee-for-Service	1225316821	1225316821	1	1	KOUCHAK, YASMIN A OD	7/14/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	SUITE P-25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
278520	Fee-for-Service	1073843371	1073843371	1	1	KAMINSKI, MELISSA M PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30141 ANTELOPE RD.	STE A	MENIFEE	CA	92584	7001	33	06065	33.68176015	-117.1680307	Riverside County
278550	Fee-for-Service	1972543023	1972543023	1	1	KEETON,MARK R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	0000	00	None	41.18328	-111.9536955	Weber County
278559	Fee-for-Service	1154390862	1154390862	1	1	KIMPLE, KRIS G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1005 N LINCOLN AVE	None	BELOIT	KS	67420	1215	00	None	39.46897901	-98.11423059	Mitchell County
278576	Fee-for-Service	1225508310	1225508310	1	1	KLAASSEN, MICHELLE LMFT	10/7/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125593	-	NOT APPLICABLE	0	In state provider	None	3647 RICARDO AVE	None	REDDING	CA	96002	2627	45	06089	40.55302414	-122.3576656	Shasta County
278601	Fee-for-Service	1407143530	1407143530	1	1	KUZA, CATHERINE M MD	5/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140191	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
278602	Fee-for-Service	1831132745	1831132745	1	1	KUSHEL, STEVEN M MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49642	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
278609	Fee-for-Service	1427402346	1427402346	1	1	KIM, ROMINA MD	3/26/2018	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	151163	40	Pediatrics	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
278613	Fee-for-Service	1356367809	1356367809	1	1	KABBESH, MOHAMMAD J MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54090	77	Infectious Disease	0	In state provider	None	632 WEST GIBSON RD	None	WOODLAND	CA	95695	5143	57	06113	38.66314048	-121.794696	Yolo County
278623	Fee-for-Service	1396804035	1396804035	1	1	KIM, AGNES S MD	5/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97058	13	Neurology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
278627	Fee-for-Service	1710203880	1710203880	1	1	KARCH, JON M MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119850	05	Anesthesiology	0	In state provider	None	3883 AIRWAY DR	SUITE 202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
278683	Fee-for-Service	1225263395	1225263395	1	1	KWON, GINA P MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137176	07	Dermatology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
278707	Fee-for-Service	1285723304	1285723304	1	1	KASHER, JOHN A MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89366	10	Gastroenterology (M.D. only)	0	In state provider	None	15211 VANOWEN STREET	#209	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
278789	Fee-for-Service	1659674620	1659674620	1	1	KOSSOL, GABRIEL	8/3/2015	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	900 BUTTE ST	None	REDDING	CA	96001	0827	45	06089	40.58587336	-122.3848508	Shasta County
278790	Fee-for-Service	1952693244	1952693244	1	1	KWOK, JOSEPH C MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117601	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
278840	Fee-for-Service	1831132745	1831132745	1	1	KUSHEL, STEVEN M MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49642	01	General Practice	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
278865	Fee-for-Service	1700802105	1700802105	1	1	KAHMANN, RICHARD D MD	1/1/1989	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	51723	20	Orthopedic Surgery	0	In state provider	None	2324 BATH ST	None	SANTA BARBARA	CA	93105	4330	42	06083	34.43130628	-119.7229224	Santa Barbara County
278915	Fee-for-Service	1689994717	1689994717	1	1	KATERKAMP, BROOKE C MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119715	08	Family Practice	0	In state provider	None	2210 DEL PASO ROAD	SUITE A	SACRAMENTO	CA	95834	9676	34	06067	38.655189	-121.5091575	Sacramento County
278920	Fee-for-Service	1609955517	1609955517	1	1	KNOXVILLE EYE SURGERY CENTER	10/9/2023	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	160 CAPITAL DR	None	KNOXVILLE	TN	37922	3343	00	None	35.90189455	-84.11291215	Knox County
278921	Fee-for-Service	1689036600	1689036600	1	1	KASTURIA, SHIRIN MD	7/10/2020	207P00000X	NA	Other	026	PHYSICIANS	154385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
278934	Fee-for-Service	1952591042	1952591042	1	1	KISTLER, ERIK B MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91700	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
278939	Fee-for-Service	1285723304	1285723304	1	1	KASHER, JOHN A MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89366	41	Internal Medicine	0	In state provider	None	15211 VANOWEN STREET	#209	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
278985	Fee-for-Service	1790881951	1790881951	1	1	KILLFOIL, JAMES J MD	3/31/1995	174400000X	NA	Other	026	PHYSICIANS	82256	40	Pediatrics	0	In state provider	None	3305 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58238894	-124.1358909	Humboldt County
278988	Fee-for-Service	1316374598	1316374598	1	1	KASHANCHI, BEHNAM MD INC	7/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	42282	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16133 VENTURA BLVD	STE 415	ENCINO	CA	91436	2429	19	06037	34.15656164	-118.4849569	Los Angeles County
279056	Fee-for-Service	1174948558	1174948558	1	1	KIRSCHENBAUM, ADAM MD	1/22/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
279058	Fee-for-Service	1417940198	1417940198	1	1	KINI, VIJAYKUMAR MD	9/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84739	30	Radiology	0	In state provider	A MEDICAL CORP	1275 N ROSE DR	STE 108	PLACENTIA	CA	92870	3919	30	06059	33.8868003	-117.8420447	Orange County
279059	Fee-for-Service	1174705719	1174705719	1	1	KOVALENKO, TETYANA O MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127147	40	Pediatrics	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
279064	Fee-for-Service	1902145774	1902145774	1	1	KUMAR, RAJIV MD	6/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113037	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA STREET	STE B555	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
279157	Fee-for-Service	1740236066	1740236066	1	1	KOO, ALEC S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61375	34	Urology and Urological Surgery	0	In state provider	None	23441 MADISON ST	STE 140	TORRANCE	CA	90505	4755	19	06037	33.81240248	-118.3477463	Los Angeles County
279217	Fee-for-Service	1508027640	1508027640	1	1	KIM, JOSEPH T MD	11/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120193	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	SUITE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
279219	Fee-for-Service	1700103298	1700103298	1	1	KLEYNBERG, ROMAN L MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120343	41	Internal Medicine	0	In state provider	None	6221 WILSHIRE BLVD	STE 504	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
279224	Fee-for-Service	1013514199	1013514199	3	1	KECK MEDICAL CENTER OF USC	1/1/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
279253	Fee-for-Service	1205849817	1205849817	1	1	KARNAVY, NOPAVAL K MD	9/5/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34413	None	None	0	In state provider	None	4950 SAN BERNARDINO ST	STE 216	MONTCLAIR	CA	91763	2328	36	06071	34.07768363	-117.6968874	San Bernardino County
279263	Fee-for-Service	1427284827	1427284827	1	1	KANG, JAMES MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114543	30	Radiology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
279270	Fee-for-Service	1831670454	1831670454	1	1	KRISTIANSEN, ALLAN NP	6/23/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11795 EDUCATION ST	STE 100	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
279276	Fee-for-Service	1629034434	1629034434	1	1	KANON, RAMAN W MD	11/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90366	05	Anesthesiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
279292	Fee-for-Service	1417940198	1417940198	1	1	KINI, VIJAYKUMAR MD	9/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84739	78	Neoplastic Diseases/Oncology	0	In state provider	A MEDICAL CORP	1275 N ROSE DR	STE 108	PLACENTIA	CA	92870	3919	30	06059	33.8868003	-117.8420447	Orange County
279308	Fee-for-Service	1508511197	1508511197	1	1	KWAN, JENEVE PT	2/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
279317	Fee-for-Service	1639136286	1639136286	1	1	KUO, JENNY MD	7/6/2009	207ZP0102X	NA	Other	026	PHYSICIANS	89121	22	Pathology (M.D. only)	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
279410	Fee-for-Service	1538219613	1538219613	1	1	KURAITIS, KESTUTIS V MD PHD	8/1/1999	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	751 WEST LEGION ROAD	SUITE 204	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
279438	Fee-for-Service	1952598518	1952598518	1	1	KIMM, SIMON Y MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	100005	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
279457	Fee-for-Service	1013514199	1013514199	3	1	KECK MEDICAL CENTER OF USC	1/1/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
279463	Fee-for-Service	1447538079	1447538079	1	1	KONANUR VENKATARAM, RAGHU M	6/28/2019	207R00000X	NA	Other	026	PHYSICIANS	147233	45	Nephrology (Renal-Kidney)	0	In state provider	D	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
279482	Fee-for-Service	1972998243	1972998243	1	1	KISLOVSKIY, YASASWI MD	6/26/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
279484	Fee-for-Service	1326199563	1326199563	1	1	KRPEKYAN, EVELINA LMFT	5/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8949 RESEDA BLVD	STE 225	LOS ANGELES	CA	91324	5811	19	06037	34.233255	-118.536109	Los Angeles County
279491	Fee-for-Service	1588051635	1588051635	1	1	KANG, SANDRA A MD	4/24/2019	208M00000X	NA	Other	026	PHYSICIANS	143902	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
279492	Fee-for-Service	1003900614	1003900614	1	1	KHATCHIKIAN, GARABET S MD	10/14/2008	207R00000X	NA	Other	026	PHYSICIANS	51830	41	Internal Medicine	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
279507	Fee-for-Service	1609157163	1609157163	1	1	KONN, RACHEL LMFT	3/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
279547	Fee-for-Service	1710079207	1710079207	1	1	KUO, MONIQUE R MD	12/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	66866	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
279593	Fee-for-Service	1194029694	1194029694	1	1	KONG, EUNICE MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110982	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
279596	Fee-for-Service	1033163175	1033163175	1	1	KRETZMANN, CAROL M LPCC	12/16/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18126 RAJARSI DR	None	NEVADA CITY	CA	95959	9316	29	06057	39.37072773	-121.0520682	Nevada County
279617	Fee-for-Service	1508817776	1508817776	1	1	KANAK, RICHARD J MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62232	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
279654	Fee-for-Service	1356838957	1356838957	1	1	KABADI, ALISHA MD	4/7/2023	207P00000X	NA	Other	026	PHYSICIANS	164137	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
279658	Fee-for-Service	1083816193	1083816193	1	1	KHAN, SAFDAR N MD	12/21/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	100291	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
279693	Fee-for-Service	1962896274	1962896274	1	1	KASLOW, ABRAHAM M MD	10/21/2022	208600000X	NA	General Surgery	026	PHYSICIANS	181237	None	None	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
279694	Fee-for-Service	1447538079	1447538079	1	1	KONANUR VENKATARAM, RAGHU M	6/28/2019	207R00000X	NA	Other	026	PHYSICIANS	147233	41	Internal Medicine	0	In state provider	D	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
279711	Fee-for-Service	1972998243	1972998243	1	1	KISLOVSKIY, YASASWI MD	6/26/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
279758	Fee-for-Service	1497133011	1497133011	1	1	KEN P OPTOMETRY CORPORATION	12/21/2015	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 OAK PARK BLVD	STE 104	PISMO BEACH	CA	93449	3406	40	06079	35.13435006	-120.6051746	San Luis Obispo County
279790	Fee-for-Service	1598221731	1598221731	1	1	KAMBANIS, ELEFTHERIA	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	151 N SUNRISE AVE	SUITE 1105	ROSEVILLE	CA	95661	2924	31	06061	38.74746043	-121.2655348	Placer County
279819	Fee-for-Service	1730587379	1730587379	1	1	KUO, ERIC C MD	11/14/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	133626	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
279831	Fee-for-Service	1104253608	1104253608	1	1	KANG, JOHN C MD APC	5/20/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3130 W OLYMPIC BLVD	STE 340	LOS ANGELES	CA	90006	2494	19	06037	34.05258529	-118.3039795	Los Angeles County
279850	Fee-for-Service	1508817776	1508817776	1	1	KANAK, RICHARD J MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62232	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
279922	Fee-for-Service	1538664362	1538664362	1	1	KUMAR, SARAYU MD	6/9/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166205	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
279969	Fee-for-Service	1043300742	1043300742	1	1	KINGERY, WADE S MD	12/31/1985	2086S0122X	NA	General Surgery	026	PHYSICIANS	56823	02	General Surgery	0	In state provider	None	525 UNIVERSITY AVE	STE 400	PALO ALTO	CA	94301	1903	43	06085	37.44861996	-122.1589531	Santa Clara County
279987	Fee-for-Service	1851485379	1851485379	1	1	KYONO, WADE T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
280022	Fee-for-Service	1578150256	1578150256	1	1	KIRAN CARE TRANSPORTATION IN	2/11/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	C	5931 STANLEY AVE	SUITE 8	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
280042	Fee-for-Service	1184127953	1184127953	1	1	KIOK, MATTHEW T MD	9/1/2021	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	164749	None	None	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
280054	Fee-for-Service	1538102207	1538102207	1	2	KERKAR, SHUBHA J MD	6/8/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	48721	None	None	0	In state provider	None	1695 N. SUNRISE WAY	None	PALM SPRINGS	CA	92262	4872	33	06065	33.844239	-116.5282075	Riverside County
280058	Fee-for-Service	1104253608	1104253608	1	1	KANG, JOHN C MD APC	5/20/2015	2086X0206X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3130 W OLYMPIC BLVD	STE 340	LOS ANGELES	CA	90006	2494	19	06037	34.05258529	-118.3039795	Los Angeles County
280102	Fee-for-Service	1376297531	1376297531	1	1	KRISHNAOM CORPORATION	3/16/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6700 NILES ST	SUITE 100	BAKERSFIELD	CA	93306	4800	15	06029	35.37616449	-118.9303406	Kern County
280115	Fee-for-Service	1598815219	1598815219	1	1	KELLY, KAREN S LMFT	10/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3585 MAPLE ST	246	VENTURA	CA	93003	3504	56	06111	34.26916737	-119.2456769	Ventura County
280137	Fee-for-Service	1942484340	1942484340	1	1	KHO, FRANCISCA K NP	1/24/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
280145	Fee-for-Service	1215244736	1215244736	1	1	KIM, JEANNE K MD	5/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115336	05	Anesthesiology	0	In state provider	None	5530 BIRDCAGE STREET	SUITE 145	CITRUS HEIGHTS	CA	95610	7690	34	06067	38.667744	-121.273758	Sacramento County
280278	Fee-for-Service	1770849275	1770849275	1	1	KARNIK, KAVITHA MD	3/17/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	-	27	Psychiatry Neurology (D.O. only)	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
280314	Fee-for-Service	1871647370	1871647370	1	1	KLEINMAN, CRAIG S LMFT	9/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
280348	Fee-for-Service	1730684408	1730684408	1	1	KRUPADEV, VINAY MD	2/13/2023	207R00000X	NA	Other	026	PHYSICIANS	181179	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
280356	Fee-for-Service	1144502618	1144502618	1	1	KADAKIA, JIGAR S MD	6/12/2014	208M00000X	NA	Other	026	PHYSICIANS	127003	01	General Practice	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
280408	Fee-for-Service	1659374866	1659374866	1	1	KHAN, MOHAMMAD B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	485 DUBSON STE 111	None	CHANDLER	AZ	85224	0000	00	None	33.29658	-111.875499	Maricopa County
280436	Fee-for-Service	1962712729	1962712729	2	1	KUMAR, NISHCHAL MD	3/11/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	128234	08	Family Practice	0	In state provider	None	3055 W. ORANGE AVE	SUITE 205	ANAHEIM	CA	92804	3159	30	06059	33.8247435	-117.99621	Orange County
280458	Fee-for-Service	1629253497	1629253497	1	1	KARIMI, DANIELLE P MD	8/19/2008	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	96781	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
280478	Fee-for-Service	1639883341	1639883341	1	1	KAUR, HARJOT NP	9/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
280498	Fee-for-Service	1376569905	1376569905	1	1	KOPELL, MAYA L MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	67503	36	Psychiatry	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
280504	Fee-for-Service	1013584879	1013584879	1	1	KANE & ASSOCIATES FAMILY COU	6/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NSELING INC.	5055 CANYON CREST	203	RIVERSIDE	CA	92507	6015	33	06065	33.95862536	-117.3310726	Riverside County
280532	Fee-for-Service	1942358734	1942358734	1	1	KIM, PAUL D MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85780	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
280556	Fee-for-Service	1477625127	1477625127	1	1	KAILAR, LAVANYA MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50542	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
280586	Fee-for-Service	1801231899	1801231899	1	1	KWAN, ALEX K LAC	7/3/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	750 W GONZALES RD	STE 260	OXNARD	CA	93036	0708	56	06111	34.21907131	-119.1858729	Ventura County
280663	Fee-for-Service	1508972910	1508972910	1	1	KANESHIGE, PETER Y MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74280	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2110 N BELLFLOWER AVE	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
280673	Fee-for-Service	1619947181	1619947181	2	1	KOOK, LORIE J OD	12/1/1999	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3323 W OLYMPIC BLVD	STE 121	LOS ANGELES	CA	90019	2351	19	06037	34.0526805	-118.30986	Los Angeles County
280676	Fee-for-Service	1043758923	1043758923	1	2	KRONEN, MARIA R MD	11/30/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146917	None	None	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
280679	Fee-for-Service	1902924152	1902924152	1	2	KAPOOR, NIKHIL MD	4/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88745	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1045 ATLANTIC AVE	STE 611	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
280681	Fee-for-Service	1629253497	1629253497	1	1	KARIMI, DANIELLE P MD	8/19/2008	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	96781	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
280686	Fee-for-Service	1780367409	1780367409	1	1	KNAPP, KIM CD	3/11/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
280707	Fee-for-Service	1386747509	1386747509	1	1	KELLY, IRENE E MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60525	01	General Practice	0	In state provider	None	3100 TELEGRAPH AVE	SUITE 2109	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
280721	Fee-for-Service	1518513480	1518513480	1	1	KEMPKEY, KATHERINE F PT	5/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
280786	Fee-for-Service	1952616369	1952616369	1	1	KANAGALINGAM, SIVAJOTHI MD	11/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	555 BLACK OAK DR	None	MEDFORD	OR	97504	8491	00	None	42.318873	-122.835653	Jackson County
280883	Fee-for-Service	1508972910	1508972910	1	1	KANESHIGE, PETER Y MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74280	41	Internal Medicine	0	In state provider	None	2110 N BELLFLOWER AVE	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
280901	Fee-for-Service	1902924152	1902924152	1	2	KAPOOR, NIKHIL MD	4/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88745	41	Internal Medicine	0	In state provider	None	1045 ATLANTIC AVE	STE 611	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
280907	Fee-for-Service	1710973987	1710973987	1	1	KULKARNI, RAGHAVENDRA MD	4/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86191	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
280945	Fee-for-Service	1740014562	1740014562	1	1	KAMIYA, DEANA	9/19/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
280963	Fee-for-Service	1871931774	1871931774	1	1	KANE, MIRANDA S DO	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13530	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
280971	Fee-for-Service	1942688387	1942688387	1	1	KAUR, MANPREET LMFT	9/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
281041	Fee-for-Service	1316908775	1316908775	1	1	KULHANEK, JAN MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102299	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
281045	Fee-for-Service	1881727519	1881727519	1	1	KAPPELER, FRANCIA M LMFT	7/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	838 4TH STREET	SUITE A	SANTA ROSA	CA	95404	4542	49	06097	38.442339	-122.709357	Sonoma County
281069	Fee-for-Service	1306808050	1306808050	1	1	KAPPLER, SHERRI L MD	5/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
281096	Fee-for-Service	1588000798	1588000798	1	1	KRUSE, RYAN C MD	3/20/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
281179	Fee-for-Service	1710116801	1710116801	1	1	KANNEGANTI, PRAVEEN	3/22/2024	207R00000X	NA	Other	026	PHYSICIANS	191956	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
281204	Fee-for-Service	1437113586	1437113586	1	1	KAPLAN, LAWRENCE D MD	10/31/1983	207RX0202X	NA	Oncology	026	PHYSICIANS	51737	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
281262	Fee-for-Service	1700248531	1700248531	1	1	KALLMAN, JOSHUA R MD	8/15/2022	2080P0006X	NA	Psychiatry	026	PHYSICIANS	162267	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
281274	Fee-for-Service	1003101874	1003101874	1	1	KIM, GRACE L MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136906	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
281337	Fee-for-Service	1306089164	1306089164	1	1	KATYAL, RADHIKA PSYD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
281366	Fee-for-Service	1962561571	1962561571	1	1	KEEN, WILLIAM D MD	3/4/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73551	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
281503	Fee-for-Service	1023043544	1023043544	1	1	KRISHNA PHARMACY INC	5/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MEDCARE PHARMACY	1285 N EUCLID ST	None	ANAHEIM	CA	92801	1954	30	06059	33.851259	-117.941807	Orange County
281513	Fee-for-Service	1144334640	1144334640	1	1	KAMIMURA, DANIEL C PT	4/7/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2200 E. MAPLE AVE	None	EL SEGUNDO	CA	90245	6507	19	06037	33.92690475	-118.3857342	Los Angeles County
281559	Fee-for-Service	1336645209	1336645209	1	1	KOSHKAKARYAN, GAYANE DO	9/13/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17681	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
281562	Fee-for-Service	1568495166	1568495166	1	1	KALIANI, NEELU J MD	10/4/2024	207R00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
281580	Fee-for-Service	1962561571	1962561571	1	1	KEEN, WILLIAM D MD	3/4/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73551	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
281582	Fee-for-Service	1508152810	1508152810	1	1	KIEHM, JAMIE H MD	5/17/2024	207KA0200X	NA	Other	026	PHYSICIANS	183196	03	Allergy	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
281584	Fee-for-Service	1780696252	1780696252	1	1	KHAVARI, PAUL A MD	1/31/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	69476	07	Dermatology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
281604	Fee-for-Service	1396815304	1396815304	1	1	KIM, DANIELA Y MD	3/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	90773	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
281618	Fee-for-Service	1144472044	1144472044	1	1	KONDAPALLI, LAVANYA MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
281622	Fee-for-Service	1811936123	1811936123	1	1	KUO, TOM MD	7/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91444	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
281636	Fee-for-Service	1386896603	1386896603	1	1	KIM, JOSEPH B MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99142	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
281649	Fee-for-Service	1174681332	1174681332	1	1	KABIR, MD SAIF AU	6/4/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	936 WESTERN	SUITE 270	SAN PEDRO	CA	90732	2427	19	06037	33.75111361	-118.3090432	Los Angeles County
281688	Fee-for-Service	1467682260	1467682260	1	1	KAUR, JAGDEEP MD	3/15/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170263	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
281694	Fee-for-Service	1447247929	1447247929	1	1	KENNETH D GLAESER, M.D.	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1650 COWLES ST	None	FAIRBANKS	AK	99701	5907	00	None	64.8310943	-147.7363579	Fairbanks North Star Borough
281728	Fee-for-Service	1497949267	1497949267	1	1	KONGSAKUL, ANDY K OD	7/27/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19636 SHERMAN WAY	None	RESEDA	CA	91335	3647	19	06037	34.20100854	-118.5613965	Los Angeles County
281754	Fee-for-Service	1144378068	1144378068	1	1	KANDEL, LORI B MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76599	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
281756	Fee-for-Service	1003840562	1003840562	1	1	KOH, DAVIS Y	2/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	YOUNGCORP REHAB SERVICES	2253 MARTIN	APT 416	IRVINE	CA	92612	1457	30	06059	33.6724591	-117.8591131	Orange County
281772	Fee-for-Service	1841733466	1841733466	1	1	KRYSLOVA, TEREZA CNM	4/6/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	44105 15TH ST W	STE 301	LANCASTER	CA	93534	4089	19	06037	34.684218	-118.1568465	Los Angeles County
281804	Fee-for-Service	1790869568	1790869568	1	6	KAISER FOUNDATION HOSPITAL	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4501 BROADWAY BLVD	None	OAKLAND	CA	94611	4501	01	06001	37.833289	-122.2531244	Alameda County
281830	Fee-for-Service	1144472044	1144472044	1	1	KONDAPALLI, LAVANYA MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
281840	Fee-for-Service	1407951395	1407951395	1	1	KERRY A HARTHCOCK, M.D.	7/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2811 TIETON DR	None	YAKIMA	WA	98902	3761	00	None	46.59274567	-120.54785	Yakima County
281845	Fee-for-Service	1538545520	1538545520	1	1	KAWEAH DELTA HEALTH CARE DIS	8/21/2017	207X00000X	NA	Orthopedic Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IC	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
281854	Fee-for-Service	1942276332	1942276332	1	1	KORTMAN, KEITH E MD	7/1/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	48065	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
281880	Fee-for-Service	1376503144	1376503144	1	1	KELLY-DOKUBO, IDUAMA MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	51025	41	Internal Medicine	0	In state provider	None	2750 E WASHINGTON BLVD	STE 370	PASADENA	CA	91107	6204	19	06037	34.1680038	-118.0943955	Los Angeles County
281886	Fee-for-Service	1780746263	1780746263	1	1	KORKIS, EBTISSAM H MD	6/19/2006	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89767	08	Family Practice	0	In state provider	None	1530 JAMACHA RD	SUITE F	EL CAJON	CA	92019	3757	37	06073	32.768073	-116.9278985	San Diego County
281958	Fee-for-Service	1295311215	1295311215	1	1	KWONG, ERIC K	5/3/2023	207R00000X	NA	Other	026	PHYSICIANS	180091	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
281966	Fee-for-Service	1144378068	1144378068	1	1	KANDEL, LORI B MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76599	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
281978	Fee-for-Service	1083330948	1083330948	1	1	KCIUK, OLGA H MD	9/4/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182674	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
281981	Fee-for-Service	1679808356	1679808356	1	1	KIM, JACK OD	4/18/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19038 NORWALK BLVD	None	ARTESIA	CA	90701	7032	19	06037	33.85727707	-118.0722655	Los Angeles County
281985	Fee-for-Service	1649634999	1649634999	1	1	KWON, HYOUNGTAE E MD	11/17/2022	390200000X	NA	Other	026	PHYSICIANS	179499	None	None	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
282010	Fee-for-Service	1689679417	1689679417	1	1	KIM, JULIE MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65461	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	510 N PROSPECT AVE	STE 320	REDONDO BEACH	CA	90277	3032	19	06037	33.85259344	-118.379739	Los Angeles County
282047	Fee-for-Service	1023310687	1023310687	1	1	KIM, SAMUEL S MD	4/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	114873	None	None	0	In state provider	None	16742 GOTHARD ST STE 210	None	HUNTINGTON BEACH	CA	92647	4567	30	06059	33.71950456	-118.0000737	Orange County
282051	Fee-for-Service	1538545520	1538545520	1	1	KAWEAH DELTA HEALTH CARE DIS	8/21/2017	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IC	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
282054	Fee-for-Service	1467500306	1467500306	1	1	KEENBERG, JANE J NP	1/24/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
282107	Fee-for-Service	1245855485	1245855485	1	1	KOROSHETZ, LYDIA MD	8/2/2023	207P00000X	NA	Other	026	PHYSICIANS	186182	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
282139	Fee-for-Service	1013514199	1013514199	3	2	KECK MEDICAL CENTER OF USC	10/21/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1520 SAN PABLO ST	L1502	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
282147	Fee-for-Service	1144600446	1144600446	1	1	KADDIS, ANDREW J MD	12/12/2018	2279E0002X	NA	Other	026	PHYSICIANS	157840	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
282154	Fee-for-Service	1174613434	1174613434	1	1	KELLY MANNING MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RAPID CITY EMERGENCY SER	353 FAIRMONT BLVD	None	RAPID CITY	SD	57701	0000	00	None	44.05854729	-103.2246985	Pennington County
282173	Fee-for-Service	1417039637	1417039637	1	1	KALKANIS, JAMES G MD	6/9/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	82979	None	None	0	In state provider	None	341 MAGNOLIA AVE	SUITE 206	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
282177	Fee-for-Service	1588604052	1588604052	1	1	KHOKHA, MUSTAFA MD	12/3/2024	2080P0203X	NA	Other	026	PHYSICIANS	66522	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
282188	Fee-for-Service	1568788545	1568788545	1	1	KULKARNI, SAMEER MD	5/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120424	41	Internal Medicine	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
282193	Fee-for-Service	1457658544	1457658544	1	1	KOROSCIL, MICHAEL A MD	11/20/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
282242	Fee-for-Service	1629002191	1629002191	1	1	KIM, CHRISTINA N MD	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96108	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
282257	Fee-for-Service	1508234220	1508234220	1	1	KHAN, MUHAMMAD N	10/4/2016	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3412 DELAWARE AVE	None	STOCKTON	CA	95204	2710	39	06077	37.97258927	-121.3332629	San Joaquin County
282259	Fee-for-Service	1538545520	1538545520	1	1	KAWEAH DELTA HEALTH CARE DIS	8/21/2017	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IC	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
282287	Fee-for-Service	1215069778	1215069778	1	1	KOJIAN, HAIG J PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19543 MAYALL ST	None	NORTHRIDGE	CA	91324	1015	19	06037	34.25366574	-118.5594058	Los Angeles County
282314	Fee-for-Service	1508442955	1508442955	1	1	KANTONO, MELVIN DO	9/24/2024	207R00000X	NA	Other	026	PHYSICIANS	22504	41	Internal Medicine	0	In state provider	None	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	36	06071	33.96437546	-117.6900161	San Bernardino County
282324	Fee-for-Service	1013011055	1013011055	1	1	KRISHNAMOORTHI, SOMA MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76562	41	Internal Medicine	0	In state provider	None	1401 SPANOS CT	STE 111	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
282326	Fee-for-Service	1376962746	1376962746	1	1	KUTIK, ELANAH J LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
282338	Fee-for-Service	1467500348	1467500348	1	1	KAISER FOUND HOSP PHAR	5/16/1980	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
282366	Fee-for-Service	1003915661	1003915661	1	1	KIM, RONALD C MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13550	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
282381	Fee-for-Service	1962609396	1962609396	1	1	KAWASE, JENNIFER K MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104807	36	Psychiatry	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
282405	Fee-for-Service	1962746065	1962746065	1	1	KILGORE, KIMBERLY A LCSW	10/12/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1090 THIRD ST	STE 1	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
282462	Fee-for-Service	1336257070	1336257070	1	1	KANG, DANIEL W MD	12/29/2009	207R00000X	NA	Other	026	PHYSICIANS	109210	None	None	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
282474	Fee-for-Service	1144858697	1144858697	1	1	KAHANU LEUNG, ALEXIS MD	6/27/2023	207P00000X	NA	Other	026	PHYSICIANS	185398	None	None	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
282478	Fee-for-Service	1700844503	1700844503	1	1	KOLMAN, BRUCE A OT	8/20/2021	174400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
282519	Fee-for-Service	1063606556	1063606556	1	1	KERN COUNTY HEALTH DEPT	6/3/1998	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY	1800 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	3302	15	06029	35.383626	-118.967417	Kern County
282568	Fee-for-Service	1932322393	1932322393	1	1	KNOWLTON, TIFFANY K LMFT	5/16/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8325 HAVEN AVE	SUITE 209	RANCHO CUCAMONGA	CA	91730	3894	36	06071	34.10122106	-117.5757252	San Bernardino County
282570	Fee-for-Service	1164950085	1164950085	1	1	KALYANASUNDARAM, SRIDEVI NP	7/24/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
282607	Fee-for-Service	1720178601	1720178601	1	1	KAMBOJ, PRADEEP K MD	6/1/1995	261Q00000X	NA	Other	026	PHYSICIANS	53364	08	Family Practice	0	In state provider	None	922 N CHERRY ST	None	TULARE	CA	93274	2210	54	06107	36.22074423	-119.337598	Tulare County
282619	Fee-for-Service	1942733266	1942733266	1	1	KAUSHIK, JASON A MD	8/2/2021	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	171418	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
282695	Fee-for-Service	1457416190	1457416190	1	1	KIRK, DUANE I OD	9/15/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	423 W MAIN ST	None	RIPON	CA	95366	2425	39	06077	37.73942352	-121.127697	San Joaquin County
282702	Fee-for-Service	1083102818	1083102818	1	1	KIM, FIONA H MD	1/6/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180668	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
282791	Fee-for-Service	1598803512	1598803512	1	1	KOONG,ALBERT C MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84199	32	Radiation Therapy (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282798	Fee-for-Service	1457605644	1457605644	1	1	KUPERMAN, TINA H LCSW	8/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
282806	Fee-for-Service	1033237987	1033237987	1	1	KIM, EDWARD J MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122547	41	Internal Medicine	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
282819	Fee-for-Service	1639243942	1639243942	1	1	KORSHKOV, YURY MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89945	05	Anesthesiology	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
282875	Fee-for-Service	1497882823	1497882823	1	1	KALLMAN, CINDY E MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65234	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
282889	Fee-for-Service	1801985726	1801985726	1	1	KAUFMAN, DAN S MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142658	68	Hematology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
282896	Fee-for-Service	1104899608	1104899608	1	1	KHANNA, HAPPY N MD	8/21/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44278	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
282914	Fee-for-Service	1184355422	1184355422	1	1	KYSSA, SASCHA LMFT	10/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
282934	Fee-for-Service	1528034485	1528034485	1	1	KIM, CHONG U MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54806	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
282952	Fee-for-Service	1760408470	1760408470	1	1	KWON, THEODORE H MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	35852	01	General Practice	0	In state provider	None	1998 N ARROWHEAD AVENUE	None	SAN BERNARDINO	CA	92405	4116	36	06071	34.1334	-117.289677	San Bernardino County
283003	Fee-for-Service	1033237987	1033237987	1	1	KIM, EDWARD J MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122547	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
283029	Fee-for-Service	1932183563	1932183563	1	1	KARNIK, RAHOOL S MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84656	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
283030	Fee-for-Service	1629859376	1629859376	1	1	KO, KENNETH PT	12/22/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
283034	Fee-for-Service	1417477183	1417477183	1	3	KIM, JONG H MD	10/18/2022	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	163105	-	NOT APPLICABLE	0	In state provider	None	845 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09032048	-117.734769	Los Angeles County
283088	Fee-for-Service	1104899608	1104899608	1	1	KHANNA, HAPPY N MD	8/21/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44278	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
283092	Fee-for-Service	1396990735	1396990735	1	1	KOCHARIAN, NAIRA MD APC	2/2/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	93881	13	Neurology (M.D. only)	0	In state provider	None	435 ARDEN AVE	STE 450	GLENDALE	CA	91203	6026	19	06037	34.15848148	-118.2628845	Los Angeles County
283104	Fee-for-Service	1871257469	1871257469	1	1	KELILE, ALMAZ GEREMEW	11/9/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3470 DURELLO CIRCLE	None	RANCHO CORDOVA	CA	95670	6913	34	06067	38.577384	-121.276512	Sacramento County
283113	Fee-for-Service	1760902837	1760902837	1	1	KAISER FOUNDATION HEALTH PLA	4/28/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	384	601 E IMPERIAL HWY	1ST FL	LA HABRA	CA	90631	7463	30	06059	33.91739949	-117.938961	Orange County
283189	Fee-for-Service	1992761571	1992761571	1	1	KANDEEL, FOUAD R MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42470	67	Endocrinology	0	In state provider	None	50 BELLEFONTAINE ST	STE 104	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
283196	Fee-for-Service	1033237987	1033237987	1	1	KIM, EDWARD J MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122547	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
283207	Fee-for-Service	1699709881	1699709881	2	1	KAKO, RONY Y MD	6/13/2023	207R00000X	NA	Other	026	PHYSICIANS	66579	None	None	0	In state provider	None	1800 PUEBLO AVE	None	NAPA	CA	94558	4751	28	06055	38.31438369	-122.3050295	Napa County
283224	Fee-for-Service	1093809790	1093809790	1	1	KIMURA, BRUCE J MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	69109	08	Family Practice	0	In state provider	None	230 PROSPECT PL	STE 250	CORONADO	CA	92118	1986	37	06073	32.69468235	-117.1677128	San Diego County
283243	Fee-for-Service	1750443354	1750443354	1	1	KOENIG, JULIE J PHD	8/21/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3840 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
283290	Fee-for-Service	1912032764	1912032764	1	1	KUO, ALEXANDER MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86787	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283292	Fee-for-Service	1871257469	1871257469	1	1	KELILE, ALMAZ GEREMEW	11/9/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3470 DURELLO CIRCLE	None	RANCHO CORDOVA	CA	95670	6913	34	06067	38.577384	-121.276512	Sacramento County
283352	Fee-for-Service	1144837923	1144837923	1	1	KAROLEWICZ, HANNAH LPCC	4/10/2025	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
283378	Fee-for-Service	1992761571	1992761571	1	1	KANDEEL, FOUAD R MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42470	01	General Practice	0	In state provider	None	50 BELLEFONTAINE ST	STE 104	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
283383	Fee-for-Service	1962693309	1962693309	1	1	KHAN, SHABANA K MD	12/26/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	86063	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
283388	Fee-for-Service	1780730887	1780730887	1	1	KOTOBI, HUMAN MD	4/18/2013	207L00000X	NA	Other	026	PHYSICIANS	87501	05	Anesthesiology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
283415	Fee-for-Service	1093809790	1093809790	1	1	KIMURA, BRUCE J MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	69109	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	230 PROSPECT PL	STE 250	CORONADO	CA	92118	1986	37	06073	32.69468235	-117.1677128	San Diego County
283421	Fee-for-Service	1144326117	1144326117	1	1	KOTHAPA, VINOD K MD	6/11/1998	207L00000X	NA	Other	026	PHYSICIANS	42884	05	Anesthesiology	0	In state provider	None	3838 SHERMAN DR	STE 11	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
283458	Fee-for-Service	1649530833	1649530833	1	1	KOHANTEB, ARASH D MD	8/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121119	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3700 SOUTH STREET	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
283470	Fee-for-Service	1992368781	1992368781	1	1	KEOWN, THOMAS W MD	9/26/2022	207P00000X	NA	Other	026	PHYSICIANS	176080	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
283489	Fee-for-Service	1407430622	1407430622	1	1	KHAN, SHAHNOOR LCSW	3/18/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
283542	Fee-for-Service	1346709649	1346709649	1	1	KASINATHAN, SIVAKANTHAN MD	2/13/2025	2080P0216X	NA	Other	026	PHYSICIANS	179778	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
283584	Fee-for-Service	1891473872	1891473872	1	1	KYLIE FULLER MD INC	9/5/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	250 W BONITA AVE	SUITE 100	POMONA	CA	91767	1863	19	06037	34.09664881	-117.751261	Los Angeles County
283601	Fee-for-Service	1093809790	1093809790	1	1	KIMURA, BRUCE J MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	69109	66	Emergency Medicine (Urgent Care)	0	In state provider	None	230 PROSPECT PL	STE 250	CORONADO	CA	92118	1986	37	06073	32.69468235	-117.1677128	San Diego County
283611	Fee-for-Service	1215163472	1215163472	1	1	KANTER, GREGORY I MD	9/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113982	34	Urology and Urological Surgery	0	In state provider	None	250 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65817286	-121.6460674	Monterey County
283647	Fee-for-Service	1871053447	1871053447	1	1	KELLEY, KEVIN W MD	8/1/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179488	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
283671	Fee-for-Service	1396168258	1396168258	1	1	KELLY, JOHN G	6/6/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3772 MISSION	SUITE 117	OCEANSIDE	CA	92058	1453	37	06073	33.22565381	-117.3312862	San Diego County
283687	Fee-for-Service	1295832020	1295832020	1	1	KETUL RAJANIKANT PATEL, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75284	5347	00	None	32.812245	-96.841584	Dallas County
283729	Fee-for-Service	1205052792	1205052792	1	1	KADAM, SHILPA MD	2/27/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	168261	None	None	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
283745	Fee-for-Service	1164181814	1164181814	1	1	KATSUYAMA, JESSICA R AU	12/8/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
283792	Fee-for-Service	1215163472	1215163472	1	1	KANTER, GREGORY I MD	9/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113982	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65817286	-121.6460674	Monterey County
283828	Fee-for-Service	1275685455	1275685455	1	1	KIM,SONG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
283864	Fee-for-Service	1053300632	1053300632	2	1	KRAFFERT, CRAIG A MD	11/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	72464	07	Dermatology	0	In state provider	None	2107 AIRPARK DR	None	REDDING	CA	96001	2433	45	06089	40.57493327	-122.4048185	Shasta County
283875	Fee-for-Service	1821483645	1821483645	1	1	KRISTA TOOKHAN MD	8/1/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	22 S GREENE ST	None	BALTIMORE	MD	21201	1544	00	None	39.28815298	-76.62364605	Baltimore city
283895	Fee-for-Service	1487956322	1487956322	1	1	KIM, JENNIFER Y MD INC	1/11/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	75250	40	Pediatrics	0	In state provider	None	360 E 7TH ST	STE M	UPLAND	CA	91786	6701	36	06071	34.08880374	-117.6465151	San Bernardino County
283917	Fee-for-Service	1114033206	1114033206	1	1	KIM, KATHERINE M OD	7/22/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19871 YORBA LINDA BLVD	STE 101	YORBA LINDA	CA	92886	2811	30	06059	33.8897307	-117.7877423	Orange County
283922	Fee-for-Service	1386714814	1386714814	1	3	KAISER FOUNDATION HOSPITALS	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
283943	Fee-for-Service	1619933157	1619933157	1	1	KELLER, DAVID W MD	3/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152769	41	Internal Medicine	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
284010	Fee-for-Service	1659362135	1659362135	1	1	KESTENBAUM, JOSEPH Y PHD	5/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21081 S WESTERN AVE	STE 250	TORRANCE	CA	90501	1708	19	06037	33.83886841	-118.3093605	Los Angeles County
284051	Fee-for-Service	1134649007	1134649007	1	1	KOSE, LARA T MD	8/19/2020	207R00000X	NA	Other	026	PHYSICIANS	157259	41	Internal Medicine	0	In state provider	None	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
284067	Fee-for-Service	1477228682	1477228682	1	1	KONYASHIN, CHRISTINA G NP	11/6/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
284085	Fee-for-Service	1821098096	1821098096	1	1	KIM, WALTER S OD	9/15/1981	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	237 N WESTERN AVE	None	LOS ANGELES	CA	90004	4107	19	06037	34.07572244	-118.3091724	Los Angeles County
284095	Fee-for-Service	1043530181	1043530181	1	1	KABIR, YASMEEN MD	12/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120936	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
284118	Fee-for-Service	1518211465	1518211465	1	1	KUO, CAMIE H NP	10/6/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284126	Fee-for-Service	1619933157	1619933157	1	1	KELLER, DAVID W MD	3/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152769	77	Infectious Disease	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
284130	Fee-for-Service	1992955983	1992955983	1	1	KIM, JEANNIE S LCSW	3/22/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 WEST MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
284143	Fee-for-Service	1841395340	1841395340	1	1	KAZALBASCH, MAHNAZ N PT	8/29/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7774 CHERRY AVE	None	FONTANA	CA	92336	4014	36	06071	34.11281482	-117.488717	San Bernardino County
284157	Fee-for-Service	1386693646	1386693646	1	1	KATKOV, WILLIAM N MD	1/16/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54468	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	# 390W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
284223	Fee-for-Service	1497721401	1497721401	1	1	KELLERMAN, PAUL MD	7/19/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	66582	45	Nephrology (Renal-Kidney)	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
284226	Fee-for-Service	1831350024	1831350024	1	1	KIM, EUGENE L MD	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125087	08	Family Practice	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
284232	Fee-for-Service	1578748646	1578748646	1	1	KESWANI, SUNDEEP G	8/23/2023	208600000X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
284234	Fee-for-Service	1992883052	1992883052	1	1	KOTIN, GEOFFREY R MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	38829	40	Pediatrics	0	In state provider	None	1235 HARRISON ST	None	SAN LEANDRO	CA	94577	4515	01	06001	37.72577467	-122.1544541	Alameda County
284238	Fee-for-Service	1508226903	1508226903	1	1	KAUR, MANVINDER NP	2/27/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
284299	Fee-for-Service	1619922077	1619922077	1	1	KEY WEST HMA LLC	6/3/2022	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5900 COLLEGE RD	None	KEY WEST	FL	33040	4342	00	None	24.581187	-81.7423965	Monroe County
284303	Fee-for-Service	1386689487	1386689487	1	1	KLICKITAT COUNTY PUBLIC HOSP	7/21/2024	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	310 S ROOSEVELT AVE	None	GOLDENDALE	WA	98620	9201	00	None	45.819513	-120.8123115	Klickitat County
284323	Fee-for-Service	1285894048	1285894048	1	1	KARRAKER, LEAH	10/1/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	840 WILLOW ST	STE 300	SAN JOSE	CA	95125	2377	43	06085	37.31069335	-121.8963251	Santa Clara County
284333	Fee-for-Service	1043669484	1043669484	1	1	KUYE, IFEDAYO O MD	7/2/2019	208M00000X	NA	Other	026	PHYSICIANS	162308	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284334	Fee-for-Service	1386693646	1386693646	1	1	KATKOV, WILLIAM N MD	1/16/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54468	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 SANTA MONICA BLVD	# 390W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
284340	Fee-for-Service	1013007483	1013007483	2	1	KUMAR, ASHISH	9/20/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	-	68	Hematology	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
284470	Fee-for-Service	1619922077	1619922077	1	1	KEY WEST HMA LLC	6/3/2022	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5900 COLLEGE RD	None	KEY WEST	FL	33040	4342	00	None	24.581187	-81.7423965	Monroe County
284471	Fee-for-Service	1619173390	1619173390	1	1	KAZANJIAN, KARIN M MD	6/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106509	30	Radiology	0	In state provider	None	11370 ANDERSON ST	SUITE 1700	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
284476	Fee-for-Service	1386689487	1386689487	1	1	KLICKITAT COUNTY PUBLIC HOSP	7/21/2024	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	310 S ROOSEVELT AVE	None	GOLDENDALE	WA	98620	9201	00	None	45.819513	-120.8123115	Klickitat County
284486	Fee-for-Service	1265411920	1265411920	1	1	KRIEGER, JEFFREY L MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61682	10	Gastroenterology (M.D. only)	0	In state provider	None	1301 2OTH ST	#280	SANTA MONICA	CA	90404	0000	19	06037	0	0	None
284506	Fee-for-Service	1538535943	1538535943	1	1	KIM, ERIC M	11/24/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
284522	Fee-for-Service	1013007483	1013007483	2	1	KUMAR, ASHISH	9/20/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
284549	Fee-for-Service	1851448179	1851448179	1	1	KAISER FOUNDATION HEALTH	2/19/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PLAN PHARMACY MOB #1	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
284550	Fee-for-Service	1144378316	1144378316	1	1	KING, CRAIG A DC	7/1/2002	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	620 ALABAMA ST	None	REDLANDS	CA	92373	8059	36	06071	34.061841	-117.208804	San Bernardino County
284559	Fee-for-Service	1801044060	1801044060	1	1	KHINE, KHIN S MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105172	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
284567	Fee-for-Service	1659792158	1659792158	1	1	KERN NEUROSURGICAL INSTITUTE	3/1/2018	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	2323 16TH ST	STE 407	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
284638	Fee-for-Service	1386608529	1386608529	1	1	KLAHR,DAVID	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVENUE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
284641	Fee-for-Service	1477648921	1477648921	1	1	KATZENMEYER, JEFFREY MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66129	08	Family Practice	0	In state provider	None	1580 CASE PL	STE A	WOODLAND	CA	95776	9581	57	06113	38.67838553	-121.747851	Yolo County
284665	Fee-for-Service	1841378569	1841378569	1	1	KLIEGER, LOUIS L MD	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82111	18	Ophthalmology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
284666	Fee-for-Service	1386742831	1386742831	1	1	KUPISK, ASYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35087	01	General Practice	0	In state provider	None	7779 W SUNSET BLVD	None	LOS ANGELES	CA	90046	3911	19	06037	34.09808552	-118.3590225	Los Angeles County
284667	Fee-for-Service	1174824015	1174824015	1	1	KAUR, NAVJOT MD	6/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123216	41	Internal Medicine	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
284671	Fee-for-Service	1790190429	1790190429	1	1	KHOURY, JOHN MD	2/18/2020	207R00000X	NA	Other	026	PHYSICIANS	167239	68	Hematology	0	In state provider	None	1135 S SUNSET BLVD	SUITE 301	WEST COVINA	CA	91790	3707	19	06037	34.06215064	-117.9453997	Los Angeles County
284691	Fee-for-Service	1619258787	1619258787	1	1	KUNKLEMAN, CINDI L LMFT	7/16/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	659 WEST SHAW AVE	SUITE E	FRESNO	CA	93704	2442	10	06019	36.8083206	-119.8056888	Fresno County
284730	Fee-for-Service	1720382864	1720382864	1	2	KELAITA, SHANNON H LCSW	5/17/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35 MAIN STREET	STE. 203	SAN ANDREAS	CA	95249	9713	05	06009	38.1968035	-120.6807116	Calaveras County
284750	Fee-for-Service	1861594574	1861594574	1	1	KHORASANI, LEILA MD	4/20/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	125929	14	Neurological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
284752	Fee-for-Service	1699710533	1699710533	1	1	KRISHNAKUMAR, TAMILSELVI	11/26/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48922	None	None	0	In state provider	MD	8100 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3948	19	06037	34.21771742	-118.3701303	Los Angeles County
284761	Fee-for-Service	1184759227	1184759227	1	1	KELLY & SCOTTS CARE HOME	2/14/2003	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	2212 5TH DR	None	DELANO	CA	93215	4239	15	06029	35.7645962	-119.2246907	Kern County
284839	Fee-for-Service	1790190429	1790190429	1	1	KHOURY, JOHN MD	2/18/2020	207R00000X	NA	Other	026	PHYSICIANS	167239	41	Internal Medicine	0	In state provider	None	1135 S SUNSET BLVD	SUITE 301	WEST COVINA	CA	91790	3707	19	06037	34.06215064	-117.9453997	Los Angeles County
284842	Fee-for-Service	1902260235	1902260235	1	1	KORNBLUTH, LILY S MD	8/2/2019	207R00000X	NA	Other	026	PHYSICIANS	152568	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284849	Fee-for-Service	1033253414	1033253414	1	1	KHAN, SARA A MD	4/15/2008	207R00000X	NA	Other	026	PHYSICIANS	100424	41	Internal Medicine	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
284883	Fee-for-Service	1154599462	1154599462	1	1	KLOHE, ERIKA LCSW	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3438 MENDOCINO AVE	STE B	SANTA ROSA	CA	95403	2275	49	06097	38.472282	-122.723991	Sonoma County
284895	Fee-for-Service	1710945340	1710945340	1	1	KORNBLUH, REBECCA MD	5/2/2024	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	79844	-	NOT APPLICABLE	0	In state provider	None	957 S. VILLAGE OAKS DR	None	COVINA	CA	91724	3696	19	06037	34.07216025	-117.8631234	Los Angeles County
284925	Fee-for-Service	1043510183	1043510183	2	1	KANSAL INC	6/21/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IA V	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
284929	Fee-for-Service	1821067059	1821067059	1	1	KOIDE, NUITON S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	700 SHADOW LN	STE 240	LAS VEGAS	NV	89106	4158	00	None	36.162027	-115.1654655	Clark County
284935	Fee-for-Service	1275692865	1275692865	1	1	KABA, FAWAZ W	4/30/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40225	18	Ophthalmology	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
284968	Fee-for-Service	1093249732	1093249732	1	1	KETHIREDDY, NIKHILA MD	7/31/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	165443	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
285014	Fee-for-Service	1255403556	1255403556	1	1	KORNFELD, HERBERT R MD	3/4/2010	174400000X	NA	Other	026	PHYSICIANS	10040	10	Gastroenterology (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	STE 707	LOS ANGELES	CA	90067	2010	19	06037	34.05887194	-118.4122914	Los Angeles County
285020	Fee-for-Service	1659516151	1659516151	1	1	KOLODENKER, GENNADY DPM	10/19/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4950 BARRANCA PKWY	SUITE 308	IRVINE	CA	92604	4631	30	06059	33.67620851	-117.7948348	Orange County
285043	Fee-for-Service	1730194317	1730194317	1	1	KESAVULU, VATSALA MD	3/1/2001	2080P0203X	NA	Other	026	PHYSICIANS	73745	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
285046	Fee-for-Service	1043281074	1043281074	1	1	KEENAN, JOANNE P DO	3/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	8728	41	Internal Medicine	0	In state provider	None	655 EUCLID AVE	SUITE 408	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
285078	Fee-for-Service	1871808790	1871808790	1	1	KUMAR, MRUDULA V MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118358	10	Gastroenterology (M.D. only)	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
285085	Fee-for-Service	1396961470	1396961470	1	1	KOENIG, KENNETH S MD	4/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63182	08	Family Practice	0	In state provider	None	770 SPANIEL DR	None	REDDING	CA	96003	4529	45	06089	40.59696782	-122.3469727	Shasta County
285107	Fee-for-Service	1114937786	1114937786	1	1	KAUT, RICHARD M	3/4/1991	207P00000X	NA	Other	026	PHYSICIANS	49176	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	0000	36	06071	34.26577765	-117.1695461	San Bernardino County
285110	Fee-for-Service	1104135938	1104135938	1	1	KULKARNI, HRISHIKESH MD	3/29/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
285111	Fee-for-Service	1417005307	1417005307	1	1	KAZEM, MARY ANN NP	11/4/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3430 E LA PALMA AVE	None	ANAHEIM	CA	92806	9999	30	06059	33.852105	-117.8444835	Orange County
285135	Fee-for-Service	1477723096	1477723096	1	1	KAN, IRENE O MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99457	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
285163	Fee-for-Service	1467520866	1467520866	1	1	KOLBER, KEITH A MD	5/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49492	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 713	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
285179	Fee-for-Service	1255403556	1255403556	1	1	KORNFELD, HERBERT R MD	3/4/2010	174400000X	NA	Other	026	PHYSICIANS	10040	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	STE 707	LOS ANGELES	CA	90067	2010	19	06037	34.05887194	-118.4122914	Los Angeles County
285199	Fee-for-Service	1295091155	1295091155	1	1	KUAN, EDWARD C MD	6/28/2018	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	127918	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
285207	Fee-for-Service	1841724226	1841724226	1	1	KOZLOVA, ALEKSANDRA A MD	10/28/2020	208M00000X	NA	Other	026	PHYSICIANS	169460	41	Internal Medicine	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
285211	Fee-for-Service	1831130632	1831130632	1	1	KAANEHE, LEIANI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1520 LILIHA ST	STE 601	HONOLULU	HI	96817	3564	00	None	21.32119222	-157.8606093	Honolulu County
285228	Fee-for-Service	1497778393	1497778393	2	1	KIM, MIRAN J OD	5/22/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2125 E THOUSAND OAKS BLV	SUITE A	THOUSAND OAKS	CA	91362	2945	56	06111	34.17525064	-118.8467186	Ventura County
285241	Fee-for-Service	1427288588	1427288588	1	1	KALA AHLUWALIA, GUNJEET K MD	11/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117446	40	Pediatrics	0	In state provider	None	895 E YORBA LINDA BLVD	STE 101	PLACENTIA	CA	92870	7600	30	06059	33.88944355	-117.8486322	Orange County
285281	Fee-for-Service	1194789875	1194789875	1	1	KUMAR, RAVIN R MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65950	28	Proctology (colon and rectal)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
285319	Fee-for-Service	1316233844	1316233844	1	1	KUSHNIR, MATTHEW Y MD	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136439	05	Anesthesiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
285324	Fee-for-Service	1467520866	1467520866	1	1	KOLBER, KEITH A MD	5/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49492	40	Pediatrics	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 713	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
285350	Fee-for-Service	1992209266	1992209266	1	1	KONDRA, KATELYN S MD	8/9/2021	208600000X	NA	General Surgery	026	PHYSICIANS	164587	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
285353	Fee-for-Service	1477889681	1477889681	1	1	KOVACIK, JENNIFER A MD	3/22/2018	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
285359	Fee-for-Service	1902287196	1902287196	1	1	KALWANI, NEIL M MD	9/10/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	156539	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
285367	Fee-for-Service	1508399478	1508399478	1	1	KHAN, ARSLAN	4/13/2021	208M00000X	NA	Other	026	PHYSICIANS	169389	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
285376	Fee-for-Service	1669524880	1669524880	1	1	KIM, JOANNE Y MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61502	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
285381	Fee-for-Service	1720136740	1720136740	1	1	KWAK, KAREN H DO	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9337	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
285385	Fee-for-Service	1518077460	1518077460	1	1	KAUPS, KRISTA L MD	12/7/1994	208600000X	NA	General Surgery	026	PHYSICIANS	80370	89	Surgery-Traumatic	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
285406	Fee-for-Service	1891113288	1891113288	1	1	KLAPHEKE, ROBERT MD	7/14/2021	163WG0100X	NA	Other	026	PHYSICIANS	154916	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
285412	Fee-for-Service	1598852816	1598852816	1	2	KIM, PAUL HANSU	9/7/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 W 6TH ST	STE 101	CORONA	CA	92882	6508	33	06065	33.87811444	-117.5920508	Riverside County
285438	Fee-for-Service	1952670309	1952670309	1	1	KARKI, NIRAJ MD	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145039	41	Internal Medicine	0	In state provider	None	11480 BROOKSHIRE AVE	None	DOWNEY	CA	90241	5026	19	06037	33.93622932	-118.1311752	Los Angeles County
285442	Fee-for-Service	1982137287	1982137287	1	1	KHANANIAN, ANNA MD	5/15/2023	207RR0500X	NA	Other	026	PHYSICIANS	147675	None	None	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
285443	Fee-for-Service	1649582511	1649582511	1	1	KO, SZU-HSIEN	8/16/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	303 W LINCOLN AVE	SUITE 140	ANAHEIM	CA	92805	2959	30	06059	33.83508976	-117.9177981	Orange County
285446	Fee-for-Service	1215121132	1215121132	1	1	KLEIN, OPHIR D MD	11/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82793	40	Pediatrics	0	In state provider	None	707 PARNASSUS	RM D1000	SAN FRANCISCO	CA	94143	2210	38	06075	37.76250114	-122.4611816	San Francisco County
285465	Fee-for-Service	1801039151	1801039151	1	1	KHURANA, JASJIT MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114131	41	Internal Medicine	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
285486	Fee-for-Service	1770074577	1770074577	1	1	KOERNER, COLIN P	1/6/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1229 COMMERCE AVE	None	ATWATER	CA	95301	5224	24	06047	37.34298769	-120.6128556	Merced County
285498	Fee-for-Service	1447645254	1447645254	1	1	KIYAMA, LINDSAY MD	2/17/2023	208600000X	NA	General Surgery	026	PHYSICIANS	180501	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
285510	Fee-for-Service	1093194524	1093194524	1	1	KNOPS, SHERREAN CCC-SLP	11/4/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
285541	Fee-for-Service	1184759227	1184759227	1	3	KELLY & SCOTTS CARE HOME	4/19/2006	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	332 N INDIANA ST	None	PORTERVILLE	CA	93257	3150	54	06107	36.071991	-119.035053	Tulare County
285545	Fee-for-Service	1356428924	1356428924	1	1	KOEK, RALPH J MD	8/4/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	58707	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
285549	Fee-for-Service	1386714814	1386714814	1	1	KAISER FOUNDATION HOSPITALS	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	REDWOOD CITY	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
285555	Fee-for-Service	1275504995	1275504995	1	1	KERENDIAN, JOSEPH MD INC	2/1/2000	193400000X	NA	Other	026	PHYSICIANS	75439	18	Ophthalmology	0	In state provider	None	17075 DEVONSHIRE ST	STE 307	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
285559	Fee-for-Service	1457470148	1457470148	1	1	KATAKA, SUSANA W NP	2/12/2025	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
285565	Fee-for-Service	1720007289	1720007289	1	1	KHOURY, NABIL H MD	11/27/1985	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	31583	01	General Practice	0	In state provider	None	2410 CARRIE LN	None	GLENDALE	CA	91208	2308	19	06037	34.18268506	-118.2226139	Los Angeles County
285578	Fee-for-Service	1891776688	1891776688	1	1	KOOPMANS, SUZANNE C MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81375	13	Neurology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
285585	Fee-for-Service	1891747929	1891747929	1	1	KANAYA, ALKA M MD	6/1/1998	207R00000X	NA	Other	026	PHYSICIANS	61562	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
285588	Fee-for-Service	1013191378	1013191378	1	1	KING, MICHAEL H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48579	01	General Practice	0	In state provider	None	400 PROFESSIONAL CTR DR	SUITE 424	NOVATO	CA	94947	4368	21	06041	38.09591405	-122.5779059	Marin County
285609	Fee-for-Service	1639453772	1639453772	1	1	KEENER, KRYSTEN A	1/30/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
285614	Fee-for-Service	1538346317	1538346317	1	1	KUPPALLI, KRUTIKA MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119416	77	Infectious Disease	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
285621	Fee-for-Service	1447510615	1447510615	1	1	KHAN, HUMAIR MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143440	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
285640	Fee-for-Service	1295763423	1295763423	1	1	KIM, SOO Y MD	1/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61217	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
285683	Fee-for-Service	1518993450	1518993450	1	1	KIM, CYNTHIA D MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76898	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
285712	Fee-for-Service	1275504995	1275504995	1	1	KERENDIAN, JOSEPH MD INC	2/1/2000	193400000X	NA	Other	026	PHYSICIANS	75439	02	General Surgery	0	In state provider	None	17075 DEVONSHIRE ST	STE 307	NORTHRIDGE	CA	91325	5408	19	06037	34.25755945	-118.50471	Los Angeles County
285738	Fee-for-Service	1982924353	1982924353	1	1	KOHLI, SONIA MD	4/19/2021	207R00000X	NA	Other	026	PHYSICIANS	128378	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
285781	Fee-for-Service	1972541845	1972541845	1	1	KJELL A BENSON MD	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10123 SE MARKET ST	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
285785	Fee-for-Service	1811524457	1811524457	1	1	KULASINGAM, RATHA MD	2/18/2025	208M00000X	NA	Other	026	PHYSICIANS	187513	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
285806	Fee-for-Service	1295833762	1295833762	1	1	KIM, ANTHONY W MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145795	33	Thoracic Surgery	0	In state provider	None	1450 SAN PABLO STREET	STE 6200	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
285838	Fee-for-Service	1518993450	1518993450	1	1	KIM, CYNTHIA D MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76898	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
285857	Fee-for-Service	1205951704	1205951704	1	1	KWOK, AMY M MD	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96221	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
285860	Fee-for-Service	1609871961	1609871961	1	1	KROHN, JEFFREY C OD	9/4/1992	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5151 N PALM AVE	STE 150	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
285863	Fee-for-Service	1275547390	1275547390	1	1	KHORSANDI, AMINOLLAH MD	11/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	56357	41	Internal Medicine	0	In state provider	None	2222 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90404	2304	19	06037	34.03052319	-118.4776873	Los Angeles County
285911	Fee-for-Service	1043510183	1043510183	2	2	KANSAL INC	10/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	IA V	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
285939	Fee-for-Service	1821038035	1821038035	1	1	KAMINSKY, ROBIN E MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76897	None	None	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
285965	Fee-for-Service	1053872309	1053872309	1	1	KORSUN, PHILIP E DO	1/26/2023	207R00000X	NA	Other	026	PHYSICIANS	19382	None	None	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
285983	Fee-for-Service	1417477183	1417477183	1	1	KIM, JONG H MD	8/3/2020	390200000X	NA	Other	026	PHYSICIANS	163105	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
286010	Fee-for-Service	1710129093	1710129093	1	1	KIM, PAUL S MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	114242	01	General Practice	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
286054	Fee-for-Service	1629031430	1629031430	1	1	KHOO, KAREN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64432	41	Internal Medicine	0	In state provider	None	2000 VAN NESS AVE	STE 303	SAN FRANCISCO	CA	94109	3020	38	06075	37.79415339	-122.422986	San Francisco County
286072	Fee-for-Service	1841367612	1841367612	1	1	KADOYA, JANE M OD	9/12/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 N VERMONT AVE	None	LOS ANGELES	CA	90027	5337	19	06037	34.09851639	-118.2918012	Los Angeles County
286105	Fee-for-Service	1467619213	1467619213	1	1	KASTURIA, BHAVNA A MD	1/6/2009	207R00000X	NA	Other	026	PHYSICIANS	103885	41	Internal Medicine	0	In state provider	None	3555 CESAR CHAVEZ STREET	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
286176	Fee-for-Service	1922425388	1922425388	1	1	KOCHMANN, MATTHIAS MD	12/14/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180502	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
286178	Fee-for-Service	1508251687	1508251687	1	1	KANAK, MIA M MD	6/10/2020	2080P0204X	NA	Other	026	PHYSICIANS	154810	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
286206	Fee-for-Service	1942568852	1942568852	1	1	KIM, CANDICE J MD	1/8/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	129381	None	None	0	In state provider	None	25395 HANCOCK AVE.	SUITE 230	MURRIETA	CA	92562	9019	33	06065	33.5591482	-117.185187	Riverside County
286220	Fee-for-Service	1902805377	1902805377	1	1	KOWALSKI, JAMES A MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	25918	30	Radiology	0	In state provider	None	515 E ROMIE LN	None	SALINAS	CA	93901	4018	27	06053	36.65992397	-121.6459411	Monterey County
286221	Fee-for-Service	1366498446	1366498446	1	1	KATZ, MARINA MD	9/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79969	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
286247	Fee-for-Service	1790869568	1790869568	1	5	KAISER FOUNDATION HOSPITAL	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	34	06067	38.594898	-121.3884765	Sacramento County
286300	Fee-for-Service	1144378985	1144378985	1	1	KAISER FOUNDATION HEALTH	11/5/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMNTE PHRM #608	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
286308	Fee-for-Service	1164834875	1164834875	1	1	KRANTZ, SARAH B MD	10/11/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155539	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93454	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
286337	Fee-for-Service	1811375371	1811375371	1	1	KOTECHA, ADITYA A MD	9/19/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
286354	Fee-for-Service	1831115054	1831115054	1	2	KESHEN, TAMIR H MD	1/19/2021	2086S0120X	NA	General Surgery	026	PHYSICIANS	87958	None	None	0	In state provider	None	1400 E CHURCH ST	BUILDING 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
286373	Fee-for-Service	1366498446	1366498446	1	1	KATZ, MARINA MD	9/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79969	36	Psychiatry	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
286388	Fee-for-Service	1336638881	1336638881	1	1	KOGACHI, SHANNON A MD	5/21/2024	208M00000X	NA	Other	026	PHYSICIANS	165617	41	Internal Medicine	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
286434	Fee-for-Service	1518122316	1518122316	1	1	KELES, EYUP S MD	6/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155891	40	Pediatrics	0	In state provider	None	7060 N RECREATION AVENUE	SUITE 101	FRESNO	CA	93720	8022	10	06019	36.8388	-119.7404335	Fresno County
286485	Fee-for-Service	1811375371	1811375371	1	1	KOTECHA, ADITYA A MD	9/19/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3701 SKYPARK DRIVE	200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
286493	Fee-for-Service	1730718875	1730718875	1	1	KAUR, HARJIT	9/27/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
286494	Fee-for-Service	1851450480	1851450480	1	1	KIMM, SANDRA P MD	11/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67981	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
286531	Fee-for-Service	1295165785	1295165785	1	1	KHELLA, JESSICA M OD	6/30/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9596 BASELINE RD	None	ALTA LOMA	CA	91701	5034	36	06071	34.12156149	-117.5954895	San Bernardino County
286536	Fee-for-Service	1881191781	1881191781	1	1	KERN COUNTY REGIONAL	7/19/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIALYSIS CENTER LLC	2661 OSWELL STREET	SUITE B	BAKERSFIELD	CA	93306	3170	15	06029	35.39425462	-118.9496655	Kern County
286570	Fee-for-Service	1154337137	1154337137	1	1	KHOA NGUYEN	3/4/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1035 116TH AVE NE	None	BELLEVUE	WA	98004	4604	00	None	47.620296	-122.1856955	King County
286607	Fee-for-Service	1427079250	1427079250	1	2	KING, WILLIAM D MD	10/8/2018	207R00000X	NA	Other	026	PHYSICIANS	71878	41	Internal Medicine	0	In state provider	None	3756 SANTA ROSALIA DRIVE	SUITE 506	LOS ANGELES	CA	90008	3656	19	06037	34.00888336	-118.3389334	Los Angeles County
286656	Fee-for-Service	1417255647	1417255647	1	1	KERRIA HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12225 SHALE RIDGE LANE	None	AUBURN	CA	95602	8870	31	06061	38.95301533	-121.0957807	Placer County
286664	Fee-for-Service	1972037406	1972037406	1	1	KIM, CAROLE H MD	8/31/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158894	None	None	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
286725	Fee-for-Service	1235161787	1235161787	1	1	KLEIN, TOM-OLIVER MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53959	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
286764	Fee-for-Service	1609973353	1609973353	1	1	KARLINSKY, MALCOLM L MD	3/31/1981	207RN0300X	NA	Nephrology	026	PHYSICIANS	39011	41	Internal Medicine	0	In state provider	None	3001 COLBY ST	None	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
286769	Fee-for-Service	1063672004	1063672004	1	1	KANG, BENJAMIN LAC	4/30/1989	193400000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	11867 ARTESIA BLVD	None	ARTESIA	CA	90701	4002	19	06037	33.8731738	-118.0805872	Los Angeles County
286777	Fee-for-Service	1790887610	1790887610	1	1	KATNENI, RATNAJA MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134129	45	Nephrology (Renal-Kidney)	0	In state provider	None	2621 S BRISTOL ST	#105	SANTA ANA	CA	92704	5718	30	06059	33.711876	-117.885371	Orange County
286815	Fee-for-Service	1346446796	1346446796	1	1	KWON, JIN Y MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	105966	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
286837	Fee-for-Service	1730313206	1730313206	1	1	KURAHASHI, MARI MD	10/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132386	13	Neurology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
286838	Fee-for-Service	1124230008	1124230008	1	1	KRONISH, ROBERT MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	63975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
286847	Fee-for-Service	1952489650	1952489650	1	1	KLOOSTER, CURT H MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
286850	Fee-for-Service	1912963109	1912963109	1	1	KEELER, JULIE A DO	7/12/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9655	None	None	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
286864	Fee-for-Service	1548657349	1548657349	1	1	KAY, ALLISON MD	5/13/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	167588	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
286889	Fee-for-Service	1578680567	1578680567	1	1	KRIEKENBEEK, MARIA S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 KEOKEA PL	None	KULA	HI	96790	7450	00	None	20.70160237	-156.3575903	Maui County
286906	Fee-for-Service	1609973353	1609973353	1	1	KARLINSKY, MALCOLM L MD	3/31/1981	207RN0300X	NA	Nephrology	026	PHYSICIANS	39011	45	Nephrology (Renal-Kidney)	0	In state provider	None	3001 COLBY ST	None	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
286971	Fee-for-Service	1508358979	1508358979	1	1	KNOELL, SOPHIA MD	8/25/2023	207R00000X	NA	Other	026	PHYSICIANS	186160	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
286977	Fee-for-Service	1124230008	1124230008	1	1	KRONISH, ROBERT MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	63975	01	General Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
286980	Fee-for-Service	1730313206	1730313206	1	1	KURAHASHI, MARI MD	10/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132386	36	Psychiatry	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
286994	Fee-for-Service	1528145463	1528145463	1	1	KAMAREI, MEHDI MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62412	34	Urology and Urological Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
287065	Fee-for-Service	1992853980	1992853980	1	1	KWON, EUGENE Y MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64509	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
287143	Fee-for-Service	1134193105	1134193105	1	1	KURTULUS, MEL MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72728	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2403 CASTILLO ST	STE 205	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
287153	Fee-for-Service	1770661365	1770661365	1	1	KAPADIA, POONAM B MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76347	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
287191	Fee-for-Service	1053456962	1053456962	1	1	KEEN MEDICAL GROUP INC	3/15/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	12021 JACARANDA AVE	SUITE 101	HESPERIA	CA	92345	4978	36	06071	34.46963618	-117.263267	San Bernardino County
287233	Fee-for-Service	1780661900	1780661900	1	1	KATZ, ANDREW L	10/15/1996	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	847 AUTO CENTER DR	STE A	PALMDALE	CA	93551	4490	19	06037	34.59142164	-118.14665	Los Angeles County
287252	Fee-for-Service	1902977960	1902977960	1	1	KAWAOKA, ERIC J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30618	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
287268	Fee-for-Service	1306924139	1306924139	1	1	KHARAZZ, BABAK MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62363	01	General Practice	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
287283	Fee-for-Service	1770788754	1770788754	1	1	KIM, ANTHONY MD A MEDICAL	1/23/2008	207T00000X	NA	General Surgery	026	PHYSICIANS	79340	14	Neurological Surgery	0	In state provider	CORPORATION	26732 CROWN VALLEY PKWY	STE 541	MISSION VIEJO	CA	92691	6376	30	06059	33.56347704	-117.66546	Orange County
287289	Fee-for-Service	1487603718	1487603718	1	1	KAMINSKAS, CAROL M MD	4/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	58880	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
287327	Fee-for-Service	1053456962	1053456962	1	1	KEEN MEDICAL GROUP INC	7/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12021 JACARANDA AVE	SUITE 101	HESPERIA	CA	92345	4978	36	06071	34.46963618	-117.263267	San Bernardino County
287365	Fee-for-Service	1184773764	1184773764	1	1	KAMBOJ, VINEET DPM	8/20/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
287373	Fee-for-Service	1699717678	1699717678	1	1	KUTMAS, MICHAEL A. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3125 DR RUSSELL SMITH WA	None	CARTHAGE	MO	64836	7402	00	None	37.13736008	-94.32030623	Jasper County
287408	Fee-for-Service	1992951651	1992951651	1	1	KIM, EUGENE T MD	7/25/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161247	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
287425	Fee-for-Service	1558821215	1558821215	1	1	KIM, BRANDON K DPM	7/12/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
287439	Fee-for-Service	1932551082	1932551082	1	1	KREPS, CHRISTOPHER DPM	8/19/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9850 GENESEE AVE	510	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
287453	Fee-for-Service	1457439200	1457439200	1	1	KRECK, THOMAS MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86118	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
287457	Fee-for-Service	1689762197	1689762197	1	1	KHALPARI, BENHOOR MD	1/28/2020	208M00000X	NA	Other	026	PHYSICIANS	70272	41	Internal Medicine	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
287466	Fee-for-Service	1588742266	1588742266	1	1	KAMKAR, MEHRNAZ M MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84505	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
287532	Fee-for-Service	1043653397	1043653397	1	1	KAUSHAL, KHUSHBOO MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132581	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
287533	Fee-for-Service	1316039647	1316039647	1	1	KEENS, THOMAS MD	4/28/1999	2080P0214X	NA	Pulmonology	026	PHYSICIANS	25220	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	# 83	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
287582	Fee-for-Service	1457439200	1457439200	1	1	KRECK, THOMAS MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86118	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
287589	Fee-for-Service	1124516885	1124516885	1	1	KAYNE, SARAH E MD	8/4/2022	207R00000X	NA	Other	026	PHYSICIANS	176103	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
287629	Fee-for-Service	1164974739	1164974739	1	1	KERN COUNTY HOSPITAL AUTHORI	2/24/2020	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	820 34TH ST	SUITE 202	BAKERSFIELD	CA	93301	2283	15	06029	35.39053308	-119.0117133	Kern County
287655	Fee-for-Service	1295745180	1295745180	1	1	KUBO, KOJI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	95628	08	Family Practice	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
287717	Fee-for-Service	1407993405	1407993405	1	1	KAN-SAI HEALTH CENTER INC	11/13/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	953 W 7TH ST	None	OXNARD	CA	93030	6756	56	06111	34.19516303	-119.1889271	Ventura County
287734	Fee-for-Service	1265726715	1265726715	1	1	KRANKL, JULIA T MD	5/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122928	36	Psychiatry	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
287750	Fee-for-Service	1578022729	1578022729	1	1	KANZAWA, MIA M MD	8/1/2022	207R00000X	NA	Other	026	PHYSICIANS	180001	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
287757	Fee-for-Service	1164974739	1164974739	1	1	KERN COUNTY HOSPITAL AUTHORI	2/24/2020	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	820 34TH ST	SUITE 202	BAKERSFIELD	CA	93301	2283	15	06029	35.39053308	-119.0117133	Kern County
287777	Fee-for-Service	1467826552	1467826552	1	1	KNOSP, MICHELLE DO	5/27/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18172	36	Psychiatry	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
287796	Fee-for-Service	1053470641	1053470641	1	1	KHATIBI, AFSHIN MD	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78118	10	Gastroenterology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
287845	Fee-for-Service	1366590978	1366590978	1	1	KAISER FOUNDATION HEALTH	7/3/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KAISER PERMANENT PHARM	710 LAWRENCE EXPY	FL 3	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
287851	Fee-for-Service	1598860645	1598860645	1	2	KEDIA, MRIDULA MD	10/12/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43406	None	None	0	In state provider	None	4201 TORRANCE BLVD	380	TORRANCE	CA	90503	4501	19	06037	33.8375955	-118.358748	Los Angeles County
287872	Fee-for-Service	1144350661	1144350661	1	1	KIM, YONG S ACUPUNCTURE	5/2/2001	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CLINIC, INC	3460 W OLYMPIC BLVD	None	LOS ANGELES	CA	90019	2124	19	06037	34.0525595	-118.3142115	Los Angeles County
287889	Fee-for-Service	1912334426	1912334426	1	1	KULBERG, ANDREA M PHD	5/26/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	225 CARRILLO ST	305	SANTA BARBARA	CA	93101	2121	42	06083	34.42430069	-119.6989389	Santa Barbara County
287894	Fee-for-Service	1790776714	1790776714	1	1	KING, DEAN E OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	900 E MORTON PL	None	HEMET	CA	92543	4529	33	06065	33.74668652	-116.9627985	Riverside County
287901	Fee-for-Service	1013154111	1013154111	1	1	KELESIDIS, IOSIF MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135517	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3770 ELIZABETH STREET	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
287920	Fee-for-Service	1295914935	1295914935	1	1	KARJOO, RAHIM MD INC	2/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	37311	None	None	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 113	GARDEN GROVE	CA	92843	1915	30	06059	33.77450141	-117.9123364	Orange County
287950	Fee-for-Service	1982628228	1982628228	1	1	KAMEL, EMAN S MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81115	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
287976	Fee-for-Service	1700836129	1700836129	1	1	KRUPNICK, KURT MD	5/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
287991	Fee-for-Service	1164865788	1164865788	1	1	KULKARNI, TARA DO	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14870	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
288015	Fee-for-Service	1053639591	1053639591	1	1	KAGUNYE, SILVESTER K MD	12/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131153	05	Anesthesiology	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93721	1365	10	06019	36.741663	-119.7841005	Fresno County
288023	Fee-for-Service	1013154111	1013154111	1	1	KELESIDIS, IOSIF MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135517	41	Internal Medicine	0	In state provider	None	3770 ELIZABETH STREET	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
288033	Fee-for-Service	1740613355	1740613355	1	1	KAN, JENNY M MD	6/20/2022	207L00000X	NA	Other	026	PHYSICIANS	164333	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
288075	Fee-for-Service	1639551302	1639551302	1	1	KHERLOPIAN, ALEC G MD	1/17/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	175765	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
288117	Fee-for-Service	1417901984	1417901984	1	1	KANDEMIR, UTKU MD	9/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96934	20	Orthopedic Surgery	0	In state provider	None	1001 POTRERO AVE	RM 3A	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
288126	Fee-for-Service	1487846853	1487846853	1	1	KUMAR, ROBERT S MD	2/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95756	41	Internal Medicine	0	In state provider	None	3010 COLBY ST	STE 221	BERKELEY	CA	94705	2056	01	06001	37.85492078	-122.2576101	Alameda County
288158	Fee-for-Service	1437557451	1437557451	1	1	KAI, CHERI H NP	1/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
288165	Fee-for-Service	1508841321	1508841321	1	1	KUN, THOMAS L MD	12/24/1981	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	23406	None	None	0	In state provider	None	2001 SANTA MONICA BLVD	STE 1260W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
288177	Fee-for-Service	1205938628	1205938628	1	1	KIM, EUNG DO MD	1/1/1996	207L00000X	NA	Other	026	PHYSICIANS	79316	05	Anesthesiology	0	In state provider	None	841 MOHAWK ST	STE 270	BAKERSFIELD	CA	93309	1547	15	06029	35.36193277	-119.0628694	Kern County
288250	Fee-for-Service	1235296591	1235296591	1	1	KIM L RICKERT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
288299	Fee-for-Service	1891972758	1891972758	1	1	KRISHNAN, JAY MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111334	None	None	0	In state provider	JAYAKRISHNAN MD	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
288330	Fee-for-Service	1811358930	1811358930	1	1	KAO, JOHNATHAN MD	3/16/2022	207R00000X	NA	Other	026	PHYSICIANS	168305	None	None	0	In state provider	None	700 W 7TH ST	S-270-D	LOS ANGELES	CA	90017	3977	19	06037	34.04833759	-118.2582588	Los Angeles County
288339	Fee-for-Service	1750495081	1750495081	1	1	KELLEHER, JOSEPH F MD	4/30/1989	207L00000X	NA	Other	026	PHYSICIANS	63386	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
288356	Fee-for-Service	1801577093	1801577093	1	1	KUANG, WENDY CRNA	7/12/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
288518	Fee-for-Service	1609113448	1609113448	1	1	KOEB, VANESSA P DO	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12586	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
288541	Fee-for-Service	1801450069	1801450069	1	1	KWONG, ZI LEI MD	1/13/2024	207L00000X	NA	Other	026	PHYSICIANS	181138	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
288579	Fee-for-Service	1871813675	1871813675	1	1	KATTAH, MICHAEL G MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118801	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
288598	Fee-for-Service	1477651651	1477651651	1	1	KURZROCK, RAZELLE MD	4/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128795	68	Hematology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288617	Fee-for-Service	1275578015	1275578015	1	1	KALJOT, KAAREL TIIT MD	8/31/1993	207R00000X	NA	Other	026	PHYSICIANS	35499	10	Gastroenterology (M.D. only)	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
288640	Fee-for-Service	1417536236	1417536236	1	1	KALAVAR, MEGHANA MD	3/18/2025	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
288672	Fee-for-Service	1013247212	1013247212	1	1	KHAKSHOOY, ANGELA OD	7/1/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVENUE	SUITE 110B	SAN DIMAS	CA	91773	2541	19	06037	34.10669347	-117.814932	Los Angeles County
288681	Fee-for-Service	1770572109	1770572109	1	1	KAMYAR, ROKAY G MD	10/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	35485	10	Gastroenterology (M.D. only)	0	In state provider	INC	5119 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.77197494	-117.0059214	San Diego County
288707	Fee-for-Service	1497293369	1497293369	1	1	KANTOFF, EMILY H NP	4/20/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
288710	Fee-for-Service	1477651651	1477651651	1	1	KURZROCK, RAZELLE MD	4/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128795	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288723	Fee-for-Service	1083317218	1083317218	1	1	KAST, CHARISSA A CRNA	5/8/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
288727	Fee-for-Service	1275578015	1275578015	1	1	KALJOT, KAAREL TIIT MD	8/31/1993	207R00000X	NA	Other	026	PHYSICIANS	35499	41	Internal Medicine	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
288730	Fee-for-Service	1790881589	1790881589	1	1	KAROLIA, SAFIYYA MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86181	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
288758	Fee-for-Service	1417428731	1417428731	1	1	KOTHARI, VINITA R CNP	6/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
288779	Fee-for-Service	1073777934	1073777934	1	2	KANARD, ROBERT C MD	2/10/2022	2086S0120X	NA	General Surgery	026	PHYSICIANS	84875	None	None	0	In state provider	None	1400 E CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
288789	Fee-for-Service	1770572109	1770572109	1	1	KAMYAR, ROKAY G MD	10/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	35485	41	Internal Medicine	0	In state provider	INC	5119 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.77197494	-117.0059214	San Diego County
288791	Fee-for-Service	1093910531	1093910531	1	1	KOHLI, MARC D MD	12/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	139298	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
288826	Fee-for-Service	1366608945	1366608945	1	1	KELLY, KENNETH M MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108350	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
288861	Fee-for-Service	1598711384	1598711384	1	1	KLEIN, ROBERT A MD INC	1/1/1975	2084N0400X	NA	Neurology	026	PHYSICIANS	36699	13	Neurology (M.D. only)	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
288898	Fee-for-Service	1770572109	1770572109	1	1	KAMYAR, ROKAY G MD	10/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	35485	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	5119 GARFIELD ST	None	LA MESA	CA	91941	5103	37	06073	32.77197494	-117.0059214	San Diego County
288941	Fee-for-Service	1588828537	1588828537	1	1	KETHIREDDY, MALINI MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109876	01	General Practice	0	In state provider	None	17095 MAIN STREET	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
288948	Fee-for-Service	1386814952	1386814952	1	1	KRISHNAN, CHANDRA E MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97374	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289010	Fee-for-Service	1043758923	1043758923	1	1	KRONEN, MARIA R MD	9/12/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146917	None	None	0	In state provider	None	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
289044	Fee-for-Service	1407967680	1407967680	1	1	KNUEPPEL, SUNG H MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90498	08	Family Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289055	Fee-for-Service	1184752974	1184752974	1	1	KAILIKOLE, THERESA L DPM	11/17/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
289056	Fee-for-Service	1053382085	1053382085	1	1	KUNCIR, ERIC J MD	7/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	72181	02	General Surgery	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
289069	Fee-for-Service	1760473482	1760473482	1	1	KUMAMOTO, KENNETH MD	5/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64958	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2151 APPIAN WAY	None	PINOLE	CA	94564	2514	07	06013	37.99738125	-122.3013414	Contra Costa County
289075	Fee-for-Service	1376920546	1376920546	1	1	KHALILI, MICHAEL MD	12/2/2024	207LP2900X	NA	Other	026	PHYSICIANS	183520	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
289100	Fee-for-Service	1033154174	1033154174	1	1	KAMALI, DEBORAH D MD	6/1/1999	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	74557	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	# M1477	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
289118	Fee-for-Service	1326550922	1326550922	1	1	KATIE M DEAN	11/8/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 PLEASANT ST	None	DES MOINES	IA	50309	1406	00	None	41.58886035	-93.63191864	Polk County
289145	Fee-for-Service	1407967680	1407967680	1	1	KNUEPPEL, SUNG H MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90498	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289166	Fee-for-Service	1790026177	1790026177	1	1	KO, DAISY Y	4/1/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	980 ROOSEVELT	STE 100	IRVINE	CA	92620	3670	30	06059	33.69380208	-117.7653165	Orange County
289207	Fee-for-Service	1790819613	1790819613	1	1	KORVER, KEITH F MD APC	4/17/2007	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2 BON AIR RD	STE 100	LARKSPUR	CA	94939	1144	21	06041	37.94364568	-122.5396483	Marin County
289229	Fee-for-Service	1689605941	1689605941	1	1	KLEINMAN, KENNETH SCOTT	7/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	50719	45	Nephrology (Renal-Kidney)	0	In state provider	NEPHROLOGY MED ASSOC	5525 ETIWANDA AVE	STE 320	TARZANA	CA	91356	6130	19	06037	34.17046451	-118.5308463	Los Angeles County
289308	Fee-for-Service	1073602470	1073602470	1	1	KERN GASTROENTEROLOGY	8/8/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	5959 TRUXTUN AVE	STE 200	BAKERSFIELD	CA	93309	0437	15	06029	35.36306164	-119.0711264	Kern County
289324	Fee-for-Service	1760034268	1760034268	1	1	KUPINSKI, KIMBERLY J MD	2/27/2024	207L00000X	NA	Other	026	PHYSICIANS	182383	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
289327	Fee-for-Service	1689605941	1689605941	1	1	KLEINMAN, KENNETH SCOTT	7/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	50719	41	Internal Medicine	0	In state provider	NEPHROLOGY MED ASSOC	5525 ETIWANDA AVE	STE 320	TARZANA	CA	91356	6130	19	06037	34.17046451	-118.5308463	Los Angeles County
289365	Fee-for-Service	1194917435	1194917435	1	1	KIM, SAM Y CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4269 W 3RD ST	None	LOS ANGELES	CA	90020	3448	19	06037	34.06901752	-118.3075409	Los Angeles County
289377	Fee-for-Service	1083784672	1083784672	1	1	KAISER FNDTN HOSP FRESNO	3/9/1995	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
289384	Fee-for-Service	1053746297	1053746297	1	1	KOBA ANTONIADOU, YULIA PSYD	1/24/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2309 PACIFIC COAST	STE 202	HERMOSA BEACH	CA	90254	2751	19	06037	33.87101437	-118.3948248	Los Angeles County
289477	Fee-for-Service	1568948685	1568948685	1	1	KORNBLUTH, MEGAN A LCSW	4/16/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15473 ARCHERY VW	None	TRUCKEE	CA	96161	1415	29	06057	39.36533064	-120.1000373	Nevada County
289482	Fee-for-Service	1518164706	1518164706	1	1	KOOLWIJK, IRENE MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121627	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
289498	Fee-for-Service	1356871834	1356871834	1	1	KWAK, KAY Y LCSW	10/16/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	65565	-	NOT APPLICABLE	0	In state provider	None	2010 ZONAL AVE	OPD 4P1 RM 1-15	LOS ANGELES	CA	90033	1026	19	06037	34.05986523	-118.2057472	Los Angeles County
289545	Fee-for-Service	1255890570	1255890570	1	1	KUPAI, ROMERO D MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	177848	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
289578	Fee-for-Service	1538204441	1538204441	1	1	KEDDINGTON AND KALRA	5/30/2003	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRISTS	687 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5628	37	06073	32.7086752	-117.0114942	San Diego County
289588	Fee-for-Service	1467862995	1467862995	1	1	KAUR, NAVNEET MD	9/16/2021	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	174541	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
289595	Fee-for-Service	1558797977	1558797977	1	1	KHIN, THIRI MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147248	68	Hematology	0	In state provider	None	1801 W ROMNEYA DR	STE 203	ANAHEIM	CA	92801	1824	30	06059	33.8506615	-117.946413	Orange County
289599	Fee-for-Service	1720382864	1720382864	1	1	KELAITA, SHANNON H LCSW	2/28/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1919 VISTA DEL LAGO	None	VALLEY SPRINGS	CA	95252	9294	05	06009	38.16838844	-120.8386897	Calaveras County
289640	Fee-for-Service	1598080780	1598080780	1	1	KADAKIA, RACHEL B MD	8/26/2019	2080P0205X	NA	Endocrinology	026	PHYSICIANS	164178	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
289664	Fee-for-Service	1518115849	1518115849	1	1	KEELER, MELODY E LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
289666	Fee-for-Service	1356769665	1356769665	1	1	KHWARG, JUEWON W MD	10/27/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	140183	None	None	0	In state provider	None	2080 CENTURY PARK E	STE 300	LOS ANGELES	CA	90067	2006	19	06037	34.05887194	-118.4122914	Los Angeles County
289673	Fee-for-Service	1316970874	1316970874	1	1	KIM, YONG HO MD	9/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	33665	08	Family Practice	0	In state provider	None	3340 W BALL RD	STE H	ANAHEIM	CA	92804	3729	30	06059	33.81726795	-118.0068541	Orange County
289674	Fee-for-Service	1558797977	1558797977	1	1	KHIN, THIRI MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147248	78	Neoplastic Diseases/Oncology	0	In state provider	None	1801 W ROMNEYA DR	STE 203	ANAHEIM	CA	92801	1824	30	06059	33.8506615	-117.946413	Orange County
289675	Fee-for-Service	1073535589	1073535589	1	1	KOKA, MADHAVI MD	1/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100644	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
289677	Fee-for-Service	1568826410	1568826410	1	1	KORIE, IJENDU P MD	11/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170427	36	Psychiatry	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
289702	Fee-for-Service	1124046172	1124046172	1	1	KUMAR, LAJU A MD	2/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132733	01	General Practice	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
289754	Fee-for-Service	1770716276	1770716276	1	1	KADOCH, MICHAEL A MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129486	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
289787	Fee-for-Service	1033446042	1033446042	1	1	KNIPPERS-DAVIS, LORA K LCSW	6/5/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
289801	Fee-for-Service	1477580595	1477580595	1	2	KRAUS, JAMES A	6/24/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	91537	-	NOT APPLICABLE	0	In state provider	None	800 SCENIC DR	BLDG 4	MODESTO	CA	95350	6131	50	06099	37.64722447	-120.9836925	Stanislaus County
289821	Fee-for-Service	1669521571	1669521571	1	1	KARL M FRANCIS JR. MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3550 N UNIVERSITY AVE	STE 250	PROVO	UT	84604	6685	00	None	40.28087789	-111.6581666	Utah County
289855	Fee-for-Service	1346603818	1346603818	1	1	KWON, OHWOOK MD	7/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153391	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
289874	Fee-for-Service	1013195841	1013195841	1	1	KHOUBIAN, FARZAD MD	1/28/2025	207W00000X	NA	Ophthalmology	026	PHYSICIANS	95916	18	Ophthalmology	0	In state provider	None	18370 BURBANK BLVD	207	TARZANA	CA	91356	2804	19	06037	34.17173059	-118.5331881	Los Angeles County
289936	Fee-for-Service	1053469981	1053469981	1	1	KATZ, MARK R MD	12/26/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	39639	36	Psychiatry	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
289954	Fee-for-Service	1477792752	1477792752	1	1	KESSLER, KENDELL MD	11/27/2017	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	106226	25	Physical Medicine and Rehabilitation	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
289966	Fee-for-Service	1679557896	1679557896	1	1	KIM, THOMAS J MD	12/6/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	97740	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
290052	Fee-for-Service	1225186208	1225186208	1	1	KIRTLAND, VIRGIL D MD	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55624	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
290143	Fee-for-Service	1669533030	1669533030	1	1	KEMP, MICHAEL W	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2620 HURLEY WAY	None	SACRAMENTO	CA	95864	3789	34	06067	38.58822	-121.400838	Sacramento County
290167	Fee-for-Service	1942735295	1942735295	1	1	KRAUSE, PHILIP MD	11/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191377	None	None	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
290171	Fee-for-Service	1891215570	1891215570	1	1	KAMEL, YASMINE MD	9/24/2020	208M00000X	NA	Other	026	PHYSICIANS	169567	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
290175	Fee-for-Service	1760829600	1760829600	1	1	KISHIYAMA, KATHARINE A MD	10/22/2019	208600000X	NA	General Surgery	026	PHYSICIANS	163919	None	None	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
290293	Fee-for-Service	1669950242	1669950242	1	1	KAKAR, FAUZIA RCP	8/31/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
290305	Fee-for-Service	1245310457	1245310457	1	1	KOENIG, KRISTI LOUISE MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61048	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2648 E 14TH ST	None	OAKLAND	CA	94601	1506	01	06001	37.78093089	-122.2316571	Alameda County
290320	Fee-for-Service	1720056187	1720056187	1	1	KATTERHAGEN MD CHRIST	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEACEHEALTH MEDICAL GRP	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
290324	Fee-for-Service	1306904883	1306904883	1	1	KIM, TERRENCE M PT	7/28/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
290340	Fee-for-Service	1174687560	1174687560	1	1	KELLEY, FREDERICK J MD	5/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71281	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
290360	Fee-for-Service	1396898664	1396898664	1	1	KIM, HANNAH MD	5/8/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1400 EMELINE AVENUE	BUILDING K	SANTA CRUZ	CA	95060	1976	44	06087	36.99276804	-122.0178271	Santa Cruz County
290363	Fee-for-Service	1255868246	1255868246	1	1	KASSEM, HISHAM A MD	7/28/2021	390200000X	NA	Other	026	PHYSICIANS	171992	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
290407	Fee-for-Service	1598843351	1598843351	1	1	KAM, NATHAN TAI PUNG	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69248	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
290439	Fee-for-Service	1780973396	1780973396	1	1	KIM, LYDIA S MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125333	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
290452	Fee-for-Service	1598843351	1598843351	1	1	KAM, NATHAN TAI PUNG	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69248	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
290466	Fee-for-Service	1457366841	1457366841	1	1	KEIDERLING, EDWARD M MD	5/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67393	08	Family Practice	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
290484	Fee-for-Service	1942215736	1942215736	1	1	KAZADI, MWANGA M MD	4/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70218	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3280 PROFESSIONAL DR	STE A	AUBURN	CA	95602	2491	31	06061	38.943891	-121.100763	Placer County
290485	Fee-for-Service	1861598500	1861598500	1	1	KEMPERT, RICHARD J MD	7/12/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37249	08	Family Practice	0	In state provider	None	34080 GOLDEN LANTERN ST	STE 201	DANA POINT	CA	92629	2679	30	06059	33.46844491	-117.6978884	Orange County
290491	Fee-for-Service	1417146093	1417146093	1	1	KELLER, BRIAN P DPM INC	3/28/2005	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	841 STERLING PARKWAY	SUITE 130	LINCOLN	CA	95648	7324	31	06061	38.869569	-121.294548	Placer County
290539	Fee-for-Service	1780627653	1780627653	1	1	KIM, TAE-SOON	6/12/1978	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	32370	25	Physical Medicine and Rehabilitation	0	In state provider	None	18895 COLIMA RD	SUITE B	ROWLAND HEIGHTS	CA	91748	2958	19	06037	33.98772522	-117.8915158	Los Angeles County
290562	Fee-for-Service	1629072533	1629072533	1	1	KELTNER, LISA V OD	10/12/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1255 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4122	19	06037	33.99914104	-117.8123495	Los Angeles County
290600	Fee-for-Service	1588049860	1588049860	1	1	KOSTA, CAROL M LPCC	12/13/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
290614	Fee-for-Service	1841376704	1841376704	1	1	KRIJANOVSKI, OLEG I MD	10/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105568	41	Internal Medicine	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
290648	Fee-for-Service	1841376704	1841376704	1	1	KRIJANOVSKI, OLEG I MD	10/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105568	78	Neoplastic Diseases/Oncology	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
290680	Fee-for-Service	1972787349	1972787349	1	1	KAPADIA, BRIJ J MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73028	30	Radiology	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
290683	Fee-for-Service	1720032360	1720032360	1	1	KOJIAN, HUMPARTZOOM J II	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71941	66	Emergency Medicine (Urgent Care)	0	In state provider	None	390 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4310	19	06037	34.01633837	-118.1016422	Los Angeles County
290745	Fee-for-Service	1497780795	1497780795	1	1	KELLER, LISA K MD	8/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	38545	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
290764	Fee-for-Service	1770068785	1770068785	1	1	KOMULAINE, JULIE L	4/4/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
290812	Fee-for-Service	1932935152	1932935152	1	1	KNUCKLES, SIERRA	3/31/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
290823	Fee-for-Service	1376569152	1376569152	1	1	KRANTZ, DAVID E MD	6/1/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	75136	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
290830	Fee-for-Service	1497744916	1497744916	1	1	KHANNA, APURV MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156845	41	Internal Medicine	0	In state provider	None	3933 COFFEE RD	STE A	BAKERSFIELD	CA	93308	5024	15	06029	35.395335	-119.092336	Kern County
290855	Fee-for-Service	1497744916	1497744916	1	1	KHANNA, APURV MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156845	45	Nephrology (Renal-Kidney)	0	In state provider	None	3933 COFFEE RD	STE A	BAKERSFIELD	CA	93308	5024	15	06029	35.395335	-119.092336	Kern County
290906	Fee-for-Service	1023615150	1023615150	1	1	KAISER FOUNDATION HEALTH PLA	10/29/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	775	9550 ESCONDIDO AVE FL 1	RM 1100	HESPERIA	CA	92345	9120	36	06071	34.42569331	-117.3730595	San Bernardino County
290962	Fee-for-Service	1437746732	1437746732	1	1	KEE-WHITE, DENISE LCSW	7/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
290983	Fee-for-Service	1386730919	1386730919	1	1	KOLDHEKAR, VAIJAYANTI MD	4/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43547	40	Pediatrics	0	In state provider	INC	931 BUENA VISTA ST	STE 302	DUARTE	CA	91010	1714	19	06037	34.141635	-117.9775755	Los Angeles County
291000	Fee-for-Service	1114186061	1114186061	1	1	KLEIN, KIMBERLY A MD	8/27/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	103510	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
291014	Fee-for-Service	1215996681	1215996681	1	1	KINI, SUNIL MD	5/18/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160552	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
291032	Fee-for-Service	1417031584	1417031584	1	1	KNEITEL, ALAN I MD	6/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	25984	41	Internal Medicine	0	In state provider	None	1545 DIVISADERO ST	# 11	SAN FRANCISCO	CA	94115	3425	38	06075	37.78393521	-122.4396714	San Francisco County
291145	Fee-for-Service	1801892450	1801892450	1	1	KAMKAR, BABAK A OD	8/1/2002	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A PROF OPTOMETRY CORP	1796 NEWPORT BLVD	None	COSTA MESA	CA	92627	2756	30	06059	33.64038674	-117.919319	Orange County
291161	Fee-for-Service	1861576126	1861576126	1	1	KAHN, MADELYN MD	2/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52531	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	390 LAUREL ST	STE 301	SAN FRANCISCO	CA	94118	1953	38	06075	37.78794842	-122.450336	San Francisco County
291179	Fee-for-Service	1104067636	1104067636	1	1	KAWEAH DELTA HLTH CARE DIST	12/3/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	839 N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21375372	-119.0961665	Tulare County
291192	Fee-for-Service	1104067636	1104067636	1	1	KAWEAH DELTA HLTH CARE DIST	3/8/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	839 N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21375372	-119.0961665	Tulare County
291207	Fee-for-Service	1104067636	1104067636	1	1	KAWEAH DELTA HLTH CARE DIST	12/3/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	839 N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21375372	-119.0961665	Tulare County
291222	Fee-for-Service	1104067636	1104067636	1	1	KAWEAH DELTA HLTH CARE DIST	10/10/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	839 N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21375372	-119.0961665	Tulare County
291226	Fee-for-Service	1174617831	1174617831	1	1	KASSIR, KARI L MD	2/19/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55576	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
291227	Fee-for-Service	1225117328	1225117328	1	1	KAURA, VINOD K MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32106	41	Internal Medicine	0	In state provider	None	1800 WESTERN AVE	STE 303	SAN BERNARDINO	CA	92411	1354	36	06071	34.1315778	-117.3182453	San Bernardino County
291240	Fee-for-Service	1609839273	1609839273	1	1	KANE, HENRY S MD	8/1/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	171481	None	None	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
291254	Fee-for-Service	1780633909	1780633909	1	1	KWON, YOUNG H MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	29312	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
291294	Fee-for-Service	1225209638	1225209638	1	1	KANE, DAVID W LMFT	4/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
291324	Fee-for-Service	1265569891	1265569891	1	1	KASTELEIN, MICHELE J MD	11/5/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72874	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
291354	Fee-for-Service	1548793524	1548793524	1	1	KOMBAZDJIAN, MARY R MD	12/27/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163966	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
291375	Fee-for-Service	1467643940	1467643940	1	1	KO, WILLIAM W MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73648	18	Ophthalmology	0	In state provider	None	117 S MISSION DR	None	SAN GABRIEL	CA	91776	1101	19	06037	34.10196423	-118.1109533	Los Angeles County
291452	Fee-for-Service	1316292733	1316292733	1	1	KHANAL, SAROJ MD	11/7/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
291518	Non-Physician Medical Practitioner	None	1144059593	0	0	KIM, HANA NP	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
291522	Non-Physician Medical Practitioner	None	1275776700	0	0	KARNS, SHAWN	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1830 FRANKLIN ST	SUITE 450	DENVER	CO	80218	1128	00	06000	39.745494	-104.968391	Denver County
291524	Non-Physician Medical Practitioner	None	1942427927	0	0	KIM, JIYOUNG	1/22/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	930 W HARRIS ST	UNIT A	EUREKA	CA	95503	3927	00	06000	40.78058482	-124.1814122	Humboldt County
291526	Non-Physician Medical Practitioner	None	1164988192	0	0	KAIKAI, SAMANTHA M NP	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
291535	Non-Physician Medical Practitioner	None	1942846050	0	0	KIM, AMY PA-C	3/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
291556	Non-Physician Medical Practitioner	None	1619452158	0	0	KUEHNER, MEGAN M NP	10/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7012 CINNAMON TEAL WAY	None	EL DORADO HILLS	CA	95762	6306	00	06000	38.6767103	-121.0077049	El Dorado County
291565	Non-Physician Medical Practitioner	None	1518949759	0	0	KHALIL, SOPHIA	5/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16 SAND POINTE	None	LAGUNA NIGUEL	CA	92677	5199	00	06000	33.51141044	-117.6832497	Orange County
291681	Non-Physician Medical Practitioner	None	1871137976	0	0	KIM, BLOSSOM E PA	6/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	825 DELBON AVE	None	TURLOCK	CA	95382	2016	00	06000	37.51052943	-120.8386573	Stanislaus County
291686	Non-Physician Medical Practitioner	None	1598829434	0	0	KARAPETYAN, KRISTINA	10/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 N ORANGE ST	SUITE 200	GLENDALE	CA	91203	1911	00	06000	34.15323119	-118.2565389	Los Angeles County
291715	Non-Physician Medical Practitioner	None	1053716977	0	0	KAUR, GAGANDEEP PA	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	847 W CHILDS AVE	None	MERCED	CA	95341	6805	00	06000	37.28825369	-120.4963159	Merced County
291744	Non-Physician Medical Practitioner	None	1982141511	0	0	KAUR, NAVPREET NP	12/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	612 W DUARTE RD	STE 801	ARCADIA	CA	91007	9249	00	06000	34.12647805	-118.051994	Los Angeles County
291760	Non-Physician Medical Practitioner	None	1437785870	0	0	KNOTT, MARISSA A PA	5/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
291761	Non-Physician Medical Practitioner	None	1194458794	0	0	KEDDINGTON, HOLLY PA	3/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	00	06000	37.75120501	-122.4352246	San Francisco County
291769	Non-Physician Medical Practitioner	None	1467144717	0	0	KAJOHN, JONATHAN K PA	7/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
291770	Non-Physician Medical Practitioner	None	1609955285	0	0	KU, TOM PA-C	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
291772	Non-Physician Medical Practitioner	None	1164977229	0	0	KAEDING, DIANA E NP	3/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10849 FRUITLAND DR	APT 202	STUDIO CITY	CA	91604	4626	00	06000	34.13825109	-118.3673898	Los Angeles County
291785	Non-Physician Medical Practitioner	None	1023051869	0	0	KASTNER VAN DER LINDEN, NICO	7/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	377 STEELHEAD WAY	None	VISTA	CA	92083	4459	00	06000	33.19946795	-117.2598395	San Diego County
291806	Non-Physician Medical Practitioner	None	1114645744	0	0	KAUR, TARANJEET NP	4/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6515 PANAMA LANE	SUITE 106-107	BAKERSFIELD	CA	93311	9729	00	06000	35.29604449	-119.0756205	Kern County
291809	Non-Physician Medical Practitioner	None	1881255933	0	0	KIM, JANE PA-C	12/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
291816	Non-Physician Medical Practitioner	None	1912410358	0	0	KHENG, LAURA H	2/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
291877	Non-Physician Medical Practitioner	None	1437453438	0	0	KURESHI, SHEHZAANA H	2/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5395 RUFFIAN ROAD.	ST. 204	SAN DIEGO	CA	92123	1338	00	06000	32.832387	-117.1266225	San Diego County
291881	Non-Physician Medical Practitioner	None	1841223807	0	0	KOLT, THOMAS LAROY	3/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1622 AVENIDA OCEANO	None	OCEANSIDE	CA	92056	6943	00	06000	33.22108955	-117.2816861	San Diego County
291891	Non-Physician Medical Practitioner	None	1598391047	0	0	KUNDARGI, POOJA K PA-C	1/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 WILSHIRE BLVD	SUITE 717	LOS ANGELES	CA	90017	4810	00	06000	34.05362775	-118.2661889	Los Angeles County
291948	Non-Physician Medical Practitioner	None	1639353105	0	0	KENNY, PATRICIA ANN JONES	4/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 GRANT RD	ECH 133	MOUNTAIN VIEW	CA	94040	4302	00	06000	37.36893518	-122.0779448	Santa Clara County
291949	Non-Physician Medical Practitioner	None	1740936111	0	0	KENDALL, RACHAEL NP	6/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10225 AUSTIN DR	STE 101	SPRING VALLEY	CA	91978	1521	00	06000	32.73081646	-116.9707735	San Diego County
291970	Non-Physician Medical Practitioner	None	1750838249	0	0	KUO, YUNG JEN NP	2/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18335 VALLEY BLVD	None	LA PUENTE	CA	91744	5968	00	06000	34.00550085	-117.9026349	Los Angeles County
291974	Non-Physician Medical Practitioner	None	1740696731	0	0	KIM, HANARANG NP	6/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	00	06000	37.24572659	-121.957997	Santa Clara County
291983	Non-Physician Medical Practitioner	None	1194964635	0	0	KROEFF, ALEXANDRA PA-C	8/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	439 NAVAJO DR	None	SALINAS	CA	93906	1735	00	06000	36.70227625	-121.6617171	Monterey County
292028	Non-Physician Medical Practitioner	None	1083425250	0	0	KIDMAN, SARA M NP	3/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6385	00	06000	37.36812305	-122.0312314	Santa Clara County
292051	Non-Physician Medical Practitioner	None	1285494898	0	0	KURPINSKY, DAVID A PA-C	3/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
292062	Non-Physician Medical Practitioner	None	1609309673	0	0	KAUR, RAJWINDER	6/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8767 FESTIVAL STREET	None	CHINO	CA	91708	8880	00	06000	33.96150339	-117.6134067	San Bernardino County
292154	Non-Physician Medical Practitioner	None	1275842536	0	0	KHILLA, AYAD I NP	6/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10401 CALLE INDEPENDENCI	None	FOUNTAIN VALLEY	CA	92708	3709	00	06000	33.7108965	-117.947133	Orange County
292167	Non-Physician Medical Practitioner	None	1245802602	0	0	KAMBHAMPATI, VIJAYALAKSHMI NP	8/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6401 TRUXTUN AVE	STE B	BAKERSFIELD	CA	93309	0674	00	06000	35.36227673	-119.07391	Kern County
292217	Non-Physician Medical Practitioner	None	1891231866	0	0	KOELLER, KAREN M NP	10/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21222 FERN CIRCLE	None	HUNTINGTON BEACH	CA	92646	7247	00	06000	33.654672	-117.9639805	Orange County
292221	Non-Physician Medical Practitioner	None	1962877977	0	0	KAPLAN, INES	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30826 OAKRIM DR	None	WESTLAKE VILLAGE	CA	91362	6123	00	06000	34.15730797	-118.7923832	Los Angeles County
292247	Non-Physician Medical Practitioner	None	1932594637	0	0	KIM, YEONG B NP	4/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14530 POPLAR ST	None	HESPERIA	CA	92345	3729	00	06000	34.41670911	-117.3456684	San Bernardino County
292283	Non-Physician Medical Practitioner	None	1659819803	0	0	KUHN, REBECCA NP	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
292314	Non-Physician Medical Practitioner	None	1619363900	0	0	KNEEN, ROXIE L NP	11/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	610 NW 93RD AVE	None	PEMBROKE PINES	FL	33024	0000	00	06000	26.0136327	-80.26942002	Broward County
292325	Non-Physician Medical Practitioner	None	1184948135	0	0	KELSEY, CARLOS A PA	6/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2445 EAST NAVAJO TRAIL	None	BEAVER	UT	84713	0000	00	06000	38.27892315	-112.5919177	Beaver County
292348	Non-Physician Medical Practitioner	None	1144475112	0	0	KOENIG, SARA S RN CPNP	4/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5 BON AIR ROAD	STE 105	LARKSPUR	CA	94939	1137	00	06000	37.9438204	-122.5395357	Marin County
292352	Non-Physician Medical Practitioner	None	1013612753	0	0	KEANE, CATHERINE S PA	8/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	00	06000	38.669562	-121.31379	Sacramento County
292357	Non-Physician Medical Practitioner	None	1427100320	0	0	KEELER, NANCY L PA	6/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	00	06000	37.36678073	-120.576731	Merced County
292375	Non-Physician Medical Practitioner	None	1831816859	0	0	KAPP, LACEY J PA-C	3/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	00	06000	34.20369349	-118.629837	Los Angeles County
292450	Non-Physician Medical Practitioner	None	1265822076	0	0	KUO, PEI NP	4/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15861 SPRIG STREET	None	CHINO HILLS	CA	91709	2857	00	06000	33.96501208	-117.7272883	San Bernardino County
292494	Non-Physician Medical Practitioner	None	1841710936	0	0	KAUR, NAVJEET NP	6/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	00	06000	37.66353653	-120.9564675	Stanislaus County
292496	Non-Physician Medical Practitioner	None	1487147013	0	0	KENNEDY, RYAN M PA-C	11/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23803 MCBEAN PKWY	SUITE 101, 201, 202	VALENCIA	CA	91355	2001	00	06000	34.39750589	-118.552072	Los Angeles County
292555	Non-Physician Medical Practitioner	None	1144735895	0	0	KIM, ANGIE B PA	12/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	901 GOLDEN SPRINGS DR	UNIT F7	DIAMOND BAR	CA	91765	4245	00	06000	34.03438747	-117.7970677	Los Angeles County
292582	Non-Physician Medical Practitioner	None	1871867606	0	0	KRIZEK, AUDREY K	3/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1056 PORTHILL LANE	None	ROSEVILLE	CA	95747	9030	00	06000	38.76823256	-121.3699397	Placer County
292600	Non-Physician Medical Practitioner	None	1821290859	0	0	KOTLER, HONORE GARRIN	6/26/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8635 W 3RD ST	STE 590 WEST	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
292602	Non-Physician Medical Practitioner	None	1144451329	0	0	KAPOOR, MONIKA B	11/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4225 N WATERSIDE DR	None	CLOVIS	CA	93619	4704	00	06000	36.79693275	-119.5955398	Fresno County
292611	Non-Physician Medical Practitioner	None	1710309984	0	0	KNIGHT, ANNA NP	12/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
292637	Non-Physician Medical Practitioner	None	1467844969	0	0	KINSEY, ERIC W	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5407 F STREET	None	SACRAMENTO	CA	95819	3024	00	06000	38.570697	-121.4347005	Sacramento County
292674	Non-Physician Medical Practitioner	None	1639648439	0	0	KITSON, MICHELLE NP	10/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	00	06000	36.84632065	-119.783885	Fresno County
292678	Non-Physician Medical Practitioner	None	1811587066	0	0	KISS, LINDSAY E PA	4/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
292685	Non-Physician Medical Practitioner	None	1558497222	0	0	KNIGHT, SONYA Y	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3649 9TH AVE	None	LOS ANGELES	CA	90018	4101	00	06000	34.0214871	-118.3271818	Los Angeles County
292753	Non-Physician Medical Practitioner	None	1750354833	0	0	KARLSTAD, DEANNA MARIE	5/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2110 PROFESSIONAL DRIVE	SUITE 120	ROSEVILLE	CA	95661	3779	00	06000	38.74234873	-121.2521259	Placer County
292778	Non-Physician Medical Practitioner	None	1487104550	0	0	KUHN, KATHRYN	4/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
292782	Non-Physician Medical Practitioner	None	1649757881	0	0	KASHANIJOU, NIKA PA	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	00	06000	34.27904453	-118.459944	Los Angeles County
292783	Non-Physician Medical Practitioner	None	1609440890	0	0	KOECHLIN, MONIQUE E PA-C	1/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	00	06000	38.463381	-121.416183	Sacramento County
292804	Non-Physician Medical Practitioner	None	1396153201	0	0	KIMMEL, JENNIFER M NP	3/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
292816	Non-Physician Medical Practitioner	None	1083249353	0	0	KORTKAMP, LORI NP	7/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 N HARBOR BLVD	None	ANAHEIM	CA	92805	1810	00	06000	33.84310811	-117.92254	Orange County
292854	Non-Physician Medical Practitioner	None	1124190475	0	0	KNOWLES, MALINDA KAY	8/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2510 AIRPARK DR STE 104	None	REDDING	CA	96001	2461	00	06000	40.57119566	-122.4016582	Shasta County
292865	Non-Physician Medical Practitioner	None	1336681444	0	0	KARAVELIOGLU, SEVIL NP	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
292879	Non-Physician Medical Practitioner	None	1639408040	0	0	KELLEY, ERIN B NP	3/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
292894	Non-Physician Medical Practitioner	None	1447624911	0	0	KIM, PAUL PA-C	2/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
292974	Non-Physician Medical Practitioner	None	1720488190	0	0	KONG, ELDA NP	6/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1320 12TH AVENUE	None	SAN FRANCISCO	CA	94122	2214	00	06000	37.76340427	-122.4694766	San Francisco County
292985	Non-Physician Medical Practitioner	None	1962175497	0	0	KANG, HANNAH H NP	7/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
293018	Non-Physician Medical Practitioner	None	1508009655	0	0	KEH, JOHNNA L	12/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1132 EAST CALIFORNIA ST	UNIT 1	GLENDALE	CA	91206	5040	00	06000	34.14987817	-118.24036	Los Angeles County
293020	Non-Physician Medical Practitioner	None	1982908794	0	0	KIM, CHRISTINE CHONG-HEE	2/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 HARRISON ST	7TH FLOOR	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
293022	Non-Physician Medical Practitioner	None	1578956827	0	0	KUECHER, ERIK PA-C	1/22/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
293023	Non-Physician Medical Practitioner	None	1154620664	0	0	KRAUTER, ROSEANNE REBECCA	5/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 WELCH RD	None	PALO ALTO	CA	94304	1611	00	06000	37.43680756	-122.1770534	Santa Clara County
293124	Non-Physician Medical Practitioner	None	1134850704	0	0	KIM, ASHLEY L NP	6/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	# B10	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
293157	Non-Physician Medical Practitioner	None	1982798153	0	0	KIM-SAECHAO, SUE	12/8/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
293164	Non-Physician Medical Practitioner	None	1548532559	0	0	KALLICHARAN, SATIE PA	10/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7325 MEDICAL CENTER DRIV	SUITE 300	WEST HILLS	CA	91307	4117	00	06000	34.20369349	-118.629837	Los Angeles County
293173	Non-Physician Medical Practitioner	None	1588063424	0	0	KANG, ANA H PA-C	3/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
293175	Non-Physician Medical Practitioner	None	1265847123	0	0	KOLBACH, CELIA	9/9/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4320 PARADISE DR	None	CARMICHAEL	CA	95608	2056	00	06000	38.64312	-121.301793	Sacramento County
293196	Non-Physician Medical Practitioner	None	1548509102	0	0	KOVACS, ELIZABETH A NP	8/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2280 N MAPLEWOOD ST	None	ORANGE	CA	92865	4365	00	06000	33.82620799	-117.8426752	Orange County
293200	Non-Physician Medical Practitioner	None	1831450782	0	0	KIM, DONGHEE NP	7/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
293221	Non-Physician Medical Practitioner	None	1730550872	0	0	KANAMORI, LAUREN M NP	8/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26511 HEATHER BROOK	None	LAKE FOREST	CA	92630	5614	00	06000	33.64150022	-117.6677633	Orange County
293259	Non-Physician Medical Practitioner	None	1013513811	0	0	KIM, DANIEL E PA-C	3/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
293263	Non-Physician Medical Practitioner	None	1184866337	0	0	KIRKHAM, MARGARET	1/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 SAN PABLO AVE	None	ALBANY	CA	94706	1103	00	06000	37.89781848	-122.3014067	Alameda County
293284	Non-Physician Medical Practitioner	None	1124058870	0	0	KILUK, MICHELLE	9/20/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
293306	Non-Physician Medical Practitioner	None	1043062052	0	0	KOVATCH, NAOMI S NP	5/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
293369	Non-Physician Medical Practitioner	None	1750730651	0	0	KLEEN, NICHOLAS PA-C	5/5/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27640 EUCALYPTUS AVE	None	MORENO VALLEY	CA	92555	4557	00	06000	33.93749258	-117.1807371	Riverside County
293385	Non-Physician Medical Practitioner	None	1811947906	0	0	KHACHIKIAN, AVETIS	5/25/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S CHEVY CHASE DR	#105	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
293392	Non-Physician Medical Practitioner	None	1295584613	0	0	KIM, JOSEPH T PA	3/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4140 JADE STREET	SUITE 100	CAPITOLA	CA	95010	3956	00	06000	36.97026148	-121.9638195	Santa Cruz County
293414	Non-Physician Medical Practitioner	None	1154738359	0	0	KAGAN, RENEE K	8/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 VAN NESS	UNIT 8	SAN FRANCISCO	CA	94109	9412	00	06000	37.79707239	-122.4238319	San Francisco County
293432	Non-Physician Medical Practitioner	None	1033611280	0	0	KIM, JA YOUNG NP	6/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	00	06000	37.35228637	-121.9754073	Santa Clara County
293443	Non-Physician Medical Practitioner	None	1831236066	0	0	KAUFMAN, BROOKE SHARRETTS	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	0000	00	06000	37.78324881	-122.4405738	San Francisco County
293463	Non-Physician Medical Practitioner	None	1629280011	0	0	KAYHAN-MAHD, ZAHRA	2/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	STE 570	LA JOLLA	CA	92037	1229	00	06000	32.882913	-117.226341	San Diego County
293504	Non-Physician Medical Practitioner	None	1881941250	0	0	KWONG, HOI YAN NP	10/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3360 E FOOTHILL BLVD	APT 418	PASADENA	CA	91107	6055	00	06000	34.1500752	-118.0807026	Los Angeles County
293506	Non-Physician Medical Practitioner	None	1457887101	0	0	KLUVER, JESSICA A	9/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6339 SAN ROLANDO CIR	None	BUENA PARK	CA	90602	3637	00	06000	33.83691506	-118.0226538	Orange County
293522	Non-Physician Medical Practitioner	None	1518564145	0	0	KAUR, MANPREET NP	3/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2030 COFFEE RD	STE A1	MODESTO	CA	95355	2498	00	06000	37.672569	-120.9757125	Stanislaus County
293578	Non-Physician Medical Practitioner	None	1114529377	0	0	KELLY, KARI C CNP	9/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3152 N MILLBROOK AVE	STE. B	FRESNO	CA	93703	1400	00	06000	36.779166	-119.7634925	Fresno County
293696	Non-Physician Medical Practitioner	None	1760594733	0	0	KOLESNIK, CARLETTE S	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2468 SAN ANTONIO CRES E	None	UPLAND	CA	91784	1180	00	06000	34.15386074	-117.6571644	San Bernardino County
293702	Non-Physician Medical Practitioner	None	1649818451	0	0	KALKAT, POONAM NP	9/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
293748	Non-Physician Medical Practitioner	None	1730953704	0	0	KINYUA, DANIELLA NP	8/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2905 TELEGRAPH AVE	None	BERKELEY	CA	94705	2063	00	06000	37.85736641	-122.2594952	Alameda County
293759	Non-Physician Medical Practitioner	None	1891421764	0	0	KAWASAKI CULLIGAN, BIENA PA-C	4/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	00	06000	36.98692657	-121.9685264	Santa Cruz County
293762	Non-Physician Medical Practitioner	None	1013446244	0	0	KAHLON, RAMNEEK K NP	10/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 CHANGO CIRCLE	None	SACRAMENTO	CA	95835	2414	00	06000	38.682279	-121.538556	Sacramento County
293798	Non-Physician Medical Practitioner	None	1285174482	0	0	KOBLER, LAURA S NP	3/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
293812	Non-Physician Medical Practitioner	None	1083444988	0	0	KOMAI, HANNAH K NP	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
293825	Non-Physician Medical Practitioner	None	1588988703	0	0	KING, KRISTI A NP	6/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 EL CANTO DR	None	SPRING VALLEY	CA	91977	1715	00	06000	32.75189774	-116.9714215	San Diego County
293834	Non-Physician Medical Practitioner	None	1285037358	0	0	KALTER, RACHEL I	2/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5901 BROADWAY	APT 23	OAKLAND	CA	94618	1572	00	06000	37.84584498	-122.2452981	Alameda County
293861	Non-Physician Medical Practitioner	None	1508413303	0	0	KWONG, JAZMINE M PA-C	11/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
293862	Non-Physician Medical Practitioner	None	1063831048	0	0	KUANG, HUI C NP	6/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1845 23RD AVE	None	SAN FRANCISCO	CA	94122	4425	00	06000	37.75315656	-122.4807424	San Francisco County
293881	Non-Physician Medical Practitioner	None	1336899491	0	0	KAUR, KHUSHWINDER NP	5/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	00	06000	36.84197867	-119.761714	Fresno County
293991	Non-Physician Medical Practitioner	None	1376878041	0	0	KANG, CINDY	10/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	311 WINSTON ST	None	LOS ANGELES	CA	90013	1519	00	06000	34.0454147	-118.2447356	Los Angeles County
294026	Non-Physician Medical Practitioner	None	1821238569	0	0	KENNEDY, MEGHAN E PA-C	2/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2290 SACRAMENTO ST	None	VALLEJO	CA	94590	2929	00	06000	38.12370851	-122.2637378	Solano County
294034	Non-Physician Medical Practitioner	None	1932947272	0	0	KISLING, DAKOTA S PA-C	9/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2900 WHIPPLE AVE	STE 230	REDWOOD CITY	CA	94062	2852	00	06000	37.4783072	-122.2551089	San Mateo County
294051	Non-Physician Medical Practitioner	None	1477191427	0	0	KILLION, LESLEY R NP	3/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
294069	Non-Physician Medical Practitioner	None	1962839258	0	0	KIM, MICHELLE J NP	2/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4020 MONTAIGNE WAY	None	PLS VRD PNSLA	CA	90274	3940	00	06000	33.78177478	-118.3541708	Los Angeles County
294073	Non-Physician Medical Practitioner	None	1508262817	0	0	KIM, SUN H NP	1/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	00	06000	37.35228637	-121.9754073	Santa Clara County
294074	Non-Physician Medical Practitioner	None	1376563007	0	0	KELLER, LAURA	4/1/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	560 MAIN STREET	None	WEAVERVILLE	CA	96093	0000	00	06000	40.73286682	-122.9405831	Trinity County
294086	Non-Physician Medical Practitioner	None	1851581128	0	0	KISER, KELLY L NP	2/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4576 CONOUGH LN	None	LAS VEGAS	NV	89129	5351	00	06000	36.24359836	-115.2650453	Clark County
294093	Non-Physician Medical Practitioner	None	1780045591	0	0	KANG, VILAYA NP	12/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	00	06000	36.74333844	-119.7831874	Fresno County
294096	Non-Physician Medical Practitioner	None	1033616008	0	0	KEITH, HEATHER L NP	12/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	00	06000	35.351487	-119.1143025	Kern County
294099	Non-Physician Medical Practitioner	None	1053859785	0	0	KRAMER, BRITTANY M NP	6/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5001 CALASIS CT	None	BAKERSFIELD	CA	93311	8945	00	06000	35.310051	-119.113829	Kern County
294100	Non-Physician Medical Practitioner	None	1629454673	0	0	KUE, PANG L NP	12/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27717 SUMMER GROVE PL	None	VALENCIA	CA	91354	9544	00	06000	34.44513094	-118.5569781	Los Angeles County
294107	Non-Physician Medical Practitioner	None	1770346025	0	0	KIMURA, NOZOMI NP	4/5/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 WESTERN	103	SAN BERNARDINO	CA	92411	1352	00	06000	34.1315778	-117.3182453	San Bernardino County
294115	Non-Physician Medical Practitioner	None	1871554170	0	0	KNUTZEN, GREGORY L NP	2/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2989 STEEPLE CHASE DRIVE	None	CHINO HILLS	CA	91709	1450	00	06000	34.00626368	-117.739282	San Bernardino County
294122	Non-Physician Medical Practitioner	None	1700203130	0	0	KING, LESLIE NP	5/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7887 N CEDAR	None	FRESNO	CA	93720	2685	00	06000	36.850473	-119.756917	Fresno County
294128	Non-Physician Medical Practitioner	None	1902290968	0	0	KIDIAVAYI, STANLEY M NP	8/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4220 SAXTON GREEN AVENUE	None	LAS VEGAS	NV	89141	4354	00	06000	35.99190644	-115.1957537	Clark County
294153	Non-Physician Medical Practitioner	None	1508022450	0	0	KIM, WONAE NP	8/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14906 LEMOLI AVENUE	APT G	GARDENA	CA	90249	3456	00	06000	33.896241	-118.3308525	Los Angeles County
294177	Non-Physician Medical Practitioner	None	1073651238	0	0	KIMBERLY, BURTON	4/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
294182	Non-Physician Medical Practitioner	None	1457418402	0	0	KAHEN, MITRA	9/19/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7900 W SUNSET BLVD	None	LOS ANGELES	CA	90046	3304	00	06000	34.09802449	-118.361997	Los Angeles County
294193	Non-Physician Medical Practitioner	None	1487934253	0	0	KOLAHI, JESSICA A PA-C	12/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
294195	Non-Physician Medical Practitioner	None	1518305820	0	0	KOCHHAR, JAIDEEP	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	11315 BRIDGEPORT WAY SW	None	LAKEWOOD	WA	98499	3004	00	06000	47.1545675	-122.5044377	Pierce County
294224	Non-Physician Medical Practitioner	None	1336551340	0	0	KAGEYAMA, SACHIKO J NP	2/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9480 ALCOSTA WAY	None	SACRAMENTO	CA	95826	1002	00	06000	38.573181	-121.345938	Sacramento County
294231	Non-Physician Medical Practitioner	None	1710177209	0	0	KEARNS, MARIE LAZARE	5/8/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	00	06000	34.21700406	-119.1582582	Ventura County
294255	Non-Physician Medical Practitioner	None	1821506940	0	0	KRAMER, NICOLE A PA-C	6/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6553 E PACIFIC COAST HWY	None	LONG BEACH	CA	90803	4202	00	06000	33.75590219	-118.1091312	Los Angeles County
294307	Non-Physician Medical Practitioner	None	1861927691	0	0	KAYE, ALEXANDER N PA	12/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6696	00	06000	34.05682871	-118.360716	Los Angeles County
294342	Non-Physician Medical Practitioner	None	1801466511	0	0	KUO, MELODY J PA-C	11/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
294350	Non-Physician Medical Practitioner	None	1477228682	0	0	KONYASHIN, CHRISTINA G NP	10/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16912 SAN FERNANDO MISSI	None	GRANADA HILLS	CA	91344	4249	00	06000	34.27201353	-118.500093	Los Angeles County
294357	Non-Physician Medical Practitioner	None	1841327012	0	0	KIRAKOSIAN, LENA MARY	9/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST STE 13	None	LOS ANGELES	CA	90033	5392	00	06000	34.06269295	-118.2030006	Los Angeles County
294359	Non-Physician Medical Practitioner	None	1760851083	0	0	KHOK, NEE Y	7/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	91 BENTLEY AVE	SUITE 2	LOS GATOS	CA	95030	6002	00	06000	37.2265873	-121.9798328	Santa Clara County
294369	Non-Physician Medical Practitioner	None	1649505041	0	0	KEILEH, RITA	7/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5179 BROOKSIDE LN	None	CONCORD	CA	94521	3621	00	06000	37.95317759	-121.9664623	Contra Costa County
294381	Non-Physician Medical Practitioner	None	1790978328	0	0	KEETH, STEPHANIE P NP	4/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6125 NORMA LANE	None	SAN BERNARDINO	CA	92407	2185	00	06000	34.19195888	-117.3523913	San Bernardino County
294408	Non-Physician Medical Practitioner	None	1285790410	0	0	KSAR, KARI JEAN	12/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	750 WELCH RD STE 116	None	PALO ALTO	CA	94304	1508	00	06000	37.43749692	-122.175445	Santa Clara County
294413	Non-Physician Medical Practitioner	None	1194465922	0	0	KIM, WOOSUK NP	7/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10941 BLOOMFIELD ST	SUITE A	LOS ALAMITOS	CA	90720	6702	00	06000	33.804234	-118.0632055	Orange County
294446	Non-Physician Medical Practitioner	None	1306680483	0	0	KATZENMEYER, MADISON M PA	3/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2030 SUTTER PL	STE 1300	DAVIS	CA	95616	6201	00	06000	38.56292466	-121.7715423	Yolo County
294488	Non-Physician Medical Practitioner	None	1831309863	0	0	KINSEY, ELIZABETH L NP	2/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2930 LORAIN RD	None	SAN MARINO	CA	91108	1234	00	06000	34.12179438	-118.0927932	Los Angeles County
294500	Non-Physician Medical Practitioner	None	1871588913	0	0	KHODAYARI, FILOMENA BAJA	5/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	00	06000	37.92699561	-122.0292732	Contra Costa County
294515	Non-Physician Medical Practitioner	None	1821194051	0	0	KUNSELMAN, ELIZABETH L NP	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	327 SKYLINE BLVD	None	LA HONDA	CA	94020	9735	00	06000	37.31255617	-122.1755061	San Mateo County
294567	Non-Physician Medical Practitioner	None	1881852432	0	0	KIM, YOUNG WOOK NP	5/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28106 RIDGEFOREST COURT	None	RANCHO PALOS VERD	CA	90275	6612	00	06000	33.77802016	-118.3889982	Los Angeles County
294612	Non-Physician Medical Practitioner	None	1962987354	0	0	KING, MOLLY A PA	8/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
294619	Non-Physician Medical Practitioner	None	1477785707	0	0	KLANAC, KARMEN PA	10/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
294653	Non-Physician Medical Practitioner	None	1760904015	0	0	KERELUK, EUGENIA	6/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
294711	Non-Physician Medical Practitioner	None	1114242278	0	0	KERLICK, ELIZABETH T	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	949 W HAWTHORN	32	SAN DIEGO	CA	92101	1772	00	06000	32.7259626	-117.1707942	San Diego County
294740	Non-Physician Medical Practitioner	None	1205319522	0	0	KIM, SAMUEL PA-C	11/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
294743	Non-Physician Medical Practitioner	None	1790330850	0	0	KEOVILAY, PHOUDONG PA-C	11/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
294751	Non-Physician Medical Practitioner	None	1619685633	0	0	KALAYDJIAN, AZADUHI	6/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 WEST AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
294767	Non-Physician Medical Practitioner	None	1801002704	0	0	KING, MARIA A CNM	3/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	00	06000	33.5580705	-117.1835458	Riverside County
294796	Non-Physician Medical Practitioner	None	1003448374	0	0	KANG, ANDREW J PA	2/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
294803	Non-Physician Medical Practitioner	None	1952052433	0	0	KENNEDY, KATHRYN E PA	10/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
294880	Non-Physician Medical Practitioner	None	1346883659	0	0	KOPP, ALEXIS C PA-C	2/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3830 VALLEY CENTRE DR	SUITE 702	SAN DIEGO	CA	92130	3320	00	06000	32.93777252	-117.2318423	San Diego County
294881	Non-Physician Medical Practitioner	None	1912099557	0	0	KAUFMAN-SCANNA, TIFFANY	12/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24910 LAS BRISAS ROAD	STE 106	MURRIETA	CA	92562	4010	00	06000	33.57522424	-117.1828078	Riverside County
294882	Non-Physician Medical Practitioner	None	1255548483	0	0	KEDREN COMMUNITY HEALTH CENTER INC	12/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4211 SOUTH AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
294912	Non-Physician Medical Practitioner	None	1356837496	0	0	KIM, JAY NP	1/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	00	06000	34.09054375	-118.392295	Los Angeles County
294954	Non-Physician Medical Practitioner	None	1003835547	0	0	KING, MELANIE ELAYNE	9/13/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6042 N FRESNO ST	SUITE 203	FRESNO	CA	93710	5279	00	06000	36.82371094	-119.7812282	Fresno County
295011	Non-Physician Medical Practitioner	None	1235949983	0	0	KAUR, JAGDEEP NP	3/8/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
295012	Non-Physician Medical Practitioner	None	1548815707	0	0	KAJANI, SAMINA NP	10/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVENUE	STE 215	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
295036	Non-Physician Medical Practitioner	None	1386084333	0	0	KIM, JIEUN NP	5/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
295046	Non-Physician Medical Practitioner	None	1922035948	0	0	KIM, DAVID Y	4/17/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1677 ASPEN GROVE DRIVE	None	DIAMOND BAR	CA	91765	2953	00	06000	33.99146139	-117.8226587	Los Angeles County
295089	Non-Physician Medical Practitioner	None	1629635008	0	0	KING, CARLY J PA	9/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
295131	Non-Physician Medical Practitioner	None	1740268721	0	0	KIRKWOOD, PEGGY L NP	3/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25555 EL CONEJO LN	None	LAGUNA HILLS	CA	92653	5315	00	06000	33.59136097	-117.6906429	Orange County
295165	Non-Physician Medical Practitioner	None	1538517263	0	0	KEBEDE, AHAD A NP	6/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
295167	Non-Physician Medical Practitioner	None	1780439158	0	0	KIM, DAVID M NP	5/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
295187	Non-Physician Medical Practitioner	None	1396457602	0	0	KRASKE, COURTNEY A NP	6/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
295234	Non-Physician Medical Practitioner	None	1952750879	0	0	KING, EMMELYNN R	10/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11217 SAN JUAN ST	None	LOMA LINDA	CA	92354	3215	00	06000	34.0500081	-117.2684655	San Bernardino County
295239	Non-Physician Medical Practitioner	None	1104565977	0	0	KAMANSKY, MILTON PA	8/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
295249	Non-Physician Medical Practitioner	None	1275166381	0	0	KAMAU, VERONICA N NP	8/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	00	06000	33.6526055	-117.910746	Orange County
295303	Non-Physician Medical Practitioner	None	1053351346	0	0	KALAW, GEORGE T	2/21/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27056 CHANNEL LANE	None	VALENCIA	CA	91355	5109	00	06000	34.42997821	-118.5616974	Los Angeles County
295347	Non-Physician Medical Practitioner	None	1851720387	0	0	KINDERMAN, ANGELA L	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1951 E 30TH ST	APT 8	OAKLAND	CA	94606	3430	00	06000	37.79748826	-122.2285989	Alameda County
295354	Non-Physician Medical Practitioner	None	1275262131	0	0	KING, SAVANNAH N CNM	3/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST.	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
295385	Non-Physician Medical Practitioner	None	1194405845	0	0	KAUR, PUNEET NP	1/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
295414	Non-Physician Medical Practitioner	None	1669954269	0	0	KOON, KELSEY L PA-C	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10590 TOWN CENTER DR	170	RANCHO CUCAMONGA	CA	91730	0360	00	06000	34.11101693	-117.5740616	San Bernardino County
295415	Non-Physician Medical Practitioner	None	1720782808	0	0	KAUFMANN, ELIZABETH M PA-C	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	00	06000	33.78003775	-118.1866604	Los Angeles County
295441	Non-Physician Medical Practitioner	None	1871944371	0	0	KENNETH, MARGARET M B NP	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4625 61ST ST	None	SACRAMENTO	CA	95820	4233	00	06000	38.533086	-121.433373	Sacramento County
295461	Non-Physician Medical Practitioner	None	1619558442	0	0	KAUR, NAVREET NP	8/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
295540	Non-Physician Medical Practitioner	None	1326213554	0	0	KELLY, AMANDA M	11/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 7TH AVE	None	SAN FRANCISCO	CA	94118	1207	00	06000	37.78586777	-122.4656862	San Francisco County
295555	Non-Physician Medical Practitioner	None	1376093054	0	0	KALEMKERIS, CHRISTINA A NP	4/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 STIERLIN ROAD	APT 7	MOUNTAIN VIEW	CA	94043	4645	00	06000	37.40111745	-122.0780226	Santa Clara County
295590	Non-Physician Medical Practitioner	None	1710627435	0	0	KRISHAN, SONAM NP	7/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2303 S UNION AVE	C2	BAKERSFIELD	CA	93307	4799	00	06000	35.322264	-119.003139	Kern County
295594	Non-Physician Medical Practitioner	None	1801580816	0	0	KIM, JI SOO PA	3/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
295618	Non-Physician Medical Practitioner	None	1518642404	0	0	KUMAR, TARA J PA	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
295627	Non-Physician Medical Practitioner	None	1932988847	0	0	KIKUCHI, BREANNA NP	3/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	00	06000	34.137603	-118.101464	Los Angeles County
295660	Non-Physician Medical Practitioner	None	1194432930	0	0	KLEIN, VERONICA A NP	5/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 NORTH INDIAN CANYON	SUITE W300	PALM SPRINGS	CA	92262	4809	00	06000	33.839505	-116.5455735	Riverside County
295691	Non-Physician Medical Practitioner	None	1356485841	0	0	KRISTOVICH, KAREN	11/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	PEDS PHYSICIAN BILLING M	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
295702	Non-Physician Medical Practitioner	None	1770078479	0	0	KOFOED, ALEXIS C PA	6/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
295760	Non-Physician Medical Practitioner	None	1760135701	0	0	KHEN, JESSE PA-C	6/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27522 ANTONIO PKWY	P3	LADERA RANCH	CA	92694	2166	00	06000	33.56343335	-117.6292292	Orange County
295776	Non-Physician Medical Practitioner	None	1609316868	0	0	KAUR, HARJOT PA	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 W RINCON ST	203	CORONCA	CA	92880	2092	00	06000	33.88674086	-117.5648598	Riverside County
295805	Non-Physician Medical Practitioner	None	1477174399	0	0	KUHN, KIRSTEN J CNP	5/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
295806	Non-Physician Medical Practitioner	None	1578630125	0	0	KPADUWA, JULIUS C	11/8/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11036 VALLEY MALL	None	EL MONTE	CA	91731	0000	00	06000	34.07437461	-118.0341696	Los Angeles County
295857	Non-Physician Medical Practitioner	None	1619485117	0	0	KAUR, GURVEEN NP	5/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 WALLACE WAY	None	YUBA CITY	CA	95993	9124	00	06000	39.145491	-121.6855835	Sutter County
295862	Non-Physician Medical Practitioner	None	1881787745	0	0	KLINE, KAREN M	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15008 CROSBY STREET	None	SAN LEANDRO	CA	94579	1704	00	06000	37.69117874	-122.1438258	Alameda County
295879	Non-Physician Medical Practitioner	None	1558029561	0	0	KHATTAIE, GITA NP	4/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1243 EAST SPRUCE AVE	SUITE 104	FRESNO	CA	93720	3379	00	06000	36.84198651	-119.7610695	Fresno County
295899	Non-Physician Medical Practitioner	None	1407491871	0	0	KARIMI, NAHID NP	4/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
295928	Non-Physician Medical Practitioner	None	1629306469	0	0	KNOTT, KATHRYN E PA-C	9/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
296004	Non-Physician Medical Practitioner	None	1750785325	0	0	KARNOSKI, JULIA C PA-C	9/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
296029	Non-Physician Medical Practitioner	None	1912116096	0	0	KNOWLTON, JANICE	8/14/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3008 SILLECT AVE	SUITE 240	BAKERSFIELD	CA	93308	6340	00	06000	35.38608607	-119.0398799	Kern County
296070	Non-Physician Medical Practitioner	None	1497956262	0	0	KRAUS, LORI A	8/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	252 STONEWOOD DR	None	LOS BANOS	CA	93635	3285	00	06000	37.07140101	-120.8415747	Merced County
296078	Non-Physician Medical Practitioner	None	1962003640	0	0	KADRI, SAMIRA	6/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296105	Non-Physician Medical Practitioner	None	1972827624	0	0	KIM, CHINSUK	5/10/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3628 E IMPERIAL HWY	SUITE 100	LYNWOOD	CA	90262	2643	00	06000	33.93070837	-118.2044557	Los Angeles County
296107	Non-Physician Medical Practitioner	None	1902952260	0	0	KENNEDY, MARGARET M CNM	7/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296113	Non-Physician Medical Practitioner	None	1932775079	0	0	KAUR, AMANDEEP NP	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1255 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4805	00	06000	38.25815459	-122.0487714	Solano County
296149	Non-Physician Medical Practitioner	None	1134570864	0	0	KAUR, RAVINDAR NP	8/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1822 WILLERT DRIVE	None	TURLOCK	CA	95380	6388	00	06000	37.47618699	-120.837984	Stanislaus County
296151	Non-Physician Medical Practitioner	None	1225724818	0	0	KOURI, KRISTINA S	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
296154	Non-Physician Medical Practitioner	None	1497390645	0	0	KANE, KARA E PA-C	2/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
296193	Non-Physician Medical Practitioner	None	1629782974	0	0	KAUR, JASDEEP NP	9/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6643 MILBURN AVE	101	FRESNO	CA	93722	2164	00	06000	36.83380123	-119.8789205	Fresno County
296217	Non-Physician Medical Practitioner	None	1962631168	0	0	KHILNANI, MAHESH M NP	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	219 MAYNARD ST	None	SAN FRANCISCO	CA	94112	1638	00	06000	37.72945866	-122.4255569	San Francisco County
296226	Non-Physician Medical Practitioner	None	1124634886	0	0	KESTENIAN, CATHERINE NP	7/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	00	06000	34.0956033	-118.2916918	Los Angeles County
296272	Non-Physician Medical Practitioner	None	1598986192	0	0	KHOSHABA, LILY P RN	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1234 AUPS CT	None	MERCED	CA	95348	9543	00	06000	37.33974953	-120.492567	Merced County
296273	Non-Physician Medical Practitioner	None	1063991511	0	0	KAM, JENNIFER	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13851 E 14TH STREET	SUITE 202	SAN LEANDRO	CA	94578	2627	00	06000	37.71458918	-122.1418781	Alameda County
296298	Non-Physician Medical Practitioner	None	1952049306	0	0	KRUSHENA, KATHERINE PA-C	1/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296315	Non-Physician Medical Practitioner	None	1003691049	0	0	KAUR, NAVJOT NP	12/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9802 STOCKDALE HWY	STE 102	BAKERSFIELD	CA	93311	3653	00	06000	35.3544067	-119.1113372	Kern County
296316	Non-Physician Medical Practitioner	None	1104602119	0	0	KUDIRKA, CHLOE	12/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 S SOTO ST	None	HUNTINGTON PARK	CA	90255	9993	00	06000	33.990444	-118.2193965	Los Angeles County
296353	Non-Physician Medical Practitioner	None	1023594579	0	0	KOSTIV, NATHAN M NP	3/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	00	06000	38.55204	-121.455387	Sacramento County
296366	Non-Physician Medical Practitioner	None	1457445793	0	0	KLIEMAN, LINDA H NP	3/6/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2429 CORONET BLVD	None	BELMONT	CA	94002	1624	00	06000	37.5134201	-122.3000885	San Mateo County
296373	Non-Physician Medical Practitioner	None	1881047892	0	0	KANTELIS, SARAH E	4/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	76 CONGRESS PL	None	IRVINE	CA	92602	1655	00	06000	33.73336009	-117.7767933	Orange County
296402	Non-Physician Medical Practitioner	None	1992980221	0	0	KWON, IRENE H PA-C	11/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296406	Non-Physician Medical Practitioner	None	1992557862	0	0	KAPSALIS, PRESLEY	4/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
296556	Non-Physician Medical Practitioner	None	1326271883	0	0	KOGAN, RACHEL	4/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	609 HARVARD ST	None	SAN MATEO	CA	94402	2219	00	06000	37.55522311	-122.328926	San Mateo County
296567	Non-Physician Medical Practitioner	None	1528506383	0	0	KIM, ANGELA M S NP	10/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2601 MONTEREY PL	None	FULLERTON	CA	92833	2032	00	06000	33.87964505	-117.9712348	Orange County
296610	Non-Physician Medical Practitioner	None	1245247774	0	0	KARN, CASSANDRA L	4/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	00	06000	33.56008604	-117.6657795	Orange County
296620	Non-Physician Medical Practitioner	None	1447320346	0	0	KLEIN, KAREN K NP	9/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 CASA ST	SUITE 130	SAN LUIS OBISPO	CA	93405	1887	00	06000	35.29359615	-120.6654304	San Luis Obispo County
296652	Non-Physician Medical Practitioner	None	1174189708	0	0	KAUR, JASMINE NP	3/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480 PLUMAS BOULEVARD	SUITE 204	YUBA CITY	CA	95991	5005	00	06000	39.13286634	-121.6142652	Sutter County
296664	Non-Physician Medical Practitioner	None	1154333045	0	0	KAMPFE, CHRISTOPHER PA-C	2/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 N MEDICAL CENTER DRI	223	CLOVIS	CA	93611	6885	00	06000	36.84152435	-119.6624818	Fresno County
296681	Non-Physician Medical Practitioner	None	1093582348	0	0	KAROLCZAK, LAURETTA NP	3/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15398 MAIN STREET	SUITE A	HESPERIA	CA	92345	3391	00	06000	34.42611361	-117.3274904	San Bernardino County
296686	Non-Physician Medical Practitioner	None	1477285781	0	0	KEENER, MATTHEW	2/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	00	06000	34.04925	-118.2177405	Los Angeles County
296692	Non-Physician Medical Practitioner	None	1356538631	0	0	KENIG, KATHRYN C	12/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	106 CRESCENT ROAD	None	CORTE MADERA	CA	94925	1316	00	06000	37.92518085	-122.5333284	Marin County
296693	Non-Physician Medical Practitioner	None	1114309192	0	0	KONG, JANET J NP	2/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	00	06000	33.89343304	-117.9279349	Orange County
296697	Non-Physician Medical Practitioner	None	1316671902	0	0	KAUR, SANDEEP RN CPNP	11/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 H STREET	None	BAKERSFIELD	CA	93301	2819	00	06000	35.38335768	-119.0211743	Kern County
296701	Non-Physician Medical Practitioner	None	1134317282	0	0	KONG, YUTHANA PA-C	3/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W LA PALMA AVE	SUITE 602	ANAHEIM	CA	92801	2815	00	06000	33.84718298	-117.933758	Orange County
296723	Non-Physician Medical Practitioner	None	1912240656	0	0	KIM, JIHYE NP	10/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13941 SHERMAN WAY	APT 402	VAN NUYS	CA	91405	2558	00	06000	34.20123007	-118.4370113	Los Angeles County
296733	Non-Physician Medical Practitioner	None	1205441599	0	0	KUIKEN, KRISTI L NP	2/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	00	06000	34.15483303	-118.4722163	Los Angeles County
296737	Non-Physician Medical Practitioner	None	1730790643	0	0	KARAMOUZ, SANAM PA	10/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
296741	Non-Physician Medical Practitioner	None	1477020246	0	0	KHAN, AHAD U NP	8/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
296742	Non-Physician Medical Practitioner	None	1891453494	0	0	KOLLEY, JESSICA Y PA-C	9/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
296751	Non-Physician Medical Practitioner	None	1578825782	0	0	KYLE, VASHTY A NP	5/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	560 COHASSET RD	None	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
296791	Non-Physician Medical Practitioner	None	1164184792	0	0	KARPACH, YULIYA PA-C	9/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	00	06000	38.570805	-121.4696385	Sacramento County
296805	Non-Physician Medical Practitioner	None	1043733827	0	0	KIM, DALILA NP	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3733 NORTH MENDONCA ST	None	VISALIA	CA	93291	6541	00	06000	36.363159	-119.328687	Tulare County
296822	Non-Physician Medical Practitioner	None	1649698812	0	0	KACHATURIAN, VICTORIA L NP	2/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10082 WATERFORD LN	None	ALTA LOMA	CA	91737	2333	00	06000	34.15219468	-117.5847733	San Bernardino County
296842	Non-Physician Medical Practitioner	None	1720536071	0	0	KAUFMAN, KATHRYN B PA-C	3/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
296885	Non-Physician Medical Practitioner	None	1902196256	0	0	KERN RURAL WELLNESS CENTERS, INC.	10/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	146 N HILL ST	None	ARVIN	CA	93203	1014	00	06000	35.210097	-118.8309345	Kern County
296993	Non-Physician Medical Practitioner	None	1083082507	0	0	KITAJIMA, MIA NP	4/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9450 MIRA MESA BLVD	STE C 628	SAN DIEGO	CA	92126	4801	00	06000	32.919093	-117.1217745	San Diego County
296997	Non-Physician Medical Practitioner	None	1487668505	0	0	KOENIG, RODNEY J	11/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6621 DARKWOOD DR	None	RIVERSIDE	CA	92506	6528	00	06000	33.93051347	-117.321597	Riverside County
297019	Non-Physician Medical Practitioner	None	1003121203	0	0	KUSTOVA, YULIA	9/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10905 DELIBAN ST	None	TUJUNGA	CA	94042	1451	00	06000	34.26756985	-118.2878213	Los Angeles County
297174	Non-Physician Medical Practitioner	None	1578749966	0	0	KIMPSON, BETH A NP	12/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
297190	Non-Physician Medical Practitioner	None	1194980920	0	0	KAUR, AMANDEEP	2/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3940 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1458	00	06000	35.39601	-119.0081515	Kern County
297197	Non-Physician Medical Practitioner	None	1477060499	0	0	KANDA, SHILPY PA-C	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
297201	Non-Physician Medical Practitioner	None	1972230126	0	0	KLISE, GUADALUPE NP	3/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6121 N THESTA AVENUE	203-205	FRESNO	CA	93710	8603	00	06000	36.82493955	-119.783139	Fresno County
297233	Non-Physician Medical Practitioner	None	1801967906	0	0	KIMURA, SHARON A NP	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2106 SAMPLE AVE	None	CLOVIS	CA	93611	7514	00	06000	36.82759119	-119.674389	Fresno County
297256	Non-Physician Medical Practitioner	None	1174629984	0	0	KOKATNUR, RANI A NP	6/3/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	216 SOUTH J STREET	None	LOMPOC	CA	93436	7224	00	06000	34.63660101	-120.4604525	Santa Barbara County
297285	Non-Physician Medical Practitioner	None	1578868626	0	0	KLESCZEWSKI, MICHELLE M NP	11/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	685 BUSH STREET	None	MOUNTAIN VIEW	CA	94041	2109	00	06000	37.38628543	-122.0794499	Santa Clara County
297371	Non-Physician Medical Practitioner	None	1700865151	0	0	KIRKLAND-WALSH, HOLLY JEAN	7/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	DAVIS 6	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
297391	Non-Physician Medical Practitioner	None	1356491112	0	0	KWOCK, JAREMY L	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6595 ALLEGHANY COURT	None	SAN JOSE	CA	95120	3001	00	06000	37.21896777	-121.8593652	Santa Clara County
297521	Non-Physician Medical Practitioner	None	1124020243	0	0	KLUMPH, MARY E	3/24/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14901 RINALDI ST	STE 200	MISSION HILLS	CA	91345	1254	00	06000	34.27903452	-118.457433	Los Angeles County
297539	Non-Physician Medical Practitioner	None	1619501194	0	0	KIM, JOYCE PA	10/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
297549	Non-Physician Medical Practitioner	None	1508202813	0	0	KAPSIMALLIS, STEPHANIE L NP	10/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	404 HANSON AVE	None	CLOVIS	CA	93611	6834	00	06000	36.82527635	-119.663111	Fresno County
297575	Non-Physician Medical Practitioner	None	1922197227	0	0	KUM, HEA S NP	9/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12636 PARK STREET	None	CERRITOS	CA	90703	1165	00	06000	33.87802451	-118.062621	Los Angeles County
297608	Non-Physician Medical Practitioner	None	1518277714	0	0	KILLEN, MARA D NP	2/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10670 WEXFORD ST	None	SAN DIEGO	CA	92131	3940	00	06000	32.93893186	-117.0982186	San Diego County
297617	Non-Physician Medical Practitioner	None	1609086651	0	0	KOPPOLU, RAJASHREE	7/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	318 S GRANT ST	UNIT 2E	SAN MATEO	CA	94401	3388	00	06000	37.56845912	-122.3167744	San Mateo County
297633	Non-Physician Medical Practitioner	None	1043612120	0	0	KAZEEM, UNAKEM A NP	2/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1766 ORIZABA AVE	None	LONG BEACH	CA	94086	7338	00	06000	33.78929811	-118.1567434	Los Angeles County
297653	Non-Physician Medical Practitioner	None	1457087124	0	0	KELLY, MELANIE A NP	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	00	06000	34.44229705	-119.2645703	Ventura County
297697	Non-Physician Medical Practitioner	None	1376288647	0	0	KRUSE, XENIA PA	12/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
297703	Non-Physician Medical Practitioner	None	1801479290	0	0	KING, PRIYA NP	12/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	00	06000	33.94435533	-117.9931159	Los Angeles County
297731	Non-Physician Medical Practitioner	None	1932783289	0	0	KIM, SUNG HEE NP	3/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	365 LENNON LN	STE 290	WALNUT CREEK	CA	94598	5915	00	06000	37.92784983	-122.0301444	Contra Costa County
297794	Non-Physician Medical Practitioner	None	1952936346	0	0	KAUR, RAVINDER NP	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1608 TULLY RD	None	MODESTO	CA	95350	4031	00	06000	37.668168	-121.012182	Stanislaus County
297795	Non-Physician Medical Practitioner	None	1881320638	0	0	KIM, JANE CA	11/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	00	06000	34.06269295	-118.2030006	Los Angeles County
297827	Non-Physician Medical Practitioner	None	1376086140	0	0	KAUR, JASLEEN PA	12/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
297868	Non-Physician Medical Practitioner	None	1063432342	0	0	KARAYAN, NICOLE PA-C	10/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	517 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4239	00	06000	34.42887266	-119.725938	Santa Barbara County
297902	Non-Physician Medical Practitioner	None	1003381971	0	0	KO, ARA PA-C	11/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
297936	Non-Physician Medical Practitioner	None	1831259910	0	0	KALMANOVICH, ANNA PA-C	8/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16300 SAND CANYON AVE	207	IRVINE	CA	92618	3712	00	06000	33.66115075	-117.7742405	Orange County
297940	Non-Physician Medical Practitioner	None	1760265367	0	0	KIM, ASHLEY G PA	8/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28212 KELLY JOHNSON PKWY	SUITE 245	VALENCIA	CA	91355	5084	00	06000	34.44856821	-118.5794922	Los Angeles County
297951	Non-Physician Medical Practitioner	None	1679179337	0	0	KUPFER, MATTHEW S PA	11/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
297974	Non-Physician Medical Practitioner	None	1053374074	0	0	KINCEL, KATHRYN M	8/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 EAST CHAPEL	SUITE 1	SANTA MARIA	CA	93454	4607	00	06000	34.9542915	-120.424455	Santa Barbara County
298050	Non-Physician Medical Practitioner	None	1578882478	0	0	KNIGHT, KELLYANN	9/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2400 E 4TH ST	SUITE 65	NATIONAL CITY	CA	91950	2026	00	06000	32.68637926	-117.0828839	San Diego County
298074	Non-Physician Medical Practitioner	None	1922367390	0	0	KIM, DELPHINA T NP	4/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 COMMERCIAL CROSSING	None	SANTA CRUZ	CA	95065	1816	00	06000	36.98796413	-121.9825327	Santa Cruz County
298088	Non-Physician Medical Practitioner	None	1710350244	0	0	KEENAN, DANIELLE A NP	3/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8851 CENTER DR	STE 500	LA MESA	CA	91942	3033	00	06000	32.78189749	-117.0075062	San Diego County
298107	Non-Physician Medical Practitioner	None	1336865807	0	0	KIM, HYUNG-GYOU PA-C	4/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
298109	Non-Physician Medical Practitioner	None	1255842639	0	0	KNAPP, SPENCER J	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1316 FULTON ST	None	SAN FRANCISCO	CA	94117	1416	00	06000	37.77678164	-122.4389235	San Francisco County
298112	Non-Physician Medical Practitioner	None	1578932190	0	0	KELLY, COLLEEN F NP	11/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1662 MOORLAND DR	UNIT 4	SAN DIEGO	CA	92109	6768	00	06000	32.78708427	-117.2356491	San Diego County
298164	Non-Physician Medical Practitioner	None	1801815998	0	0	KANG, VERONICA Y NP	3/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18543 YORBA LINDA AVE	APT 214	YORBA LINDA	CA	92886	4135	00	06000	33.8886933	-117.8095395	Orange County
298178	Non-Physician Medical Practitioner	None	1316510332	0	0	KHAN, MUNIR NP	8/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
298200	Non-Physician Medical Practitioner	None	1578125829	0	0	KARLIN, STEPHANIE D PA	10/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
298237	Non-Physician Medical Practitioner	None	1093870016	0	0	KING, RICHARD WAYNE	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
298262	Non-Physician Medical Practitioner	None	1871809574	0	0	KEESIS, HEIDI M	8/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
298277	Non-Physician Medical Practitioner	None	1417598228	0	0	KAUR, JASLEEN PA-C	7/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
298300	Non-Physician Medical Practitioner	None	1407386642	0	0	KAUR, KAMALJEET NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5818 E PROVINCE AVE	None	CLOVIS	CA	93619	7806	00	06000	36.86917047	-119.6779455	Fresno County
298320	Non-Physician Medical Practitioner	None	1700245776	0	0	KIRKPATRICK, HEATHER NP	2/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
298325	Non-Physician Medical Practitioner	None	1356694582	0	0	KERR, CHRISTINE M PA-C	4/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	218 W OLIVE AVE	None	MONROVIA	CA	91016	3338	00	06000	34.14473639	-118.003777	Los Angeles County
298327	Non-Physician Medical Practitioner	None	1811373897	0	0	KAUR, KARANVIR NP	9/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 N MEDICAL CENTER DR	STE. 125	CLOVIS	CA	93611	6881	00	06000	36.84186593	-119.6624867	Fresno County
298347	Non-Physician Medical Practitioner	None	1982740619	0	0	KONG, CELIA	11/27/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N ROBERTSON BLVD STE	None	BEVERLY HILLS	CA	90211	6002	00	06000	34.069509	-118.383743	Los Angeles County
298362	Non-Physician Medical Practitioner	None	1134754963	0	0	KAUR, JASPREET NP	3/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS	STE 406	FRESNO	CA	93701	2167	00	06000	36.74500687	-119.7846885	Fresno County
298450	Non-Physician Medical Practitioner	None	1285765313	0	0	KARUNARATNE, MYTHILLA B NP	3/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1321 MARSHALL ST	STE 101	REDWOOD CITY	CA	96003	2557	00	06000	37.48771849	-122.2203748	San Mateo County
298465	Non-Physician Medical Practitioner	None	1962706341	0	0	KIRBY, SHELLEY B PA-C	8/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3301 C ST	STE 550	SACRAMENTO	CA	95816	3372	00	06000	38.579877	-121.456143	Sacramento County
298483	Non-Physician Medical Practitioner	None	1689801110	0	0	KLEINHANS, SUZANNE M PA	9/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
298490	Non-Physician Medical Practitioner	None	1154683118	0	0	KLEINMAN, RENSINA	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1736 UNION ST	None	ALAMEDA	CA	94501	1342	00	06000	37.77358012	-122.2524635	Alameda County
298495	Non-Physician Medical Practitioner	None	1306119292	0	0	KIMBLE, MYEASHA	1/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5901 E 7TH ST	None	LONG BEACH	CA	90822	5201	00	06000	33.778494	-118.118844	Los Angeles County
298500	Non-Physician Medical Practitioner	None	1578160230	0	0	KLEWEIN, CRYSTAL NP	1/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 E 7TH ST	None	LONG BEACH	CA	90813	5002	00	06000	33.77531254	-118.1728263	Los Angeles County
298527	Non-Physician Medical Practitioner	None	1639205784	0	0	KELLEY, KIMBERLY H NP	5/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11338 LONGSHORE COURT	None	SAN DIEGO	CA	92130	8632	00	06000	32.92420733	-117.2179483	San Diego County
298535	Non-Physician Medical Practitioner	None	1437570686	0	0	KIM, HULDA Y NP	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5735 WATT AVENUE	None	NORTH HIGHLANDS	CA	95660	4751	00	06000	38.671749	-121.3838325	Sacramento County
298555	Non-Physician Medical Practitioner	None	1881342277	0	0	KARAGUEZIAN, JESSICA D NP	11/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	00	06000	34.24862229	-118.2886742	Los Angeles County
298563	Non-Physician Medical Practitioner	None	1962656017	0	0	KIRK, CHRISTINA MARIE	2/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
298576	Non-Physician Medical Practitioner	None	1396093902	0	0	KEY, CHRISTOPHER T	10/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6512 N DEARING AVE	None	FRESNO	CA	93710	4803	00	06000	36.83069858	-119.7370278	Fresno County
298632	Non-Physician Medical Practitioner	None	1134362262	0	0	KATZAKIS, STELIOS	6/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
298636	Non-Physician Medical Practitioner	None	1952800203	0	0	KUMISKI, MAXX A PA	6/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 MARKET ST	None	SAN FRANCISCO	CA	94102	5910	00	06000	37.77393281	-122.4208671	San Francisco County
298642	Non-Physician Medical Practitioner	None	1801338157	0	0	KITTIPHA, PANICHA F NP	4/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12201 HOMESTEAD PL	None	GARDEN GROVE	CA	92840	5718	00	06000	33.77546149	-117.919845	Orange County
298670	Non-Physician Medical Practitioner	None	1932256617	0	0	KETNER, KAREN MARIE	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	00	06000	37.48948529	-122.2232468	San Mateo County
298681	Non-Physician Medical Practitioner	None	1801348859	0	0	KEHRES, HEATHER J PA-C	3/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 4TH ST	STE 100	SANTA ROSA	CA	95404	3661	00	06000	38.448801	-122.699439	Sonoma County
298682	Non-Physician Medical Practitioner	None	1528788775	0	0	KIM, REBECCA NP	8/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	00	06000	34.137603	-118.101464	Los Angeles County
298684	Non-Physician Medical Practitioner	None	1417582313	0	0	KOTANJIAN, CELINA M NP	10/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11822 FLORAL DR	None	WHITTIER	CA	90601	2900	00	06000	33.99172377	-118.0495187	Los Angeles County
298695	Non-Physician Medical Practitioner	None	1083265565	0	0	KAUR, RAJWINDER NP	4/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	650 HOWE AVE	SUITE 600	SACRAMENTO	CA	95825	4731	00	06000	38.577294	-121.4146395	Sacramento County
298699	Non-Physician Medical Practitioner	None	1922270255	0	0	KAMAU, MIRIAM NP	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5850 EL CAMINO REAL	None	ATASCADERO	CA	93422	3318	00	06000	35.48962035	-120.670989	San Luis Obispo County
298720	Non-Physician Medical Practitioner	None	1184783813	0	0	KAUR, NAVJOT PA-C	6/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
298769	Non-Physician Medical Practitioner	None	1033765839	0	0	KUNG, JEANY L NP	7/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3325 TYLER AVE	None	EL MONTE	CA	91731	3101	00	06000	34.069212	-118.0360275	Los Angeles County
298827	Non-Physician Medical Practitioner	None	1588056063	0	0	KUANG, LENA NP	5/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15925 LUJON ST	None	HACIENDA HEIGHTS	CA	91745	3530	00	06000	34.00010613	-117.9624041	Los Angeles County
298836	Non-Physician Medical Practitioner	None	1174853907	0	0	KIDANE, MEAZA Z PA	11/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	00	06000	37.90582392	-122.0613697	Contra Costa County
298860	Non-Physician Medical Practitioner	None	1104262757	0	0	KINKLE, BARBARA J PA	6/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 COHASSET RD	STE 240	CHICO	CA	95926	2235	00	06000	39.75090044	-121.8522609	Butte County
298867	Non-Physician Medical Practitioner	None	1982849600	0	0	KOWALLIS, DAVID W	1/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23279 SARATOGA SPGS PL	None	MURRIETA	CA	92562	4802	00	06000	33.592595	-117.2204225	Riverside County
298886	Non-Physician Medical Practitioner	None	1255500724	0	0	KAUFMAN, BRITNEY ELISE	9/28/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1851 AMBROSIA AVE	None	UPLAND	CA	91784	9215	00	06000	34.13084236	-117.6294245	San Bernardino County
298894	Non-Physician Medical Practitioner	None	1689128928	0	0	KARASIK, DANIELLE S PA	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90024	0000	00	06000	34.06527974	-118.4462792	Los Angeles County
298914	Non-Physician Medical Practitioner	None	1609979772	0	0	KOELZER, DIAN FORRESTER	5/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	00	06000	38.644479	-121.1349735	Sacramento County
298916	Non-Physician Medical Practitioner	None	1396967261	0	0	KAM, PETRICE P NP	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
298944	Non-Physician Medical Practitioner	None	1568879088	0	0	KARAOUNI, JASMINE A NP	12/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5634 WEBER RD	None	VACAVILLE	CA	95687	9435	00	06000	38.40234012	-121.8920416	Solano County
298976	Non-Physician Medical Practitioner	None	1053439562	0	0	KATZEN, EVE M PA-C	5/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	713 N DOUGLAS ST.	None	EL SEGUNDO	CA	90245	2830	00	06000	33.92546537	-118.3832318	Los Angeles County
298998	Non-Physician Medical Practitioner	None	1447903877	0	0	KINCAID, ASHLEY N NP	8/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10100 CULVER BLVD	STE E	CULVER CITY	CA	90232	3175	00	06000	34.01935201	-118.3979919	Los Angeles County
299087	Non-Physician Medical Practitioner	None	1063919561	0	0	KAUR, KAMALPREET NP	10/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1517 BIGAROON CT	None	CERES	CA	95307	7005	00	06000	37.608165	-120.9297995	Stanislaus County
299170	Non-Physician Medical Practitioner	None	1811624695	0	0	KAUR, RAJINDER NP	9/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	00	06000	36.83832032	-119.7632391	Fresno County
299183	Non-Physician Medical Practitioner	None	1669839213	0	0	KIRUI, CYNTHIA C PA	8/29/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47111 MONROE ST	None	INDIO	CA	92201	6739	00	06000	33.70620698	-116.2339008	Riverside County
299207	Non-Physician Medical Practitioner	None	1801316153	0	0	KENT, LAUREL K B NP	7/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2309 KENT STREET	None	SAN MATEO	CA	94403	1543	00	06000	37.54696003	-122.2957929	San Mateo County
299233	Non-Physician Medical Practitioner	None	1275245631	0	0	KOUKLADAS, TATUM K NP	4/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	00	06000	33.89815111	-117.8419708	Orange County
299249	Non-Physician Medical Practitioner	None	1386336576	0	0	KASHKOUL, HANAN PA	1/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	00	06000	35.12986992	-120.6006027	San Luis Obispo County
299279	Non-Physician Medical Practitioner	None	1811528623	0	0	KIM, YEON SUN PA-C	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2550 HOLLYWOOD	STE 100	BURBANK	CA	91505	1055	00	06000	34.195086	-118.348892	Los Angeles County
299286	Non-Physician Medical Practitioner	None	1053771584	0	0	KHOSA, NAVREET K PA-C	12/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
299300	Non-Physician Medical Practitioner	None	1003219601	0	0	KUANG, WEI	6/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1451 ROCKY RIDGE DR	APT 904	ROSEVILLE	CA	95661	3006	00	06000	38.75341372	-121.2471694	Placer County
299318	Non-Physician Medical Practitioner	None	1336608496	0	0	KACHAKIAN, RITA NP	3/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4922 WHITTIER BLVD	None	LOS ANGELES	CA	90022	1111	00	06000	34.02163273	-118.1631725	Los Angeles County
299375	Non-Physician Medical Practitioner	None	1730864992	0	0	KEUNG, MICHELLE	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1212 S MAIN ST	None	SALINAS	CA	93901	2260	00	06000	36.65759539	-121.6594973	Monterey County
299412	Non-Physician Medical Practitioner	None	1932676384	0	0	KERSHAW, RUTH PA	8/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
299422	Non-Physician Medical Practitioner	None	1538312822	0	0	KOHRING, LAURIE J NP	4/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7847 SHENANDOAH DR	None	ELIZABETH	CO	80107	9337	00	06000	39.50384145	-104.5172948	Elbert County
299431	Non-Physician Medical Practitioner	None	1326582669	0	0	KELSON, LAUREN	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3191 S SEPULVEDA BLVD	APT 107	LOS ANGELES	CA	90034	4208	00	06000	34.02486079	-118.4267124	Los Angeles County
299434	Non-Physician Medical Practitioner	None	1942984026	0	0	KIM, JANE S NP	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
299446	Non-Physician Medical Practitioner	None	1538319264	0	0	KORAS, THOMAS	10/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23267 KENT COURT	None	MURRIETA	CA	92562	5086	00	06000	33.57335365	-117.2505333	Riverside County
299488	Non-Physician Medical Practitioner	None	1710627450	0	0	KISSOYAN, HERA NP	11/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
299496	Non-Physician Medical Practitioner	None	1689392078	0	0	KOHANCHI, JOSHUA A PA	9/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4550 VAN NUYS BLVD	STE A4	SHERMAN OAKS	CA	91403	2844	00	06000	34.154658	-118.4486715	Los Angeles County
299522	Non-Physician Medical Practitioner	None	1821827601	0	0	KOODA-BLACK, SARAH PA-C	3/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6926 BROCKTON AVE	SUITE 6 & 11	RIVERSIDE	CA	92506	3800	00	06000	33.947919	-117.3967225	Riverside County
299545	Non-Physician Medical Practitioner	None	1558584466	0	0	KRAMER, RENEE H NP	3/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4253 RED HILL RD	None	VALLECITO	CA	95251	0000	00	06000	38.08669254	-120.4849287	Calaveras County
299630	Non-Physician Medical Practitioner	None	1306895651	0	0	KRAFT, THOMAS A	4/27/1992	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	00	06000	37.66742737	-120.9731413	Stanislaus County
299687	Non-Physician Medical Practitioner	None	1477133320	0	0	KIBBE, REBEKAH NP	1/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 SHERMAN DR	STE 7	RIVERSIDE	CA	92503	4001	00	06000	33.92678822	-117.4368632	Riverside County
299699	Non-Physician Medical Practitioner	None	1265938054	0	0	KHOSHABIAN, COLIN NP	6/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
299712	Non-Physician Medical Practitioner	None	1770949513	0	0	KANIEWSKA, MONIKA NP	4/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27061 SEGOVIA	None	MISSION VIEJO	CA	92691	5049	00	06000	33.60481599	-117.6578633	Orange County
299736	Non-Physician Medical Practitioner	None	1518664705	0	0	KING, JUSTIN NP	1/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE ST	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
299741	Non-Physician Medical Practitioner	None	1336916188	0	0	KAUR, BALJINDER NP	5/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 COFFEE RD	SUITE 100	BAKERSFIELD	CA	93309	1273	00	06000	35.356392	-119.092153	Kern County
299775	Non-Physician Medical Practitioner	None	1730816877	0	0	KAHKOSKO, BERNICE P NP	9/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
299795	Non-Physician Medical Practitioner	None	1225239114	0	0	KIM, JULIE S	2/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1754 REDWILLOW ROAD	None	FULLERTON	CA	92833	1434	00	06000	33.88968324	-117.974571	Orange County
299832	Non-Physician Medical Practitioner	None	1770885741	0	0	KAY, RACHEL L	12/14/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 WEBSTER ST	SUITE 304	OAKLAND	CA	94609	3117	00	06000	37.82132826	-122.2621843	Alameda County
299937	Non-Physician Medical Practitioner	None	1972806941	0	0	KORSHAK, EVE BAGG	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 CAMINO ENCINAS	None	ORINDA	CA	94563	0000	00	06000	37.87679015	-122.1800856	Contra Costa County
299941	Non-Physician Medical Practitioner	None	1063870723	0	0	KIM, EDWARDS J	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9237 REGENTS ROAD	UNIT K407	LA JOLLA	CA	92037	9184	00	06000	32.87383814	-117.2161012	San Diego County
300001	Non-Physician Medical Practitioner	None	1629371356	0	0	KOSER, LISA NP	1/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
300048	Non-Physician Medical Practitioner	None	1902201957	0	0	KHOUW, STEPHANIE NP	4/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7398 VILLAREAL DR	None	CASTRO VALLEY	CA	94552	5253	00	06000	37.71717523	-122.0240874	Alameda County
300051	Non-Physician Medical Practitioner	None	1184207771	0	0	KUTILEK, RUVY ROSE D NP	10/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
300053	Non-Physician Medical Practitioner	None	1790279479	0	0	KENNEDY, JOSEPH R PA-C	11/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	00	06000	33.9316595	-116.9468639	Riverside County
300055	Non-Physician Medical Practitioner	None	1346471000	0	0	KAMNIKAR, JENNIFER L	2/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 BRODIA WAY	None	WALNUT CREEK	CA	94598	4920	00	06000	37.90451273	-122.0266832	Contra Costa County
300086	Non-Physician Medical Practitioner	None	1609567866	0	0	KHAMSONE, LINDA NP	11/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 N MEDICAL CENTER DR	STE 205	CLOVIS	CA	93611	6886	00	06000	36.84186593	-119.6624867	Fresno County
300091	Non-Physician Medical Practitioner	None	1033528591	0	0	KIDDLE, MATTHEW W	3/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 WHITNEY AVE	UNIT 2	POMONA	CA	91767	1666	00	06000	34.10253278	-117.7509258	Los Angeles County
300132	Non-Physician Medical Practitioner	None	1639909740	0	0	KHADKA, ASTHA PA	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5451 WALNUT AVE	None	CHINO	CA	91710	2609	00	06000	34.02626886	-117.6858645	San Bernardino County
300145	Non-Physician Medical Practitioner	None	1063038107	0	0	KIM, SARAH PA-C	3/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 SAN PABLO STREET	SUITE 6200	LOS ANGELES	CA	90033	4500	00	06000	34.06189518	-118.203256	Los Angeles County
300157	Non-Physician Medical Practitioner	None	1114226628	0	0	KOSARI, BEHNOUSH NP	4/29/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
300158	Non-Physician Medical Practitioner	None	1376623538	0	0	KERN COUNTY HOSPITAL AUTHORITY	12/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MOUNT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
300181	Non-Physician Medical Practitioner	None	1376296004	0	0	KAHN, RACHAEL NP	7/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
300193	Non-Physician Medical Practitioner	None	1780887299	0	0	KIRBY, KELLY R NP	7/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	723 CLARK WAY	None	PALO ALTO	CA	94304	2312	00	06000	37.43886644	-122.1781043	Santa Clara County
300213	Non-Physician Medical Practitioner	None	1295064335	0	0	KIMKER, BRIDGET M	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2378 CORAL SEA ST	None	ALAMEDA	CA	94501	3583	00	06000	37.78344394	-122.2838892	Alameda County
300262	Non-Physician Medical Practitioner	None	1003458977	0	0	KIM, JESSICA J PA-C	11/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4950 SAN BERNARDINO ST	200	MONTCLAIR	CA	91763	2328	00	06000	34.07768363	-117.6968874	San Bernardino County
300295	Non-Physician Medical Practitioner	None	1215664800	0	0	KREITEM, LAILA I PA	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
300318	Non-Physician Medical Practitioner	None	1972129013	0	0	KIM, LAUREN PA-C	2/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2222 S MAIN ST	None	SANTA ANA	CA	92707	3220	00	06000	33.717168	-117.867929	Orange County
300326	Non-Physician Medical Practitioner	None	1770291569	0	0	KAUR, JASMEEN NP	6/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 N MEDICAL CENTER DR	STE 205	CLOVIS	CA	93611	6886	00	06000	36.84186593	-119.6624867	Fresno County
300332	Non-Physician Medical Practitioner	None	1356620983	0	0	KISCADEN, LAUREN L PA-C	10/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
300362	Non-Physician Medical Practitioner	None	1275021347	0	0	KNIGHT, CATHERINE C PA-C	3/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	00	06000	33.52069117	-117.1653103	Riverside County
300383	Non-Physician Medical Practitioner	None	1841661980	0	0	KELLY, NANCY NP	2/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1230 JEFFERSON ST	None	DELANO	CA	93215	2204	00	06000	35.77274103	-119.2450573	Kern County
300399	Non-Physician Medical Practitioner	None	1659846483	0	0	KUIZENGA, ALEXANDRA M PA-C	6/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	00	06000	37.80110374	-121.1974853	San Joaquin County
300404	Non-Physician Medical Practitioner	None	1336399252	0	0	KONIOR, JENNIFER PA	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25865 BARTON RD	D101, D102, D103, D104	LOMA LINDA	CA	92354	3895	00	06000	34.04824853	-117.2403225	San Bernardino County
300415	Non-Physician Medical Practitioner	None	1801510755	0	0	KIM, JENNIFER PA-C	7/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23961 CALLE DE LA MAGDAL	500	LAGUNA HILLS	CA	92653	7622	00	06000	33.60999658	-117.7126577	Orange County
300468	Non-Physician Medical Practitioner	None	1568613339	0	0	KAY, DANNY CHU KIONG	11/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1850 SULLIVAN AVE	SUITE #330	DALY CITY	CA	94015	2221	00	06000	37.68085904	-122.4728842	San Mateo County
300498	Non-Physician Medical Practitioner	None	1124660295	0	0	KOMEN, NGAWINA V PA-C	5/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	00	06000	34.20369349	-118.629837	Los Angeles County
300507	Non-Physician Medical Practitioner	None	1265840987	0	0	KENNEDY, ALLISON L	2/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3922 RAVENSWOOD DRIVE	None	YORBA LINDA	CA	92886	6903	00	06000	33.90501403	-117.7724412	Orange County
300522	Non-Physician Medical Practitioner	None	1013082825	0	0	KIRKPATRICK, NANCY J NP	4/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5 DOVE PLACE	None	NOVATO	CA	94949	6615	00	06000	38.04577511	-122.5417177	Marin County
300526	Non-Physician Medical Practitioner	None	1164141164	0	0	KUENHOLD, MIKAELAH R NP	2/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
300547	Non-Physician Medical Practitioner	None	1013496538	0	0	KATSARELIS, EMMELINE J NP	10/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	79 MERITAGE CMN	UNIT 107	LIVERMORE	CA	94551	7492	00	06000	37.70975363	-121.8084079	Alameda County
300559	Non-Physician Medical Practitioner	None	1003380593	0	0	KINZER, IRYNA PA-C	8/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 TERRACINA BLVD	STE 205C	REDLANDS	CA	92373	4870	00	06000	34.03788441	-117.2055761	San Bernardino County
300570	Non-Physician Medical Practitioner	None	1598424996	0	0	KING, SKYLER PA-C	8/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	00	06000	34.58364037	-118.1441012	Los Angeles County
300581	Non-Physician Medical Practitioner	None	1841697513	0	0	KIM, MIN K PA	12/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2600 VIA DE LA VALLE	SUITE 200	DEL MAR	CA	92014	1192	00	06000	32.98053969	-117.2508471	San Diego County
300599	Non-Physician Medical Practitioner	None	1487276382	0	0	KALAMBAY, NDAYA B PA	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	130 LA CASA VIA	2-210	WALNUT CREEK	CA	94598	3045	00	06000	37.91175467	-122.0414101	Contra Costa County
300602	Non-Physician Medical Practitioner	None	1285145995	0	0	KWAN, JOSH D NP	5/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 E HARDY ST	IRA KAUFMAN PAVILION	INGLEWOOD	CA	90301	4106	00	06000	33.94909549	-118.3481595	Los Angeles County
300610	Non-Physician Medical Practitioner	None	1689967960	0	0	KLAUSA, INGRIDA	3/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	454 S REXFORD DR	APT 2	BEVERLY HILLS	CA	90212	4751	00	06000	34.05757391	-118.3938572	Los Angeles County
300622	Non-Physician Medical Practitioner	None	1962739862	0	0	KARDOS, ZAHRA B	4/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81719 DOCTOR CARREON	C-1	INDIO	CA	92201	0600	00	06000	33.70738353	-116.2386945	Riverside County
300683	Non-Physician Medical Practitioner	None	1164500690	0	0	KLIMST-ZINGO, SUSAN	7/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3299 BUS MCGALL RD	None	UKIAH	CA	95482	9339	00	06000	39.016296	-123.1886745	Mendocino County
300692	Non-Physician Medical Practitioner	None	1316984388	0	0	KREUTZ, JOHANNA M	8/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4225 ETHEL AVE	APT 16	STUDIO CITY	CA	91604	1995	00	06000	34.14693349	-118.418354	Los Angeles County
300709	Non-Physician Medical Practitioner	None	1093581068	0	0	KIDKA, HELEN NP	5/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
300738	Non-Physician Medical Practitioner	None	1922586643	0	0	KIKER, DEVON L NP	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2595 W SAMPLE AVE	None	FRESNO	CA	93711	1770	00	06000	36.8276755	-119.839698	Fresno County
300763	Non-Physician Medical Practitioner	None	1508238619	0	0	KWAN, TRACY M NP	3/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3595 GRANADA AVE	APT 348	SANTA CLARA	CA	95051	3488	00	06000	37.34906417	-121.9948046	Santa Clara County
300767	Non-Physician Medical Practitioner	None	1083031504	0	0	KENWORTHEY, WILLIAM H	10/31/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10855 CHRUCH ST	APT 2401	RANCHO CUCAMONGA	CA	91730	8594	00	06000	34.11104225	-117.5693492	San Bernardino County
300799	Non-Physician Medical Practitioner	None	1992942478	0	0	KAN, CATHERINE A	7/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 AVALON DR	None	PACIFICA	CA	94044	2305	00	06000	37.6469895	-122.4894292	San Mateo County
300805	Non-Physician Medical Practitioner	None	1093246779	0	0	KHAIRA, JASLEEN K NP	6/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32824 ASHLEY ROSE CT	None	TEMECULA	CA	92592	7112	00	06000	33.49770425	-117.0865246	Riverside County
300842	Non-Physician Medical Practitioner	None	1891811030	0	0	KELSCHEUR, JACOB J	5/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5150 BAREBACK SQUARE	None	SAN DIEGO	CA	92130	1213	00	06000	32.9748534	-117.2090776	San Diego County
300866	Non-Physician Medical Practitioner	None	1760626030	0	0	KANG, SUSAN	7/31/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	SUITE 214	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
300870	Non-Physician Medical Practitioner	None	1285461053	0	0	KIMMEL, DESTINY D NP	11/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 J STREET	STE 350	SACRAMENTO	CA	95819	3633	00	06000	38.570652	-121.4535465	Sacramento County
300901	Non-Physician Medical Practitioner	None	1639735624	0	0	KOCH, ALLISON L PA	3/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 ILLINOIS ST	None	SAN FRANCISCO	CA	94107	0000	00	06000	37.76487693	-122.3880446	San Francisco County
300922	Non-Physician Medical Practitioner	None	1083806517	0	0	KIN, ISRAEL M	6/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	356 N POINSETTIA PL	None	LOS ANGELES	CA	90036	2507	00	06000	34.077798	-118.348644	Los Angeles County
300934	Non-Physician Medical Practitioner	None	1790535862	0	0	KLINE, MAXWELL PA-C	8/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	00	06000	33.9316595	-116.9468639	Riverside County
300935	Non-Physician Medical Practitioner	None	1235745415	0	0	KAMACHI, ROLAND A PA-C	12/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
300980	Non-Physician Medical Practitioner	None	1720321318	0	0	KAVIANI, ASHKHAN N	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	903 S MARENGO AVE	APT 4	PASADENA	CA	91106	4708	00	06000	34.13020668	-118.1458516	Los Angeles County
301006	Non-Physician Medical Practitioner	None	1437557451	0	0	KAI, CHERI H NP	1/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
301064	Non-Physician Medical Practitioner	None	1124804349	0	0	KAUR, NAVPREET NP	2/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5701 YOUNG ST	STE 201	BAKERSFIELD	CA	93313	8897	00	06000	35.302788	-119.0986965	Kern County
301092	Non-Physician Medical Practitioner	None	1912463589	0	0	KIZZAR, KATHRYN E NP	5/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5827 PINE AVE	SUITE A	CHINO HILLS	CA	91709	6534	00	06000	33.94745656	-117.6777147	San Bernardino County
301144	Non-Physician Medical Practitioner	None	1306942529	0	0	KEATON, EVELYN NP	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	00	06000	38.598876	-121.4502885	Sacramento County
301148	Non-Physician Medical Practitioner	None	1669002093	0	0	KIM, SAINTE ELAN J NP	11/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
301168	Non-Physician Medical Practitioner	None	1316594310	0	0	KOVARIK, KIMBERLY NP	1/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
301177	Non-Physician Medical Practitioner	None	1457084659	0	0	KAUR, JASNOOR PA	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 COFFEE RD	None	MODESTO	CA	95355	2803	00	06000	37.668645	-120.9756715	Stanislaus County
301244	Non-Physician Medical Practitioner	None	1619342086	0	0	KUMAR, SUNAYNA NP	3/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	00	06000	37.95582533	-121.967442	Contra Costa County
301348	Non-Physician Medical Practitioner	None	1235480005	0	0	KERR, STACEY	11/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
301356	Non-Physician Medical Practitioner	None	1740942242	0	0	KAUR, JASPINDERJIT NP	11/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1215 34TH ST	None	BAKERSFIELD	CA	93301	2107	00	06000	35.39050249	-119.015775	Kern County
301379	Non-Physician Medical Practitioner	None	1952322661	0	0	KERR-SCHIFRIN, NANCY	5/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	940 SYLVA LN	SUITE E	SONORA	CA	95370	5969	00	06000	37.98764779	-120.3681842	Tuolumne County
301392	Non-Physician Medical Practitioner	None	1427831536	0	0	KHAMIS, DEENA S CNP	9/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2271 E PALMDALE BLVD	SUITE E	PALMDALE	CA	93550	1340	00	06000	34.58021047	-118.087218	Los Angeles County
301402	Non-Physician Medical Practitioner	None	1003508995	0	0	KHACHIKYAN, VAHE PA	1/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	00	06000	34.01891346	-118.186614	Los Angeles County
301410	Non-Physician Medical Practitioner	None	1043780216	0	0	KIM, JIYEON NP	1/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6733 N WILLOW AVE	SUITE 107	FRESNO	CA	93710	5953	00	06000	36.83464076	-119.7311553	Fresno County
301425	Non-Physician Medical Practitioner	None	1972249662	0	0	KAUR, GULNEET NP	10/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	00	06000	37.66742737	-120.9731413	Stanislaus County
301472	Non-Physician Medical Practitioner	None	1962850313	0	0	KIM, BRIAN J PA	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
301490	Non-Physician Medical Practitioner	None	1861236895	0	0	KAROLY, MEGAN PA	3/30/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11800 WILSHIRE BLVD	None	LOS ANGELES	CA	90025	6606	00	06000	34.0475456	-118.4632671	Los Angeles County
301503	Non-Physician Medical Practitioner	None	1164998142	0	0	KEITH, ANNE K NP	8/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	421 NUT TREE RD	None	VACAVILLE	CA	95687	3508	00	06000	38.36441975	-121.9525909	Solano County
301527	Non-Physician Medical Practitioner	None	1588424287	0	0	KAUR, SIMARPREET NP	5/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7325 MEDICAL CENTER DRIV	SUITE 300	WEST HILLS	CA	91307	4117	00	06000	34.20369349	-118.629837	Los Angeles County
301555	Non-Physician Medical Practitioner	None	1235583360	0	0	KAMYAB, MARIAM NP	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 TELEGRAPH AVE	110	BERKELEY	CA	94705	1159	00	06000	37.85808554	-122.2594469	Alameda County
301568	Non-Physician Medical Practitioner	None	1518083773	0	0	KREWSUN, MARY C	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3903 EL CANTO DR	None	SPRING VALLEY	CA	91977	1715	00	06000	32.75105674	-116.969729	San Diego County
301574	Non-Physician Medical Practitioner	None	1649793068	0	0	KAYANI, ANNA NP	3/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5353 G STREET	None	CHINO	CA	91710	5249	00	06000	34.00987149	-117.6880905	San Bernardino County
301622	Non-Physician Medical Practitioner	None	1861525602	0	0	KOREAN COMMUNITY SERVICES	11/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7212 ORANGETHORPE AVE	SUITE 9A	BUENA PARK	CA	90621	4667	00	06000	33.85890953	-118.007244	Orange County
301627	Non-Physician Medical Practitioner	None	1194276923	0	0	KAUR, SUKHJOT NP	12/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14013 LA CASCADA CT	None	BAKERSFIELD	CA	93314	5249	00	06000	35.39605352	-119.15793	Kern County
301631	Non-Physician Medical Practitioner	None	1215561006	0	0	KRETKOWSKI, PAUL D PA-C	10/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	830 JEFFERSON AVE	STE M	REDWOOD CITY	CA	94063	1804	00	06000	37.48599384	-122.2282125	San Mateo County
301658	Non-Physician Medical Practitioner	None	1639813413	0	0	KIM, DORIAN PA-C	5/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	00	06000	34.06794352	-118.1229278	Los Angeles County
301672	Non-Physician Medical Practitioner	None	1700297744	0	0	KLEINER, STEPHANIE L NP	10/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	324 N WINNIPEG PLACE	None	LONG BEACH	CA	90814	2563	00	06000	33.76928829	-118.1556277	Los Angeles County
301681	Non-Physician Medical Practitioner	None	1114352747	0	0	KNUTSON, RAQUEL L PA-C	10/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	453 INKOPATH STREET	None	CHULA VISTA	CA	91911	0000	00	06000	32.62530096	-117.0400636	San Diego County
301682	Non-Physician Medical Practitioner	None	1598158206	0	0	KOAY, SEOKHOOI NP	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39243 LIBERTY ST	None	FREMONT	CA	94538	1501	00	06000	37.55043899	-121.9813016	Alameda County
301685	Non-Physician Medical Practitioner	None	1518089507	0	0	KARTHIKEYA DEVIREDDY MD INC	4/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	311 W I ST	None	LOS BANOS	CA	93635	3479	00	06000	37.06343055	-120.8570545	Merced County
301700	Non-Physician Medical Practitioner	None	1053177147	0	0	KOE, JONATHAN M PA-C	8/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	707 S GARFIELD AVE	None	ALHAMBRA	CA	91801	5859	00	06000	34.088688	-118.123106	Los Angeles County
301735	Non-Physician Medical Practitioner	None	1265172969	0	0	KAUR, DAPINDER NP	5/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3466 EL CAMINO REAL	None	SANTA CLARA	CA	95051	2809	00	06000	37.35225555	-121.9921875	Santa Clara County
301818	Non-Physician Medical Practitioner	None	1902565401	0	0	KLEPAC, WILLIAM D NP	4/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 KASHIAN LN	301	FRESNO	CA	93701	2230	00	06000	36.74333844	-119.7831874	Fresno County
301863	Non-Physician Medical Practitioner	None	1710319041	0	0	KUBA, EULA M A NP	10/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3810 W 185TH ST	None	TORRANCE	CA	90504	4819	00	06000	33.86260005	-118.3412964	Los Angeles County
301893	Non-Physician Medical Practitioner	None	1265955256	0	0	KALAW, ALLAN B NP	9/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2024 BANJO DR	None	SANTA ROSA	CA	95407	4514	00	06000	38.407626	-122.7334905	Sonoma County
301906	Non-Physician Medical Practitioner	None	1104425818	0	0	KAUR, KIRANDIP NP	11/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 STONE BLVD	STE 190	WEST SACRAMENTO	CA	95691	4055	00	06000	38.56318049	-121.5379228	Yolo County
301918	Non-Physician Medical Practitioner	None	1083242499	0	0	KLAN, CAITLYN PA-C	10/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	00	06000	35.29325417	-120.667547	San Luis Obispo County
301944	Non-Physician Medical Practitioner	None	1164206223	0	0	KAUR, SATPREET NP	3/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	00	06000	38.494602	-121.513743	Sacramento County
301970	Non-Physician Medical Practitioner	None	1073089074	0	0	KAUR, SUKHDEEP NP	1/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1679 E MONTE VISTA AVE	STE. 140	VACAVILLE	CA	95688	3122	00	06000	38.36981273	-121.9599958	Solano County
302022	Non-Physician Medical Practitioner	None	1114259363	0	0	KHA, VINH	5/26/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	06000	32.73710364	-97.3419336	Tarrant County
302109	Non-Physician Medical Practitioner	None	1003206004	0	0	KELLY, MICHAEL S NP	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17601 17TH ST	120	TUSTIN	CA	92780	1946	00	06000	33.75990351	-117.8253082	Orange County
302115	Non-Physician Medical Practitioner	None	1700378981	0	0	KAPOOR, NEHA NP	8/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9802 STOCKDALE HWY	STE 102	BAKERSFIELD	CA	93311	3653	00	06000	35.3544067	-119.1113372	Kern County
302124	Non-Physician Medical Practitioner	None	1154042885	0	0	KIM, CHRISTINE NP	6/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	00	06000	33.8601747	-118.148313	Los Angeles County
302139	Non-Physician Medical Practitioner	None	1609127042	0	0	KARYNA, KARPIYEVICH	6/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4528 ANTELOPE PARK WAY	None	ANTELOPE	CA	95843	5737	00	06000	38.711331	-121.3590465	Sacramento County
302193	Non-Physician Medical Practitioner	None	1962772970	0	0	KILLIAN-BENIGNO, CHRISTINA	4/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4817 BAYLOR DR	None	SAN DIEGO	CA	92115	3522	00	06000	32.76498991	-117.0820581	San Diego County
302198	Non-Physician Medical Practitioner	None	1801855861	0	0	KIRSHBAUM, DAVID PA-C	1/15/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8283 GROVE AVE	201	RANCHO CUCAMONGA	CA	91730	3140	00	06000	34.10380433	-117.6285116	San Bernardino County
302200	Non-Physician Medical Practitioner	None	1932132719	0	0	KOHLER, JANA	3/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
302274	Non-Physician Medical Practitioner	None	1831198597	0	0	KABAIVANOFF, DEBRA L NP	12/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3601 W VERDUGO	APT 211	BURBANK	CA	91505	4901	00	06000	34.16132833	-118.3427133	Los Angeles County
302279	Non-Physician Medical Practitioner	None	1093588832	0	0	KIM, SUE NP	4/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	00	06000	37.53249631	-121.9198141	Alameda County
302325	Non-Physician Medical Practitioner	None	1477975860	0	0	KOLODRUBETZ, HIVA S NP	6/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1737 SOLANO AVE	APT 307	BERKELEY	CA	94707	2203	00	06000	37.89126052	-122.2818666	Alameda County
302355	Non-Physician Medical Practitioner	None	1093082133	0	0	KLOPOTEK, BLAINE PA-C	9/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	760 OTAY LAKES RD	None	CHULA VISTA	CA	91910	6915	00	06000	32.64603447	-117.0015068	San Diego County
302372	Non-Physician Medical Practitioner	None	1902910318	0	0	KARELIUS, JANICE ELLEN	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	00	06000	33.49961197	-117.7420867	Orange County
302377	Non-Physician Medical Practitioner	None	1215049002	0	0	KRAJEWSKI, RICHARD ERIC	2/14/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
302407	Non-Physician Medical Practitioner	None	1740545987	0	0	KERNER, LISA M	9/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10238 JERICHO DRIVE	None	STOCKTON	CA	95219	7283	00	06000	38.04917362	-121.3899962	San Joaquin County
302433	Non-Physician Medical Practitioner	None	1275997629	0	0	KLEINSMITH, DARIN PA-C	2/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
302447	Non-Physician Medical Practitioner	None	1821754458	0	0	KWAN, CARRIE NP	4/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
302454	Non-Physician Medical Practitioner	None	1376884809	0	0	KAUR, KULWINDER NP	9/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6017 N SYCAMORE AVE	None	FRESNO	CA	93723	4008	00	06000	36.82297301	-119.9158295	Fresno County
302469	Non-Physician Medical Practitioner	None	1588704522	0	0	KERRIGAN, KIMBERLY ALLEN	10/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15611 POMERADO RD	3RD FLOOR	POWAY	CA	92064	2437	00	06000	32.99706	-117.05544	San Diego County
302530	Non-Physician Medical Practitioner	None	1821035122	0	0	KRAMER, MIRANDA J	4/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	144 HUCKLEBERRY TRAIL	None	WOODSIDE	CA	94062	4600	00	06000	37.43513273	-122.3218376	San Mateo County
302553	Non-Physician Medical Practitioner	None	1548912660	0	0	KODJANIAN, ARIK PA-C	4/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6440 PLATT AVE	None	WEST HILLS	CA	91307	3216	00	06000	34.18784988	-118.6427021	Los Angeles County
302555	Non-Physician Medical Practitioner	None	1225783855	0	0	KAUR, PARDEEP PA	4/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 WASHINGTON ST	STE 512	SAN DIEGO	CA	92103	2231	00	06000	32.74986289	-117.1599343	San Diego County
302559	Non-Physician Medical Practitioner	None	1265803514	0	0	KHALID, FAUZIA NP	3/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5669 N FRESNO ST	APT 244	FRESNO	CA	93710	8320	00	06000	36.820575	-119.7813485	Fresno County
302585	Non-Physician Medical Practitioner	None	1245447937	0	0	KIM, CHRISTINE M.	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 CALIFORNIA ST RM 70	None	SAN FRANCISCO	CA	94118	1509	00	06000	37.78591809	-122.4575439	San Francisco County
302591	Non-Physician Medical Practitioner	None	1962663658	0	0	KOESTER, DIANE KAY	8/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9834 GENESEE AVE STE 300	None	LA JOLLA	CA	92037	1215	00	06000	32.884074	-117.225855	San Diego County
302618	Non-Physician Medical Practitioner	None	1093095358	0	0	KAZEMI, SHIRIN	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5862 MAURY AVE	None	WOODLAND HILLS	CA	91367	1046	00	06000	34.17709924	-118.6606356	Los Angeles County
302631	Non-Physician Medical Practitioner	None	1407237522	0	0	KITCHEN, NICOLE A PA	1/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	00	06000	32.72663119	-117.1611714	San Diego County
302635	Non-Physician Medical Practitioner	None	1891197943	0	0	KOSTNER, MICHELLE D PA	12/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10605 SCRIPPS POWAY PKWY	SUITE B AND C	SAN DIEGO	CA	92131	3925	00	06000	32.93714729	-117.0990446	San Diego County
302690	Non-Physician Medical Practitioner	None	1205385267	0	0	KING, JENNIFER PA	8/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
302700	Non-Physician Medical Practitioner	None	1609407394	0	0	KEENE, RENEE M NP	9/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
302742	Non-Physician Medical Practitioner	None	1790036994	0	0	KU, VICTORIA F NP	7/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9902 HOWLAND DR	None	TEMPLE CITY	CA	91780	3234	00	06000	34.097626	-118.0526966	Los Angeles County
302822	Non-Physician Medical Practitioner	None	1083236046	0	0	KENDRICK, BRITTANY C CNM	3/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 SUTTER PL	None	DAVIS	CA	95616	6201	00	06000	38.56287659	-121.7715536	Yolo County
302864	Non-Physician Medical Practitioner	None	1174581532	0	0	KEHRLI, DIANE L	6/29/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
302951	Non-Physician Medical Practitioner	None	1184613432	0	0	KANDALLU, NALINI	1/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12418 RANCHERIA DR	None	OAKDALE	CA	95361	8855	00	06000	37.79334563	-120.7648846	Stanislaus County
302974	Non-Physician Medical Practitioner	None	1245892454	0	0	KAAIKALA, KEALA P PA-C	10/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	00	06000	34.54034956	-117.2645069	San Bernardino County
303008	Non-Physician Medical Practitioner	None	1851414247	0	0	KUMAR, IRINA	11/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3529 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3031	00	06000	33.95422949	-118.2050894	Los Angeles County
303043	Non-Physician Medical Practitioner	None	1548533847	0	0	KUMAR, VIJAYASREE PA	11/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303050	Non-Physician Medical Practitioner	None	1225166556	0	0	KULKA, CYRIL	2/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
303063	Non-Physician Medical Practitioner	None	1104215250	0	0	KOTHARI, BINNI	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	06000	36.163269	-115.1654465	Clark County
303131	Non-Physician Medical Practitioner	None	1902584733	0	0	KIM, JANET NP	8/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
303147	Non-Physician Medical Practitioner	None	1861104416	0	0	KRAWCZYK, JESSICA M NP	5/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	782 EAST HARDING WAY	None	STOCKTON	CA	95204	6101	00	06000	37.96910043	-121.284224	San Joaquin County
303151	Non-Physician Medical Practitioner	None	1811552805	0	0	KUO, JENNIFER NP	4/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
303251	Non-Physician Medical Practitioner	None	1831522010	0	0	KLEIN, SUSAN H NP	4/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1716 CALIBAN DR	None	ENCINITAS	CA	92024	3005	00	06000	33.05078589	-117.2509153	San Diego County
303267	Non-Physician Medical Practitioner	None	1427352491	0	0	KLEIN, MELISSA J NP	8/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4992 W HERNDON AVE	APT 103	FRESNO	CA	93722	8430	00	06000	36.83728593	-119.8819048	Fresno County
303275	Non-Physician Medical Practitioner	None	1356956460	0	0	KOZIOL, KALI A PA	12/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
303286	Non-Physician Medical Practitioner	None	1366281925	0	0	KIM, TYLER K PA-C	7/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303316	Non-Physician Medical Practitioner	None	1255073748	0	0	KONDAN, CHRISTIAN PA-C	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	00	06000	32.99706	-117.05544	San Diego County
303317	Non-Physician Medical Practitioner	None	1134702947	0	0	KAUR, VIRENDER NP	7/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3551 Q ST	None	BAKERSFIELD	CA	93301	1657	00	06000	35.392059	-119.010556	Kern County
303318	Non-Physician Medical Practitioner	None	1871985333	0	0	KNUDSEN, JON NP	4/26/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5014 W REESE CT	None	VISALIA	CA	93277	0623	00	06000	36.291924	-119.3461695	Tulare County
303364	Non-Physician Medical Practitioner	None	1811480312	0	0	KHA, JENNIFER PA	5/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
303386	Non-Physician Medical Practitioner	None	1568683944	0	0	KTSHIAN, GAYANE	4/24/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1636 N SINALOA AVENUE	None	PASADENA	CA	91104	1530	00	06000	34.17426108	-118.1157322	Los Angeles County
303396	Non-Physician Medical Practitioner	None	1790127298	0	0	KERDAR, JEILA M PA	10/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303426	Non-Physician Medical Practitioner	None	1164645966	0	0	KARUBE, MICHIKO	9/9/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5324	00	06000	34.06238259	-118.2030986	Los Angeles County
303428	Non-Physician Medical Practitioner	None	1831853324	0	0	KOJIMA, MICHAEL K NP	11/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
303431	Non-Physician Medical Practitioner	None	1083659833	0	0	KRALJ, HOLLY TANYA	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1665 ESPLANADE	None	CHICO	CA	95926	3312	00	06000	39.74388808	-121.8503372	Butte County
303459	Non-Physician Medical Practitioner	None	1740490267	0	0	KUMELACHEW, HIRUTH PA-C	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
303461	Non-Physician Medical Practitioner	None	1164048807	0	0	KRPAN, LINDELL K PA	10/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	00	06000	37.89281357	-122.0598728	Contra Costa County
303469	Non-Physician Medical Practitioner	None	1972711406	0	0	KESSLER, KEITH A	5/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18752 HAVEN LN	None	YORBA LINDA	CA	92886	2630	00	06000	33.89177122	-117.8067573	Orange County
303511	Non-Physician Medical Practitioner	None	1477066132	0	0	KANILIAR-RUIZ, BASAK J	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4341 CLARK AVENUE	None	LONG BEACH	CA	90808	1414	00	06000	33.8372635	-118.1338722	Los Angeles County
303537	Non-Physician Medical Practitioner	None	1528550928	0	0	KHANAL, RUBY NP	11/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4875 WILLOW RD	UNIT 202	PLEASANTON	CA	94588	4492	00	06000	37.69848497	-121.8981774	Alameda County
303540	Non-Physician Medical Practitioner	None	1558684043	0	0	KISHMAN, ADAM J	5/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3311 TIDERMAN DRIVE	None	LEMOORE	CA	93245	3563	00	06000	36.26631127	-119.8773637	Kings County
303576	Non-Physician Medical Practitioner	None	1235958679	0	0	KAVA, JONATHON PA	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4929 VAN NUYS BLVD	ATTN: EMERGENCY DEPT	SHERMAN OAKS	CA	91403	1702	00	06000	34.1602022	-118.4487313	Los Angeles County
303604	Non-Physician Medical Practitioner	None	1346435849	0	0	KAUFMAN, JENNIFER BROOKE	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6475 ALVARADO RD	SUITE 120	SAN DIEGO	CA	92120	5003	00	06000	32.77826653	-117.061265	San Diego County
303644	Non-Physician Medical Practitioner	None	1609463710	0	0	KASPER, CRAIG A NP	5/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	74785 HIGHWAY 111	SUITE 100	INDIAN WELLS	CA	92210	7129	00	06000	33.72131925	-116.360116	Riverside County
303663	Non-Physician Medical Practitioner	None	1104365766	0	0	KONG, AMY S	1/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3800 LOS AMIGOS STREET	None	GLENDALE	CA	91214	1611	00	06000	34.24310818	-118.2618483	Los Angeles County
303675	Non-Physician Medical Practitioner	None	1952019333	0	0	KAUR, NAVNEET PA-C	11/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
303725	Non-Physician Medical Practitioner	None	1396265807	0	0	KIM, JANE	1/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	905 E 2ND ST	APT 229	LOS ANGELES	CA	90012	4454	00	06000	34.04720226	-118.2348174	Los Angeles County
303752	Non-Physician Medical Practitioner	None	1508204058	0	0	KORTE, KAILEEN M NP	1/1/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
303759	Non-Physician Medical Practitioner	None	1902505423	0	0	KAUR, TANJIT NP	7/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 N MEDICAL CENTER DR	STE 205	CLOVIS	CA	93611	6886	00	06000	36.84186593	-119.6624867	Fresno County
303836	Non-Physician Medical Practitioner	None	1275803447	0	0	KOTITSCHKE, KAREN	1/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 S. BUENA VISTA STREE	SUITE #215 LAKESIDE COMM	BURBANK	CA	91505	4505	00	06000	34.15872557	-118.3283863	Los Angeles County
303840	Non-Physician Medical Practitioner	None	1598283228	0	0	KAUR, RAMANDEEP NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15697 W BOTELHO AVE	None	KERMAN	CA	93630	1378	00	06000	36.73425248	-120.072744	Fresno County
303937	Non-Physician Medical Practitioner	None	1114671229	0	0	KEY, DEBRA S NP	3/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	00	06000	33.95782448	-117.3904065	Riverside County
303943	Non-Physician Medical Practitioner	None	1982416277	0	0	KAUR, RAMANDEEP NP	2/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8191 TIMBERLAKE WAY	SUITE 400	SACRAMENTO	CA	95823	5418	00	06000	38.460222	-121.4131365	Sacramento County
304094	Non-Physician Medical Practitioner	None	1386897809	0	0	KLING, MARIA S	11/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	831 NW COUNCIL DR	SUITE 101	GRESHAM	OR	97030	3721	00	06000	45.5102698	-122.4412691	Multnomah County
304140	Non-Physician Medical Practitioner	None	1063581668	0	0	KLUGER, SHARON PA-C	3/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1661 SOQUEL DR STE E	None	SANTA CRUZ	CA	95065	1709	00	06000	36.98906386	-121.981629	Santa Cruz County
304142	Non-Physician Medical Practitioner	None	1356923205	0	0	KNIGHT, IRENE S NP	2/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1120 WEST AVENUE M-4	None	PALMDALE	CA	93551	1432	00	06000	34.6457071	-118.155831	Los Angeles County
304154	Non-Physician Medical Practitioner	None	1003480005	0	0	KLEIN, DANIEL PA	10/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
304183	Non-Physician Medical Practitioner	None	1790061208	0	0	KEENE, NELAE J PA-C	2/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2510 DOUGLAS BLVD	#300	ROSEVILLE	CA	95661	3300	00	06000	38.74412472	-121.2400335	Placer County
304192	Non-Physician Medical Practitioner	None	1306438395	0	0	KOHLER, JESSICA PA-C	9/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	00	06000	34.95203385	-120.4131707	Santa Barbara County
304205	Non-Physician Medical Practitioner	None	1194199083	0	0	KHADKA, ANITA NP	9/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	00	06000	36.97734512	-122.0204895	Santa Cruz County
304280	Non-Physician Medical Practitioner	None	1407942097	0	0	KELLEY, ROSEMARIE	3/7/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	DOCTOR'S MEDICAL CENTER	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
304293	Non-Physician Medical Practitioner	None	1811543143	0	0	KIM, MIN JOO PA	12/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
304325	Non-Physician Medical Practitioner	None	1700529344	0	0	KAUR, RAMANPREET PA-C	10/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	00	06000	36.359649	-119.331567	Tulare County
304354	Non-Physician Medical Practitioner	None	1346482783	0	0	KOCHAI, MANIZHA AISHA	2/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	HC133 MC5239	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
304422	Non-Physician Medical Practitioner	None	1275072423	0	0	KHALEGHI, MANI	10/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6654 HEMINGWAY DR	None	SAN DIEGO	CA	92120	1616	00	06000	32.81492043	-117.0566523	San Diego County
304424	Non-Physician Medical Practitioner	None	1841607801	0	0	KAWEAH DELTA HEALTH CARE DISTRICT	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 MONTE VISTA DR	None	DINUBA	CA	93618	0000	00	06000	36.544158	-119.404117	Tulare County
304425	Non-Physician Medical Practitioner	None	1851060453	0	0	KNERR, GRACE A PA-C	11/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 NORTH TUSTIN AVE	None	SANTA ANA	CA	92705	3502	00	06000	33.75363187	-117.8341886	Orange County
304463	Non-Physician Medical Practitioner	None	1508240375	0	0	KWONG, KATHERINE W NP	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	00	06000	37.35228637	-121.9754073	Santa Clara County
304515	Non-Physician Medical Practitioner	None	1740309608	0	0	KLYDE, M B	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2391 N RIVER TRAIL RD	None	ORANGE	CA	92865	2036	00	06000	33.82807191	-117.8639196	Orange County
304520	Non-Physician Medical Practitioner	None	1982989166	0	0	KILLEN, JENNIFER L PA-C	9/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
304522	Non-Physician Medical Practitioner	None	1508526823	0	0	KORNOWSKI, REBECCA J PA-C	3/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1085 VALENCIA ST	None	SAN FRANCISCO	CA	94110	2405	00	06000	37.75563342	-122.4209694	San Francisco County
304531	Non-Physician Medical Practitioner	None	1093225658	0	0	KIM, MI SUN N NP	6/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	00	06000	33.81384593	-118.3465974	Los Angeles County
304565	Non-Physician Medical Practitioner	None	1881649341	0	0	KOSANOVICH, FELICIA HOPE	2/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	0000	00	06000	37.36893518	-122.0779448	Santa Clara County
304593	Non-Physician Medical Practitioner	None	1235817826	0	0	KITZEROW, EMILY NP	10/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	00	06000	37.78594176	-122.421322	San Francisco County
304608	Non-Physician Medical Practitioner	None	1336651967	0	0	KLUG, DANIEL G NP	5/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1485 RIVER PARK DR	STE 200	SACRAMENTO	CA	95815	4501	00	06000	38.599614	-121.438728	Sacramento County
304617	Non-Physician Medical Practitioner	None	1669182812	0	0	KROEKER, JEREMIAH J NP	2/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15434 W SAGE ST	None	VICTORVILLE	CA	92395	3965	00	06000	34.51210263	-117.3272335	San Bernardino County
304620	Non-Physician Medical Practitioner	None	1144840786	0	0	KEELER, NICHOLAS F NP	6/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 TRANCAS ST	SUITE 1	NAPA	CA	94558	2906	00	06000	38.32349768	-122.2963137	Napa County
304652	Non-Physician Medical Practitioner	None	1114560182	0	0	KLUCZINSKE, MICHELLE NP	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
304702	Non-Physician Medical Practitioner	None	1588964456	0	0	KHAN, KHADEER CNP	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	00	06000	33.85835623	-118.2987754	Los Angeles County
304767	Non-Physician Medical Practitioner	None	1013646306	0	0	KILEKAS, MIA'ARIARNA PA	12/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	00	06000	33.1857	-117.290538	San Diego County
304773	Non-Physician Medical Practitioner	None	1376180448	0	0	KAUR, JASWINDER NP	6/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	560 COHASSET RD	None	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
304804	Non-Physician Medical Practitioner	None	1841346087	0	0	KAMPERMAN, KATHRYN JUNE	3/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	875 BLAKE WILBUR DR	None	PALO ALTO	CA	94304	2205	00	06000	37.43562782	-122.1766097	Santa Clara County
304812	Non-Physician Medical Practitioner	None	1437626181	0	0	KILMURRAY, KEVIN J PA	3/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	949 CALHOUN PL	STE D	HEMET	CA	92543	4403	00	06000	33.7502744	-116.9618423	Riverside County
304841	Non-Physician Medical Practitioner	None	1023316619	0	0	KLANN, VIVIAN Y NP	7/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	708 E MAGNOLIA BLVD	APT B	BURBANK	CA	91501	1127	00	06000	34.18917473	-118.3052131	Los Angeles County
304870	Non-Physician Medical Practitioner	None	1184719460	0	0	K, RIAR J	5/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2220 SERENA AVE	None	CLOVIS	CA	93720	2518	00	06000	36.86576555	-119.6737785	Fresno County
304940	Non-Physician Medical Practitioner	None	1770833352	0	0	KUBIN, PAUL B PA	8/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6105 RICH HILL DR	None	ORANGEVALE	CA	95662	4762	00	06000	38.676375	-121.2137595	Sacramento County
304951	Non-Physician Medical Practitioner	None	1265826150	0	0	KINLAW, JAIMIE C	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	584 SWALLOW DR	None	MANTECA	CA	95336	3275	00	06000	37.81235895	-121.208955	San Joaquin County
304952	Non-Physician Medical Practitioner	None	1396122156	0	0	KIM, FLORENCE H NP	9/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1842 CHANTILLY LANE	None	FULLERTON	CA	92833	1290	00	06000	33.90026315	-117.9598584	Orange County
304973	Non-Physician Medical Practitioner	None	1760642797	0	0	KEPLINGER, SWEET-CHARITY M	6/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 VINTAGE CIRCLE	APT 3137	PLEASANTON	CA	94566	6258	00	06000	37.66800166	-121.8563124	Alameda County
304987	Non-Physician Medical Practitioner	None	1083151674	0	0	KLEIN, STEPHANIE L	4/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	W326N4251 REGATTA CT	None	NASHOTAH	WI	53058	9526	00	06000	43.09577613	-88.39661156	Waukesha County
305007	Non-Physician Medical Practitioner	None	1487906152	0	0	KUNTZ, NANCY V	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11 GARRISON LOOP	None	LADERA RANCH	CA	92694	0604	00	06000	33.56091284	-117.6481882	Orange County
305029	Non-Physician Medical Practitioner	None	1316049620	0	0	KYNARD, ANDREA	2/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 N PRAIRIE AVE	SUITE 230	INGLEWOOD	CA	90301	4507	00	06000	33.965712	-118.3439965	Los Angeles County
305038	Non-Physician Medical Practitioner	None	1245002641	0	0	KAUR, RUBEL	11/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1212 S MAIN ST	None	SALINAS	CA	93901	2260	00	06000	36.65759539	-121.6594973	Monterey County
305103	Non-Physician Medical Practitioner	None	1871291856	0	0	KING, CRISTINA PA	11/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
305107	Non-Physician Medical Practitioner	None	1609415140	0	0	KNESEK, SHANG NP	12/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	00	06000	36.83752653	-119.7776433	Fresno County
305159	Non-Physician Medical Practitioner	None	1346834900	0	0	KAHN, SAVANNAH A NP	5/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
305195	Non-Physician Medical Practitioner	None	1700819828	0	0	KEYES, KIMBERLY	10/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
305208	Non-Physician Medical Practitioner	None	1386398022	0	0	KAUR, RAJPREET PA-C	3/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	825 DELBON AVE	None	TURLOCK	CA	95382	2016	00	06000	37.51052943	-120.8386573	Stanislaus County
305302	Non-Physician Medical Practitioner	None	1174638548	0	0	KIRKPATRICK, HALEY D	8/25/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	600 MARY ST	None	EVANSVILLE	IN	47710	1674	00	06000	37.98309188	-87.57072541	Vanderburgh County
305303	Non-Physician Medical Practitioner	None	1972157352	0	0	KIRKWOOD, SUYOUNG CNP	9/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2031 MCDANIEL ST	SUITE 140	NORTH LAS VEGAS	NV	89030	6303	00	06000	36.19740597	-115.1207123	Clark County
305374	Non-Physician Medical Practitioner	None	1013579952	0	0	KOCHER, ALEXANDRA E NP	7/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	00	06000	33.67620851	-117.7948348	Orange County
305377	Non-Physician Medical Practitioner	None	1710172135	0	0	KODYSH, PATRICIA G NP	2/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5307 OLVERA AVE	None	SAN DIEGO	CA	92114	5313	00	06000	32.69811647	-117.0806097	San Diego County
305379	Non-Physician Medical Practitioner	None	1528309226	0	0	KAUR, MANPREET	10/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
305448	Non-Physician Medical Practitioner	None	1215456231	0	0	KADAKIA, RAJVI D PA-C	8/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305455	Non-Physician Medical Practitioner	None	1407181035	0	0	KORKUCH, BRIGITTE	6/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6645 ALVARADO RD	STE 415	SAN DIEGO	CA	92120	5208	00	06000	32.7772577	-117.0575222	San Diego County
305461	Non-Physician Medical Practitioner	None	1346268430	0	0	KERR, LINDA S	3/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1868 PACIFIC AVE	None	LONG BEACH	CA	90806	6113	00	06000	33.791391	-118.193652	Los Angeles County
305468	Non-Physician Medical Practitioner	None	1457487266	0	0	KLEIN, MAUREEN HARDEN	1/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	12500 W 58TH AVE	SUITE 233	ARVADA	CO	80002	1103	00	06000	39.80174469	-105.1394461	Jefferson County
305481	Non-Physician Medical Practitioner	None	1548923659	0	0	KOENIG, LEAH M NP	9/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1595 SOQUEL DR	STE 140	SANTA CRUZ	CA	95065	1717	00	06000	36.98879599	-121.9826354	Santa Cruz County
305482	Non-Physician Medical Practitioner	None	1730891359	0	0	KUBES, ARIELLE N PA-C	1/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4001 J STREET	None	SACRAMENTO	CA	95819	3626	00	06000	38.570526	-121.4521695	Sacramento County
305499	Non-Physician Medical Practitioner	None	1184379596	0	0	KANG, ELISHA PA-C	11/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 N. TUSTIN AVE	UNIT # 216	SANTA ANA	CA	92705	3528	00	06000	33.754167	-117.834191	Orange County
305508	Non-Physician Medical Practitioner	None	1306324850	0	0	KANG, JEOUNG S NP	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W LA VETA AVE	STE 200	ORANGE	CA	92868	4301	00	06000	33.78028244	-117.8635552	Orange County
305510	Non-Physician Medical Practitioner	None	1225741838	0	0	KIRPAL, SABY NP	12/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	00	06000	37.5531875	-121.9805141	Alameda County
305524	Non-Physician Medical Practitioner	None	1538227681	0	0	KHOURY, USAMA S	11/6/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 E VALENCIA ST	None	RIALTO	CA	92376	4334	00	06000	34.11541809	-117.368026	San Bernardino County
305548	Non-Physician Medical Practitioner	None	1033598289	0	0	KING, JOSEPH J	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1203 BIRCH AVE	None	SAN MATEO	CA	94402	1975	00	06000	37.56285065	-122.3077454	San Mateo County
305554	Non-Physician Medical Practitioner	None	1801251087	0	0	KULESZA, JENNIFER L PA	5/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	00	06000	33.8375955	-118.358748	Los Angeles County
305583	Non-Physician Medical Practitioner	None	1073825097	0	0	KAWASHIMA, CHIKA	3/21/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 E VALENCIA MESA DR	SUITE 310	FULLERTON	CA	92835	3813	00	06000	33.89343304	-117.9279349	Orange County
305588	Non-Physician Medical Practitioner	None	1164053989	0	0	KC, DANIELLE M NP	8/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	00	06000	40.78052829	-124.1363953	Humboldt County
305604	Non-Physician Medical Practitioner	None	1659826733	0	0	KEATING, ALISHA J NP	7/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
305623	Non-Physician Medical Practitioner	None	1831651736	0	0	KRAFT, ALLISON M PA	11/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
305677	Non-Physician Medical Practitioner	None	1073274601	0	0	KRIVASHEI, CHASE D PA-C	1/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	00	06000	33.7016655	-117.955521	Orange County
305691	Non-Physician Medical Practitioner	None	1841513900	0	0	KATSUYAMA, JENNIFER D	2/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3110 MONTEVIDEO DR	None	SAN RAMON	CA	94583	2630	00	06000	37.75276963	-121.9495876	Contra Costa County
305711	Non-Physician Medical Practitioner	None	1871375444	0	0	KAJIWARA, MEGAN	4/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	00	06000	35.63564004	-118.407037	Kern County
305730	Non-Physician Medical Practitioner	None	1902202807	0	0	KUTTLER, JAMIE M PA-C	7/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	00	06000	40.78355148	-124.1420294	Humboldt County
305766	Non-Physician Medical Practitioner	None	1548351026	0	0	KRISA, SHANNON DIANE	7/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1160 SUNSET BLVD	None	ROCKLIN	CA	95765	3710	00	06000	38.8125	-121.2848698	Placer County
305838	Non-Physician Medical Practitioner	None	1609938117	0	0	KRUPP, PETRA	3/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10470 OLD PLACERVILLE RD	SUITE 100	SACRAMENTO	CA	95827	2539	00	06000	38.572371	-121.305537	Sacramento County
305848	Non-Physician Medical Practitioner	None	1043323611	0	0	KASS, DEBORAH	11/16/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1150 STATE HIGHWAY 248	SUITE 100	BRANSON	MO	65616	3758	00	06000	36.66349443	-93.23631137	Taney County
305863	Non-Physician Medical Practitioner	None	1992287437	0	0	KAUR, NAVNEET NP	6/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	809 SYLVAN AVE	500A	MODESTO	CA	95350	1500	00	06000	37.68900616	-120.9836976	Stanislaus County
305864	Non-Physician Medical Practitioner	None	1710251434	0	0	KANSARA, LINA N PA	2/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	00	06000	37.88758326	-122.1181419	Contra Costa County
305890	Non-Physician Medical Practitioner	None	1477951564	0	0	KOMP, AMELIA T NP	3/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1640 OAK AVE	None	MENLO PARK	CA	94025	5838	00	06000	37.43633025	-122.1871171	San Mateo County
305924	Non-Physician Medical Practitioner	None	1336499342	0	0	KOKOZIAN, CECILE K NP	10/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
305960	Non-Physician Medical Practitioner	None	1790774057	0	0	KELLY, SHARON K NP	9/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	00	06000	34.27684353	-118.4684024	Los Angeles County
305975	Non-Physician Medical Practitioner	None	1285973859	0	0	KIM, BILLY Y	3/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7018 OREGON ST	None	BUENA PARK	CA	90621	3624	00	06000	33.86100539	-117.991713	Orange County
305977	Non-Physician Medical Practitioner	None	1760116123	0	0	KASMAJIAN, MARY PA	11/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
305978	Non-Physician Medical Practitioner	None	1972022465	0	0	KEENAN, AMBER R NP	2/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 COHASSET RD	SUITE 370	CHICO	CA	95926	2241	00	06000	39.75090044	-121.8522609	Butte County
306036	Non-Physician Medical Practitioner	None	1588615181	0	0	KUCH, ONICA A	11/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 CALIFORNIA ST	B555	SAN FRANCISCO	CA	94118	1618	00	06000	37.78614008	-122.4556866	San Francisco County
306067	Non-Physician Medical Practitioner	None	1063850212	0	0	KAMIMURA, NANCY C NP	4/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
306078	Non-Physician Medical Practitioner	None	1548949704	0	0	KIM, EUNICE PA	2/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
306132	Non-Physician Medical Practitioner	None	1003437047	0	0	KAHURA, OLIVE NP	4/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3710 E CESAR CHAVEZ AVE	None	LOS ANGELES	CA	90063	2219	00	06000	34.04048853	-118.1854845	Los Angeles County
306137	Non-Physician Medical Practitioner	None	1720127392	0	0	KAVIANIAN, NANCY	11/20/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	69175 RAMON RD BLDG A	None	CATHEDRAL CITY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
306153	Non-Physician Medical Practitioner	None	1477199412	0	0	KELLER, BRIAUNA D NP	3/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70554251	-121.873005	Alameda County
306193	Non-Physician Medical Practitioner	None	1619756681	0	0	KHREMIAN, JOYCE S NP	7/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
306224	Non-Physician Medical Practitioner	None	1851601819	0	0	KIM, JENNIFER STOWE	11/29/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4311 3RD AVE	None	SAN DIEGO	CA	92103	1407	00	06000	32.758578	-117.1637685	San Diego County
306227	Non-Physician Medical Practitioner	None	1184317794	0	0	KAUR, NAVNEET	7/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7130 MILLBROOK AVE	SUITE 112	FRESNO	CA	93720	3347	00	06000	36.83832032	-119.7632391	Fresno County
306229	Non-Physician Medical Practitioner	None	1063567295	0	0	KATHLEEN, ERICKSON	3/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
306245	Non-Physician Medical Practitioner	None	1477045599	0	0	KUNOWSKI, LARA NP	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	00	06000	36.83951763	-119.7815709	Fresno County
306268	Non-Physician Medical Practitioner	None	1942484340	0	0	KHO, FRANCISCA	10/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	920 2ND AVE S	SUITE 400	MINNEAPOLIS	MN	55402	3318	00	06000	44.97310912	-93.27171852	Hennepin County
306274	Non-Physician Medical Practitioner	None	1508066309	0	0	KELLER, LISA A NP	7/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4249 E CHAPAROSA WAY	None	CAVE CREEK	AZ	85331	3819	00	06000	33.768621	-111.9906315	Maricopa County
306286	Non-Physician Medical Practitioner	None	1881767895	0	0	KO, JOUNGHWA	2/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 S HARBOR BLVD	250	SANTA ANA	CA	92704	6824	00	06000	33.70467057	-117.919705	Orange County
306299	Non-Physician Medical Practitioner	None	1972061729	0	0	KORSZYK, PATRICIA M PA-C	5/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
306310	Non-Physician Medical Practitioner	None	1003235748	0	0	KEEGAN, JACQUELYN NP	10/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1430 NORTH MARTEL AVENUE	None	LOS ANGELES	CA	90046	4562	00	06000	34.09683158	-118.3506489	Los Angeles County
306319	Non-Physician Medical Practitioner	None	1164997698	0	0	KIM, JENIFER H	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3970 INGRAHAM ST	105	LOS ANGELES	CA	90005	3255	00	06000	34.06065647	-118.313658	Los Angeles County
306379	Non-Physician Medical Practitioner	None	1174670087	0	0	KHORRAM, SARAH	10/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34800 BOB WILSON DR	NMCSD	SAN DIEGO	CA	92134	1098	00	06000	32.724567	-117.145467	San Diego County
306382	Non-Physician Medical Practitioner	None	1083126460	0	0	KU, ELISSA NP	11/29/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2150 N WATERMAN AVE	STE 202	SAN BERNARDINO	CA	92404	4811	00	06000	34.134705	-117.2787865	San Bernardino County
306388	Non-Physician Medical Practitioner	None	1508330960	0	0	KAUR, SIMRANJIT NP	2/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	00	06000	36.80840238	-119.8594473	Fresno County
306439	Non-Physician Medical Practitioner	None	1114417854	0	0	KUKU, OLUKEMI A NP	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2740 GRANT ST	None	CONCORD	CA	94520	2265	00	06000	37.98580944	-122.0385574	Contra Costa County
306461	Non-Physician Medical Practitioner	None	1013311448	0	0	KOREAN HEALTH, EDUCATION, INFORMATION AND RESEARCH	3/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3255 WILSHIRE BLVD	SUITE 120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
306479	Non-Physician Medical Practitioner	None	1902564396	0	0	KOJIMA, SHIHO NP	7/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
306496	Non-Physician Medical Practitioner	None	1811621006	0	0	KEVAKIAN, ANISE PA	10/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
306533	Non-Physician Medical Practitioner	None	1255992293	0	0	KAO, JASON PA	1/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
306561	Non-Physician Medical Practitioner	None	1982939302	0	0	KOON, MARSHALL R	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5810 OLD RANCH RD	None	RIVERSIDE	CA	92504	1346	00	06000	33.96714503	-117.4094155	Riverside County
306601	Non-Physician Medical Practitioner	None	1447798111	0	0	KLOPOVIC, NICOLE PA	6/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	00	06000	38.570805	-121.4696385	Sacramento County
306658	Non-Physician Medical Practitioner	None	1730438359	0	0	KONGBANDALSUKE, NONGNUCH	11/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16323 CLARK AVENUE #C	None	BELLFLOWER	CA	90706	0000	00	06000	33.885693	-118.1339975	Los Angeles County
306676	Non-Physician Medical Practitioner	None	1487813697	0	0	KONG, CHRISTA	6/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	365 HAWTHORNE AVE	SUITE 201	OAKLAND	CA	94609	3107	00	06000	37.82079728	-122.2633226	Alameda County
306723	Non-Physician Medical Practitioner	None	1245751775	0	0	KIM, TAEHO PA	5/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
306740	Non-Physician Medical Practitioner	None	1396813481	0	0	KIMBLE, MARIA GUADALUPE	6/17/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVE	#310	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
306743	Non-Physician Medical Practitioner	None	1720594179	0	0	KYLE, MELISSA NP	8/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18200 YORBA LINDA BLVD	SUITE 250	YORBA LINDA	CA	92886	4044	00	06000	33.88842824	-117.8154698	Orange County
306750	Non-Physician Medical Practitioner	None	1841509171	0	0	KING, KEVIN M	11/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6400 CRESCENT PARK E	APT 304	PLAYA VISTA	CA	90094	2356	00	06000	33.9695694	-118.4269601	Los Angeles County
306751	Non-Physician Medical Practitioner	None	1376213793	0	0	KAUR, MANDEEP NP	1/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	340 4TH AVE	STE 11	CHULA VISTA	CA	91910	3813	00	06000	32.63831293	-117.0833536	San Diego County
306756	Non-Physician Medical Practitioner	None	1578093050	0	0	KANABOLO, BARIASA C NP	1/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	00	06000	34.13470788	-117.262434	San Bernardino County
306758	Non-Physician Medical Practitioner	None	1881811685	0	0	KELLEY, JUDY A NP	10/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
306774	Non-Physician Medical Practitioner	None	1427690072	0	0	KAUR, KAMALJIT NP	1/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
306779	Non-Physician Medical Practitioner	None	1023869021	0	0	KRASNER, ROBIN L	6/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
306821	Non-Physician Medical Practitioner	None	1134802283	0	0	KLEMENCIC, TAHNEE C NP	9/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	00	06000	32.80027449	-117.153846	San Diego County
306830	Non-Physician Medical Practitioner	None	1972908358	0	0	KEANE, CYNTHIA T NP	5/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	935 LONGRIDGE RD	None	OAKLAND	CA	94610	2444	00	06000	37.80977886	-122.2332239	Alameda County
306831	Non-Physician Medical Practitioner	None	1699502815	0	0	KENDALL, NOELLE M PA-C	12/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26024 ACERO	None	MISSION VIEJO	CA	92691	2768	00	06000	33.61784172	-117.6769661	Orange County
306848	Non-Physician Medical Practitioner	None	1770934655	0	0	KYLE, DIANNE NP	10/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 JASMINE ST	J-1	VICTORVILLE	CA	92395	5794	00	06000	34.47489156	-117.2961422	San Bernardino County
306858	Non-Physician Medical Practitioner	None	1952581738	0	0	KIM, JANICE C NP	12/11/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
306860	Non-Physician Medical Practitioner	None	1649523929	0	0	KELIIHOLOKAI, ELIZABETH E PA	3/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	680 LANGSDORF DR	SUITE 103	FULLERTON	CA	92831	3702	00	06000	33.87673088	-117.8824577	Orange County
306867	Non-Physician Medical Practitioner	None	1164146494	0	0	KODAMA, KELLIE PA-C	3/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 E COMMONWEALTH AVE	STE 100	FULLERTON	CA	92832	1905	00	06000	33.87034048	-117.922437	Orange County
306881	Non-Physician Medical Practitioner	None	1740756493	0	0	KAOVORAKARN, EVELYN PA-C	11/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	00	06000	38.599524	-121.437738	Sacramento County
306885	Non-Physician Medical Practitioner	None	1497059406	0	0	KHASHAN, AMMAR PA-C	12/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7590 MIRAMAR RD	STE C	SAN DIEGO	CA	92126	4232	00	06000	32.88443824	-117.1520684	San Diego County
306896	Non-Physician Medical Practitioner	None	1326117920	0	0	KROCHMAL, RACHEL E	6/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10110 BOULDER KNOLLS	None	ESCONDIDO	CA	92082	0000	00	06000	33.22421216	-117.1127639	San Diego County
306945	Non-Physician Medical Practitioner	None	1285952531	0	0	KANDAN, SANGEETHA PA	5/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
306950	Non-Physician Medical Practitioner	None	1578794129	0	0	KANG, KRIS S NP	5/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2735 WALLACE ST	None	BERKELEY	CA	94702	2229	00	06000	37.85641209	-122.2868626	Alameda County
306978	Non-Physician Medical Practitioner	None	1538694914	0	0	KANG, JUNGMIN	10/26/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	538 MARBLE ARCH AVE	None	SAN JOSE	CA	95136	3742	00	06000	37.28196452	-121.858497	Santa Clara County
307123	Non-Physician Medical Practitioner	None	1659644748	0	0	KING, ELISABETH M NP	2/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
307146	Non-Physician Medical Practitioner	None	1205343720	0	0	KAUR, ANOOPINDER NP	12/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8151 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2300	00	06000	38.461554	-121.4167635	Sacramento County
307166	Non-Physician Medical Practitioner	None	1124500087	0	0	KIM, ERICA E NP	4/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11340 MOUNTAIN VIEW AVEN	SUITE B1	LOMA LINDA	CA	92354	3884	00	06000	34.04699925	-117.2436953	San Bernardino County
307167	Non-Physician Medical Practitioner	None	1639842131	0	0	KANSCHAT, APRIL W PA-C	3/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	00	06000	36.94519024	-120.0420086	Madera County
307174	Non-Physician Medical Practitioner	None	1649844929	0	0	KEPLEY, ELIZABETH N PA-C	6/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	825 DELBON AVE	None	TURLOCK	CA	95382	2016	00	06000	37.51052943	-120.8386573	Stanislaus County
307182	Non-Physician Medical Practitioner	None	1639313745	0	0	KRISHNASASTRY, TARA PA-C	2/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	00	06000	33.6087201	-117.7076948	Orange County
307190	Non-Physician Medical Practitioner	None	1740485903	0	0	KORNBLUTH, PENELOPE GRACE	7/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 W 3RD ST	SUITE 800E	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
307202	Non-Physician Medical Practitioner	None	1699956359	0	0	KORZEWSKI, MARGARET NP	9/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3435 KLEVNER WAY	None	RANCHO CORDOVA	CA	95670	6932	00	06000	38.578302	-121.273011	Sacramento County
307230	Non-Physician Medical Practitioner	None	1205171261	0	0	KOKO, GEORGIANA A NP	10/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1565 BULLDOG LANE	APT 104	FRESNO	CA	93710	7328	00	06000	36.81219768	-119.7596229	Fresno County
307259	Non-Physician Medical Practitioner	None	1528718327	0	0	KENNEALLY, SOFIA PA-C	7/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	00	06000	37.79071145	-122.4308506	San Francisco County
307286	Non-Physician Medical Practitioner	None	1295991149	0	0	KRUGOMOVA, IRINA	11/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR A 301	None	STANFORD	CA	94305	0000	00	06000	37.43304542	-122.1759654	Santa Clara County
307294	Non-Physician Medical Practitioner	None	1508243338	0	0	KIRUPANANTHAN, ANUJEETHA NP	9/5/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
307308	Non-Physician Medical Practitioner	None	1275243255	0	0	KAUR, INDERJEET NP	2/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 MARKET ST	None	SAN FRANCISCO	CA	94102	5910	00	06000	37.77393281	-122.4208671	San Francisco County
307314	Non-Physician Medical Practitioner	None	1114275104	0	0	KO, KRISTEN B	4/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2748 MANZA	None	TUSTIN	CA	92782	9155	00	06000	33.727995	-117.793026	Orange County
307315	Non-Physician Medical Practitioner	None	1326419441	0	0	KOLTE, JESSICA L	8/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6380 VIA AMIGOS	None	SAN JOSE	CA	95120	2818	00	06000	37.22466506	-121.868326	Santa Clara County
307333	Non-Physician Medical Practitioner	None	1053016840	0	0	KAUR, SANDEEP	10/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
307336	Non-Physician Medical Practitioner	None	1467636159	0	0	KNIGHT, SUMMER CNM	9/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
307367	Non-Physician Medical Practitioner	None	1053183525	0	0	KEUM, SARAH NP	12/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 4TH AVENUE	SUITE 311	CHULA VISTA	CA	91910	4429	00	06000	32.63513513	-117.0820663	San Diego County
307443	Non-Physician Medical Practitioner	None	1558716704	0	0	KILIAN, KAITLIN E NP	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1030 LOMA AVENUE	UNIT 112	LONG BEACH	CA	90804	8883	00	06000	33.779673	-118.1501905	Los Angeles County
307460	Non-Physician Medical Practitioner	None	1194379149	0	0	KAPITZ, ADAM J PA-C	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	180 S LAKE AVE	SUITE 615	PASADENA	CA	91101	4763	00	06000	34.14274552	-118.1322395	Los Angeles County
307515	Non-Physician Medical Practitioner	None	1962556779	0	0	KEE, WILSON	7/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	87 ENCINA AVE	2ND FLOOR	PALO ALTO	CA	94301	2322	00	06000	37.43951747	-122.1594268	Santa Clara County
307524	Non-Physician Medical Practitioner	None	1952912131	0	0	KIER, NORMAN NP	7/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7600 HOSPITAL DR	STE G	SACRAMENTO	CA	95823	5406	00	06000	38.463876	-121.414698	Sacramento County
307567	Non-Physician Medical Practitioner	None	1093105660	0	0	KONADU, AFUA	12/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
307600	Non-Physician Medical Practitioner	None	1386814663	0	0	KOSTANTAS, HELENA MIRIAM	4/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14311 RAMONA BLVD	14311 RAMONA BLVD	BALDWIN PARK	CA	91706	3242	00	06000	34.08641009	-117.9620353	Los Angeles County
307605	Non-Physician Medical Practitioner	None	1972551497	0	0	KNOTTS, GWENDOLYN K NP	2/18/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3029 TIFFANY LANE	None	COLTON	CA	92324	9215	00	06000	34.03208517	-117.2764874	San Bernardino County
307612	Non-Physician Medical Practitioner	None	1033511266	0	0	KAUR, GURCHARANJIT NP	2/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5287 FINKAS LANE	None	FAIRFIELD	CA	94533	1556	00	06000	38.3021258	-121.973993	Solano County
307636	Non-Physician Medical Practitioner	None	1841580289	0	0	KESSEY, KARIN M	6/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	953 WELLESLEY AVE	None	LOS ANGELES	CA	90049	5849	00	06000	34.04510917	-118.4732904	Los Angeles County
307641	Non-Physician Medical Practitioner	None	1801243241	0	0	KINGSTROM, SARAH K	6/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2933 PIGEON POINT RD	None	EUREKA	CA	95503	9733	00	06000	40.77841576	-124.1064164	Humboldt County
307737	Non-Physician Medical Practitioner	None	1134851892	0	0	KURCHIN, MARIANA	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8120 TIMBERLAKE WAY	SUITE 212	SACRAMENTO	CA	95823	5412	00	06000	38.461023	-121.41414	Sacramento County
307780	Non-Physician Medical Practitioner	None	1215234737	0	0	KHAN, MUHAMMAD KHURSHID	3/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28570 BARN ROCK DR	None	HAYWARD	CA	94542	2230	00	06000	37.65751671	-122.022743	Alameda County
307786	Non-Physician Medical Practitioner	None	1275616393	0	0	KWONG, KRISTIN	5/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23600 TELO AVE	SUITE 150	TORRANCE	CA	90505	4035	00	06000	33.81215054	-118.3384029	Los Angeles County
307853	Non-Physician Medical Practitioner	None	1922578426	0	0	KAUR, NAVDEEP NP	3/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3551 Q ST	STE 100	BAKERSFIELD	CA	93301	1658	00	06000	35.392059	-119.010556	Kern County
307887	Non-Physician Medical Practitioner	None	1558862458	0	0	KIRK, JENNIFER E NP	4/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3828 SCHAUFELE AVE	STE 340	LONG BEACH	CA	90808	1793	00	06000	33.8283	-118.1479725	Los Angeles County
307892	Non-Physician Medical Practitioner	None	1184754962	0	0	KEEFE, RYAN J PA-C	7/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
307916	Non-Physician Medical Practitioner	None	1154340099	0	0	KENDALL, CAROL A	2/15/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	829 CHIEF EDDIE HOFFMAN	None	BETHEL	AK	99559	0000	00	06000	60.79285572	-161.7502431	Bethel Census Area
307960	Non-Physician Medical Practitioner	None	1477178184	0	0	KELLY, MORGAN B PA-C	4/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	00	06000	36.83939464	-119.6661479	Fresno County
307988	Non-Physician Medical Practitioner	None	1861676777	0	0	KEMP, DONALD J	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	951 JANET LANE	None	LAFAYETTE	CA	94549	4718	00	06000	37.89185252	-122.1010367	Contra Costa County
307989	Non-Physician Medical Practitioner	None	1639368103	0	0	KHOUKAZ, TALINE NP	7/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12212 HARTSOOK STREET	None	VALLEY VILLAGE	CA	91607	3055	00	06000	34.16395075	-118.3990888	Los Angeles County
307992	Non-Physician Medical Practitioner	None	1871757211	0	0	KNECHEL, NANCY A	6/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	221 HAMMOND DR	None	AUBURN	CA	95603	3207	00	06000	38.92580391	-121.0487799	Placer County
308029	Non-Physician Medical Practitioner	None	1538869862	0	0	KING, SYDNEY C PA-C	4/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25405 HANCOCK AVE.	STE. 108	MURRIETA	CA	92563	5978	00	06000	33.5580833	-117.1850127	Riverside County
308056	Non-Physician Medical Practitioner	None	1609535244	0	0	KASHANI, ALEJANDRO PA-C	1/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
308059	Non-Physician Medical Practitioner	None	1740615558	0	0	KANE, MARK B	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9 LA LOMA COURT	None	SAN RAFAEL	CA	94901	5147	00	06000	37.96203433	-122.5235696	Marin County
308100	Non-Physician Medical Practitioner	None	1518477348	0	0	KUNZ, DAVID A	1/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5406 NAVAJO COURT	None	ANTIOCH	CA	94531	8159	00	06000	37.95478452	-121.773672	Contra Costa County
308156	Non-Physician Medical Practitioner	None	1124556832	0	0	KAUFFMAN, CHELSEA PA	12/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
308175	Non-Physician Medical Practitioner	None	1992173124	0	0	KRASOVIC, ERYNN E PA	12/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2680 MAGELLAN LANE	None	VISTA	CA	92081	8711	00	06000	33.16246284	-117.237812	San Diego County
308179	Non-Physician Medical Practitioner	None	1437594678	0	0	KLEE, STEPHANIE J NP	12/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	188 EL GRANDA BLVD	None	HALF MOON BAY	CA	94019	4851	00	06000	37.50492282	-122.463789	San Mateo County
308209	Non-Physician Medical Practitioner	None	1366874703	0	0	KOVALL, JESSICA	12/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
308214	Non-Physician Medical Practitioner	None	1417378597	0	0	KEDREN COMMUNITY HEALTH CENTER, INC.	3/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4211 AVALON BLVD	BUILDING A	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
308225	Non-Physician Medical Practitioner	None	1174963177	0	0	KAUR, MANJU NP	10/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17712 FAIRBREEZE CT	None	RIVERSIDE	CA	92504	8849	00	06000	33.86241067	-117.358293	Riverside County
308236	Non-Physician Medical Practitioner	None	1699506071	0	0	KELLEY, KAYLENE N CNM	10/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	00	06000	35.39052148	-119.0070765	Kern County
308237	Non-Physician Medical Practitioner	None	1376670281	0	0	KRUPITSKY, CARRIE LYNN	9/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
308264	Non-Physician Medical Practitioner	None	1538728431	0	0	KAZARYAN, LUIZA NP	9/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
308296	Non-Physician Medical Practitioner	None	1053185686	0	0	KING, CASSANDRA L NP	9/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13365 W WASHINGTON BLVD	None	CULVER CITY	CA	90066	5134	00	06000	33.99238471	-118.4439832	Los Angeles County
308305	Non-Physician Medical Practitioner	None	1922291541	0	0	KELLY, JENNIFER R.	11/15/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2288 AUBURN BLVD	SUITE 200	SACRAMENTO	CA	95821	1618	00	06000	38.625345	-121.4114985	Sacramento County
308345	Non-Physician Medical Practitioner	None	1497005268	0	0	KING, THOMAS J NP	3/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19875 WHITTO MINE ROAD	None	SONORA	CA	95370	8405	00	06000	37.9832252	-120.2818214	Tuolumne County
308374	Non-Physician Medical Practitioner	None	1982211769	0	0	KONISHI, MINAMI NP	12/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 EUCLID ST	203	ANAHEIM	CA	92801	4122	00	06000	33.8420837	-117.9415765	Orange County
308382	Non-Physician Medical Practitioner	None	1073587572	0	0	KIM, JUN YUNG	4/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2925 SYCAMORE DR	SUITE 204/205	SIMI VALLEY	CA	93065	1207	00	06000	34.288398	-118.7439175	Ventura County
308399	Non-Physician Medical Practitioner	None	1760452130	0	0	KING, KELLEY L	1/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4601 79TH STREET	None	SACRAMENTO	CA	95820	3652	00	06000	38.533644	-121.412223	Sacramento County
308416	Non-Physician Medical Practitioner	None	1497316814	0	0	KARIMI, ASHLEY PA	2/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
308424	Non-Physician Medical Practitioner	None	1194460709	0	0	KINHOLT, COURTNEY PA-C	7/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	00	06000	33.78236048	-117.8664975	Orange County
308490	Non-Physician Medical Practitioner	None	1689917494	0	0	KIM, MIA D NP	6/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
308491	Non-Physician Medical Practitioner	None	1881220234	0	0	KASRAVI, SHIVA PA	5/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
308492	Non-Physician Medical Practitioner	None	1013305267	0	0	KEENAN, JANICE L	11/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	9751 COLORED WIND AVE	None	LAS VEGAS	NV	89148	5525	00	06000	36.08240498	-115.3056138	Clark County
308517	Non-Physician Medical Practitioner	None	1972053791	0	0	KLINGER, EDNA F NP	12/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
308521	Non-Physician Medical Practitioner	None	1396598835	0	0	KAUR, RACHHPAL NP	8/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2287 MOWRY AVE	C	FREMONT	CA	94538	1622	00	06000	37.55664244	-121.9818434	Alameda County
308536	Non-Physician Medical Practitioner	None	1831609627	0	0	KANG, RAVNEET S	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3180 RIVIERA ROAD	None	LIVE OAK	CA	95953	9713	00	06000	39.30147698	-121.6749856	Sutter County
308539	Non-Physician Medical Practitioner	None	1144643404	0	0	KELLEHER, ROBERT S NP	12/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2773 HARRIS STREET	SUITE B	EUREKA	CA	95503	4866	00	06000	40.78052829	-124.1363953	Humboldt County
308544	Non-Physician Medical Practitioner	None	1629750328	0	0	KWONG, MELINDA PA-C	12/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	00	06000	33.67718578	-117.9887516	Orange County
308553	Non-Physician Medical Practitioner	None	1598862054	0	0	KNEPPER, M M	6/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	452 COUNTY RD 750	None	ENTERPRISE	AL	36330	7917	00	06000	31.36808106	-85.80758486	Coffee County
308557	Non-Physician Medical Practitioner	None	1801134275	0	0	KELLY, KATHERINE M CNM	12/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	00	06000	33.12123297	-117.1199417	San Diego County
308570	Non-Physician Medical Practitioner	None	1184978504	0	0	KAUR, SUKHDEEP	6/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5810 E LAURITE AVE	None	FRESNO	CA	93727	9040	00	06000	36.71261951	-119.6902125	Fresno County
308637	Non-Physician Medical Practitioner	None	1972748259	0	0	KIM, SUN MIN	5/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
308659	Non-Physician Medical Practitioner	None	1164085882	0	0	KHATIB, SARAH PA-C	3/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 ADOBE ST	None	CONCORD	CA	94520	2313	00	06000	37.97700068	-122.0381159	Contra Costa County
308668	Non-Physician Medical Practitioner	None	1700187812	0	0	KATO, JASON S	11/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	227 EAST MAIN STREET	None	SAN GABRIEL	CA	91776	2533	00	06000	34.09697392	-118.097435	Los Angeles County
308672	Non-Physician Medical Practitioner	None	1356627525	0	0	KNOLL, MARIA P CNM	6/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 WEST AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
308718	Non-Physician Medical Practitioner	None	1497445183	0	0	KERNER, JORDYN PA-C	10/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	00	06000	34.1315778	-117.3182453	San Bernardino County
308724	Non-Physician Medical Practitioner	None	1063115897	0	0	KAUR, SUKHWINDER NP	12/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	00	06000	34.24862229	-118.2886742	Los Angeles County
308730	Non-Physician Medical Practitioner	None	1235767112	0	0	KWAK, HELEN B NP	6/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	00	06000	33.89443025	-117.9288328	Orange County
308761	Non-Physician Medical Practitioner	None	1467153023	0	0	KAMDAR, MONISHA R NP	10/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
308776	Non-Physician Medical Practitioner	None	1154433258	0	0	KIM, YEUN HEE	9/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2030 W PICO BLVD	None	LOS ANGELES	CA	90006	5011	00	06000	34.04706445	-118.2822723	Los Angeles County
308798	Non-Physician Medical Practitioner	None	1922568633	0	0	KING-JACOBS, MELLISSA	10/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	00	06000	38.23580279	-122.0858445	Solano County
308804	Non-Physician Medical Practitioner	None	1871232124	0	0	KNIGHT, HEATHER M	1/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1292 W MILL ST	105	SAN BERNARDINO	CA	92410	2500	00	06000	34.09216953	-117.313173	San Bernardino County
308840	Non-Physician Medical Practitioner	None	1881880912	0	0	KHUU, PIA L PA-C	6/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 N VERMONT AVE	1001	LOS ANGELES	CA	90027	6098	00	06000	34.0956033	-118.2916918	Los Angeles County
308847	Non-Physician Medical Practitioner	None	1720480767	0	0	KERR, WILLIAM	1/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26709 COLT DR	None	CORONA	CA	92883	5291	00	06000	33.73173274	-117.4305492	Riverside County
308889	Non-Physician Medical Practitioner	None	1588207641	0	0	KANE, GABRIEL J NP	10/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18876 VAN BUREN BLVD	100	RIVERSIDE	CA	92508	9114	00	06000	33.88727646	-117.3328605	Riverside County
308892	Non-Physician Medical Practitioner	None	1760907976	0	0	KUO, CHRISTINA S PA	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	00	06000	33.89552551	-117.186021	Riverside County
308916	Non-Physician Medical Practitioner	None	1558136465	0	0	KIM, ANNIE J NP	5/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
308969	Non-Physician Medical Practitioner	None	1215235825	0	0	KUM, HAOYEN S NP	6/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	00	06000	33.859611	-118.1511435	Los Angeles County
308986	Non-Physician Medical Practitioner	None	1720225766	0	0	KANE, ADRIENNE D	1/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27951 EDGECLIFF WAY	None	HAYWARD	CA	94542	2107	00	06000	37.65351704	-122.0369709	Alameda County
308988	Non-Physician Medical Practitioner	None	1679905822	0	0	KASPEREK, KIMBERLY D	1/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 E OCEAN BLVD	None	LONG BEACH	CA	90802	6100	00	06000	33.76461869	-118.1695406	Los Angeles County
308998	Non-Physician Medical Practitioner	None	1942456124	0	0	KHAN, MATTHEW PATRICK	10/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5646 BRIDGER PEAK CT	None	SPARKS	NV	89436	1803	00	06000	39.59453436	-119.7323419	Washoe County
309009	Non-Physician Medical Practitioner	None	1447082896	0	0	KNUDSEN, MORGAN NP	9/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	STE 560	LA JOLLA	CA	92037	1229	00	06000	32.882913	-117.226341	San Diego County
309016	Non-Physician Medical Practitioner	None	1538433701	0	0	KREY, KRYSTALEE A	11/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14873 MORINGSIDE DR	None	POWAY	CA	92064	2859	00	06000	32.98493754	-117.0647925	San Diego County
309017	Non-Physician Medical Practitioner	None	1194131649	0	0	KHASAKIA, AMI NP	1/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6408 BRANT WAY	None	ROCKLIN	CA	95765	5810	00	06000	38.80323285	-121.2906318	Placer County
309054	Non-Physician Medical Practitioner	None	1891421715	0	0	KOHN, GABRIELA T PA	1/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	00	06000	33.8375955	-118.358748	Los Angeles County
309061	Non-Physician Medical Practitioner	None	1164555769	0	0	KOENK, LEON T	11/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5841 E CHARLESTON BLVD	None	LAS VEGAS	NV	89142	1021	00	06000	36.15938152	-115.046109	Clark County
309084	Non-Physician Medical Practitioner	None	1881621084	0	0	KING, TEKOA L	1/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
309096	Non-Physician Medical Practitioner	None	1134776016	0	0	KOEPPEN-BABCOCK, ANNA L PA	10/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
309100	Non-Physician Medical Practitioner	None	1710399449	0	0	KIM, MYOUNG M NP	8/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 WEATHERLY PLACE	None	FULLERTON	CA	92833	1201	00	06000	33.89636884	-117.9695584	Orange County
309119	Non-Physician Medical Practitioner	None	1841727658	0	0	KAPTRYAN, SIRVARD M NP	6/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4625 W SIERRA AVENUE	None	FRESNO	CA	93722	7606	00	06000	36.82986854	-119.876429	Fresno County
309169	Non-Physician Medical Practitioner	None	1871578104	0	0	KRUSE, PATRICIA ANN	4/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	OB/GYN, #2500, ACC	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
309209	Non-Physician Medical Practitioner	None	1770918153	0	0	KANIECKI, BRIANNE B	11/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2205 FARRELL AVE	APT 103	REDONDO BEACH	CA	90278	1832	00	06000	33.88375346	-118.372347	Los Angeles County
309219	Non-Physician Medical Practitioner	None	1043569528	0	0	KENNEWEG, JILL L NP	1/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3569 MEDER RD	None	SHINGLE SPRINGS	CA	95682	8716	00	06000	38.67916908	-120.9581278	El Dorado County
309227	Non-Physician Medical Practitioner	None	1649704610	0	0	KILDAY, DANA T NP	11/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5831 O ST	None	SACRAMENTO	CA	95819	4238	00	06000	38.558304	-121.4345655	Sacramento County
309315	Non-Physician Medical Practitioner	None	1093799660	0	0	KASTEN, JEFF S NP	1/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6313 TAMARACK WAY	None	SODA SPRINGS	CA	95728	0843	00	06000	39.30616806	-120.3893489	Placer County
309353	Non-Physician Medical Practitioner	None	1598985806	0	0	KAUR, SARBJEET	8/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1210 E ALMOND AVE	None	MADERA	CA	93637	5606	00	06000	36.94540933	-120.0458266	Madera County
309363	Non-Physician Medical Practitioner	None	1144536145	0	0	KUSUMA, JOYCE DEVINA	11/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 SUMMIT BLVD	None	BIG BEAR LAKE	CA	92315	0000	00	06000	34.24579572	-116.8883656	San Bernardino County
309395	Non-Physician Medical Practitioner	None	1548499619	0	0	KOVACEVICH, LORI J NP	8/26/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11323 N VIA NAPOLI DRIVE	None	FRESNO	CA	93720	8832	00	06000	36.9010094	-119.7572101	Fresno County
309403	Non-Physician Medical Practitioner	None	1750722666	0	0	KENNEY, ELIZABETH S	4/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	515 4TH STREET	None	CORONADO	CA	92118	1130	00	06000	32.69706699	-117.180925	San Diego County
309441	Non-Physician Medical Practitioner	None	1497187090	0	0	KING, PAILAI I NP	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3470 COASTLINE PLACE	None	SAN DIEGO	CA	92110	5346	00	06000	32.74891437	-117.2156482	San Diego County
309442	Non-Physician Medical Practitioner	None	1225681372	0	0	KRAFT, SHEILA M NP	10/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18092 WIKA ROAD	SUITE 220	APPLE VALLEY	CA	92307	2132	00	06000	34.54070062	-117.2694542	San Bernardino County
309500	Non-Physician Medical Practitioner	None	1033870290	0	0	KING, KALYN PA	5/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
309504	Non-Physician Medical Practitioner	None	1437742749	0	0	KAUR, RAJVIR PA	10/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1243 EAST SPRUCE AVE	SUITE 104	FRESNO	CA	93720	3379	00	06000	36.84198651	-119.7610695	Fresno County
309508	Non-Physician Medical Practitioner	None	1881879781	0	0	KRAMER, ALICE W	2/6/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28275 PLUMBLOSSOM LN	None	HIGHLAND	CA	92346	6067	00	06000	34.13353731	-117.188469	San Bernardino County
309512	Non-Physician Medical Practitioner	None	1376214684	0	0	KOBAYASHI, GARRETT J PA-C	2/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
309514	Non-Physician Medical Practitioner	None	1205815891	0	0	KHAN, ZARIN G	6/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2234 OLYMPIC VIEW DRIVE	None	CHINO HILLS	CA	91709	1337	00	06000	34.00873927	-117.7567766	San Bernardino County
309549	Non-Physician Medical Practitioner	None	1699191932	0	0	KARIM, HASSAN M	1/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 S STREET	APT 148	SACRAMENTO	CA	95816	7070	00	06000	38.562894	-121.4684415	Sacramento County
309551	Non-Physician Medical Practitioner	None	1427657550	0	0	KANE, ADRIANA S NP	10/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30230 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	1585	00	06000	33.52397575	-117.6652094	Orange County
309603	Non-Physician Medical Practitioner	None	1104145481	0	0	KHAN, RIZWAN S PA-C	6/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	00	06000	33.6526055	-117.910746	Orange County
309645	Non-Physician Medical Practitioner	None	1639383862	0	0	KARIMJEE, JABEEN NP	6/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 SUMMIT ST	2ND FLOOR	OAKLAND	CA	94609	3410	00	06000	37.82018974	-122.2643221	Alameda County
309661	Non-Physician Medical Practitioner	None	1649843590	0	0	KURTZ, STEVEN L PA-C	1/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4700 NORTHGATE BLVD	STE 100	SACRAMENTO	CA	95834	1149	00	06000	38.654262	-121.4770455	Sacramento County
309675	Non-Physician Medical Practitioner	None	1184287013	0	0	KWON, JUNG HA NP	6/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
309678	Non-Physician Medical Practitioner	None	1154518041	0	0	KAZARIANS, ALICIA V NP	10/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2920 CONATA STREET	None	DUARTE	CA	91010	1426	00	06000	34.14709291	-117.9421313	Los Angeles County
309702	Non-Physician Medical Practitioner	None	1063518538	0	0	KAVENY, CORINNE M	10/29/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	926 LOCUST AVE	None	LONG BEACH	CA	90813	3908	00	06000	33.778233	-118.1910535	Los Angeles County
309771	Non-Physician Medical Practitioner	None	1114113800	0	0	KRUEGER, LISA	2/26/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1600 MEDICAL PKWY	None	CARSON CITY	NV	89703	4625	00	06000	39.202263	-119.7841095	Consolidated Municipality of Carson City
309777	Non-Physician Medical Practitioner	None	1659980233	0	0	KHOU, BELINDA K PA-C	12/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	855 E ANAHEIM ST	None	LONG BEACH	CA	90813	3550	00	06000	33.78263447	-118.1827035	Los Angeles County
309784	Non-Physician Medical Practitioner	None	1437749306	0	0	KRISHNAMURTHY, TARIKA PA-C	4/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
309838	Non-Physician Medical Practitioner	None	1821430893	0	0	KATZ, DANIELLE A NP	6/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36702 REYNOLDS DRIVE	None	FREMONT	CA	94536	2507	00	06000	37.56810774	-122.0078449	Alameda County
309841	Non-Physician Medical Practitioner	None	1366999187	0	0	KUMP, SEAN N	8/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1960 LASSEN DR	None	RENO	NV	89503	1522	00	06000	39.54475638	-119.8378178	Washoe County
309842	Non-Physician Medical Practitioner	None	1467469734	0	0	KUBOTA, RICHARD KENJI	3/17/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	SUITE 0200	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
309850	Non-Physician Medical Practitioner	None	1003559907	0	0	KOPRUCKI, ELIZABETH PA-C	5/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1740 ROSECRANS ST	None	SAN DIEGO	CA	92106	1928	00	06000	32.72903913	-117.2254885	San Diego County
309852	Non-Physician Medical Practitioner	None	1558316786	0	0	KELLEY, RICHARD	3/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	0000	00	06000	37.66508443	-120.9962589	Stanislaus County
309861	Non-Physician Medical Practitioner	None	1538574231	0	0	KAUTH, ASHLEY NP	5/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
309873	Non-Physician Medical Practitioner	None	1306594478	0	0	KHADKA, KESHAV R NP	5/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
309897	Non-Physician Medical Practitioner	None	1114517356	0	0	KITAHARA, EMI M	2/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
309943	Non-Physician Medical Practitioner	None	1477096766	0	0	KIM, JOO YOUNG PA-C	7/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25 STOWE LANE	None	MENLO PARK	CA	94025	6329	00	06000	37.41991965	-122.1893502	San Mateo County
310013	Non-Physician Medical Practitioner	None	1457787566	0	0	KASANZA, COSETTE C NP	2/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10610 N. BONADELLE AVE	None	FRESNO	CA	93730	3502	00	06000	36.89062916	-119.7402153	Fresno County
310027	Non-Physician Medical Practitioner	None	1851840763	0	0	KWON, JI MIN PA	12/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
310046	Non-Physician Medical Practitioner	None	1912427386	0	0	KRATZIG, MELINDA E NP	10/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
310082	Non-Physician Medical Practitioner	None	1750714408	0	0	KIM, MIHAE NP	6/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11625 MONTANA AVE	APT 11	LOS ANGELES	CA	90049	4666	00	06000	34.05657679	-118.4651724	Los Angeles County
310109	Non-Physician Medical Practitioner	None	1316207863	0	0	KOCIEMBA, RACHEL ANNE	1/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	06000	39.742164	-104.8350375	Adams County
310174	Non-Physician Medical Practitioner	None	1831790450	0	0	KAMENOVA, LORA S PA	2/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	00	06000	33.95062799	-118.0051627	Los Angeles County
310192	Non-Physician Medical Practitioner	None	1023780244	0	0	KAUR, SUKHJIT NP	10/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19929 GREENLEY RD	None	SONORA	CA	95370	5996	00	06000	37.9837971	-120.366851	Tuolumne County
310239	Non-Physician Medical Practitioner	None	1124264239	0	0	KELLY, HEATHER ANN ROBRECHT	4/26/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W. GIBSON ROAD	None	WOODLAND	CA	95695	0000	00	06000	38.66314048	-121.794696	Yolo County
310318	Non-Physician Medical Practitioner	None	1326196247	0	0	KOBERNUSZ, BRENDA R	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	205 ACACIA AVE	None	MONROVIA	CA	91016	2105	00	06000	34.1544446	-118.0044055	Los Angeles County
310354	Non-Physician Medical Practitioner	None	1780071399	0	0	KASIAN, ELIZA B PA	3/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
310369	Non-Physician Medical Practitioner	None	1790406882	0	0	KSENDZ, PAVEL NP	4/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
310386	Non-Physician Medical Practitioner	None	1992793525	0	0	KONING, CORALEE R PA-C	3/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9300 VALLEY CHILRENS PL	None	MADERA	CA	93638	8761	00	06000	36.88437894	-119.8003484	Madera County
310395	Non-Physician Medical Practitioner	None	1093386203	0	0	KOHLER, DANE M NP	9/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
310404	Non-Physician Medical Practitioner	None	1437188943	0	0	KELSEY, AMY OSHEA	8/7/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	SUITE 2112	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
310410	Non-Physician Medical Practitioner	None	1396804019	0	0	KIDD, VASCO D PA-C	6/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
310416	Non-Physician Medical Practitioner	None	1831736958	0	0	KAUR, JASDEEP NP	3/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11306 MOUNTAIN VIEW AVE	STE E	LOMA LINDA	CA	92354	3832	00	06000	34.047513	-117.243647	San Bernardino County
310423	Non-Physician Medical Practitioner	None	1396865770	0	0	KEENE, MELLIE F NP	1/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	781 BRAHMA STREET	None	PASO ROBLES	CA	93446	4635	00	06000	35.60584027	-120.6741846	San Luis Obispo County
310453	Non-Physician Medical Practitioner	None	1891206538	0	0	KIM, ELIZABETH S NP	9/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	00	06000	34.06544724	-118.4459249	Los Angeles County
310479	Non-Physician Medical Practitioner	None	1073771242	0	0	KALATHIL, PEGGY P NP	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	00	06000	34.06544724	-118.4459249	Los Angeles County
310482	Non-Physician Medical Practitioner	None	1285243360	0	0	KAUR, CHARANJIT	12/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1801 E MARCH LN	STE C310	STOCKTON	CA	95210	6676	00	06000	38.00315652	-121.2868715	San Joaquin County
310496	Non-Physician Medical Practitioner	None	1124365051	0	0	KRAINSON, MELISSA A PA-C	8/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
310501	Non-Physician Medical Practitioner	None	1194029629	0	0	KODITUWAKKU, LAKMALI	2/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15717 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	4377	00	06000	33.890355	-118.160178	Los Angeles County
310525	Non-Physician Medical Practitioner	None	1487924643	0	0	KIDDE, ELIZABETH NP	3/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
310538	Non-Physician Medical Practitioner	None	1770822116	0	0	KELLEY, HARUKA NP	8/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
310566	Non-Physician Medical Practitioner	None	1861846982	0	0	KULIG-KORT, OLIVIA E NP	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11611 BLUCHER AVE	UNIT 168	GRANADA HILLS	CA	91344	7333	00	06000	34.28116017	-118.4697517	Los Angeles County
310573	Non-Physician Medical Practitioner	None	1245695006	0	0	KELLEHER, BRIDGET M NP	8/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1413 1/2 N ALEXANDRIA	AVE	LOS ANGELES	CA	90027	5803	00	06000	34.096977	-118.2983655	Los Angeles County
310598	Non-Physician Medical Practitioner	None	1447580113	0	0	KIM, ESTHER J	10/24/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1240 N MISSION RD RM L-9	None	LOS ANGELES	CA	90033	1019	00	06000	34.06214495	-118.212017	Los Angeles County
310637	Non-Physician Medical Practitioner	None	1053990127	0	0	KIM, ASHLEY PA	7/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 E COMMONWEALTH AVE	STE 100	FULLERTON	CA	92832	1905	00	06000	33.87034048	-117.922437	Orange County
310659	Non-Physician Medical Practitioner	None	1851006514	0	0	KELLER, YESENIA NP	6/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	340 4TH AVE	11	CHULA VISTA	CA	91910	3813	00	06000	32.63831293	-117.0833536	San Diego County
310663	Non-Physician Medical Practitioner	None	1306408950	0	0	KARAM, MOURHAF M PA	11/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
310664	Non-Physician Medical Practitioner	None	1558747204	0	0	KOHLMAN, KRYSTAL S	1/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	151 CALDERON AVE	APT 1	MOUNTAIN VIEW	CA	94041	1424	00	06000	37.39134094	-122.0718038	Santa Clara County
310670	Non-Physician Medical Practitioner	None	1285876318	0	0	KANIGHER, AMY	10/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2525 WHITNEY OAKS LANE	None	RENO	NV	89523	2116	00	06000	39.54032966	-119.9121274	Washoe County
310676	Non-Physician Medical Practitioner	None	1336280015	0	0	KIMBLE, MARTIN	8/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
310704	Non-Physician Medical Practitioner	None	1912068107	0	0	KWAN, ANNIE	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	00	06000	37.23948065	-121.8005798	Santa Clara County
310706	Non-Physician Medical Practitioner	None	1770037715	0	0	KNUTSON, JENNIFER R NP	10/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	109 TERMINO AVE	None	LONG BEACH	CA	90815	2668	00	06000	33.76121507	-118.1459883	Los Angeles County
310724	Non-Physician Medical Practitioner	None	1427770213	0	0	KROGSTAD, SIRORAT	7/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
310775	Non-Physician Medical Practitioner	None	1962423640	0	0	KITTNER, HASKE P	11/8/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 IRVINE HALL	None	IRVINE	CA	92697	4275	00	06000	33.73065629	-117.7840819	Orange County
310789	Non-Physician Medical Practitioner	None	1063033801	0	0	KINN, AARON C PA	12/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	06000	43.383456	-124.2330435	Coos County
310866	Non-Physician Medical Practitioner	None	1487823928	0	0	KIM, CHRISTINA NP	6/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
310884	Non-Physician Medical Practitioner	None	1568622264	0	0	KATZ, KATHERINE M PA-C	3/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2525 ERRINGER RD.	None	SIMI VALLEY	CA	93065	2352	00	06000	34.280838	-118.7614975	Ventura County
310921	Non-Physician Medical Practitioner	None	1942907514	0	0	KIM, ELDEN H NP	5/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 BROADWAY	STE 302	MILLBRAE	CA	94030	1978	00	06000	37.60544641	-122.3978603	San Mateo County
310945	Non-Physician Medical Practitioner	None	1629057237	0	0	KALIS, VANESSA M NP	3/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28 BLOOMFIELD LANE	None	RANCHO SANTA MARG	CA	92688	8729	00	06000	33.58337308	-117.6240302	Orange County
310970	Non-Physician Medical Practitioner	None	1154727832	0	0	KANE, KAITLIN PA	1/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.78673844	-118.2965289	Los Angeles County
310989	Non-Physician Medical Practitioner	None	1174887897	0	0	KAUR, NAVJOT NP	2/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 REDHAWK CIR	APT L207	FREMONT	CA	94453	4775	00	06000	37.55609372	-121.9682892	Alameda County
311033	Non-Physician Medical Practitioner	None	1164663902	0	0	KARPIN, MICHELLE C CNM	7/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 CASA ST	STE 220	SAN LUIS OBISPO	CA	93405	1890	00	06000	35.29359615	-120.6654304	San Luis Obispo County
311037	Non-Physician Medical Practitioner	None	1962022319	0	0	KHECHEMYAN, ELMA NP	6/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11550 INDIAN HILLS RD	STE 240	MISSION HILLS	CA	91345	1202	00	06000	34.28024575	-118.4588775	Los Angeles County
311038	Non-Physician Medical Practitioner	None	1881143410	0	0	KELLER, DAY PA	12/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	06000	33.38982	-111.8760885	Maricopa County
311045	Non-Physician Medical Practitioner	None	1952447625	0	0	KIM, JIN T	2/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30 RICHARDSON RD	None	NOVATO	CA	94949	6170	00	06000	38.05210161	-122.5098088	Marin County
311061	Non-Physician Medical Practitioner	None	1154995280	0	0	KIM, PAUL PA	2/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	00	06000	34.2214515	-118.4573205	Los Angeles County
311068	Non-Physician Medical Practitioner	None	1154001733	0	0	KIRPICHYAN, HAGOP PA-C	3/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
311088	Non-Physician Medical Practitioner	None	1932594140	0	0	KAVOUSSI, BEN	4/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4225 MAHOGANY LANE	None	DAVIS	CA	95618	6080	00	06000	38.5396471	-121.6973275	Yolo County
311107	Non-Physician Medical Practitioner	None	1932773900	0	0	KIM, CHARLES PA	7/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311117	Non-Physician Medical Practitioner	None	1376992354	0	0	KARPEN, SARAH	2/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
311125	Non-Physician Medical Practitioner	None	1952002156	0	0	KWON, CLARA H PA	5/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
311153	Non-Physician Medical Practitioner	None	1366690778	0	0	KAZAN, NANCY A NP	4/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6921 ESPANITA STREET	APT 6	LONG BEACH	CA	90815	4820	00	06000	33.78435443	-118.0979708	Los Angeles County
311180	Non-Physician Medical Practitioner	None	1841847167	0	0	KIZUKA, RACHEL Z NP	10/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
311241	Non-Physician Medical Practitioner	None	1609996958	0	0	KLEIN, ALLYSON E NP	5/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
311252	Non-Physician Medical Practitioner	None	1508357484	0	0	KUKLINSKI, COURTNEY D NP	5/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
311274	Non-Physician Medical Practitioner	None	1679552335	0	0	KNIGHT, ANNE NINITA	11/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 POWELL ST	SUITE 900	EMERYVILLE	CA	94608	1826	00	06000	37.83953006	-122.2990736	Alameda County
311299	Non-Physician Medical Practitioner	None	1316412984	0	0	KERSTNER, LAUREN C PA-C	8/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
311330	Non-Physician Medical Practitioner	None	1891267399	0	0	KIM, REINA N NP	12/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	# B10	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
311375	Non-Physician Medical Practitioner	None	1942893581	0	0	KAING, JARED C PA	7/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	00	06000	34.12632952	-117.1956652	San Bernardino County
311395	Non-Physician Medical Practitioner	None	1619927696	0	0	KOUPALIAN, ARAKSYA R	1/26/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16410 SHAMHART DR	None	GRANADA HILLS	CA	91344	2864	00	06000	34.28670361	-118.4893169	Los Angeles County
311413	Non-Physician Medical Practitioner	None	1225103617	0	0	KNUTZEN, SUZANNE GAUDINEER	11/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 COLLEGE WAY	STUDENT HEALTH SERVICES	CLAREMONT	CA	91711	0000	00	06000	34.10113145	-117.7126476	Los Angeles County
311429	Non-Physician Medical Practitioner	None	1336811561	0	0	KAUR, KIRANJEET NP	11/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
311441	Non-Physician Medical Practitioner	None	1346434297	0	0	KILANI, SUHEIR	7/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6535 MONTAIRE ST	None	LA PALMA	CA	90623	1057	00	06000	33.86556864	-118.0366446	Orange County
311470	Non-Physician Medical Practitioner	None	1235371915	0	0	KOTAREK, STEPHEN K	7/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1726 PEART COURTT	None	WOODLAND	CA	95776	6385	00	06000	38.6568431	-121.759086	Yolo County
311473	Non-Physician Medical Practitioner	None	1669979761	0	0	KING, JENNIFER H NP	10/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7023 OWENSMOUTH AVE	None	CANOGA PARK	CA	91303	2006	00	06000	34.19809485	-118.6015764	Los Angeles County
311525	Non-Physician Medical Practitioner	None	1053658005	0	0	KIM, JAMIE S PA	6/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
311530	Non-Physician Medical Practitioner	None	1184899296	0	0	KRIEGER, BETHANY A NP	8/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5137 GOLDEN FOOTHILL PKW	STE 120	EL DORADO HLS	CA	95762	9671	00	06000	38.63972246	-121.0689815	El Dorado County
311557	Non-Physician Medical Practitioner	None	1821150269	0	0	KIM, JOHN H	10/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1717 LAS GALLINAS AVE	None	SAN RAFAEL	CA	94903	1805	00	06000	38.01556294	-122.5493219	Marin County
311585	Non-Physician Medical Practitioner	None	1982482816	0	0	KEOBOUNNAM, ATHENA M PA	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
311593	Non-Physician Medical Practitioner	None	1225796683	0	0	KEHINDE, ASHLEY NP	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 W REDLANDS BLVD	None	REDLANDS	CA	92373	8054	00	06000	34.06288379	-117.2156673	San Bernardino County
311722	Non-Physician Medical Practitioner	None	1912246984	0	0	KIM, LINDA I Y	3/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1968 W HARRIET LANE	None	ANAHEIM	CA	92804	6005	00	06000	33.81194025	-117.9536193	Orange County
311775	Non-Physician Medical Practitioner	None	1609228014	0	0	KIM, JOSHUA S	10/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3674 FINNIAN WY	None	DUBLIN	CA	94568	7202	00	06000	37.70729427	-121.8669151	Alameda County
311789	Non-Physician Medical Practitioner	None	1902248859	0	0	KARIMPOUR, FARMOUSH	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2831 WEST TYLER AVENUE	None	VISALIA	CA	93291	6566	00	06000	36.363177	-119.323521	Tulare County
311849	Non-Physician Medical Practitioner	None	1447349519	0	0	KULJIAN, NANCY M NP	9/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29826 HAUN ROAD	SUITE 203	MENIFEE	CA	92586	6547	00	06000	33.68719818	-117.1748757	Riverside County
311868	Non-Physician Medical Practitioner	None	1386893766	0	0	KEEKEEBHAI, AISHA	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12954 HAWTHORNE BLVD	SUITE 100	HAWTHORNE	CA	90250	4418	00	06000	33.91447388	-118.3523875	Los Angeles County
311869	Non-Physician Medical Practitioner	None	1194587253	0	0	KAUR, GURPREET NP	4/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	00	06000	37.52910755	-120.8840959	Stanislaus County
311878	Non-Physician Medical Practitioner	None	1215982426	0	0	KANTMANN, CHRISTOPHER J	7/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7182 LANGLEY COURT	None	PRUNEDALE	CA	93907	8927	00	06000	36.81357437	-121.653703	Monterey County
311902	Non-Physician Medical Practitioner	None	1265172936	0	0	KANG, MICHAEL	11/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
311904	Non-Physician Medical Practitioner	None	1386760510	0	0	KUYKENDALL, HARRISON S III	1/18/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	626 OVERLOOK PLACE	None	CHULA VISTA	CA	91914	1200	00	06000	32.66659061	-116.9458446	San Diego County
311923	Non-Physician Medical Practitioner	None	1629137351	0	0	KRANTZBERG, JAMIE L	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17338 PEAR ST	None	FONTANA	CA	92337	6808	00	06000	34.05165885	-117.4260403	San Bernardino County
311929	Non-Physician Medical Practitioner	None	1962275305	0	0	KIM, MATTHEW J PA-C	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 S. BROADWAY	None	SANTA ANA	CA	92701	5633	00	06000	33.744159	-117.8697125	Orange County
311941	Non-Physician Medical Practitioner	None	1225426471	0	0	KIM, HYUNJI NP	3/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 MEDICAL PLAZA	STE 130	ROSEVILLE	CA	95661	3038	00	06000	38.76507948	-121.2477476	Placer County
311955	Non-Physician Medical Practitioner	None	1750631552	0	0	KAUR, RAMANDEEP NP	5/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2420 MEADOWLAND WAY	None	LINCOLN	CA	95648	2451	00	06000	38.90518372	-121.3244232	Placer County
311975	Non-Physician Medical Practitioner	None	1689046310	0	0	KEYES, AMY J PA-C	7/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3020	00	06000	32.77978322	-117.0094766	San Diego County
312027	Non-Physician Medical Practitioner	None	1588401285	0	0	KAUR, CHARANJOT	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1255 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4801	00	06000	38.25815459	-122.0487714	Solano County
312082	Non-Physician Medical Practitioner	None	1396180816	0	0	KANE, VALARIE M PA-C	4/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4001 J STREET	None	SACRAMENTO	CA	95819	3626	00	06000	38.570526	-121.4521695	Sacramento County
312142	Non-Physician Medical Practitioner	None	1306329586	0	0	KNOPPEL-CALAS, SOFIA F PA	10/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
312149	Non-Physician Medical Practitioner	None	1801901830	0	0	KIRBY, LEE MICHAEL	10/10/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	00	06000	34.133598	-118.1534895	Los Angeles County
312177	Non-Physician Medical Practitioner	None	1184109100	0	0	KHAN, ZENITH S NP	7/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	00	06000	34.02726451	-118.4857138	Los Angeles County
312202	Non-Physician Medical Practitioner	None	1376281279	0	0	KHEIR, TAMARA O MD	9/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
312231	Non-Physician Medical Practitioner	None	1457779993	0	0	KAUR, BHUPINDER	8/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10707 QUEENSBURY DR	None	BAKERSFIELD	CA	93312	7049	00	06000	35.35763252	-119.1225012	Kern County
312234	Non-Physician Medical Practitioner	None	1255734265	0	0	KRUETZ, JOHANNA M	8/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4225 ETHEL AVE	APT 16	STUDIO CITY	CA	91604	1995	00	06000	34.14693349	-118.418354	Los Angeles County
312284	Non-Physician Medical Practitioner	None	1629670203	0	0	KAKPO-MOORE, SENAN I	1/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12998 HESPERIA RD	STE 204	VICTORVILLE	CA	92395	8317	00	06000	34.48789715	-117.2906992	San Bernardino County
312329	Non-Physician Medical Practitioner	None	1437789195	0	0	KWON, DUSTIN K PA	3/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
312374	Non-Physician Medical Practitioner	None	1144612516	0	0	KOTTMAN, KAITLYN PA	1/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
312383	Non-Physician Medical Practitioner	None	1588060636	0	0	KIM, SUYUN NP	12/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
312394	Non-Physician Medical Practitioner	None	1942924907	0	0	KLINE, KACIE A PA-C	7/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 E 3RD ST	STE 805	LOS ANGELES	CA	90013	1646	00	06000	34.04702011	-118.241912	Los Angeles County
312437	Non-Physician Medical Practitioner	None	1811667538	0	0	KAMKAR, SHAHAM PA	4/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
312488	Non-Physician Medical Practitioner	None	1275813370	0	0	KIM, DANIEL	12/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13939 MOUNTAIN VIEW PL	None	SYLMAR	CA	91342	1976	00	06000	34.32514586	-118.4122104	Los Angeles County
312514	Non-Physician Medical Practitioner	None	1982476479	0	0	KIL, PAUL NP	11/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E HIGHLAND AVE	# 551	SAN BERNARDINO	CA	92404	3861	00	06000	34.1358627	-117.2757778	San Bernardino County
312518	Non-Physician Medical Practitioner	None	1861020190	0	0	KARPEL, JOSEPH PA-C	11/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3814 AUBURN BLVD	72	SACRAMENTO	CA	95821	2123	00	06000	38.639034	-121.375305	Sacramento County
312519	Non-Physician Medical Practitioner	None	1417013756	0	0	KAMP, JULIA I	1/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	563 HOMER AVE	None	PALO ALTO	CA	94301	2824	00	06000	37.4467469	-122.1547052	Santa Clara County
312546	Non-Physician Medical Practitioner	None	1477136802	0	0	KELLER, ASHLEY L PA	4/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	00	06000	36.84225164	-119.7833937	Fresno County
312560	Non-Physician Medical Practitioner	None	1740376656	0	0	KELL, KELLIE T NP	5/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2322 BARTON LANE	None	MONTROSE	CA	91020	1224	00	06000	34.21494147	-118.2289746	Los Angeles County
312578	Non-Physician Medical Practitioner	None	1346710464	0	0	KOZIOL, ANDRY NP	7/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	108 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3013	00	06000	37.9124899	-122.0426939	Contra Costa County
312584	Non-Physician Medical Practitioner	None	1083707319	0	0	KEAGY, ANDREA D	8/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 HOLLOWAY AVE	None	SAN FRANCISCO	CA	94132	1740	00	06000	37.72087043	-122.4782195	San Francisco County
312590	Non-Physician Medical Practitioner	None	1811696529	0	0	KAUR, RIMANDEEP NP	1/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	00	06000	36.83832032	-119.7632391	Fresno County
312601	Non-Physician Medical Practitioner	None	1871143834	0	0	KOPSTEIN, JASON PA	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	00	06000	34.06914052	-117.2695442	San Bernardino County
312639	Non-Physician Medical Practitioner	None	1487255816	0	0	KANDYBE, JESSICA A NP	8/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE STREET	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
312646	Non-Physician Medical Practitioner	None	1932691383	0	0	KILMER, APRIL J NP	2/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1818 N ORANGE GROVE AVE	200	POMONA	CA	91767	3028	00	06000	34.07694934	-117.7489598	Los Angeles County
312653	Non-Physician Medical Practitioner	None	1285932426	0	0	KWOK, JENNIFER C S RN	5/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	273 BENHAM DRIVE	None	MARTINEZ	CA	94553	6043	00	06000	37.96541549	-122.1024194	Contra Costa County
312656	Non-Physician Medical Practitioner	None	1083636203	0	0	KOSOVA, JENNIFER R	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6250 HOLLYWOOD BLVD	UNIT 5A	LOS ANGELES	CA	90028	5331	00	06000	34.10158784	-118.3259533	Los Angeles County
312660	Non-Physician Medical Practitioner	None	1578085494	0	0	KAO, WENDY C PA	6/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
312725	Non-Physician Medical Practitioner	None	1760630941	0	0	KRAY, MARGARET	5/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 FRED JACKSON WAY	None	RICHMOND	CA	94801	1516	00	06000	37.955016	-122.3669575	Contra Costa County
312779	Non-Physician Medical Practitioner	None	1457685372	0	0	KOVACS, ANCA S	1/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9426 SPECTRUM	None	IRVINE	CA	92618	3422	00	06000	33.65277043	-117.7533888	Orange County
312784	Non-Physician Medical Practitioner	None	1316186638	0	0	KINOTI, MICHAEL PA-C	12/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
312794	Non-Physician Medical Practitioner	None	1316093362	0	0	KUSNIERCZYK, PETER A NP	4/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
312804	Non-Physician Medical Practitioner	None	1083177760	0	0	KRAM, BEVERLY A NP	12/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
312825	Non-Physician Medical Practitioner	None	1811260029	0	0	KNOX, STEPHANIE N	3/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	429 EBI WAY	None	FOLSOM	CA	95630	9542	00	06000	38.654838	-121.166829	Sacramento County
312844	Non-Physician Medical Practitioner	None	1891303293	0	0	KWAK, CAROL PA	2/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4139 BALL RD	None	CYPRESS	CA	90630	3465	00	06000	33.81766548	-118.060362	Orange County
312871	Non-Physician Medical Practitioner	None	1699436600	0	0	KENDEIGH, HEIDI K PA-C	3/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
312908	Non-Physician Medical Practitioner	None	1457743155	0	0	KENNEDY, LINDSAY M	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	309 4TH ST	APT 118	OAKLAND	CA	94607	4147	00	06000	37.79614535	-122.2722769	Alameda County
313002	Non-Physician Medical Practitioner	None	1932405453	0	0	KURTZ, KIMBERLY N	7/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39141 CIVIC CENTER DR	SUITE #130	FREMONT	CA	94538	5818	00	06000	37.55436307	-121.9764708	Alameda County
313012	Non-Physician Medical Practitioner	None	1760718985	0	0	KIM-HAYES, WANDA SUE	12/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1950 SYCAMORE CANYON RD	None	SANTA BARBARA	CA	93108	1716	00	06000	34.44361897	-119.6699557	Santa Barbara County
313013	Non-Physician Medical Practitioner	None	1639753262	0	0	KAUFMAN, SHAULA C NP	2/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
313051	Non-Physician Medical Practitioner	None	1326398363	0	0	KIM, JEONG BIN NP	5/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7225 RAINBOW DR	None	SAN JOSE	CA	95129	4552	00	06000	37.30146258	-122.0315034	Santa Clara County
313053	Non-Physician Medical Practitioner	None	1477864908	0	0	KENNERLEY, GENEVIEVE	4/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2828 FRESNO ST	None	FRESNO	CA	93721	1327	00	06000	36.7418099	-119.7838487	Fresno County
313060	Non-Physician Medical Practitioner	None	1831421767	0	0	KLINE, SEAN T NP	9/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	20262 E SILVER CREEK LN	None	QUEEN CREEK	AZ	85242	6287	00	06000	33.24321	-111.645495	Maricopa County
313090	Non-Physician Medical Practitioner	None	1376674390	0	0	KRUEGER, PHILIP JOHN	4/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	901 CAMPUS DR	SUITE 111	DALY CITY	CA	94015	4900	00	06000	37.66535778	-122.4763793	San Mateo County
313099	Non-Physician Medical Practitioner	None	1760970784	0	0	KATINDOY, JUSTINE K NP	10/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
313138	Non-Physician Medical Practitioner	None	1568588796	0	0	KONOPACKE, VICTORIA G	3/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13821 MERCADO DR	None	DEL MAR	CA	92014	3122	00	06000	32.94916619	-117.25082	San Diego County
313172	Non-Physician Medical Practitioner	None	1295885911	0	0	KOREY, LAURALIE GIBSON	4/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	550 PEACHTREE RD	SUITE 1700	ATLANTA	GA	30308	0000	00	06000	33.76888979	-84.38524145	Fulton County
313176	Non-Physician Medical Practitioner	None	1598191207	0	0	KO, GRACE NP	4/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	00	06000	32.80027449	-117.153846	San Diego County
313291	Non-Physician Medical Practitioner	None	1073230884	0	0	KAUR, SHARANJIT NP	7/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	761 WEST SHAW AVE	None	CLOVIS	CA	93612	3217	00	06000	36.80859652	-119.7268065	Fresno County
313292	Non-Physician Medical Practitioner	None	1154573483	0	0	KRENTZ, GINGER D NP	2/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	432 SAMUELS AVE	APT 1211	FT WORTH	TX	76102	2480	00	06000	32.76240498	-97.32889399	Tarrant County
313304	Non-Physician Medical Practitioner	None	1093803751	0	0	KHALSA, DALBIR K	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
313322	Non-Physician Medical Practitioner	None	1811586076	0	0	KADKHODA, NIKKI PA	8/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15477 VENTURA BLVD	STE 100	SHERMAN OAKS	CA	91403	3046	00	06000	34.15468022	-118.4712272	Los Angeles County
313347	Non-Physician Medical Practitioner	None	1346008489	0	0	KOVALTCHOUK, DANIELLE K PA-C	7/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	00	06000	36.962588	-122.0439201	Santa Cruz County
313353	Non-Physician Medical Practitioner	None	1275041139	0	0	KIRSCHT, PAIGE P NP	1/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
313386	Non-Physician Medical Practitioner	None	1407431216	0	0	KAUR, HARPREET NP	7/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	00	06000	37.9839146	-121.3516231	San Joaquin County
313418	Non-Physician Medical Practitioner	None	1710535430	0	0	KHADKA, ANITA NP	9/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
313423	Non-Physician Medical Practitioner	None	1699371591	0	0	KAPRIELIAN, VATCHE PA-C	2/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13193 CENTRAL AVE	SUITE 220	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
313441	Non-Physician Medical Practitioner	None	1780362392	0	0	KIM, KRISTIN NP	10/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
313462	Non-Physician Medical Practitioner	None	1588878623	0	0	KELLEY, ELLEN L NP	7/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	72780 COUNTRY CLUB DR	BLDG B 203	RANCHO MIRAGE	CA	92270	4126	00	06000	33.75795596	-116.392246	Riverside County
313524	Non-Physician Medical Practitioner	None	1679193296	0	0	KAM, JUSTIN J PA	7/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
313557	Non-Physician Medical Practitioner	None	1194117499	0	0	KIMBRO, KATHERINE L NP	6/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3501 W ELOWIN AVENUE	None	VISALIA	CA	93291	8436	00	06000	36.343755	-119.328876	Tulare County
313593	Non-Physician Medical Practitioner	None	1336240316	0	0	KOHFELD, JEFFREY D PA	3/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	72780 COUNTRY CLUB DR	STE C300	RANCHO MIRAGE	CA	92270	4150	00	06000	33.75795596	-116.392246	Riverside County
313595	Non-Physician Medical Practitioner	None	1265460695	0	0	KEEDY, RICHARD MARK	11/1/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
313620	Non-Physician Medical Practitioner	None	1881365500	0	0	KUHLMAN, KELLY NP	11/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
313628	Non-Physician Medical Practitioner	None	1316256548	0	0	KETCHEDJIAN, NAYIRI Z	12/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 CLOVERLEAF DR	APT A	MONROVIA	CA	91016	1665	00	06000	34.1619695	-118.0081653	Los Angeles County
313661	Non-Physician Medical Practitioner	None	1669015830	0	0	KHAN, SAMINA R NP	9/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	135 MISSION RANCH BLVD	SUITE 100	CHICO	CA	95926	2175	00	06000	39.75330715	-121.8611016	Butte County
313662	Non-Physician Medical Practitioner	None	1245560515	0	0	KALB, ALISON E	10/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1101 LINCOLN BLVD	APT 1-A	SANTA MONICA	CA	90403	5222	00	06000	34.02339724	-118.4959025	Los Angeles County
313673	Non-Physician Medical Practitioner	None	1902820152	0	0	KHORRAM, BABAK	2/21/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13330 BLOOMFIELD AVE	None	NORWALK	CA	90650	3251	00	06000	33.90988905	-118.0644875	Los Angeles County
313719	Non-Physician Medical Practitioner	None	1992272223	0	0	KANEKO, KENTARO J NP	3/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 SUMMIT ST	2ND FLOOR	OAKLAND	CA	94609	3410	00	06000	37.82018974	-122.2643221	Alameda County
313771	Non-Physician Medical Practitioner	None	1083098099	0	0	KIM, ANNA J	4/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	227 DOWNS RD	None	TUSTIN	CA	92782	3746	00	06000	33.69980195	-117.8146535	Orange County
313820	Non-Physician Medical Practitioner	None	1942514708	0	0	KETTLEY, JASMINE L	4/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	51 49TH STREET	None	SACRAMENTO	CA	95819	2212	00	06000	38.578194	-121.43763	Sacramento County
313841	Non-Physician Medical Practitioner	None	1487276853	0	0	KOGAN, MARSEL NP	7/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19042 SOLEDAD CANYON RD	A	SANTA CLARITA	CA	91351	3362	00	06000	34.4156522	-118.46848	Los Angeles County
313844	Non-Physician Medical Practitioner	None	1801297197	0	0	KING, BRITTANY A PA	3/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2069 E 3RD ST	UNIT 6	LONG BEACH	CA	90814	3911	00	06000	33.76878889	-118.1661981	Los Angeles County
313848	Non-Physician Medical Practitioner	None	1497043913	0	0	KINGRA, GAGANDEEP K	8/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
313877	Non-Physician Medical Practitioner	None	1730637182	0	0	KIM, DANIEL S PA	10/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2313 SANTA FE AVE	None	TORRANCE	CA	90501	4317	00	06000	33.8223412	-118.3231604	Los Angeles County
313930	Non-Physician Medical Practitioner	None	1538268016	0	0	KALK, EILEEN R	8/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4135 MAIN ST	None	KELSEYVILLE	CA	95451	8941	00	06000	38.97752848	-122.8356478	Lake County
313934	Non-Physician Medical Practitioner	None	1942366141	0	0	KINNEY, ASHLEY L	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6310 STONERIDGE MALL RD	D110	PLEASANTON	CA	94588	8042	00	06000	37.69229724	-121.9234756	Alameda County
313949	Non-Physician Medical Practitioner	None	1033301528	0	0	KOJIMA, JUAN R PA-C	3/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
313957	Non-Physician Medical Practitioner	None	1598082760	0	0	KIM, JI SEO	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 THICKET	None	IRVINE	CA	92614	5474	00	06000	33.66982442	-117.8112448	Orange County
313963	Non-Physician Medical Practitioner	None	1164081105	0	0	KENT, ABIGAIL G PA-C	8/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
313971	Non-Physician Medical Practitioner	None	1821498817	0	0	KADAMBI, ROHIT R	8/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 BRET KNOLL COURT	None	SAN JOSE	CA	95120	3215	00	06000	37.21095838	-121.8448182	Santa Clara County
313982	Non-Physician Medical Practitioner	None	1194476754	0	0	KAUR, RAJANDEEP NP	9/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
313983	Non-Physician Medical Practitioner	None	1396088514	0	0	KAVIANI, REBECCA A	12/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9534 EAST NAOMI AVENUE	None	ARADIA	CA	91107	7721	00	06000	34.12262937	-118.0651426	Los Angeles County
314007	Non-Physician Medical Practitioner	None	1982795597	0	0	KINNARD, FELICIA	10/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	0000	00	06000	34.129683	-117.970857	Los Angeles County
314021	Non-Physician Medical Practitioner	None	1356695373	0	0	KISSLING, NICOLE M	5/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1141 11TH ST	APT B	MAHATTAN BEACH	CA	90266	6051	00	06000	33.88657686	-118.3946277	Los Angeles County
314025	Non-Physician Medical Practitioner	None	1366116543	0	0	KALTNER, MICHAELA K PA-C	1/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
314059	Non-Physician Medical Practitioner	None	1316719511	0	0	KOVAR, LESLIE D NP	2/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	06000	36.143271	-115.1254975	Clark County
314079	Non-Physician Medical Practitioner	None	1447469085	0	0	KINNEY, BENTON PA-C	12/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
314102	Non-Physician Medical Practitioner	None	1518519305	0	0	KOTULA, KELLY E NP	7/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
314123	Non-Physician Medical Practitioner	None	1578922464	0	0	KWAN, KEVIN R NP	11/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15975 HARBOR BOULEVARD	None	FOUNTAIN VALLEY	CA	92708	1303	00	06000	33.73140379	-117.9200162	Orange County
314126	Non-Physician Medical Practitioner	None	1164559415	0	0	KITTLESON, JEANIE	12/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	237 HANLEY WAY	None	HENDERSON	NV	89074	5387	00	06000	36.044802	-115.0855875	Clark County
314140	Non-Physician Medical Practitioner	None	1952635237	0	0	KHALEGHI, MARJAN NP	4/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	974 W FOOTHILL BLVD	None	UPLAND	CA	91786	3728	00	06000	34.106562	-117.6651435	San Bernardino County
314168	Non-Physician Medical Practitioner	None	1649365289	0	0	KIDWELL, MARY ANNE PA-C	8/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	06000	36.03815706	-114.9842287	Clark County
314201	Non-Physician Medical Practitioner	None	1578891628	0	0	KIM, SUNGHEE	4/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25333 BARTON RD	None	LOMA LINDA	CA	92350	0210	00	06000	34.04804051	-117.2515455	San Bernardino County
314249	Non-Physician Medical Practitioner	None	1932305224	0	0	KLIMPEL, LISA M NP	8/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23741 VIA EL ROCIO	None	MISSION VIEJO	CA	92691	3533	00	06000	33.61814907	-117.6593357	Orange County
314260	Non-Physician Medical Practitioner	None	1508102690	0	0	KWONG, WAI YEE NP	7/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5956 PALM SPRINGS CIRCLE	None	SAN JOSE	CA	95123	4025	00	06000	37.23973016	-121.8399471	Santa Clara County
314277	Non-Physician Medical Practitioner	None	1295464469	0	0	KIM, EUNSOOK NP	6/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 E COMMONWEALTH AVE	STE 100	FULLERTON	CA	92832	1905	00	06000	33.87034048	-117.922437	Orange County
314369	Non-Physician Medical Practitioner	None	1043684863	0	0	KIM, EUNICE E NP	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23456 HAWTHORNE BLVD	260	TORRANCE	CA	90505	4716	00	06000	33.812631	-118.3510145	Los Angeles County
314418	Non-Physician Medical Practitioner	None	1528479516	0	0	KELLY, CHRISTINE S NP	2/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7556 N BAIN AVE	None	FRESNO	CA	93722	2250	00	06000	36.84652537	-119.8985046	Fresno County
314461	Non-Physician Medical Practitioner	None	1093555773	0	0	KHWAJA, FAZILA PA-C	9/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8191 TIMBERLAKE WAY	SUITE 400	SACRAMENTO	CA	95823	5418	00	06000	38.460222	-121.4131365	Sacramento County
314465	Non-Physician Medical Practitioner	None	1447037452	0	0	KAUR, GURWINDER NP	2/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	00	06000	33.94354395	-117.394926	Riverside County
314502	Non-Physician Medical Practitioner	None	1528655867	0	0	KAGIRI, FELICITY NP	4/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	00	06000	38.65716	-121.1738175	Sacramento County
314504	Non-Physician Medical Practitioner	None	1558029827	0	0	KOKUBUN, DAVID PA	12/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.85429563	-117.8166478	Orange County
314520	Non-Physician Medical Practitioner	None	1053191841	0	0	KOUE, LAURA M NP	1/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1662 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1816	00	06000	36.99033079	-121.9816507	Santa Cruz County
314530	Non-Physician Medical Practitioner	None	1962716316	0	0	KEAN, JULIE J CNM	1/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 CASA ST	STE 220	SAN LUIS OBISPO	CA	93405	1890	00	06000	35.29359615	-120.6654304	San Luis Obispo County
314550	Non-Physician Medical Practitioner	None	1518609007	0	0	KIM, HEIDI NP	9/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
314580	Non-Physician Medical Practitioner	None	1730413931	0	0	KIRBY, LIORA J	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31532 MENDOCINO CT	None	TEMECULA	CA	92592	2843	00	06000	33.46334946	-117.10919	Riverside County
314677	Non-Physician Medical Practitioner	None	1114329612	0	0	KANTAS, PARIS J NP	5/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
314703	Non-Physician Medical Practitioner	None	1134231004	0	0	KINNEY, JOAN FRANCES	4/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5088 CONDE CT	None	FREMONT	CA	94538	2406	00	06000	37.52347286	-121.9789017	Alameda County
314704	Non-Physician Medical Practitioner	None	1437488160	0	0	KONYN, CATHERINE L NP	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3164 FERNCREEK LANE	None	ESCONDIDO	CA	92027	6743	00	06000	33.11478765	-117.00386	San Diego County
314712	Non-Physician Medical Practitioner	None	1326774993	0	0	KIGERL, CHELSEA M PA	1/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	00	06000	34.13805177	-117.4457839	San Bernardino County
314724	Non-Physician Medical Practitioner	None	1437748191	0	0	KIMBERLEY-BRYANT, MAXWELL PA-C	7/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	00	06000	37.84779018	-122.2868874	Alameda County
314763	Non-Physician Medical Practitioner	None	1346261005	0	0	KOMATSU, JUDITH NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
314792	Non-Physician Medical Practitioner	None	1699444638	0	0	KNIGHT, LIZA CNM	12/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1423 MAGNOLIA	None	CHICO	CA	95926	3226	00	06000	39.74063551	-121.8499048	Butte County
314810	Non-Physician Medical Practitioner	None	1073664231	0	0	KASTNER, MARY P CNP	7/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	00	06000	37.89859467	-122.0843018	Contra Costa County
314818	Non-Physician Medical Practitioner	None	1497380539	0	0	KURIYAMA, TOMOYO NP	5/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 ATLANTIC AVENUE	None	LONG BEACH	CA	90802	5121	00	06000	33.7685184	-118.1850803	Los Angeles County
314820	Non-Physician Medical Practitioner	None	1144797895	0	0	KOMIYA, ASAKO NP	6/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4150 REGENTS PARK ROW	STE 355	LA JOLLA	CA	92037	9102	00	06000	32.87272099	-117.2175656	San Diego County
314827	Non-Physician Medical Practitioner	None	1578849816	0	0	KAN, AARON	11/22/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6 DEAUVILE	None	IRVINE	CA	92606	0829	00	06000	33.69221273	-117.800863	Orange County
314839	Non-Physician Medical Practitioner	None	1063928711	0	0	KNOWLES, ERICA L NP	1/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2281 VIA MADEROS	None	LOS ALTOS	CA	94024	7113	00	06000	37.33578536	-122.079031	Santa Clara County
314866	Non-Physician Medical Practitioner	None	1134431158	0	0	KATY, AMANDA S PA-C	8/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8260 MIRA MESA BLVD	SUITE A	SAN DIEGO	CA	92126	2662	00	06000	32.91277002	-117.1459433	San Diego County
314914	Non-Physician Medical Practitioner	None	1467591651	0	0	KOORJI, AZMINA	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3012 SUMMIT ST FL 2	None	OAKLAND	CA	94609	3480	00	06000	37.81947101	-122.264516	Alameda County
314934	Non-Physician Medical Practitioner	None	1790461952	0	0	KIM, CAROLINE NP	9/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
314947	Non-Physician Medical Practitioner	None	1699840280	0	0	KWAN, MAY YUEN MAY	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	00	06000	37.55102172	-121.9759026	Alameda County
314957	Non-Physician Medical Practitioner	None	1629381827	0	0	KOPP, ERIN A NP	7/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	412 ETON DRIVE	None	BURBANK	CA	91504	2129	00	06000	34.19704682	-118.3242717	Los Angeles County
314958	Non-Physician Medical Practitioner	None	1376573188	0	0	KEJRIWAL, REEWA NP	12/3/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1320 ARROYO CRES	None	REDLANDS	CA	92373	6508	00	06000	34.02925995	-117.1924828	San Bernardino County
315014	Non-Physician Medical Practitioner	None	1326391368	0	0	KHAN, SHANOOR PA	7/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	00	06000	34.04624254	-118.267606	Los Angeles County
315016	Non-Physician Medical Practitioner	None	1780903997	0	0	KLEIN, SUSAN L CNP	4/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
315018	Non-Physician Medical Practitioner	None	1710902572	0	0	KENNEDY, HEATHER M	10/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	653 POLO WOODS DR	None	CINCINNATI	OH	45244	5014	00	06000	39.14607096	-84.2770747	Clermont County
315047	Non-Physician Medical Practitioner	None	1104013127	0	0	KIRYA, SARAH N	10/29/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5545 MULBERRY WAY	None	YORBA LINDA	CA	92887	5820	00	06000	33.87875164	-117.7051334	Orange County
315112	Non-Physician Medical Practitioner	None	1366758153	0	0	KAPLAN, KEESHA PAMELA	3/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2080 E. CALVADA BLVD.	STE. 500	PAHRUMP	NV	89048	6578	00	06000	36.19356838	-115.9768852	Nye County
315113	Non-Physician Medical Practitioner	None	1073346557	0	0	KIM, KYUNG Y NP	10/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 N ROBERTSON BLVD	206	BEVERLY HILLS	CA	90211	2142	00	06000	34.06812722	-118.3837146	Los Angeles County
315142	Non-Physician Medical Practitioner	None	1497829998	0	0	KELLY, MEGHAN ANNE	4/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 HOSPITAL PKWY	SUITE 310	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
315153	Non-Physician Medical Practitioner	None	1780952960	0	0	KOROLEVA, EKATERINA	5/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1400 HUBBELL PLACE	APT 1209	SEATTLE	WA	98101	1976	00	06000	47.61221883	-122.3300155	King County
315192	Non-Physician Medical Practitioner	None	1386136513	0	0	KWOK, JIE Z PA	10/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1526 N EDGEMONT STREET	None	LOS ANGELES	CA	90027	5260	00	06000	34.098921	-118.2961105	Los Angeles County
315194	Non-Physician Medical Practitioner	None	1992141840	0	0	KEM, SOKKUNTHAIR	8/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	439 HARRIET LANE	None	WEST SACRAMENTO	CA	95605	2324	00	06000	38.58641834	-121.5136581	Yolo County
315201	Non-Physician Medical Practitioner	None	1376881227	0	0	KOSTYUKEVICH, VITALIY	3/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7932 GOLDEN RING WAY	None	ANTELOPE	CA	95834	6124	00	06000	38.710791	-121.366971	Sacramento County
315217	Non-Physician Medical Practitioner	None	1225605025	0	0	KAMAKIA, DENNIS NP	12/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11149 CRENSHAW BLVD	None	INGLEWOOD	CA	90303	2338	00	06000	33.933465	-118.3265975	Los Angeles County
315233	Non-Physician Medical Practitioner	None	1609173442	0	0	KATZMAN, ARAM C	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 PINE LANE	None	SAN RAFAEL	CA	94903	2336	00	06000	38.01621112	-122.5643392	Marin County
315250	Non-Physician Medical Practitioner	None	1407904766	0	0	KUROWSKI, MATTHEW	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
315251	Non-Physician Medical Practitioner	None	1841646627	0	0	KITSON, RACHEL E	8/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	00	06000	37.688107	-121.8861427	Alameda County
315255	Non-Physician Medical Practitioner	None	1043544778	0	0	KEANE, MATTHEW G	9/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2155 E BELLAMY RD	None	PALM SPRINGS	CA	92262	2522	00	06000	33.85509949	-116.523135	Riverside County
315256	Non-Physician Medical Practitioner	None	1881212397	0	0	KANG, VESHUDHA PA	1/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	00	06000	36.80840238	-119.8594473	Fresno County
315270	Non-Physician Medical Practitioner	None	1215585278	0	0	KAMBOJ, AMRITA S PA-C	3/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
315280	Non-Physician Medical Practitioner	None	1629608906	0	0	KAHAUSEGOVIA, JENNIFER M NP	6/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 S FAIR OAKS AVE	405	PASADENA	CA	91105	2562	00	06000	34.140348	-118.1504565	Los Angeles County
315315	Non-Physician Medical Practitioner	None	1043524077	0	0	KALMYKOW, BRIANNA C NP	8/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3401 WINFIN WAY	None	CARMICHAEL	CA	95608	3135	00	06000	38.626389	-121.3490025	Sacramento County
315351	Non-Physician Medical Practitioner	None	1447831110	0	0	KUTTLER, ERIC J NP	7/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2576 RENFREW ST	None	EUREKA	CA	95501	3345	00	06000	40.78539559	-124.1387085	Humboldt County
315410	Non-Physician Medical Practitioner	None	1649408329	0	0	KIM, CHRISTINA YIYOUNG	9/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
315421	Non-Physician Medical Practitioner	None	1699872796	0	0	KILBORN, DEBORA C NP	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3320 ROSADA COURT	None	PLEASANTON	CA	94588	7700	00	06000	37.68791469	-121.8849454	Alameda County
315485	Non-Physician Medical Practitioner	None	1679057905	0	0	KARINGADA, CASSANDRA M NP	2/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5353 G STREET	None	CHINO	CA	91710	5249	00	06000	34.00987149	-117.6880905	San Bernardino County
315573	Non-Physician Medical Practitioner	None	1558542449	0	0	KAUFMANN, RONALD THOMAS	11/6/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4477 W 118TH ST	SUITE #303	HAWTHORNE	CA	90250	2255	00	06000	33.92734752	-118.354221	Los Angeles County
315597	Non-Physician Medical Practitioner	None	1831509124	0	0	KAHEN, NEGIN R	9/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5140 WHITE OAK AVE	108	ENCINO	CA	91316	2434	00	06000	34.163874	-118.518501	Los Angeles County
315611	Non-Physician Medical Practitioner	None	1558495895	0	0	KREPPS-HOFFER, CYNDY RN	8/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28051 SHEFFIELD	None	MISSION VIEJO	CA	92692	2808	00	06000	33.60139131	-117.640618	Orange County
315613	Non-Physician Medical Practitioner	None	1699737676	0	0	KENT, MELISSA S PA-C	6/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3075 HEALTH CENTER DR	STE 102	SAN DIEGO	CA	92123	2773	00	06000	32.79963065	-117.1556197	San Diego County
315619	Non-Physician Medical Practitioner	None	1205425972	0	0	KIM, LINDSEY NP	5/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	00	06000	33.95062799	-118.0051627	Los Angeles County
315646	Non-Physician Medical Practitioner	None	1558854984	0	0	KENNER, KATI L PA-C	5/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
315675	Non-Physician Medical Practitioner	None	1033586896	0	0	KINKADE, LAURA NP	2/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
315711	Non-Physician Medical Practitioner	None	1841768108	0	0	KULLAR, TAJINDER K NP	6/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 JAN	STE 150	CHICO	CA	95928	4418	00	06000	39.71826923	-121.7919151	Butte County
315738	Non-Physician Medical Practitioner	None	1205180981	0	0	KIM, CHRISTINA C	11/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1518 ORCHARD HILL LN	None	HACIENDA HEIGHTS	CA	91745	3839	00	06000	33.99523977	-117.9367602	Los Angeles County
315747	Non-Physician Medical Practitioner	None	1295188464	0	0	KIM, HYOMIN NP	4/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7615 EASTERN AVE	None	BELL GARDENS	CA	90201	4509	00	06000	33.96380674	-118.1653991	Los Angeles County
315763	Non-Physician Medical Practitioner	None	1871529891	0	0	KHAN, YASMEEN	9/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2740 ANDREO AVENUE	UNIT A	TORRANCE	CA	90501	7631	00	06000	33.82021743	-118.3169075	Los Angeles County
315818	Non-Physician Medical Practitioner	None	1235533134	0	0	KEMP, EDWARD N	6/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3398 BRAEMAR LANE	None	CORONA	CA	92882	8671	00	06000	33.88054825	-117.6330941	Riverside County
315829	Non-Physician Medical Practitioner	None	1629627864	0	0	KELLER, ELIZABETH G PA-C	7/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	00	06000	34.06736471	-118.3763201	Los Angeles County
315830	Non-Physician Medical Practitioner	None	1801349774	0	0	KOTLER, LISA M PA-C	12/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3330 LOMITA	None	TORRANCE	CA	90505	5002	00	06000	33.81253631	-118.3435557	Los Angeles County
315843	Non-Physician Medical Practitioner	None	1447967682	0	0	KIM, DAVID NP	6/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
315910	Non-Physician Medical Practitioner	None	1124562939	0	0	KIRUUTA, PAUL NP	7/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
315919	Non-Physician Medical Practitioner	None	1518106533	0	0	KRAMER, LEILA ANN	8/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE.	None	SANTA CRUZ	CA	95065	1794	00	06000	36.98191238	-121.9975767	Santa Cruz County
315993	Non-Physician Medical Practitioner	None	1629552815	0	0	KENT, LEANNE F PA-C	12/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6160 LAUREL CANYON BLVD	STE 160	NORTH HOLLYWOOD	CA	91606	3287	00	06000	34.18258805	-118.3964946	Los Angeles County
316001	Non-Physician Medical Practitioner	None	1265975148	0	0	KLITH, DAISY A	3/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 1043	None	GEORGETOWN	CA	95634	1043	00	06000	0	0	None
316004	Non-Physician Medical Practitioner	None	1346937810	0	0	KIRBY, KALEIGH-JO T	2/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	06000	34.480224	-114.3390555	Mohave County
316023	Non-Physician Medical Practitioner	None	1033519392	0	0	KIDDER, JOELLE M	10/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1415 N SUNRISE WAY	UNIT 53	PALM SPRINGS	CA	92262	5380	00	06000	33.84154912	-116.5282068	Riverside County
316089	Ordering, Referring, Prescribing	N/A	1003080243	0	0	KELLETI, ARUNASRI MD	10/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99796	N/A	N/A	N/A	N/A	N/A	1642 E. CAPITOL EXPRESSW	None	SAN JOSE	CA	95121	5212	00	06000	37.3061289	-121.8119182	Santa Clara County
316097	Ordering, Referring, Prescribing	N/A	1003110396	0	0	KNIGHT, MARGARET S LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87278	N/A	N/A	N/A	N/A	N/A	3020 CHILDRENS WAY	MC 5016	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
316110	Ordering, Referring, Prescribing	N/A	1003127275	0	0	KUM, SEON B MD	8/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143156	N/A	N/A	N/A	N/A	N/A	1529 E PALMDALE BLVD	150	PALMDALE	CA	93550	2034	00	06000	34.57966052	-118.102275	Los Angeles County
316151	Ordering, Referring, Prescribing	N/A	1003183765	0	0	KNEDGEN, CHARLENE A	1/27/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0031455	N/A	N/A	N/A	N/A	N/A	1201 N STEWART STREET	SUITE 120	CARSON CITY	NV	89706	3004	00	06000	39.171627	-119.7637965	Consolidated Municipality of Carson City
316162	Ordering, Referring, Prescribing	N/A	1003195348	0	0	KOH, SEAN PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61526	N/A	N/A	N/A	N/A	N/A	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.8531521	-117.8160824	Orange County
316291	Ordering, Referring, Prescribing	N/A	1003369141	0	0	KINDEL, LAURIE LCSW	9/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96887	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
316314	Ordering, Referring, Prescribing	N/A	1003401399	0	0	KNUTSON, HALEY A NP	2/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016604	N/A	N/A	N/A	N/A	N/A	2237 W. BALL RD.	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
316327	Ordering, Referring, Prescribing	N/A	1003424409	0	0	KIM, NICHOLAS F PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71954	N/A	N/A	N/A	N/A	N/A	260 EL CAMINO REAL	None	BURLINGAME	CA	94010	5120	00	06000	37.5763288	-122.3496381	San Mateo County
316352	Ordering, Referring, Prescribing	N/A	1003454802	0	0	KIM, CHANKYO PHARMD	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81250	N/A	N/A	N/A	N/A	N/A	13045 ROSEDALE HWY	None	BAKERSFIELD	CA	93314	9496	00	06000	35.38346424	-119.1464256	Kern County
316398	Ordering, Referring, Prescribing	N/A	1003565987	0	0	KORWAR, SUCHETA P MD	8/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188621	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
316402	Ordering, Referring, Prescribing	N/A	1003576216	0	0	KIM, JONAS PHARMD	11/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH40260	N/A	N/A	N/A	N/A	N/A	10230 ARTESIA AVE,	STE 101	BELLFLOWER	CA	90706	6768	00	06000	33.8728276	-118.1160403	Los Angeles County
316425	Ordering, Referring, Prescribing	N/A	1003845702	0	0	KAPETANOVIC, SUAD MD	7/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85682	N/A	N/A	N/A	N/A	N/A	8627 JUNIPER ST	None	LOS ANGELES	CA	90002	1539	00	06000	33.95900918	-118.2329116	Los Angeles County
316447	Ordering, Referring, Prescribing	N/A	1003934423	0	0	KUMAR, SHRIBALA MD	2/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67888	N/A	N/A	N/A	N/A	N/A	150 W 7TH ST	None	SAN PEDRO	CA	90731	3320	00	06000	33.73786341	-118.2810362	Los Angeles County
316494	Ordering, Referring, Prescribing	N/A	1013016856	0	0	KLEIST, LYNN M MSW LCSW	7/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18691	N/A	N/A	N/A	N/A	N/A	3631 S HARBOR BLVD	STE. 200	SANTA ANA	CA	92704	6951	00	06000	33.6988425	-117.919374	Orange County
316531	Ordering, Referring, Prescribing	N/A	1013091958	0	0	KINSLEY, KELLY A MD	10/24/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G77600	N/A	N/A	N/A	N/A	N/A	4715 VALLEY EAST BLVD	#3	ARCATA	CA	95521	3586	00	06000	40.90112023	-124.0814061	Humboldt County
316572	Ordering, Referring, Prescribing	N/A	1013173608	0	0	KHALILI, SOROUR LMFT	11/6/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT31644	N/A	N/A	N/A	N/A	N/A	1401 W VALENCIA DR	None	FULLERTON	CA	92833	3938	00	06000	33.86655147	-117.9512235	Orange County
316600	Ordering, Referring, Prescribing	N/A	1013215698	0	0	KATYAL, RAHAT	1/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51647	N/A	N/A	N/A	N/A	N/A	3150 FOSTORIA WAY	None	DANVILLE	CA	94526	5553	00	06000	37.78145555	-121.9725562	Contra Costa County
316722	Ordering, Referring, Prescribing	N/A	1013397058	0	0	KELLOGG, KORNELIA R DO	8/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17509	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
316750	Ordering, Referring, Prescribing	N/A	1013446244	0	0	KAHLON, RAMNEEK K NP	10/26/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007860	N/A	N/A	N/A	N/A	N/A	1275 THARP ROAD	None	YUBA CITY	CA	95993	2645	00	06000	39.14572609	-121.6484225	Sutter County
316775	Ordering, Referring, Prescribing	N/A	1013479997	0	0	KIM, GRACE C MD	5/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178510	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
316817	Ordering, Referring, Prescribing	N/A	1013578558	0	0	KIM, LILA Q PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79380	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
316845	Ordering, Referring, Prescribing	N/A	1013751619	0	0	KIM, EUNICE LCSW	9/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117423	N/A	N/A	N/A	N/A	N/A	1120 W LA VETA AVE	660	ORANGE	CA	92868	4464	00	06000	33.78029455	-117.864369	Orange County
316879	Ordering, Referring, Prescribing	N/A	1023064151	0	0	KERSEY, PAMELA L MD	9/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	36580	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
316890	Ordering, Referring, Prescribing	N/A	1023106036	0	0	KWAN, CYNTHIA Y PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54994	N/A	N/A	N/A	N/A	N/A	2547 30TH AVE	None	SAN FRANCISCO	CA	94116	2931	00	06000	37.73977507	-122.487318	San Francisco County
316937	Ordering, Referring, Prescribing	N/A	1023200557	0	0	KIMURA, YURI LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW59615	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
316953	Ordering, Referring, Prescribing	N/A	1023236023	0	0	KINLOCH, JULIA A LCSW	5/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19754	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
316972	Ordering, Referring, Prescribing	N/A	1023283124	0	0	KACHIKWU, EVELYN L MD	4/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94067	N/A	N/A	N/A	N/A	N/A	1345 A PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3159	00	06000	40.43531297	-120.6557201	Lassen County
316974	Ordering, Referring, Prescribing	N/A	1023286325	0	0	KASOW, ZACHARY LMFT	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93749	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
316982	Ordering, Referring, Prescribing	N/A	1023302189	0	0	KIRKLAND, SUZAN C LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91619	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
317015	Ordering, Referring, Prescribing	N/A	1023372059	0	0	KHANGURA, NINA MD	1/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138779	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
317029	Ordering, Referring, Prescribing	N/A	1023396462	0	0	KALIN, MARK J LMFT	10/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110888	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
317036	Ordering, Referring, Prescribing	N/A	1023406238	0	0	KASAI, SARAH OD	10/17/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34226	N/A	N/A	N/A	N/A	N/A	3750 SPORTS ARENA BLVD	STE 9	SAN DIEGO	CA	92110	5133	00	06000	32.75447872	-117.2159625	San Diego County
317042	Ordering, Referring, Prescribing	N/A	1023413390	0	0	KESHESHE, NARIS LMFT	9/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121649	N/A	N/A	N/A	N/A	N/A	237 N CENTRAL AVE	None	GLENDALE	CA	91203	3526	00	06000	34.14943423	-118.2579487	Los Angeles County
317048	Ordering, Referring, Prescribing	N/A	1023420601	0	0	KIMMEL, CHRISTINE PHD	11/3/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30726	N/A	N/A	N/A	N/A	N/A	11650 IBERIA PL	130	SAN DIEGO	CA	92128	2431	00	06000	33.01582056	-117.0780483	San Diego County
317063	Ordering, Referring, Prescribing	N/A	1023441912	0	0	KLEIN, AILEEN LCSW	8/29/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117808	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
317071	Ordering, Referring, Prescribing	N/A	1023457975	0	0	KAUL, ANUBHAV MD	12/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C175892	N/A	N/A	N/A	N/A	N/A	470 NOOR AVE	1057	SOUTH SAN FRANCIS	CA	94080	5957	00	06000	37.64110105	-122.4220074	San Mateo County
317077	Ordering, Referring, Prescribing	N/A	1023459211	0	0	KOLOSKY, MATTHEW DO	5/26/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15989	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
317082	Ordering, Referring, Prescribing	N/A	1023480472	0	0	KNOTT, KIMBERLY LMFT	7/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133796	N/A	N/A	N/A	N/A	N/A	2400 WASHINGTON AVE	None	REDDING	CA	96001	2802	00	06000	40.577499	-122.371478	Shasta County
317091	Ordering, Referring, Prescribing	N/A	1023491214	0	0	KARDOS, DAVID PHARMD	10/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	61779	N/A	N/A	N/A	N/A	N/A	1421 MANHATTAN AVE	None	FULLERTON	CA	92831	5221	00	06000	33.85701	-117.902438	Orange County
317100	Ordering, Referring, Prescribing	N/A	1023504495	0	0	KHAIRA, JASPREET S PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76708	N/A	N/A	N/A	N/A	N/A	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
317104	Ordering, Referring, Prescribing	N/A	1023505534	0	0	KAMAL, SALMAAN MD	10/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178503	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
317108	Ordering, Referring, Prescribing	N/A	1023508991	0	0	KO, DANIEL D PHARMD	10/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	77651	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
317134	Ordering, Referring, Prescribing	N/A	1023559283	0	0	KIMBALL, KERILYN W DO	8/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16745	N/A	N/A	N/A	N/A	N/A	1081 N. CHINA LAKE BLVD.	None	RIDGECREST	CA	93555	3198	00	06000	35.640783	-117.6698475	Kern County
317135	Ordering, Referring, Prescribing	N/A	1023562451	0	0	KAMBOURIAN, CHARLES	1/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73139	N/A	N/A	N/A	N/A	N/A	2100 DR MARTIN LUTHER KI	None	CHICO	CA	95928	4422	00	06000	39.721077	-121.811508	Butte County
317147	Ordering, Referring, Prescribing	N/A	1023577285	0	0	KIM, BORA MD	6/1/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PTL216	N/A	N/A	N/A	N/A	N/A	401 PARNASSUS AVE.	None	SAN FRANCISCO	CA	94143	2212	00	06000	37.76376114	-122.4567626	San Francisco County
317197	Ordering, Referring, Prescribing	N/A	1023679537	0	0	KHATUN, MST NURJAHAN MD	4/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177424	N/A	N/A	N/A	N/A	N/A	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
317263	Ordering, Referring, Prescribing	N/A	1033161740	0	0	KISTLER, JONATHAN MD	11/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73938	N/A	N/A	N/A	N/A	N/A	2101 GEER RD	120	TURLOCK	CA	95382	2454	00	06000	37.512324	-120.8489985	Stanislaus County
317280	Ordering, Referring, Prescribing	N/A	1033234380	0	0	KOLTS, ROSA MARIA LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34154	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD.	A	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
317303	Ordering, Referring, Prescribing	N/A	1033267240	0	0	KAMIAK, SANDRA N MD	3/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G37877	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
317311	Ordering, Referring, Prescribing	N/A	1033271747	0	0	KANE, JOSHUA S MD	2/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102594	N/A	N/A	N/A	N/A	N/A	720 WOOD ST.	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
317317	Ordering, Referring, Prescribing	N/A	1033289186	0	0	KING, MAIKO S LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111211	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
317319	Ordering, Referring, Prescribing	N/A	1033291950	0	0	KOPELOWICZ, ALEX MD	11/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G66500	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	9998	00	06000	34.32450186	-118.4456317	Los Angeles County
317322	Ordering, Referring, Prescribing	N/A	1033295548	0	0	KHAN, YASMIN F MD	6/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70089	N/A	N/A	N/A	N/A	N/A	1887 MONTEREY ROAD	205	SAN JOSE	CA	95112	6192	00	06000	37.308636	-121.8664102	Santa Clara County
317427	Ordering, Referring, Prescribing	N/A	1033475280	0	0	KESSINGER, CONNIE LMFT	6/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44432	N/A	N/A	N/A	N/A	N/A	6800 OWENSMOUTH AVE	160	CANOGA PARK	CA	91303	3159	00	06000	34.194276	-118.6014945	Los Angeles County
317429	Ordering, Referring, Prescribing	N/A	1033471511	0	0	KONG, FRANCES LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96676	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR.	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
317441	Ordering, Referring, Prescribing	N/A	1033488457	0	0	KARIM, HARUMI S PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67145	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
317442	Ordering, Referring, Prescribing	N/A	1033491089	0	0	KIM, PETER PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51670	N/A	N/A	N/A	N/A	N/A	1916	WEBSTER ST	ALAMEDA	CA	94501	1055	00	06000	0	0	None
317445	Ordering, Referring, Prescribing	N/A	1033496062	0	0	KAO, DEBBIE Y PHARMD	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52024	N/A	N/A	N/A	N/A	N/A	4050 SUNRISE BLVD	None	RANCHO CORDOVA	CA	95742	6907	00	06000	38.555946	-121.2435855	Sacramento County
317470	Ordering, Referring, Prescribing	N/A	1033519392	0	0	KIDDER, JOELLE M PA	10/8/2017	Taxonomy not applicable	NA	n/a	000	Unknown	51882	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
317472	Ordering, Referring, Prescribing	N/A	1033515671	0	0	KO, VINCENT PHARMD	9/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	71914	N/A	N/A	N/A	N/A	N/A	1335 WEBSTER ST	None	SAN FRANCISCO	CA	94115	4277	00	06000	37.78279538	-122.4309399	San Francisco County
317520	Ordering, Referring, Prescribing	N/A	1033597885	0	0	KHEDER, KEVIN MD	2/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150282	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
317527	Ordering, Referring, Prescribing	N/A	1033618509	0	0	KIM, HONGGYUN NP	5/13/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008286	N/A	N/A	N/A	N/A	N/A	5300 SANTA MONICA BLVD	None	LOS ANGELES	CA	90029	1131	00	06000	34.09075271	-118.305509	Los Angeles County
317566	Ordering, Referring, Prescribing	N/A	1033674817	0	0	KIM, YEON H	5/1/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103518	N/A	N/A	N/A	N/A	N/A	1125 E CALIFORNIA AVE	None	BAKERSFIELD	CA	93307	1201	00	06000	35.3683725	-118.9882125	Kern County
317567	Ordering, Referring, Prescribing	N/A	1033674213	0	0	KATZ, SARAH LCSW	6/16/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108537	N/A	N/A	N/A	N/A	N/A	1300 S GRAND AVE	BLDG. C #213W	SANTA ANA	CA	92705	4484	00	06000	33.73222238	-117.8504455	Orange County
317570	Ordering, Referring, Prescribing	N/A	1033676820	0	0	KING, SARAH A LMFT	1/16/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139840	N/A	N/A	N/A	N/A	N/A	36218 TOULON PL	None	NEWARK	CA	94560	2347	00	06000	37.53846392	-122.0438463	Alameda County
317598	Ordering, Referring, Prescribing	N/A	1033704184	0	0	KIM, GRACE H PHARMD	7/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77164	N/A	N/A	N/A	N/A	N/A	928 S WESTERN AVE	110	LOS ANGELES	CA	90006	1009	00	06000	34.055145	-118.3090505	Los Angeles County
317641	Ordering, Referring, Prescribing	N/A	1033854534	0	0	KENCHEY, HIMAJA MD	3/11/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A201647	N/A	N/A	N/A	N/A	N/A	200 COTTAGE AVE	103	MANTECA	CA	95336	4935	00	06000	37.79956104	-121.1982472	San Joaquin County
317717	Ordering, Referring, Prescribing	N/A	1043369895	0	0	KIM, ANDREW Y	10/5/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D54867	N/A	N/A	N/A	N/A	N/A	7275 E SOUTHGATE DRIVE	SUITE 204206	SACRAMENTO	CA	95823	2628	00	06000	38.493576	-121.436559	Sacramento County
317719	Ordering, Referring, Prescribing	N/A	1043374028	0	0	KY, PAUL K DO	5/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10743	N/A	N/A	N/A	N/A	N/A	6169 N THESTA	None	FRESNO	CA	93710	5266	00	06000	36.82583257	-119.7831277	Fresno County
317720	Ordering, Referring, Prescribing	N/A	1043376601	0	0	KIM, KIRSTIN L PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49107	N/A	N/A	N/A	N/A	N/A	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	00	06000	37.54350476	-122.2913782	San Mateo County
317732	Ordering, Referring, Prescribing	N/A	1043400302	0	0	KHAN, MOHAMMED RAHEEMUDDIN MD	6/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A51273	N/A	N/A	N/A	N/A	N/A	450 E SAN JACINTO AVE	100	PERRIS	CA	92571	2833	00	06000	33.78662816	-117.2164923	Riverside County
317798	Ordering, Referring, Prescribing	N/A	1043539810	0	0	KAZI, ASMA M MD FACP	3/24/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112332	N/A	N/A	N/A	N/A	N/A	72757 FRED WARING DR	SUITE 8	PALM DESERT	CA	92260	9341	00	06000	33.72857196	-116.3953539	Riverside County
317815	Ordering, Referring, Prescribing	N/A	1043575723	0	0	KASKA, BENJAMIN C PA-C	1/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA22317	N/A	N/A	N/A	N/A	N/A	3800 KILROY AIRPORT WAY	SUITE 100	LONG BEACH	CA	90806	2452	00	06000	33.80725242	-118.14497	Los Angeles County
317830	Ordering, Referring, Prescribing	N/A	1043598212	0	0	KASPER, CLARE M MD	10/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124703	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
317838	Ordering, Referring, Prescribing	N/A	1043602857	0	0	KIAMCO, KATHREEN D CNP	3/13/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	722724	N/A	N/A	N/A	N/A	N/A	2801 S. SAN PEDRO ST.	None	LOS ANGELES	CA	90011	2023	00	06000	34.01966657	-118.2625434	Los Angeles County
317866	Ordering, Referring, Prescribing	N/A	1043654056	0	0	KAISER, STEPHANIE C	8/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT94554	N/A	N/A	N/A	N/A	N/A	360 NEVADA ST	None	AUBURN	CA	95603	3721	00	06000	38.9065593	-121.0824284	Placer County
317891	Ordering, Referring, Prescribing	N/A	1043691066	0	0	KRUMLAND, STEPHEN MD	7/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162137	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
317902	Ordering, Referring, Prescribing	N/A	1043704190	0	0	KHAN, RIFFAT	12/5/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004306	N/A	N/A	N/A	N/A	N/A	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	00	06000	34.22073847	-118.532988	Los Angeles County
317903	Ordering, Referring, Prescribing	N/A	1043706096	0	0	KUMANCHIK, DANIELLE R LMFT	10/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135053	N/A	N/A	N/A	N/A	N/A	200 E DEL MAR BLVD	SUITE 160	PASADENA	CA	91105	2544	00	06000	34.14047497	-118.1464685	Los Angeles County
317992	Ordering, Referring, Prescribing	N/A	1043846033	0	0	KOH, ALLYSON H	1/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	4672	N/A	N/A	N/A	N/A	N/A	1201 W LA VETA AVE	525	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
318003	Ordering, Referring, Prescribing	N/A	1043864739	0	0	KLISE, DANIELLE H PHARMD	1/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83853	N/A	N/A	N/A	N/A	N/A	1018 CASITAS PASS RD	None	CARPINTERIA	CA	93013	0000	00	06000	34.395972	-119.5130879	Santa Barbara County
318066	Ordering, Referring, Prescribing	N/A	1053088849	0	0	KIM, MIN H NP	5/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017412	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
318073	Ordering, Referring, Prescribing	N/A	1053127571	0	0	KAUR, JATINDER NP	7/16/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031143	N/A	N/A	N/A	N/A	N/A	315 E 13TH STRRET	None	MERCED	CA	95341	6211	00	06000	37.29248035	-120.4730619	Merced County
318088	Ordering, Referring, Prescribing	N/A	1053303883	0	0	KUHLMAN, PAULA MD	8/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78549	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
318106	Ordering, Referring, Prescribing	N/A	1053374074	0	0	KINCEL, KATHRYN M PA-C	8/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	15892	N/A	N/A	N/A	N/A	N/A	43658 STATE HIGHWAY 299	None	FALL RIVER MILLS	CA	96028	9819	00	06000	41.02828938	-121.4208217	Shasta County
318133	Ordering, Referring, Prescribing	N/A	1053458166	0	0	KANG, XIN MD	11/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88134	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
318158	Ordering, Referring, Prescribing	N/A	1053489724	0	0	KLEYMAN, ELLA	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49577	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
318171	Ordering, Referring, Prescribing	N/A	1053517490	0	0	KHAN, UZMA A MD	2/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100026	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS,	SUITE 20	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
318179	Ordering, Referring, Prescribing	N/A	1053521138	0	0	KATO, YUKA LMFT	12/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47312	N/A	N/A	N/A	N/A	N/A	231 E. THIRD ST.	G106	LOS ANGELES	CA	90013	1493	00	06000	34.04804033	-118.2438699	Los Angeles County
318203	Ordering, Referring, Prescribing	N/A	1053565713	0	0	KELLEY, FELICIA P LCSW	12/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW112644	N/A	N/A	N/A	N/A	N/A	4590 ALLSTATE DR	None	RIVERSIDE	CA	92501	1702	00	06000	34.00399445	-117.3768474	Riverside County
318210	Ordering, Referring, Prescribing	N/A	1053575142	0	0	KAZMI, SYED HARIS ZAMIR MD	6/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C160185	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
318220	Ordering, Referring, Prescribing	N/A	1053604058	0	0	KOROI, DIANA V	5/17/2021	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM303	N/A	N/A	N/A	N/A	N/A	1570 SOQUEL DR	3	SANTA CRUZ	CA	95065	1707	00	06000	36.98832521	-121.9837966	Santa Cruz County
318232	Ordering, Referring, Prescribing	N/A	1053626549	0	0	KAUR, HARPREET MD	11/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139481	N/A	N/A	N/A	N/A	N/A	2561 CALIFORNIA PARK DR	300	CHICO	CA	95928	4208	00	06000	39.749274	-121.792491	Butte County
318253	Ordering, Referring, Prescribing	N/A	1053666032	0	0	KIKUCHI, CRAIG L PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	52218	N/A	N/A	N/A	N/A	N/A	1700 S BRADLEY RD	None	SANTA MARIA	CA	93454	8001	00	06000	34.92801184	-120.4200671	Santa Barbara County
318264	Ordering, Referring, Prescribing	N/A	1053677161	0	0	KING, BRYAN LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78812	N/A	N/A	N/A	N/A	N/A	919 1ST ST	None	SAN FERNANDO	CA	91340	2957	00	06000	34.28328995	-118.4389224	Los Angeles County
318269	Ordering, Referring, Prescribing	N/A	1053686204	0	0	KUO, GARY R MD	11/10/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126766	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
318289	Ordering, Referring, Prescribing	N/A	1053714428	0	0	KENNEDY, CHRISTINE PHARMD	6/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74707	N/A	N/A	N/A	N/A	N/A	9750 WOODMAN AVE	None	ARLETA	CA	91331	6422	00	06000	34.24797121	-118.448713	Los Angeles County
318322	Ordering, Referring, Prescribing	N/A	1053752865	0	0	KRISON, KATHARINA LCSW	1/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120406	N/A	N/A	N/A	N/A	N/A	1051 PICADOR BLVD	None	SAN DIEGO	CA	92154	3548	00	06000	32.57614401	-117.0562098	San Diego County
318323	Ordering, Referring, Prescribing	N/A	1053756080	0	0	KAUR, MANPREET LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109435	N/A	N/A	N/A	N/A	N/A	6833 STOCKTON BLVD	SUITE # 485	SACRAMENTO	CA	95823	2501	00	06000	38.502684	-121.430124	Sacramento County
318333	Ordering, Referring, Prescribing	N/A	1053764662	0	0	KENNEDY, VINCENT DO	3/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18751	N/A	N/A	N/A	N/A	N/A	2100 NAPA-VALLEJO HWY	None	NAPA	CA	94558	6234	00	06000	38.277846	-122.2678305	Napa County
318348	Ordering, Referring, Prescribing	N/A	1053780189	0	0	KADAKIA, SALONI P DO	12/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	20A16992	N/A	N/A	N/A	N/A	N/A	4327 GOLDEN CENTER DRIVE	None	PLACERVILLE	CA	95667	9566	00	06000	38.70662835	-120.8276613	El Dorado County
318352	Ordering, Referring, Prescribing	N/A	1053781229	0	0	KLEIN, JENIFER B LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83486	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	200	LOS ANGELES	CA	90018	1353	00	06000	34.037415	-118.3176815	Los Angeles County
318413	Ordering, Referring, Prescribing	N/A	1053880864	0	0	KARWACKI, ANDRZEJ M LMFT	8/6/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT92504	N/A	N/A	N/A	N/A	N/A	828 SAN PABLO AVENUE	SUITE 120B	ALBANY	CA	94706	1567	00	06000	37.89159884	-122.2994097	Alameda County
318447	Ordering, Referring, Prescribing	N/A	1053971770	0	0	KIM, MEGAN M MD	7/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180712	N/A	N/A	N/A	N/A	N/A	3800 W CHAPMAN AVE	SUITE 500	ORANGE	CA	92868	1638	00	06000	33.78885849	-117.8950802	Orange County
318483	Ordering, Referring, Prescribing	N/A	1063056679	0	0	KASSOWITZ, AMY LCSW	6/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108460	N/A	N/A	N/A	N/A	N/A	5350 MACHADO RD.	None	CULVER CITY	CA	90230	8800	00	06000	33.99781622	-118.3966503	Los Angeles County
318545	Ordering, Referring, Prescribing	N/A	1063476307	0	0	KIDO, REX Y	3/20/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D33601	N/A	N/A	N/A	N/A	N/A	500 TULLY RD	CHABOYA DENTAL CLINIC	SAN JOSE	CA	95111	1917	00	06000	37.30579894	-121.8506333	Santa Clara County
318564	Ordering, Referring, Prescribing	N/A	1063520062	0	0	KHAN, MOHAMMAD S MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C137433	N/A	N/A	N/A	N/A	N/A	1142 ROSE AVE	STE B	SELMA	CA	93662	3251	00	06000	36.56886527	-119.5983853	Fresno County
318568	Ordering, Referring, Prescribing	N/A	1063530400	0	0	KHAN-AMRIKANI, SHEREEN A	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90678	N/A	N/A	N/A	N/A	N/A	200 24TH STREET	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
318574	Ordering, Referring, Prescribing	N/A	1063530806	0	0	KIM, CAREY A LCSW	8/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26886	N/A	N/A	N/A	N/A	N/A	529 S. MAPLE AVE	None	LOS ANGELES	CA	90013	1511	00	06000	34.04465262	-118.2472846	Los Angeles County
318591	Ordering, Referring, Prescribing	N/A	1063551356	0	0	KARP, CLAIRE L LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT30651	N/A	N/A	N/A	N/A	N/A	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
318595	Ordering, Referring, Prescribing	N/A	1063551398	0	0	KROGH, LINDSEY B LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22469	N/A	N/A	N/A	N/A	N/A	21081 S. WESTERN AVE.	SUITE 295	TORRANCE	CA	90501	1707	00	06000	33.83886841	-118.3093605	Los Angeles County
318679	Ordering, Referring, Prescribing	N/A	1063712115	0	0	KRESEL, WILLIAM	3/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	41630	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
318721	Ordering, Referring, Prescribing	N/A	1063781003	0	0	KUMNERDPUN, WIWON PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63520	N/A	N/A	N/A	N/A	N/A	825 MARKET ST	None	SAN FRANCISCO	CA	94103	1901	00	06000	37.78516779	-122.4065094	San Francisco County
318737	Ordering, Referring, Prescribing	N/A	1063796233	0	0	KOIZUMI, STUART PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH53507	N/A	N/A	N/A	N/A	N/A	8900 WASHINGTON BLVD	None	PICO RIVERA	CA	90660	0000	00	06000	33.98348209	-118.0976934	Los Angeles County
318741	Ordering, Referring, Prescribing	N/A	1063802437	0	0	KAO, TRUDY NP	5/4/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001819	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
318782	Ordering, Referring, Prescribing	N/A	1063849123	0	0	KLEMM, ALDEN R PHARMD	4/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	66704	N/A	N/A	N/A	N/A	N/A	1540 FROOM RANCH WAY	None	SAN LUIS OBISPO	CA	93405	7211	00	06000	35.25089426	-120.6906169	San Luis Obispo County
318800	Ordering, Referring, Prescribing	N/A	1063882504	0	0	KAZIM, AMIR E	2/7/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	100077	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
318818	Ordering, Referring, Prescribing	N/A	1063898831	0	0	KUMAR, SAIRAM	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155499	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
318874	Ordering, Referring, Prescribing	N/A	1063991495	0	0	KNAPP, AMANDA J LCSW	5/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101595	N/A	N/A	N/A	N/A	N/A	3725 TAYLOR RD	1	LOOMIS	CA	95650	9283	00	06000	38.81963826	-121.1950015	Placer County
318906	Ordering, Referring, Prescribing	N/A	1073041927	0	0	KAUR, AMANDEEP LMFT	4/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139250	N/A	N/A	N/A	N/A	N/A	1020 W MAIN ST	None	MERCED	CA	95340	4521	00	06000	37.30432864	-120.49132	Merced County
318939	Ordering, Referring, Prescribing	N/A	1073094587	0	0	KIM, SUE S PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77548	N/A	N/A	N/A	N/A	N/A	2395 E LACEY BLVD	None	HANFORD	CA	93230	4740	00	06000	36.325962	-119.606697	Kings County
318980	Ordering, Referring, Prescribing	N/A	1073179529	0	0	KAKAIYA, ROSHNI DO	4/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19485	N/A	N/A	N/A	N/A	N/A	678 THIRD AVE	None	CHULA VISTA	CA	91910	5736	00	06000	32.62870793	-117.0750108	San Diego County
319009	Ordering, Referring, Prescribing	N/A	1073367066	0	0	KULON, MELISSA MD	8/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL16139	N/A	N/A	N/A	N/A	N/A	1000 WEST CARSON STREET	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
319018	Ordering, Referring, Prescribing	N/A	1073513149	0	0	KIM, DEAN D	3/18/2005	Taxonomy not applicable	NA	n/a	099	DENTIST	D45276	N/A	N/A	N/A	N/A	N/A	250 E ANTELOPE AVE	SUITE D	WOODLAKE	CA	93286	1565	00	06000	36.41561341	-119.0969743	Tulare County
319022	Ordering, Referring, Prescribing	N/A	1073540621	0	0	KIM, SAM YONG H	6/3/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D46396	N/A	N/A	N/A	N/A	N/A	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	00	06000	39.02117456	-122.0619172	Colusa County
319049	Ordering, Referring, Prescribing	N/A	1073645453	0	0	KUSHEL, ROY MD	1/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G31518	N/A	N/A	N/A	N/A	N/A	181 N OAK KNOLL AVE	None	PASADENA	CA	91101	4170	00	06000	34.14910036	-118.1353879	Los Angeles County
319050	Ordering, Referring, Prescribing	N/A	1073644878	0	0	KJELDGAARD, THERESA A LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39308	N/A	N/A	N/A	N/A	N/A	14535 SHERMAN CIRCLE	None	VAN NUYS	CA	91405	3087	00	06000	34.20064259	-118.450312	Los Angeles County
319062	Ordering, Referring, Prescribing	N/A	1073677456	0	0	KAO, BENJAMIN LCSW	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22210	N/A	N/A	N/A	N/A	N/A	4000 GEARY BLVD	201	SAN FRANCISCO	CA	94118	3119	00	06000	37.78121135	-122.4623304	San Francisco County
319077	Ordering, Referring, Prescribing	N/A	1073706966	0	0	KERHULAS, IKE LMFT	8/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT20162	N/A	N/A	N/A	N/A	N/A	5425 SIERRA VISTA AVE	None	RIVERSIDE	CA	92505	3113	00	06000	33.92652824	-117.5056425	Riverside County
319156	Ordering, Referring, Prescribing	N/A	1073891420	0	0	KILPATRICK, ERIN C LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90864	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	None	SAN PABLO	CA	94806	0000	00	06000	37.95651393	-122.3371491	Contra Costa County
319240	Ordering, Referring, Prescribing	N/A	1083022164	0	0	KAHN, JONATHAN A	7/26/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D63745	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	None	LONG BEACH	CA	90813	3271	00	06000	33.779655	-118.1880065	Los Angeles County
319259	Ordering, Referring, Prescribing	N/A	1083031322	0	0	KOBLENZ, ERIC LMFT	2/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93172	N/A	N/A	N/A	N/A	N/A	1442A WALNUT ST	#321	BERKELEY	CA	94709	1405	00	06000	37.88073128	-122.2682363	Alameda County
319263	Ordering, Referring, Prescribing	N/A	1083040679	0	0	KESLER, BRITTANY M LCSW	1/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79520	N/A	N/A	N/A	N/A	N/A	1360 E LASSEN AVE	None	CHICO	CA	95973	7823	00	06000	39.77359746	-121.8420053	Butte County
319270	Ordering, Referring, Prescribing	N/A	1083050967	0	0	KOENIG, JESSICA A MD	9/18/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149210	N/A	N/A	N/A	N/A	N/A	558 CLAYTON ST	None	SAN FRANCISCO	CA	94117	2907	00	06000	37.76993716	-122.4485805	San Francisco County
319276	Ordering, Referring, Prescribing	N/A	1083057525	0	0	KELLY, ISAAC L MD	1/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134284	N/A	N/A	N/A	N/A	N/A	290 N WAYTE LN	None	FRESNO	CA	93701	2124	00	06000	36.74643429	-119.7837416	Fresno County
319279	Ordering, Referring, Prescribing	N/A	1083067623	0	0	KAO, CHHUNAKAR	11/10/2019	Taxonomy not applicable	NA	n/a	000	Unknown	62195	N/A	N/A	N/A	N/A	N/A	3400 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	00	06000	34.02767826	-118.2008037	Los Angeles County
319288	Ordering, Referring, Prescribing	N/A	1083076822	0	0	KOPPINGER, JAYSON MD	12/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154116	N/A	N/A	N/A	N/A	N/A	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	00	06000	39.3245308	-120.2013097	Nevada County
319304	Ordering, Referring, Prescribing	N/A	1083102941	0	0	KIM, HOON S DO MD	9/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19143	N/A	N/A	N/A	N/A	N/A	2710 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2436	00	06000	33.9598587	-118.3237499	Los Angeles County
319317	Ordering, Referring, Prescribing	N/A	1083127583	0	0	KUZMICH, MATTHEW A LCSW	7/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95731	N/A	N/A	N/A	N/A	N/A	2090 EVANS LN	None	SAN JOSE	CA	95125	2072	00	06000	37.29521613	-121.8762569	Santa Clara County
319339	Ordering, Referring, Prescribing	N/A	1083155584	0	0	KARMALLY, ADAM	12/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76548	N/A	N/A	N/A	N/A	N/A	5700 LINDERO CANYON RD	None	WESTLAKE VILLAGE	CA	91362	4063	00	06000	34.15352777	-118.7978196	Los Angeles County
319352	Ordering, Referring, Prescribing	N/A	1083171086	0	0	KAUR, MANPREET	8/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79894	N/A	N/A	N/A	N/A	N/A	4771 W ASHLAN AVE	None	FRESNO	CA	93722	4307	00	06000	36.79349651	-119.8796918	Fresno County
319392	Ordering, Referring, Prescribing	N/A	1083257786	0	0	KIMBALL, NICOLE PA	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA59084	N/A	N/A	N/A	N/A	N/A	347 W MISSION AVE	None	ESCONDIDO	CA	92025	1729	00	06000	33.12861918	-117.0906689	San Diego County
319395	Ordering, Referring, Prescribing	N/A	1083244016	0	0	KEO, MONICA NP	10/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012007	N/A	N/A	N/A	N/A	N/A	560 S ST LOUIS ST	None	LOS ANGELES	CA	90033	4320	00	06000	34.03924138	-118.2172475	Los Angeles County
319399	Ordering, Referring, Prescribing	N/A	1083265565	0	0	KAUR, RAJWINDER NP	9/10/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012757	N/A	N/A	N/A	N/A	N/A	7275 E SOUTHGATE DR	204	SACRAMENTO	CA	95823	2629	00	06000	38.493576	-121.436559	Sacramento County
319422	Ordering, Referring, Prescribing	N/A	1083332076	0	0	KAUR, PARDEEP NP	6/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021494	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
319446	Ordering, Referring, Prescribing	N/A	1083445613	0	0	KANG, IRENE DDS	8/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110480	N/A	N/A	N/A	N/A	N/A	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	00	06000	34.58013142	-118.0898273	Los Angeles County
319453	Ordering, Referring, Prescribing	N/A	1083479984	0	0	KIM, SUJIN NP	6/29/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025754	N/A	N/A	N/A	N/A	N/A	8800 ALONDRA BLVD	STE C	BELLFLOWER	CA	90706	4302	00	06000	33.88918249	-118.1446785	Los Angeles County
319454	Ordering, Referring, Prescribing	N/A	1083487243	0	0	KAUR, JASMEET NP	10/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027906	N/A	N/A	N/A	N/A	N/A	6001 TRUXTUN AVE	SUITE 160	BAKERSFIELD	CA	93309	0693	00	06000	35.36252236	-119.072932	Kern County
319483	Ordering, Referring, Prescribing	N/A	1083726905	0	0	KOH, SANDY S	6/21/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A34583	N/A	N/A	N/A	N/A	N/A	2727 N PECK RD	None	EL MONTE	CA	91733	2434	00	06000	34.060311	-118.0306097	Los Angeles County
319490	Ordering, Referring, Prescribing	N/A	1083742258	0	0	KOMPEL-REINFELD, NATALIA P PSYD	12/8/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24705	N/A	N/A	N/A	N/A	N/A	12440 FIRESTONE BLVD	3015	NORWALK	CA	90650	4300	00	06000	33.90523023	-118.0681168	Los Angeles County
319493	Ordering, Referring, Prescribing	N/A	1083744502	0	0	KATZMAN, JESSICA B PSYD	6/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	22569	N/A	N/A	N/A	N/A	N/A	4200 18TH STREET	SUITE 202	SAN FRANCISCO	CA	94114	2470	00	06000	37.76083025	-122.4363219	San Francisco County
319548	Ordering, Referring, Prescribing	N/A	1083866586	0	0	KEO, SOPHEAK PHARMD	1/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60652	N/A	N/A	N/A	N/A	N/A	4440 TASSAJARA RD	None	DUBLIN	CA	94568	4501	00	06000	37.7067598	-121.8722011	Alameda County
319553	Ordering, Referring, Prescribing	N/A	1083890305	0	0	KEECH, CATHERINE	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77577	N/A	N/A	N/A	N/A	N/A	545 ESTUDILLO AVE	None	SAN LEANDRO	CA	94577	4611	00	06000	37.72679439	-122.1491972	Alameda County
319554	Ordering, Referring, Prescribing	N/A	1083885164	0	0	KASE, MICHAEL MD	7/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106492	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	4324	00	06000	37.54524373	-122.3205511	San Mateo County
319569	Ordering, Referring, Prescribing	N/A	1083918106	0	0	KOYL, MICHAL L NP	12/5/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19097	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVENUE	None	SAN DIEGO	CA	92115	0000	00	06000	32.76023438	-117.0667611	San Diego County
319575	Ordering, Referring, Prescribing	N/A	1083922074	0	0	KIRSCH, NICOLE PSYD	5/27/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27558	N/A	N/A	N/A	N/A	N/A	445 BELLEVUE AVE	STE 101	OAKLAND	CA	94610	1230	00	06000	37.80910261	-122.2526914	Alameda County
319584	Ordering, Referring, Prescribing	N/A	1083939714	0	0	KAYNE-O'GILVIE, DANIELLE LMFT	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53740	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	208	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
319593	Ordering, Referring, Prescribing	N/A	1083951735	0	0	KAUR, SUKHPREET NP	8/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	841083	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
319606	Ordering, Referring, Prescribing	N/A	1083978449	0	0	KAUFMAN, ANYA MSW LCSW	11/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21915	N/A	N/A	N/A	N/A	N/A	151 KALMUS DRIVE	K2	COSTA MESA	CA	92626	0000	00	06000	33.67282141	-117.8824994	Orange County
319613	Ordering, Referring, Prescribing	N/A	1083987655	0	0	KAUR, RITIKA LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101199	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
319622	Ordering, Referring, Prescribing	N/A	1083997175	0	0	KWONG, LYNDA A PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH41513	N/A	N/A	N/A	N/A	N/A	670 4TH STREET	None	SAN FRANCISCO	CA	94107	1618	00	06000	37.7773478	-122.3954502	San Francisco County
319625	Ordering, Referring, Prescribing	N/A	1083997704	0	0	KUYUMJIAN, ARI PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54345	N/A	N/A	N/A	N/A	N/A	56 LAS LOMAS RD	None	DUARTE	CA	91010	3607	00	06000	34.15320777	-117.9454638	Los Angeles County
319679	Ordering, Referring, Prescribing	N/A	1093097750	0	0	KANTOROV, INGA PHARMD	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51907	N/A	N/A	N/A	N/A	N/A	1916 WEBSTER ST	None	ALAMEDA	CA	94501	2140	00	06000	37.77899648	-122.2765416	Alameda County
319702	Ordering, Referring, Prescribing	N/A	1093140329	0	0	KOVACIK, PHILIP A LCSW	8/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96510	N/A	N/A	N/A	N/A	N/A	2730 SALVIO ST	None	CONCORD	CA	94519	2599	00	06000	37.98056223	-122.0282614	Contra Costa County
319704	Ordering, Referring, Prescribing	N/A	1093142291	0	0	KELLUM, KATHERINE T LCSW	12/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68083	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	None	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
319709	Ordering, Referring, Prescribing	N/A	1093144743	0	0	KRIEGER, KIMBERLY L LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82228	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE.	100	LOS ANGELES	CA	90018	1353	00	06000	34.037415	-118.3176815	Los Angeles County
319748	Ordering, Referring, Prescribing	N/A	1093199119	0	0	KUNG, LING Y PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71656	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
319760	Ordering, Referring, Prescribing	N/A	1093212722	0	0	KIM, ESTELLE I PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77573	N/A	N/A	N/A	N/A	N/A	2628 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	2922	00	06000	35.39121722	-118.9676027	Kern County
319785	Ordering, Referring, Prescribing	N/A	1093251779	0	0	KUALA-GILBERT, KEHAU K LCSW	5/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73355	N/A	N/A	N/A	N/A	N/A	28125 BRADLEY RD	260	MENIFEE	CA	92586	2248	00	06000	33.71309746	-117.1898349	Riverside County
319822	Ordering, Referring, Prescribing	N/A	1093305039	0	0	KINCAID, EMILY PA-C	9/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59216	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
319845	Ordering, Referring, Prescribing	N/A	1093362592	0	0	KIM, HAN NA LCSW	10/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117679	N/A	N/A	N/A	N/A	N/A	3727 W.6TH ST	STE 402	LOS ANGELES	CA	90020	5112	00	06000	34.06358655	-118.3037656	Los Angeles County
319854	Ordering, Referring, Prescribing	N/A	1093413437	0	0	KECHICHIAN, NANOR M NP	12/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023657	N/A	N/A	N/A	N/A	N/A	8800 ALONDRA BLVD	STE C	BELLFLOWER	CA	90706	4354	00	06000	33.88918249	-118.1446785	Los Angeles County
319865	Ordering, Referring, Prescribing	N/A	1093418287	0	0	KENT, JANA L NP	2/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024278	N/A	N/A	N/A	N/A	N/A	2813 S MAIN ST	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
319892	Ordering, Referring, Prescribing	N/A	1093597221	0	0	KALSI, VERUNA PHARMD	9/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88696	N/A	N/A	N/A	N/A	N/A	4495 FIRST ST	None	LIVERMORE	CA	94551	6902	00	06000	37.69630144	-121.7443221	Alameda County
319907	Ordering, Referring, Prescribing	N/A	1093791816	0	0	KELLER, BRIAN P DPM	7/18/2023	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E4185	N/A	N/A	N/A	N/A	N/A	965 EL CAMINO AVE	None	SACRAMENTO	CA	95815	2530	00	06000	38.611638	-121.4444745	Sacramento County
319972	Ordering, Referring, Prescribing	N/A	1093906109	0	0	KARANAM, DEEPTHI	3/5/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143662	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
319973	Ordering, Referring, Prescribing	N/A	1093907842	0	0	KARPMAN, AARON J PSYD	7/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24500	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
320097	Ordering, Referring, Prescribing	N/A	1104169044	0	0	KANG, JUDY H DDS	10/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51268	N/A	N/A	N/A	N/A	N/A	11092 ANDERSON ST	None	LOMA LINDA	CA	92350	1180	00	06000	34.05203016	-117.2623278	San Bernardino County
320118	Ordering, Referring, Prescribing	N/A	1104203405	0	0	KO, JEFFREY Z MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144966	N/A	N/A	N/A	N/A	N/A	10535 HOSPITAL WAY	None	MATHER	CA	95655	4200	00	06000	38.572443	-121.2965235	Sacramento County
320149	Ordering, Referring, Prescribing	N/A	1104244870	0	0	KANG, SANG WON PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63745	N/A	N/A	N/A	N/A	N/A	58133 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	5801	00	06000	34.12845391	-116.395626	San Bernardino County
320169	Ordering, Referring, Prescribing	N/A	1104269752	0	0	KARAZE, IMADEDDIN PHARMD	11/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70554	N/A	N/A	N/A	N/A	N/A	835 HIGHLAND SPRINGS AVE	110	BEAUMONT	CA	92223	5770	00	06000	33.93245893	-116.9469871	Riverside County
320173	Ordering, Referring, Prescribing	N/A	1104287721	0	0	KIRK, NICK LMFT	9/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122998	N/A	N/A	N/A	N/A	N/A	201 N CIVIC DR STE 183	STE 183	WALNUT CREEK	CA	94596	3864	00	06000	37.91024298	-122.0593495	Contra Costa County
320183	Ordering, Referring, Prescribing	N/A	1104304765	0	0	KELLOGG, ALEXANDER J PHARMD	12/14/2019	Taxonomy not applicable	NA	n/a	000	Unknown	77828	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	21ST FLOOR	LOS ANGELES	CA	90020	1992	00	06000	34.065	-118.291631	Los Angeles County
320188	Ordering, Referring, Prescribing	N/A	1104317361	0	0	KUMAR, NATASHA LMFT	1/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130606	N/A	N/A	N/A	N/A	N/A	455 1ST STREET	None	WOODLAND	CA	95695	4023	00	06000	38.675781	-121.773122	Yolo County
320194	Ordering, Referring, Prescribing	N/A	1104319912	0	0	KHATAMI, NAZANIN LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115410	N/A	N/A	N/A	N/A	N/A	1503 GRANT AVE	110	MOUNTAIN VIEW	CA	94040	3270	00	06000	37.37672165	-122.0757295	Santa Clara County
320219	Ordering, Referring, Prescribing	N/A	1104351097	0	0	KRAFFT, VICTORIA S	11/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	54861	N/A	N/A	N/A	N/A	N/A	15403 PARK AVE E.	None	VICTORVILLE	CA	92392	2482	00	06000	34.50640129	-117.3250645	San Bernardino County
320222	Ordering, Referring, Prescribing	N/A	1104359835	0	0	KIM, YOO J	11/8/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102411	N/A	N/A	N/A	N/A	N/A	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	00	06000	36.98837145	-121.9802206	Santa Cruz County
320302	Ordering, Referring, Prescribing	N/A	1104572379	0	0	KIM, HANNAH PHARMD	6/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86160	N/A	N/A	N/A	N/A	N/A	3970 RIVERMARK PLZ	None	SANTA CLARA	CA	95054	4155	00	06000	37.39481183	-121.9460207	Santa Clara County
320322	Ordering, Referring, Prescribing	N/A	1104833383	0	0	KATTIH, MOHAMED Z MD	11/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81609	N/A	N/A	N/A	N/A	N/A	219 W BADILLO ST	B	COVINA	CA	91723	1907	00	06000	34.0863333	-117.8928703	Los Angeles County
320352	Ordering, Referring, Prescribing	N/A	1104946300	0	0	KIMBLE, SANDRA LMFT	9/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47337	N/A	N/A	N/A	N/A	N/A	7365 CARNELIAN ST	STE #231	RANCHO CUCAMONGA	CA	91730	1136	00	06000	34.12038413	-117.6160525	San Bernardino County
320400	Ordering, Referring, Prescribing	N/A	1114031721	0	0	KANCHANANAKHIN, PHACHARAWUT MD	8/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A91530	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
320414	Ordering, Referring, Prescribing	N/A	1114052719	0	0	KERWOOD, MICHELLE F LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49198	N/A	N/A	N/A	N/A	N/A	232 E. CANON PERDIDO ST.	None	SANTA BARBARA	CA	93101	0000	00	06000	34.42349188	-119.6973758	Santa Barbara County
320431	Ordering, Referring, Prescribing	N/A	1114072535	0	0	KRAMER, PAUL J LMFT	12/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46231	N/A	N/A	N/A	N/A	N/A	1910 OLYMPIC BLVD SUIT	None	WALNUT CREEK	CA	94596	1033	00	06000	37.89453628	-122.0662326	Contra Costa County
320448	Ordering, Referring, Prescribing	N/A	1114121621	0	0	KENNEMER, KENNE W LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	24498	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	101	SANTA ROSA	CA	95407	5441	00	06000	38.425491	-122.7519	Sonoma County
320453	Ordering, Referring, Prescribing	N/A	1114130267	0	0	KURIMOTO, CHRISTOPHER J	9/26/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D45480	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
320481	Ordering, Referring, Prescribing	N/A	1114175825	0	0	KOON, MARY J NP	3/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	313818	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	FL 29	LOS ANGELES	CA	90017	1644	00	06000	34.05611213	-118.2570905	Los Angeles County
320525	Ordering, Referring, Prescribing	N/A	1114264868	0	0	KENNEDY, SARAH LCSW	2/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69940	N/A	N/A	N/A	N/A	N/A	2000 E 4TH ST	SUITE 201	SANTA ANA	CA	92705	3907	00	06000	33.74807154	-117.838566	Orange County
320527	Ordering, Referring, Prescribing	N/A	1114260957	0	0	KIM, BOUREE LCSW	2/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69743	N/A	N/A	N/A	N/A	N/A	485 N 1ST ST	None	SAN JOSE	CA	95112	4041	00	06000	37.34444033	-121.8968517	Santa Clara County
320528	Ordering, Referring, Prescribing	N/A	1114274651	0	0	KOSAKOWSKI, CRISTINA R MSW LCSW	1/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93647	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
320557	Ordering, Referring, Prescribing	N/A	1114316403	0	0	KEST, ANDREW PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68351	N/A	N/A	N/A	N/A	N/A	5934 SPRINGCREST ST	None	EASTVALE	CA	92880	3142	00	06000	33.98052478	-117.5732744	Riverside County
320583	Ordering, Referring, Prescribing	N/A	1114361540	0	0	KIFLEZGHIE, BISRAT T	1/29/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0625895	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC AVE	STE 370	LONG BEACH	CA	90806	2661	00	06000	33.805854	-118.1936805	Los Angeles County
320590	Ordering, Referring, Prescribing	N/A	1114375656	0	0	KWAN, JOANNA N LPCC	2/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC9216	N/A	N/A	N/A	N/A	N/A	9412 BIG HORN BLVD	6	ELK GROVE	CA	95758	1101	00	06000	38.415861	-121.407957	Sacramento County
320597	Ordering, Referring, Prescribing	N/A	1114381092	0	0	KIRKPATRICK, SARAH A LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75214	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE.	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
320616	Ordering, Referring, Prescribing	N/A	1114417854	0	0	KUKU, OLUKEMI NP	6/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009037	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
320618	Ordering, Referring, Prescribing	N/A	1114413101	0	0	KIRK, VIVIANE-SPECIAL LCSW	12/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110735	N/A	N/A	N/A	N/A	N/A	6950 65TH ST	None	SACRAMENTO	CA	95823	2316	00	06000	38.50065	-121.4357265	Sacramento County
320620	Ordering, Referring, Prescribing	N/A	1114423050	0	0	KOSTICK, TALIA E MD	9/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164772	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
320638	Ordering, Referring, Prescribing	N/A	1114456431	0	0	KHOAN, JOHN PHARMD	4/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75670	N/A	N/A	N/A	N/A	N/A	2620 CHESTER AVE	None	BAKERSFIELD	CA	93301	2015	00	06000	35.383563	-119.018681	Kern County
320643	Ordering, Referring, Prescribing	N/A	1114460920	0	0	KHACHTOURIANS, LUCINE LMFT	3/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124909	N/A	N/A	N/A	N/A	N/A	10200 SEPULVEDA BLVD	170	MISSION HILLS	CA	91345	1100	00	06000	34.25572562	-118.4673156	Los Angeles County
320650	Ordering, Referring, Prescribing	N/A	1114471158	0	0	KAVANAUGH, RACHEL W PSYD	12/2/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30499	N/A	N/A	N/A	N/A	N/A	13130 BURBANK BLVD.	None	SHERMAN OAKS	CA	91401	6037	00	06000	34.17210778	-118.4192552	Los Angeles County
320673	Ordering, Referring, Prescribing	N/A	1114517356	0	0	KITAHARA, EMI PA	2/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA59245	N/A	N/A	N/A	N/A	N/A	3637 S LA BREA AVE	None	LOS ANGELES	CA	90016	5311	00	06000	34.01991	-118.355626	Los Angeles County
320680	Ordering, Referring, Prescribing	N/A	1114505138	0	0	KIM, PAUL DDS	5/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110095	N/A	N/A	N/A	N/A	N/A	2219 E 1ST ST	None	LOS ANGELES	CA	90033	3901	00	06000	34.04452444	-118.2114844	Los Angeles County
320681	Ordering, Referring, Prescribing	N/A	1114539673	0	0	KARAPETYAN, GARY K PHARMD	7/29/2024	Taxonomy not applicable	NA	n/a	000	Unknown	89703	N/A	N/A	N/A	N/A	N/A	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
320745	Ordering, Referring, Prescribing	N/A	1114755196	0	0	KILLEBREW, JENNIFER	1/4/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028593	N/A	N/A	N/A	N/A	N/A	2633 16TH ST	None	BAKERSFIELD	CA	93301	3348	00	06000	35.37232854	-119.0327985	Kern County
320749	Ordering, Referring, Prescribing	N/A	1114794682	0	0	KABERWAL, KULJEET	10/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027513	N/A	N/A	N/A	N/A	N/A	4555 PRECISSI LN	None	STOCKTON	CA	95207	5743	00	06000	37.98919284	-121.3152121	San Joaquin County
320757	Ordering, Referring, Prescribing	N/A	1114937786	0	0	KAUT, RICHARD M MD	2/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49176	N/A	N/A	N/A	N/A	N/A	284 SPRUCE ST.	None	GRIDLEY	CA	95948	2116	00	06000	39.36699345	-121.6910745	Butte County
320790	Ordering, Referring, Prescribing	N/A	1124105788	0	0	KHANJIAN, ANGELA PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52169	N/A	N/A	N/A	N/A	N/A	1515 N VERMONT AVE	237	LOS ANGELES	CA	90027	5337	00	06000	34.09851639	-118.2918012	Los Angeles County
320836	Ordering, Referring, Prescribing	N/A	1124162151	0	0	KASPIAN, SUSAN J OD	7/17/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	13200	N/A	N/A	N/A	N/A	N/A	1735 PACIFIC COAST HWY	None	LOMITA	CA	90717	2719	00	06000	33.78948452	-118.309149	Los Angeles County
320864	Ordering, Referring, Prescribing	N/A	1124210844	0	0	KEFLEZIGHI, BAHGHI R MD	11/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100391	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
320913	Ordering, Referring, Prescribing	N/A	1124328281	0	0	KOBASHIKAWA, DANA	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55192	N/A	N/A	N/A	N/A	N/A	1291 S VICTORIA AVE	None	OXNARD	CA	93035	1292	00	06000	34.188363	-119.221387	Ventura County
320938	Ordering, Referring, Prescribing	N/A	1124369848	0	0	KERN, ANNA L LMFT	4/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37069	N/A	N/A	N/A	N/A	N/A	2454 POWELL STREET	SUITE A	EMERYVILLE	CA	94608	1738	00	06000	37.83721379	-122.3039867	Alameda County
321003	Ordering, Referring, Prescribing	N/A	1124472212	0	0	KANELL, MICHAEL MD	6/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153023	N/A	N/A	N/A	N/A	N/A	330 N FAIRFAX AVE	None	LOS ANGELES	CA	90036	2109	00	06000	34.07691863	-118.3614432	Los Angeles County
321009	Ordering, Referring, Prescribing	N/A	1124476270	0	0	KHADER, WASEEM M DO	2/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16567	N/A	N/A	N/A	N/A	N/A	1250 SIXTH AVE	#100	SAN DIEGO	CA	92101	4300	00	06000	32.71854144	-117.1593008	San Diego County
321056	Ordering, Referring, Prescribing	N/A	1124550835	0	0	KING, KEVIN MD	9/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165926	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
321060	Ordering, Referring, Prescribing	N/A	1124556832	0	0	KAUFFMAN, CHELSEA L PA-C	1/28/2019	Taxonomy not applicable	NA	n/a	000	Unknown	54550	N/A	N/A	N/A	N/A	N/A	3727 W 6TH ST	SUITE 200	LOS ANGELES	CA	90020	5105	00	06000	34.06358655	-118.3037656	Los Angeles County
321061	Ordering, Referring, Prescribing	N/A	1124557657	0	0	KHOV, KEAV S LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72283	N/A	N/A	N/A	N/A	N/A	4510 E PACIFIC COAST HWY	STE 600	LONG BEACH	CA	90804	3279	00	06000	33.78815204	-118.1400821	Los Angeles County
321064	Ordering, Referring, Prescribing	N/A	1124562939	0	0	KIRUUTA, PAUL T NP	7/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95078148	N/A	N/A	N/A	N/A	N/A	16 RITTER ST	None	SAN RAFAEL	CA	94901	3323	00	06000	37.97151013	-122.5251246	Marin County
321098	Ordering, Referring, Prescribing	N/A	1124614540	0	0	KE, MICHELLE	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83732	N/A	N/A	N/A	N/A	N/A	310 S LAKE AVE	None	PASADENA	CA	91101	0000	00	06000	34.14044971	-118.1322366	Los Angeles County
321128	Ordering, Referring, Prescribing	N/A	1124671854	0	0	KIM, KAHYUN Y	10/1/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104102	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
321132	Ordering, Referring, Prescribing	N/A	1124681770	0	0	KAHSAY, MEDHIN NP	7/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95017401	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
321154	Ordering, Referring, Prescribing	N/A	1124780408	0	0	KEATON, HEATHER M CNP	10/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018668	N/A	N/A	N/A	N/A	N/A	802 W COLTON AVE	E	REDLANDS	CA	92374	2905	00	06000	34.06290649	-117.1918845	San Bernardino County
321169	Ordering, Referring, Prescribing	N/A	1134120736	0	0	KO, GERALD PHARMD	6/16/2019	Taxonomy not applicable	NA	n/a	000	Unknown	53893	N/A	N/A	N/A	N/A	N/A	2001 SANTA MONICA BLVD	100W	SANTA MONICA	CA	90404	2176	00	06000	34.02891163	-118.4797466	Los Angeles County
321185	Ordering, Referring, Prescribing	N/A	1134203672	0	0	KRESS, AMY C	2/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14001	N/A	N/A	N/A	N/A	N/A	14659 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	0200	00	06000	34.32412624	-118.4525494	Los Angeles County
321196	Ordering, Referring, Prescribing	N/A	1134217813	0	0	KOTHARY, HEMMAL S MD	5/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A76603	N/A	N/A	N/A	N/A	N/A	1500 6TH AVE	None	DELANO	CA	93215	0000	00	06000	35.76504054	-119.236779	Kern County
321199	Ordering, Referring, Prescribing	N/A	1134207285	0	0	KRAISOSKY, ALISSA J MD	4/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88627	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	BUILDING A	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
321200	Ordering, Referring, Prescribing	N/A	1134230329	0	0	KASAWA, JOHN MD	2/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79338	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
321213	Ordering, Referring, Prescribing	N/A	1134245228	0	0	KEMP, KATHERINE S LCSW	9/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20547	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
321245	Ordering, Referring, Prescribing	N/A	1134297252	0	0	KONG, CAROLYN PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52801	N/A	N/A	N/A	N/A	N/A	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
321252	Ordering, Referring, Prescribing	N/A	1134314180	0	0	KOGER, M KATHRYN	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0507938	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
321257	Ordering, Referring, Prescribing	N/A	1134334550	0	0	KURKJIAN, AZAD PAUL MD	2/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99007	N/A	N/A	N/A	N/A	N/A	2335 S. MOUNTAIN AVE.,	None	DUARTE	CA	91010	3559	00	06000	34.12268096	-117.9903597	Los Angeles County
321263	Ordering, Referring, Prescribing	N/A	1134349558	0	0	KHOURY, FADY S PHARMD	2/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50740	N/A	N/A	N/A	N/A	N/A	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	00	06000	37.4876781	-122.2249265	San Mateo County
321291	Ordering, Referring, Prescribing	N/A	1134409733	0	0	KOVALCIK, JESSE G LMFT	8/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83782	N/A	N/A	N/A	N/A	N/A	1266 14TH STREET	None	OAKLAND	CA	94607	2205	00	06000	37.81022696	-122.2887619	Alameda County
321327	Ordering, Referring, Prescribing	N/A	1134488265	0	0	KAHLE, DEANA LMFT	1/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99258	N/A	N/A	N/A	N/A	N/A	3600 LIME STREET	BUILDING 2	RIVERSIDE	CA	92501	2971	00	06000	33.98276147	-117.3693188	Riverside County
321357	Ordering, Referring, Prescribing	N/A	1134521941	0	0	KUIPERS, JENNA C NP	3/23/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000910	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
321375	Ordering, Referring, Prescribing	N/A	1134558620	0	0	KUHL, MELISSA LMFT	12/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94334	N/A	N/A	N/A	N/A	N/A	3301 37TH ST.	None	SACRAMENTO	CA	95824	2418	00	06000	38.5445894	-121.4671827	Sacramento County
321379	Ordering, Referring, Prescribing	N/A	1134570864	0	0	KAUR, RAVINDAR NP	2/1/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004158	N/A	N/A	N/A	N/A	N/A	1717 LAS VEGAS STREET	None	MODESTO	CA	95358	5500	00	06000	37.6052798	-121.0027523	Stanislaus County
321385	Ordering, Referring, Prescribing	N/A	1134573140	0	0	KELLEY, LINDSEY R PA	2/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53379	N/A	N/A	N/A	N/A	N/A	1964 VIA CTR	None	VISTA	CA	92081	6056	00	06000	33.18400138	-117.283827	San Diego County
321394	Ordering, Referring, Prescribing	N/A	1134582141	0	0	KIRALLA, HEATHER LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111813	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
321443	Ordering, Referring, Prescribing	N/A	1134661473	0	0	KOGKETSIDOU-SOUSA, AIKATERINI LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115484	N/A	N/A	N/A	N/A	N/A	901 OLIVE STREET	102	SANTA BARBARA	CA	93101	1406	00	06000	34.42588414	-119.6949769	Santa Barbara County
321455	Ordering, Referring, Prescribing	N/A	1134681513	0	0	KWONG-LEE, KARY MSW LCSW	8/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117779	N/A	N/A	N/A	N/A	N/A	45 FARALLONES ST	None	SAN FRANCISCO	CA	94112	3005	00	06000	37.71408691	-122.4538573	San Francisco County
321516	Ordering, Referring, Prescribing	N/A	1134869662	0	0	KHAN, MURTAZA MD	9/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190769	N/A	N/A	N/A	N/A	N/A	2130 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1337	00	06000	38.557593	-121.4616735	Sacramento County
321545	Ordering, Referring, Prescribing	N/A	1144220831	0	0	KOLLMANN, ALICE B CNP	11/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	267510	N/A	N/A	N/A	N/A	N/A	2250 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1402	00	06000	36.98359419	-121.9939668	Santa Cruz County
321553	Ordering, Referring, Prescribing	N/A	1144228396	0	0	KURERA, HEATHER M DO	6/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12214	N/A	N/A	N/A	N/A	N/A	1350 3RD ST	None	LA VERNE	CA	91750	5201	00	06000	34.10427088	-117.7847615	Los Angeles County
321579	Ordering, Referring, Prescribing	N/A	1144346602	0	0	KUKIHARA, YUKO LCSW	6/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24772	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	165	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
321581	Ordering, Referring, Prescribing	N/A	1144349770	0	0	KING, DAPHNE C LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46377	N/A	N/A	N/A	N/A	N/A	1617 CRAVENS AVE	None	TORRANCE	CA	90501	3203	00	06000	33.83269486	-118.3158222	Los Angeles County
321583	Ordering, Referring, Prescribing	N/A	1144349929	0	0	KESLING, TARA S LCSW	9/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20810	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
321614	Ordering, Referring, Prescribing	N/A	1144412560	0	0	KANAAN, ZEYAD MD	9/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C157617	N/A	N/A	N/A	N/A	N/A	3883 AIRWAY DRIVE	220	SANTA ROSA	CA	95403	0000	00	06000	38.483226	-122.739705	Sonoma County
321616	Ordering, Referring, Prescribing	N/A	1144414541	0	0	KUO, JIMMY T PHARMD	4/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59331	N/A	N/A	N/A	N/A	N/A	17284 SLOVER AVE	SUITE 203	FONTANA	CA	92337	7584	00	06000	34.065396	-117.4277475	San Bernardino County
321622	Ordering, Referring, Prescribing	N/A	1144418021	0	0	KINDSCHI, DAHLIA M LMFT	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91204	N/A	N/A	N/A	N/A	N/A	500 CROWN POINT CIRCLE	120	GRASS VALLEY	CA	95945	9561	00	06000	39.22028885	-121.0316663	Nevada County
321652	Ordering, Referring, Prescribing	N/A	1144503988	0	0	KAWASE, KRISTINA PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51067	N/A	N/A	N/A	N/A	N/A	1201 E YORBA LINDA BLVD	None	PLACENTIA	CA	92870	3830	00	06000	33.88844148	-117.841293	Orange County
321662	Ordering, Referring, Prescribing	N/A	1144517764	0	0	KIM, SUHEE PHARMD	3/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48885	N/A	N/A	N/A	N/A	N/A	2640 LOMITA BLVD	None	TORRANCE	CA	90505	5214	00	06000	33.80800785	-118.332844	Los Angeles County
321665	Ordering, Referring, Prescribing	N/A	1144520388	0	0	KARAZHOVA, LARISA NP	11/15/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20335	N/A	N/A	N/A	N/A	N/A	7855 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	5344	00	06000	34.0908873	-118.36044	Los Angeles County
321700	Ordering, Referring, Prescribing	N/A	1144594748	0	0	KWOK, XENIA T LMFT	11/25/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84865	N/A	N/A	N/A	N/A	N/A	3924 RIVERVIEW DR.	None	JURUPA VALLEY	CA	92509	6611	00	06000	33.99857971	-117.4142203	Riverside County
321714	Ordering, Referring, Prescribing	N/A	1144616970	0	0	KLATMAN, SAMUEL H MD	6/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166831	N/A	N/A	N/A	N/A	N/A	955 LANE AVE.	STE. 200	CHULA VISTA	CA	91914	4525	00	06000	32.65121611	-116.9615942	San Diego County
321721	Ordering, Referring, Prescribing	N/A	1144620402	0	0	KASKOWITZ, SOMMER R NP	3/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001110	N/A	N/A	N/A	N/A	N/A	5970 S. CENTRAL AVENUE	None	LOS ANGELES	CA	90001	1150	00	06000	33.985584	-118.256433	Los Angeles County
321738	Ordering, Referring, Prescribing	N/A	1144639303	0	0	KATY, MIKE N PHARMD	5/28/2020	Taxonomy not applicable	NA	n/a	000	Unknown	80794	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
321772	Ordering, Referring, Prescribing	N/A	1144689886	0	0	KATAVICH, MALLORY LCSW	4/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101297	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
321782	Ordering, Referring, Prescribing	N/A	1144705963	0	0	KIEU, VAN PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79091	N/A	N/A	N/A	N/A	N/A	27982 LA PAZ RD	None	LAGUNA NIGUEL	CA	92677	3921	00	06000	33.55690213	-117.7093902	Orange County
321814	Ordering, Referring, Prescribing	N/A	1144741257	0	0	KRIZEK, JOSEPHINE M NP	8/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006756	N/A	N/A	N/A	N/A	N/A	1685 E MAIN ST	SUITE 301	EL CAJON	CA	92021	5292	00	06000	32.81132509	-116.9192044	San Diego County
321884	Ordering, Referring, Prescribing	N/A	1144848979	0	0	KIAI, NAKISA MD	3/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181394	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
321889	Ordering, Referring, Prescribing	N/A	1144854084	0	0	KOROBKIN, SHARON R	7/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117294	N/A	N/A	N/A	N/A	N/A	5731 W SLAUSON AVE	220	CULVER CITY	CA	90230	6537	00	06000	33.98898953	-118.3818077	Los Angeles County
321899	Ordering, Referring, Prescribing	N/A	1144868647	0	0	KAUR, KOMALPREET PHARMD	12/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81027	N/A	N/A	N/A	N/A	N/A	4080 SAN PABLO AVE	None	HERCULES	CA	94547	3903	00	06000	38.01370523	-122.2728505	Contra Costa County
321905	Ordering, Referring, Prescribing	N/A	1144874355	0	0	KAHN, AMY B LCSW	5/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19022	N/A	N/A	N/A	N/A	N/A	2213 BUCHANAN RD	STE. 103	ANTIOCH	CA	94509	4265	00	06000	37.99879828	-121.8360576	Contra Costa County
321935	Ordering, Referring, Prescribing	N/A	1144996240	0	0	KITHEKA, DAMARIS NP	10/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	NP95022878	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	FL2	SAN PABLO	CA	94806	3863	00	06000	37.95651393	-122.3371491	Contra Costa County
321963	Ordering, Referring, Prescribing	N/A	1154084143	0	0	KINDEM, ANNELIESE LCSW	5/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115283	N/A	N/A	N/A	N/A	N/A	1989 VICENTE DR	None	SAN LUIS OBISPO	CA	93405	6863	00	06000	35.25396985	-120.6858341	San Luis Obispo County
321965	Ordering, Referring, Prescribing	N/A	1154090405	0	0	KASPERICK, CANDACE RN	9/13/2020	Taxonomy not applicable	NA	n/a	000	Unknown	499304	N/A	N/A	N/A	N/A	N/A	4350 MT. EVEREST BLVD. B	None	SAN DIEGO	CA	92117	4847	00	06000	32.82035159	-117.1861458	San Diego County
321989	Ordering, Referring, Prescribing	N/A	1154333045	0	0	KAMPFE, CHRISTOPHER J JR	5/1/2017	Taxonomy not applicable	NA	n/a	000	Unknown	17006	N/A	N/A	N/A	N/A	N/A	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	00	06000	36.72031784	-120.060276	Fresno County
321996	Ordering, Referring, Prescribing	N/A	1154385854	0	0	KELLY-MCGARRY, MARGARET	10/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48002	N/A	N/A	N/A	N/A	N/A	995 SPERRY AVE	None	PATTERSON	CA	95363	9262	00	06000	37.46446646	-121.1402745	Stanislaus County
322017	Ordering, Referring, Prescribing	N/A	1154428753	0	0	KESSLER, ROBERT MD	2/7/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G00088833	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
322030	Ordering, Referring, Prescribing	N/A	1154455384	0	0	KHA, MY T MD	3/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107132	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	STE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
322048	Ordering, Referring, Prescribing	N/A	1154496511	0	0	KIM, SARAH S	2/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28601	N/A	N/A	N/A	N/A	N/A	2221 ENBORG LN	None	SAN JOSE	CA	95128	2608	00	06000	37.31105733	-121.937923	Santa Clara County
322076	Ordering, Referring, Prescribing	N/A	1154542793	0	0	KAUTZKY, BETH E NP	11/25/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	409866	N/A	N/A	N/A	N/A	N/A	18111 NORDHOFF STREET	None	NORTHRIDGE	CA	91330	8270	00	06000	34.239213	-118.527768	Los Angeles County
322098	Ordering, Referring, Prescribing	N/A	1154586675	0	0	KREPS-FALK, RACHEL H MD MPH	5/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102047	N/A	N/A	N/A	N/A	N/A	1580 VALENCIA ST	STE 701	SAN FRANCISCO	CA	94110	4421	00	06000	37.74746923	-122.4202583	San Francisco County
322101	Ordering, Referring, Prescribing	N/A	1154588663	0	0	KOTHA, PREETI PHARMD	12/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	59756	N/A	N/A	N/A	N/A	N/A	795 E. SECOND ST	SUITE 1	POMONA	CA	91766	1854	00	06000	34.05845654	-117.7423951	Los Angeles County
322117	Ordering, Referring, Prescribing	N/A	1154599462	0	0	KLOHE, ERIKA L LCSW	6/16/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108533	N/A	N/A	N/A	N/A	N/A	201 ALAMEDA DEL PRADO	None	NOVATO	CA	94949	6688	00	06000	38.04928431	-122.533057	Marin County
322133	Ordering, Referring, Prescribing	N/A	1154648905	0	0	KENDALL, LAURA MD	11/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110900	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
322140	Ordering, Referring, Prescribing	N/A	1154671980	0	0	KURADA, MANJUSHA MD	5/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132203	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
322145	Ordering, Referring, Prescribing	N/A	1154676609	0	0	KATZMAN, JENNA B	3/4/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015950	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
322147	Ordering, Referring, Prescribing	N/A	1154677045	0	0	KWAN, NATALIE D PHARMD	3/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67286	N/A	N/A	N/A	N/A	N/A	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.8531521	-117.8160824	Orange County
322162	Ordering, Referring, Prescribing	N/A	1154706661	0	0	KENDALL, KYLE LMFT	2/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129035	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTIONAL BLVD	200	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
322165	Ordering, Referring, Prescribing	N/A	1154708535	0	0	KIEU, CAROLYN NP	1/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001503	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
322172	Ordering, Referring, Prescribing	N/A	1154722189	0	0	KOODIE, NANDITA S PHARMD	9/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83224	N/A	N/A	N/A	N/A	N/A	480 REDWOOD ST	#33	VALLEJO	CA	94590	2450	00	06000	38.12315545	-122.2597619	Solano County
322177	Ordering, Referring, Prescribing	N/A	1154722551	0	0	KETABCHI, ELIKA	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71352	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST.	None	OAKLAND	CA	00009	4611	00	06000	37.80593773	-122.2656714	Alameda County
322190	Ordering, Referring, Prescribing	N/A	1154749976	0	0	KELADA, BASSEM S MD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A153031	N/A	N/A	N/A	N/A	N/A	505 E ALMOND AVE	101	MADERA	CA	93637	5742	00	06000	36.94551349	-120.0508739	Madera County
322254	Ordering, Referring, Prescribing	N/A	1154849842	0	0	KIEU, VY NP	5/15/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005410	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
322265	Ordering, Referring, Prescribing	N/A	1154862357	0	0	KURZ, TROY L MD	5/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157190	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY COURT	SUITE 300	RIVERSIDE	CA	92507	2155	00	06000	34.00024862	-117.32403	Riverside County
322298	Ordering, Referring, Prescribing	N/A	1154938090	0	0	KESHISHIAN, GARABET	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83423	N/A	N/A	N/A	N/A	N/A	174 S ALVARADO ST	None	LOS ANGELES	CA	90057	2211	00	06000	34.06468367	-118.2715689	Los Angeles County
322317	Ordering, Referring, Prescribing	N/A	1154967727	0	0	KILIMNIK, MARIA PHARMD	5/14/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58767	N/A	N/A	N/A	N/A	N/A	8704 SEPULVEDA BLVD.	None	NORTH HILLS	CA	91343	5112	00	06000	34.22837871	-118.4675863	Los Angeles County
322375	Ordering, Referring, Prescribing	N/A	1164079034	0	0	KNECHEL, JESSICA	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82066	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
322382	Ordering, Referring, Prescribing	N/A	1164082483	0	0	KIM, DONGHWAN B	10/1/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103804	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
322393	Ordering, Referring, Prescribing	N/A	1164124103	0	0	KAY, MOLLY DO	7/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23170	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
322398	Ordering, Referring, Prescribing	N/A	1164141164	0	0	KUENHOLD, MIKAELAH NP	7/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021593	N/A	N/A	N/A	N/A	N/A	690 OXFORD ST	None	CHULA VISTA	CA	91911	7111	00	06000	32.60532439	-117.0853713	San Diego County
322427	Ordering, Referring, Prescribing	N/A	1164403929	0	0	KHANDADASH, MANOUCHEHR MD	5/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51781	N/A	N/A	N/A	N/A	N/A	38440 5TH STREET WEST	None	PALMDALE	CA	93551	4498	00	06000	34.58068723	-118.1384686	Los Angeles County
322441	Ordering, Referring, Prescribing	N/A	1164508362	0	0	KALIR, HENRY H MD	2/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A39953	N/A	N/A	N/A	N/A	N/A	303 C ST	None	LOMPOC	CA	93436	7305	00	06000	34.64226582	-120.4514394	Santa Barbara County
322465	Ordering, Referring, Prescribing	N/A	1164552667	0	0	KOENEN, DIANA S LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34962	N/A	N/A	N/A	N/A	N/A	541 N SAN JACINTO ST	None	HEMET	CA	92543	3107	00	06000	33.75498593	-116.9587409	Riverside County
322509	Ordering, Referring, Prescribing	N/A	1164624441	0	0	KWAK, SHELLY	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84488	N/A	N/A	N/A	N/A	N/A	1450 CIVIC CT	SUITE 200	CONCORD	CA	94520	5295	00	06000	37.9718675	-122.0496338	Contra Costa County
322526	Ordering, Referring, Prescribing	N/A	1164663902	0	0	KARPIN, MICHELLE C CNM	8/10/2015	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	621908	N/A	N/A	N/A	N/A	N/A	705 GRAND AVENUE	None	SAN LUIS OBISPO	CA	93401	2639	00	06000	35.29019621	-120.6532543	San Luis Obispo County
322576	Ordering, Referring, Prescribing	N/A	1164754156	0	0	KOGAN, DIANA LMFT	4/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46929	N/A	N/A	N/A	N/A	N/A	2801 BRISTOL ST	None	COSTA MESA	CA	92626	5996	00	06000	33.67474907	-117.889122	Orange County
322629	Ordering, Referring, Prescribing	N/A	1164839817	0	0	KENDALL, REGINA E LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79660	N/A	N/A	N/A	N/A	N/A	1131 COMMUNITY PARKWAY	None	HOLLISTER	CA	95023	2816	00	06000	36.87274132	-121.3983499	San Benito County
322645	Ordering, Referring, Prescribing	N/A	1164871083	0	0	KOMORI, KRISTINA A LMFT	5/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132718	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
322646	Ordering, Referring, Prescribing	N/A	1164873840	0	0	KHOSROVI-EGHBAL, ARASH MD	4/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157669	N/A	N/A	N/A	N/A	N/A	2400 WIBLE RD	SUITE 14	BAKERSFIELD	CA	93304	4734	00	06000	35.3328934	-119.0389535	Kern County
322692	Ordering, Referring, Prescribing	N/A	1164953410	0	0	KHONG, CHRISTINA H LCSW	3/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96725	N/A	N/A	N/A	N/A	N/A	6060 N PARAMOUNT BLVD	None	LONG BEACH	CA	90805	3711	00	06000	33.865083	-118.157517	Los Angeles County
322697	Ordering, Referring, Prescribing	N/A	1164955639	0	0	KELLER, ELIZABETH K NP	12/31/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006481	N/A	N/A	N/A	N/A	N/A	400 W PABLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.64450234	-120.4764505	Santa Barbara
322701	Ordering, Referring, Prescribing	N/A	1164970372	0	0	KULUBYA, EDWIN S MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156619	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2309	00	06000	38.555181	-121.4566785	Sacramento County
322703	Ordering, Referring, Prescribing	N/A	1164979217	0	0	KAUR, AMANPREET V	9/21/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100659	N/A	N/A	N/A	N/A	N/A	302 FRESNO ST	STE 204	FRESNO	CA	93706	3641	00	06000	36.72393092	-119.8091084	Fresno County
322709	Ordering, Referring, Prescribing	N/A	1164985297	0	0	KHADEM, FABION G PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80254	N/A	N/A	N/A	N/A	N/A	7787 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	2309	00	06000	38.706741	-121.2724305	Sacramento County
322760	Ordering, Referring, Prescribing	N/A	1174070890	0	0	KUO, HSIN C PHARMD	7/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70669	N/A	N/A	N/A	N/A	N/A	470 N SANTA CRUZ AVE	None	LOS GATOS	CA	95030	5313	00	06000	37.23162694	-121.9796316	Santa Clara County
322768	Ordering, Referring, Prescribing	N/A	1174077887	0	0	KENOBI, ROBBIE K LCSW	9/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96722	N/A	N/A	N/A	N/A	N/A	6 CENTER POINTE DR	700	LA PALMA	CA	90623	2545	00	06000	33.86052378	-118.0296232	Orange County
322809	Ordering, Referring, Prescribing	N/A	1174151690	0	0	KRIKSCIUN, JESSICA MD	9/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180605	N/A	N/A	N/A	N/A	N/A	1666 PRECISION PARK LANE	None	SAN YSIDRO	CA	92173	1322	00	06000	32.5659146	-117.059667	San Diego County
322811	Ordering, Referring, Prescribing	N/A	1174152631	0	0	KWON, SUE MIN MD	5/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186401	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
322822	Ordering, Referring, Prescribing	N/A	1174162515	0	0	KALENDAREVA, YANA PHARMD	2/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	81636	N/A	N/A	N/A	N/A	N/A	1130 BROADWAY	None	CHULA VISTA	CA	91911	2707	00	06000	32.60853	-117.083862	San Diego County
322858	Ordering, Referring, Prescribing	N/A	1174287965	0	0	KESHAVARZ, MELODY S PHARMD	10/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85473	N/A	N/A	N/A	N/A	N/A	550 16TH ST	None	SAN FRANCISCO	CA	94158	2545	00	06000	37.769553	-122.390109	San Francisco County
322868	Ordering, Referring, Prescribing	N/A	1174396188	0	0	KAMALI, AMIR DDS	10/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109580	N/A	N/A	N/A	N/A	N/A	1206 E 17TH ST	101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
322878	Ordering, Referring, Prescribing	N/A	1174543664	0	0	KITSON, NANCY MD	7/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G162576	N/A	N/A	N/A	N/A	N/A	1560 MESA RD	STE 100	NIPOMO	CA	93444	6709	00	06000	35.02977199	-120.5498922	San Luis Obispo County
322898	Ordering, Referring, Prescribing	N/A	1174642557	0	0	KALAMA, JONATHAN D AU	8/16/2020	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	AU2000	N/A	N/A	N/A	N/A	N/A	623 W DUARTE RD	8	ARCADIA	CA	91007	7330	00	06000	34.12648672	-118.0522757	Los Angeles County
322999	Ordering, Referring, Prescribing	N/A	1174823124	0	0	KHANNA, VIJAY K PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	29946	N/A	N/A	N/A	N/A	N/A	12350 CARMEL MOUNTAIN RD	None	SAN DIEGO	CA	92128	4616	00	06000	32.987565	-117.078192	San Diego County
323000	Ordering, Referring, Prescribing	N/A	1174824536	0	0	KIM, VICTORIA LCSW	1/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27230	N/A	N/A	N/A	N/A	N/A	420 S. SAN PEDRO STREET	G3	LOS ANGELES	CA	90013	2182	00	06000	34.04517855	-118.2433177	Los Angeles County
323008	Ordering, Referring, Prescribing	N/A	1174851695	0	0	KOFCHOCK, NITA NP	7/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014865	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
323012	Ordering, Referring, Prescribing	N/A	1174854202	0	0	KALAR, DENISE N LMFT	9/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128305	N/A	N/A	N/A	N/A	N/A	207 E STREET	SUITE B	DAVIS	CA	95616	4523	00	06000	38.54345888	-121.7412256	Yolo County
323017	Ordering, Referring, Prescribing	N/A	1174864151	0	0	KWAN, AN CHUN PHARMD	10/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62505	N/A	N/A	N/A	N/A	N/A	1900 DAVIS ST	None	SAN LEANDRO	CA	94577	1209	00	06000	37.720791	-122.181849	Alameda County
323030	Ordering, Referring, Prescribing	N/A	1174882476	0	0	KIM, GRACE S LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84752	N/A	N/A	N/A	N/A	N/A	3530 ATLANTIC AVE	None	LONG BEACH	CA	90807	4569	00	06000	33.820875	-118.1850035	Los Angeles County
323047	Ordering, Referring, Prescribing	N/A	1174897300	0	0	KHOURY, SYLVIA M PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51333	N/A	N/A	N/A	N/A	N/A	13111 PEYTON DR	None	CHINO HILLS	CA	91709	6002	00	06000	34.014636	-117.741339	San Bernardino County
323060	Ordering, Referring, Prescribing	N/A	1174910129	0	0	KUGEL, VERA	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	81037	N/A	N/A	N/A	N/A	N/A	1503 GRANT RD.	110	MOUNTAIN VIEW	CA	94040	3270	00	06000	37.37672165	-122.0757295	Santa Clara County
323102	Ordering, Referring, Prescribing	N/A	1174958573	0	0	KILBY, HOPE E LMFT	2/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131195	N/A	N/A	N/A	N/A	N/A	560 COHASSET RD	180	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
323105	Ordering, Referring, Prescribing	N/A	1174964399	0	0	KRITTMAN, STUART W PSYD	8/8/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20233	N/A	N/A	N/A	N/A	N/A	333 H ST	2010	CHULA VISTA	CA	91910	5555	00	06000	32.63411233	-117.0783636	San Diego County
323112	Ordering, Referring, Prescribing	N/A	1174981500	0	0	KYLE, MARCI L LCSW	2/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78555	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
323127	Ordering, Referring, Prescribing	N/A	1174991640	0	0	KOBOLD, DEBRA M LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106921	N/A	N/A	N/A	N/A	N/A	191 SAND CREEK ROAD, SUI	None	BRENTWOOD	CA	94513	2220	00	06000	37.94665949	-121.7001303	Contra Costa County
323145	Ordering, Referring, Prescribing	N/A	1184024259	0	0	KOERNER-JORDAN, SARAH PSYD	5/4/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26399	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
323165	Ordering, Referring, Prescribing	N/A	1184039042	0	0	KATTA, SHWETHA R MD	8/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172200	N/A	N/A	N/A	N/A	N/A	225 SOUTH CABRILLO HWY	SUITE 100A	HALF MOON BAY	CA	94019	1738	00	06000	37.46542425	-122.4337617	San Mateo County
323211	Ordering, Referring, Prescribing	N/A	1184101693	0	0	KUMAR, DOREEN L NP	5/19/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009130	N/A	N/A	N/A	N/A	N/A	4555 PRECISSI LN	None	STOCKTON	CA	95207	3717	00	06000	37.98919284	-121.3152121	San Joaquin County
323226	Ordering, Referring, Prescribing	N/A	1184120487	0	0	KOZYRYEV, MARYNA F	9/12/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104251	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
323236	Ordering, Referring, Prescribing	N/A	1184145807	0	0	KIM, MICHELLE M MD	4/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL1267	N/A	N/A	N/A	N/A	N/A	3800 W CHAPMAN AVE	STE 500	ORANGE	CA	92868	1638	00	06000	33.78885849	-117.8950802	Orange County
323273	Ordering, Referring, Prescribing	N/A	1184214181	0	0	KHOMICH, NADZEYA PHARMD	6/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84001	N/A	N/A	N/A	N/A	N/A	5720 NAVE DR	None	NOVATO	CA	94949	6210	00	06000	38.06183912	-122.5329177	Marin County
323274	Ordering, Referring, Prescribing	N/A	1184198053	0	0	KUANG, SIMON K PHARMD	9/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79319	N/A	N/A	N/A	N/A	N/A	1344 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3807	00	06000	37.79820871	-122.408678	San Francisco County
323290	Ordering, Referring, Prescribing	N/A	1184242976	0	0	KIM, HEEJIN E NP	9/1/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009125	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD	SUITE 10	STANTON	CA	90680	1514	00	06000	33.78298855	-117.9927453	Orange County
323291	Ordering, Referring, Prescribing	N/A	1184237141	0	0	KIM, JULIE PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76402	N/A	N/A	N/A	N/A	N/A	8900 WASHINGTON BLVD	None	PICO RIVERA	CA	90660	3765	00	06000	33.98348209	-118.0976934	Los Angeles County
323316	Ordering, Referring, Prescribing	N/A	1184280380	0	0	KHANOON, SHAISTA LMFT	9/15/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149787	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET, SAN	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
323329	Ordering, Referring, Prescribing	N/A	1184326712	0	0	KHALIL, HOUDA MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197382	N/A	N/A	N/A	N/A	N/A	505 S MAIN ST	STE 525	ORANGE	CA	92868	4509	00	06000	33.78004808	-117.8672472	Orange County
323338	Ordering, Referring, Prescribing	N/A	1184358780	0	0	KHACHATRIAN, GORE PA-C	6/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64597	N/A	N/A	N/A	N/A	N/A	1311 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
323351	Ordering, Referring, Prescribing	N/A	1184395147	0	0	KUMAR, VANDANA NP	9/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018424	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
323360	Ordering, Referring, Prescribing	N/A	1184400491	0	0	KIM, RENEE PHARMD	8/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88380	N/A	N/A	N/A	N/A	N/A	11800 DE PALMA RD	None	CORONA	CA	92883	8498	00	06000	33.74635292	-117.4536847	Riverside County
323369	Ordering, Referring, Prescribing	N/A	1184469777	0	0	KNOLL, NATHANIEL	6/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030772	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
323389	Ordering, Referring, Prescribing	N/A	1184702631	0	0	KHAN, AHMAD S MD	10/17/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	13268	N/A	N/A	N/A	N/A	N/A	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	06000	35.220006	-114.0380145	Mohave County
323391	Ordering, Referring, Prescribing	N/A	1184710303	0	0	KHAN, SAMEERA MD	7/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C134649	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
323410	Ordering, Referring, Prescribing	N/A	1184750341	0	0	KROES, ANNETTE PHD	6/21/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19919	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
323415	Ordering, Referring, Prescribing	N/A	1184752248	0	0	KHAWAJA, JOE LMFT	5/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42334	N/A	N/A	N/A	N/A	N/A	4500 E PACIFIC COAST HWY	SUITE 100	LONG BEACH	CA	90804	3275	00	06000	33.78808863	-118.1399827	Los Angeles County
323472	Ordering, Referring, Prescribing	N/A	1184873432	0	0	KEPPE, JASON F LMFT	5/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50069	N/A	N/A	N/A	N/A	N/A	575 W FREMONT AVE	None	SUNNYVALE	CA	94087	2556	00	06000	37.35222904	-122.0350225	Santa Clara County
323475	Ordering, Referring, Prescribing	N/A	1184876633	0	0	KADIYALA, CHANDRA SEKHAR RAO PHD	2/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH68509	N/A	N/A	N/A	N/A	N/A	1471 B ST.	STE R	LIVINGSTON	CA	95334	1432	00	06000	37.38601696	-120.7221808	Merced County
323482	Ordering, Referring, Prescribing	N/A	1184889289	0	0	KONLANI, CHIMERA R LCSW	10/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29514	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
323524	Ordering, Referring, Prescribing	N/A	1184958670	0	0	KAWAKAMI, DWAYNE S LCSW	12/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW15888	N/A	N/A	N/A	N/A	N/A	3333 M ST	None	MERCED	CA	95348	2714	00	06000	37.32440393	-120.4783871	Merced County
323591	Ordering, Referring, Prescribing	N/A	1194083337	0	0	KAPLANSKY, GALINA LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77151	N/A	N/A	N/A	N/A	N/A	12821 VICTORY BLVD.	None	NORTH HOLLYWOOD	CA	91606	3012	00	06000	34.18670951	-118.41246	Los Angeles County
323613	Ordering, Referring, Prescribing	N/A	1194119545	0	0	KUO, TERESA MD	11/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144307	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
323650	Ordering, Referring, Prescribing	N/A	1194184366	0	0	KIM, GRACE	3/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55714	N/A	N/A	N/A	N/A	N/A	3550 ROUNDBARN BLVD	#109	SANTA ROSA	CA	95403	0922	00	06000	38.476152	-122.7257685	Sonoma County
323671	Ordering, Referring, Prescribing	N/A	1194220392	0	0	KWONG, AUSTIN MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165774	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
323678	Ordering, Referring, Prescribing	N/A	1194225680	0	0	KAUR HERNANDEZ, JASMEEN LPCC	11/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	18007	N/A	N/A	N/A	N/A	N/A	6615 VALLEY HI DR	None	SACRAMENTO	CA	95823	7076	00	06000	38.470986	-121.4276985	Sacramento County
323696	Ordering, Referring, Prescribing	N/A	1194253161	0	0	KOHANBASH, GERSHON E PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78258	N/A	N/A	N/A	N/A	N/A	1051 W BURBANK BLVD	None	BURBANK	CA	91506	1421	00	06000	34.186032	-118.324359	Los Angeles County
323711	Ordering, Referring, Prescribing	N/A	1194272872	0	0	KRISTY, SARAH E LCSW	8/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116987	N/A	N/A	N/A	N/A	N/A	210 E. ENOS DRIVE	A	SANTA MARIA	CA	93454	1002	00	06000	34.9340215	-120.4343968	Santa Barbara County
323714	Ordering, Referring, Prescribing	N/A	1194276923	0	0	KAUR, SUKHJOT NP	8/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	741748	N/A	N/A	N/A	N/A	N/A	3850 RIVERLAKES DR	STE B	BAKERSFIELD	CA	93312	6662	00	06000	35.39426565	-119.0936823	Kern County
323718	Ordering, Referring, Prescribing	N/A	1194289587	0	0	KHALAF, NOHA G PHARMD	8/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72396	N/A	N/A	N/A	N/A	N/A	24100 CHATENAY LANE	None	MURRIETA	CA	92562	1986	00	06000	33.57562106	-117.21277	Riverside County
323727	Ordering, Referring, Prescribing	N/A	1194305482	0	0	KRAMER, ERIC MD MPH	10/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182455	N/A	N/A	N/A	N/A	N/A	3055 W ORANGE AVE	SUITE 105	ANAHEIM	CA	92804	3159	00	06000	33.8247435	-117.99621	Orange County
323781	Ordering, Referring, Prescribing	N/A	1194489781	0	0	KANG, ELLEN H PHARMD	10/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85429	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
323783	Ordering, Referring, Prescribing	N/A	1194532523	0	0	KENNEDY, GABRIELLE J OT	1/17/2024	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	25432	N/A	N/A	N/A	N/A	N/A	678 THIRD AVE	None	CHULA VISTA	CA	91910	5736	00	06000	32.62870793	-117.0750108	San Diego County
323787	Ordering, Referring, Prescribing	N/A	1194554097	0	0	KALINA, MATHILDA NP	5/31/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030314	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
323795	Ordering, Referring, Prescribing	N/A	1194708412	0	0	KRAUS, SUSAN FALZONE MD	2/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A83754	N/A	N/A	N/A	N/A	N/A	600 B ST	None	LIVINGSTON	CA	95334	9593	00	06000	37.38589253	-120.734559	Merced County
323806	Ordering, Referring, Prescribing	N/A	1194742825	0	0	KRISHNAMOORTHY, DIVYA	4/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54901	N/A	N/A	N/A	N/A	N/A	762 WEST CYPRESS STREET	None	SAN DIMAS	CA	91773	3505	00	06000	34.09577399	-117.8223776	Los Angeles County
323856	Ordering, Referring, Prescribing	N/A	1194874032	0	0	KINOY, ELLEN LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT33176	N/A	N/A	N/A	N/A	N/A	1266 14TH STREET	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
323871	Ordering, Referring, Prescribing	N/A	1194894543	0	0	KUCHUK, MARINA PHARMD	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52248	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	CANOGA PARK	CA	91367	0000	00	06000	34.17030266	-118.5881699	Los Angeles County
323874	Ordering, Referring, Prescribing	N/A	1194906651	0	0	KRAVETS, CYNTHIA J LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT41979	N/A	N/A	N/A	N/A	N/A	2500 SOUTH C STREET	SUITE D	OXNARD	CA	93033	4574	00	06000	34.17646093	-119.1812737	Ventura County
323936	Ordering, Referring, Prescribing	N/A	1205057759	0	0	KRACHMAN, JANINE R	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0427401	N/A	N/A	N/A	N/A	N/A	71777 SAN JACINTO DR	SUITE 202	RANCHO MIRAGE	CA	92270	4457	00	06000	33.74394755	-116.4124572	Riverside County
323939	Ordering, Referring, Prescribing	N/A	1205052792	0	0	KADAM, SHILPA MD	1/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C168261	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
323948	Ordering, Referring, Prescribing	N/A	1205089752	0	0	KUMAR, SARITA NP	2/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17394	N/A	N/A	N/A	N/A	N/A	1540 FLORIDA AVE	None	MODESTO	CA	95350	4408	00	06000	37.667115	-120.9962205	Stanislaus County
323961	Ordering, Referring, Prescribing	N/A	1205110483	0	0	KIM, SUN PHARMD	9/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54031	N/A	N/A	N/A	N/A	N/A	18296 COLLIER AVE	None	LAKE ELSINORE	CA	92530	2532	00	06000	33.69042777	-117.3403538	Riverside County
323984	Ordering, Referring, Prescribing	N/A	1205137726	0	0	KARABINIS, GINA S LCSW	5/29/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86374	N/A	N/A	N/A	N/A	N/A	360 NEVADA STREET	None	AUBURN	CA	95603	3720	00	06000	38.9065593	-121.0824284	Placer County
324026	Ordering, Referring, Prescribing	N/A	1205232535	0	0	KRAUS, STEPHANIE A	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102503	N/A	N/A	N/A	N/A	N/A	200 24TH STREET	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
324034	Ordering, Referring, Prescribing	N/A	1205246865	0	0	KURUKULASURIYA, DAYANTHI DO	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15689	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
324067	Ordering, Referring, Prescribing	N/A	1205298767	0	0	KOAN, CAROLINE MD	9/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150384	N/A	N/A	N/A	N/A	N/A	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
324105	Ordering, Referring, Prescribing	N/A	1205347150	0	0	KIM, MEE KYOUNG PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59611	N/A	N/A	N/A	N/A	N/A	3511 W.OLYMPIC BLVD	STE 102	LOS ANGELES	CA	90019	3563	00	06000	34.0525695	-118.3152015	Los Angeles County
324111	Ordering, Referring, Prescribing	N/A	1205360542	0	0	KUMAR, DEEPIKA MD	7/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158314	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
324137	Ordering, Referring, Prescribing	N/A	1205389285	0	0	KIM, GRACE J PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76802	N/A	N/A	N/A	N/A	N/A	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	00	06000	37.72317409	-122.162925	Alameda County
324153	Ordering, Referring, Prescribing	N/A	1205440104	0	0	KIM, JASON LCSW	6/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122986	N/A	N/A	N/A	N/A	N/A	5350 MACHADO LN	None	CULVER CITY	CA	90230	8800	00	06000	33.99772397	-118.3961412	Los Angeles County
324155	Ordering, Referring, Prescribing	N/A	1205425972	0	0	KIM, LINDSEY NP	7/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019634	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
324216	Ordering, Referring, Prescribing	N/A	1205614088	0	0	KAING, KARENA OD	9/28/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35593	N/A	N/A	N/A	N/A	N/A	1104 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	3219	00	06000	37.695303	-121.9287465	Alameda County
324247	Ordering, Referring, Prescribing	N/A	1205926995	0	0	KANG, ERIKA Y PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47594	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
324261	Ordering, Referring, Prescribing	N/A	1205958865	0	0	KRETZ, ROBERT K PSYD	5/21/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18198	N/A	N/A	N/A	N/A	N/A	1722 SOUTH LEWIS ROAD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
324271	Ordering, Referring, Prescribing	N/A	1205971363	0	0	KASTORAS, MARIA LCSW	10/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25994	N/A	N/A	N/A	N/A	N/A	2011 LITTLE ORCHARD ST	None	SAN JOSE	CA	95125	1031	00	06000	37.30374212	-121.8702811	Santa Clara County
324289	Ordering, Referring, Prescribing	N/A	1215007802	0	0	KELLENBACH, ERICA M LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25257	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD.	None	OAKLAND	CA	94605	0000	00	06000	37.76047483	-122.157608	Alameda County
324319	Ordering, Referring, Prescribing	N/A	1215069778	0	0	KOJIAN, HAIG J PHD	1/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY13721	N/A	N/A	N/A	N/A	N/A	2934 E GARVEY AVE S	100	WEST COVINA	CA	91791	2190	00	06000	34.07157499	-117.8836824	Los Angeles County
324321	Ordering, Referring, Prescribing	N/A	1215075767	0	0	KALLMANN, KARL DC	12/15/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	15607	N/A	N/A	N/A	N/A	N/A	650 ZEDIKER AVE	None	PARLIER	CA	93648	2666	00	06000	36.60500164	-119.5210273	Fresno County
324324	Ordering, Referring, Prescribing	N/A	1215078399	0	0	KRYSTAL, ALAN M MD	2/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G74558	N/A	N/A	N/A	N/A	N/A	1492 PIONEER CIR	None	OCEANSIDE	CA	92057	1804	00	06000	33.2732663	-117.3036802	San Diego County
324373	Ordering, Referring, Prescribing	N/A	1215193305	0	0	KARPENSKE, KRISTY LCSW	4/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73763	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH STREET	SUITE 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
324376	Ordering, Referring, Prescribing	N/A	1215199930	0	0	KABLER, AMY L LMFT	9/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109049	N/A	N/A	N/A	N/A	N/A	127 E LEXINGTON AVE.	None	EL CAJON	CA	92020	4511	00	06000	32.79269801	-116.9617323	San Diego County
324411	Ordering, Referring, Prescribing	N/A	1215226485	0	0	KYLE, CLAY W	10/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53565	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
324413	Ordering, Referring, Prescribing	N/A	1215243902	0	0	KUSUMOTO, JAMIE PHARMD	9/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61737	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
324415	Ordering, Referring, Prescribing	N/A	1215245774	0	0	KOMURA, NATHAN	1/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	43715	N/A	N/A	N/A	N/A	N/A	13111 PEYTON DR	None	CHINO HILLS	CA	91709	6002	00	06000	34.014636	-117.741339	San Bernardino County
324433	Ordering, Referring, Prescribing	N/A	1215284161	0	0	KAMEL, AMMAR PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67034	N/A	N/A	N/A	N/A	N/A	215 N 2ND STREET	None	ELCAJON	CA	92021	7243	00	06000	32.796792	-116.935631	San Diego County
324450	Ordering, Referring, Prescribing	N/A	1215310230	0	0	KAOHCHANG, SOPHIA PHARMD	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	40123	N/A	N/A	N/A	N/A	N/A	16600 BOLSA CHICA ST	None	HUNTINGTON BEACH	CA	92649	3583	00	06000	33.72120809	-118.041396	Orange County
324451	Ordering, Referring, Prescribing	N/A	1215309729	0	0	KASSE, NEBILA S PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73569	N/A	N/A	N/A	N/A	N/A	19746 TURTLE SPRINGS WAY	None	PORTER RANCH	CA	91326	3891	00	06000	34.29244594	-118.5640008	Los Angeles County
324496	Ordering, Referring, Prescribing	N/A	1215376033	0	0	KIM, CHRISTOPHER H MD	7/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133397	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
324518	Ordering, Referring, Prescribing	N/A	1215391768	0	0	KIM, JESSICA J MD	4/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154015	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
324523	Ordering, Referring, Prescribing	N/A	1215424130	0	0	KROSHNA, OKSANA DDS	2/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	104234	N/A	N/A	N/A	N/A	N/A	6800 PALM AVE	C	SEBASTOPOL	CA	95472	4269	00	06000	38.39602719	-122.8185446	Sonoma County
324547	Ordering, Referring, Prescribing	N/A	1215476205	0	0	KOOKTAPEH, ASHOURINA	2/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	76146	N/A	N/A	N/A	N/A	N/A	801 TIOGA AVE	None	SAND CITY	CA	93955	3050	00	06000	36.61641241	-121.845767	Monterey County
324579	Ordering, Referring, Prescribing	N/A	1215518634	0	0	KIM, MIYOUNG PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84015	N/A	N/A	N/A	N/A	N/A	1186 CALIMESA BLVD	None	CALIMESA	CA	92320	1509	00	06000	33.99496056	-117.0579751	Riverside County
324581	Ordering, Referring, Prescribing	N/A	1215512975	0	0	KIM, SHANNON L PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84207	N/A	N/A	N/A	N/A	N/A	550 S RIVERSIDE AVE	None	RIALTO	CA	92376	7028	00	06000	34.09069396	-117.3703752	San Bernardino County
324586	Ordering, Referring, Prescribing	N/A	1215530290	0	0	KRINJAK, KAYLA	12/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88028	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
324598	Ordering, Referring, Prescribing	N/A	1215559042	0	0	KAVANAGH, KEVIN PHARMD	7/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81078	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	RM G35	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
324629	Ordering, Referring, Prescribing	N/A	1215629696	0	0	KERR, DAMIAN C LCSW	5/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122385	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD	None	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
324634	Ordering, Referring, Prescribing	N/A	1215642996	0	0	KAUR, NAVPREET	1/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023905	N/A	N/A	N/A	N/A	N/A	2769 CORDELIA LN	None	TRACY	CA	95377	8485	00	06000	37.69868947	-121.467159	San Joaquin County
324663	Ordering, Referring, Prescribing	N/A	1215946876	0	0	KEHOE, KEATHER A MD	1/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70038	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
324672	Ordering, Referring, Prescribing	N/A	1225025133	0	0	KADAR, DAVID M	11/22/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D50760	N/A	N/A	N/A	N/A	N/A	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4238	00	06000	34.045119	-117.6464565	San Bernardino County
324701	Ordering, Referring, Prescribing	N/A	1225128580	0	0	KOREN, SHEILA A LMFT	6/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35849	N/A	N/A	N/A	N/A	N/A	524 45TH AVENUE	None	SAN FRANCISCO	CA	94121	2421	00	06000	37.7785061	-122.506091	San Francisco County
324744	Ordering, Referring, Prescribing	N/A	1225194418	0	0	KAPLAN, INNA PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53043	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE.	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
324746	Ordering, Referring, Prescribing	N/A	1225200710	0	0	KONDOR, AMBER M MD	11/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110390	N/A	N/A	N/A	N/A	N/A	150 W 7TH ST	None	SAN PEDRO	CA	90731	3320	00	06000	33.73786341	-118.2810362	Los Angeles County
324751	Ordering, Referring, Prescribing	N/A	1225212855	0	0	KERR, KAIVALYA LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80878	N/A	N/A	N/A	N/A	N/A	3125 MYERS ST	None	RIVERSIDE	CA	92503	2503	00	06000	33.90932558	-117.4428095	Riverside County
324775	Ordering, Referring, Prescribing	N/A	1225264419	0	0	KEM, SAVUTH PA	11/11/2019	Taxonomy not applicable	NA	n/a	000	Unknown	20164	N/A	N/A	N/A	N/A	N/A	311 WEST I STREET	None	LOS BANOS	CA	93635	3479	00	06000	37.06343055	-120.8570545	Merced County
324791	Ordering, Referring, Prescribing	N/A	1225302755	0	0	KENAN, JOSEPH N MD	4/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66080	N/A	N/A	N/A	N/A	N/A	9735 WILSHIRE BLVD	212	BEVERLY HILLS	CA	90212	2107	00	06000	34.06711051	-118.4074605	Los Angeles County
324796	Ordering, Referring, Prescribing	N/A	1225293178	0	0	KENNEDY, WENDY M LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45904	N/A	N/A	N/A	N/A	N/A	631 S. ORCHARD ST.	None	UKIAH	CA	95482	5011	00	06000	39.14619517	-123.1986323	Mendocino County
324831	Ordering, Referring, Prescribing	N/A	1225354897	0	0	KREMNITZER, JILL PA	2/4/2013	Taxonomy not applicable	NA	n/a	000	Unknown	00PA21011	N/A	N/A	N/A	N/A	N/A	11722 S WILMINGTON AVE	None	LOS ANGELES	CA	90059	2543	00	06000	33.9267675	-118.2390104	Los Angeles County
324855	Ordering, Referring, Prescribing	N/A	1225414857	0	0	KHAN, HAMMAD MD	12/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164291	N/A	N/A	N/A	N/A	N/A	4378 AUBURN BLVD	None	SACRAMENTO	CA	95841	4175	00	06000	38.645082	-121.3614315	Sacramento County
324880	Ordering, Referring, Prescribing	N/A	1225461866	0	0	KNUDSEN, KASSIE LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109145	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	GOLETA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
324892	Ordering, Referring, Prescribing	N/A	1225463409	0	0	KELLY, CATHERINE J PSYD	5/17/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30952	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
324912	Ordering, Referring, Prescribing	N/A	1225501109	0	0	KIM, ELIJAH S CNP	2/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19455	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
324950	Ordering, Referring, Prescribing	N/A	1225544497	0	0	KIM, LINDA	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77787	N/A	N/A	N/A	N/A	N/A	946 S BROOKHURST ST	None	ANAHEIM	CA	92804	4305	00	06000	33.818652	-117.958912	Orange County
324962	Ordering, Referring, Prescribing	N/A	1225563083	0	0	KORELOVA, OLGA MD	5/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164005	N/A	N/A	N/A	N/A	N/A	12865 POINTE DEL MAR WAY	250	DEL MAR	CA	92014	3860	00	06000	32.93310886	-117.2428542	San Diego County
324974	Ordering, Referring, Prescribing	N/A	1225574528	0	0	KINNEY, HOPE LMFT	7/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140433	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	100	LOS ANGELES	CA	90018	1336	00	06000	34.037415	-118.3176815	Los Angeles County
324977	Ordering, Referring, Prescribing	N/A	1225578545	0	0	KIM, JEEYOON PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74085	N/A	N/A	N/A	N/A	N/A	25011 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	4312	00	06000	33.91720845	-117.2256545	Riverside County
325054	Ordering, Referring, Prescribing	N/A	1235153123	0	0	KANENAGA, JENNIFER R NP	1/3/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12712	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
325111	Ordering, Referring, Prescribing	N/A	1235287574	0	0	KADIN, STEVEN M PHD	5/24/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	14766	N/A	N/A	N/A	N/A	N/A	676 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3945	00	06000	35.27640631	-120.6628883	San Luis Obispo County
325152	Ordering, Referring, Prescribing	N/A	1235370545	0	0	KESTER, CONSUELLA L LMFT	9/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128317	N/A	N/A	N/A	N/A	N/A	2311 LOVERIDGE RD	2ND FLOOR	PITTSBURG	CA	94565	5117	00	06000	38.00694767	-121.8712439	Contra Costa County
325163	Ordering, Referring, Prescribing	N/A	1235406638	0	0	KOOS, JENNIFER N NP	8/10/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	499431	N/A	N/A	N/A	N/A	N/A	705 GRAND AVE	None	SAN LUIS OBISPO	CA	93401	2639	00	06000	35.29019621	-120.6532543	San Luis Obispo County
325165	Ordering, Referring, Prescribing	N/A	1235406695	0	0	KIM, DANNY D	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65949	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
325187	Ordering, Referring, Prescribing	N/A	1235430018	0	0	KURZMAN, MARK MD	11/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131481	N/A	N/A	N/A	N/A	N/A	5901 GREEN VALLEY CIR	405	CULVER CITY	CA	90230	6938	00	06000	33.98409358	-118.3923715	Los Angeles County
325198	Ordering, Referring, Prescribing	N/A	1235451360	0	0	KIM, JANET B MD	7/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G82040	N/A	N/A	N/A	N/A	N/A	451 W LINCOLN AVE	STE 100	ANAHEIM	CA	92805	2912	00	06000	33.83445082	-117.9189372	Orange County
325200	Ordering, Referring, Prescribing	N/A	1235458530	0	0	KYRIACOU, CHARALAMBOS PSYD	10/3/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22208	N/A	N/A	N/A	N/A	N/A	611 S KINGSLEY DR.	None	LOS ANGELES	CA	90005	2319	00	06000	34.06305793	-118.3028813	Los Angeles County
325205	Ordering, Referring, Prescribing	N/A	1235464447	0	0	KELLY, KEVIN E	11/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19354	N/A	N/A	N/A	N/A	N/A	1451 28TH AVE	None	OAKLAND	CA	94601	1632	00	06000	37.78066946	-122.2292246	Alameda County
325212	Ordering, Referring, Prescribing	N/A	1235473174	0	0	KIM, JAE YOUNG PHARMD	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	71953	N/A	N/A	N/A	N/A	N/A	16830 SAN FERNANDO MISSI	None	GRANADA HILLS	CA	91344	4247	00	06000	34.27201051	-118.500093	Los Angeles County
325231	Ordering, Referring, Prescribing	N/A	1235513102	0	0	KUMAR, GAURAV MD	4/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151187	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
325232	Ordering, Referring, Prescribing	N/A	1235507351	0	0	KHAN, SIDRA MD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A155621	N/A	N/A	N/A	N/A	N/A	344 E 6TH ST	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
325265	Ordering, Referring, Prescribing	N/A	1235557075	0	0	KHACHATRYAN, IRINA MD	6/16/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141010	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
325268	Ordering, Referring, Prescribing	N/A	1235563131	0	0	KELLER, ELIZABETH LMFT	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101551	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
325280	Ordering, Referring, Prescribing	N/A	1235578790	0	0	KRAMER, SHAUN MD	2/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139109	N/A	N/A	N/A	N/A	N/A	15733 WHITTIER BLVD	None	WHITTIER	CA	90603	2312	00	06000	33.94402086	-117.9922473	Los Angeles County
325286	Ordering, Referring, Prescribing	N/A	1235584129	0	0	KHALIFEH, BLANCA L MSW LCSW	5/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101356	N/A	N/A	N/A	N/A	N/A	530 W BADILLO ST	None	COVINA	CA	91722	3787	00	06000	34.08625283	-117.8999625	Los Angeles County
325295	Ordering, Referring, Prescribing	N/A	1235600669	0	0	KOHL, ALYSON R LMFT	1/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LFT33101	N/A	N/A	N/A	N/A	N/A	1095 HILLTOP DR # 369	None	REDDING	CA	96003	3811	00	06000	40.59126719	-122.3582225	Shasta County
325325	Ordering, Referring, Prescribing	N/A	1235649021	0	0	KIM, KATHERINE A MSW LCSW	3/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114113	N/A	N/A	N/A	N/A	N/A	591 N KING RD	STE 3	SAN JOSE	CA	95133	1661	00	06000	37.36198326	-121.8647378	Santa Clara County
325342	Ordering, Referring, Prescribing	N/A	1235672502	0	0	KLOBERDANZ, KELSEY NP	2/26/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005293	N/A	N/A	N/A	N/A	N/A	6244 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3918	00	06000	32.76342577	-117.0636924	San Diego County
325347	Ordering, Referring, Prescribing	N/A	1235678244	0	0	KO, SARAH H LMFT	11/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141825	N/A	N/A	N/A	N/A	N/A	3030 W OLYMPIC BLVD	206	LOS ANGELES	CA	90006	6501	00	06000	34.05260995	-118.3015825	Los Angeles County
325385	Ordering, Referring, Prescribing	N/A	1235782913	0	0	KING, GALEN L	4/21/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104108	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
325394	Ordering, Referring, Prescribing	N/A	1235797176	0	0	KAGAN, MARCEYA LMFT	9/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139998	N/A	N/A	N/A	N/A	N/A	700 FREDERICK ST.	SUITE 103	SANTA CRUZ	CA	95062	2237	00	06000	36.98031434	-122.004438	Santa Cruz County
325401	Ordering, Referring, Prescribing	N/A	1235831652	0	0	KIRAKOSYAN, DIANA	5/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025376	N/A	N/A	N/A	N/A	N/A	9900 CABANAS AVE	None	TUJUNGA	CA	91042	2929	00	06000	34.24728843	-118.2688064	Los Angeles County
325433	Ordering, Referring, Prescribing	N/A	1245009141	0	0	KIM, JEONG SU OD	1/6/2024	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT35621TLG	N/A	N/A	N/A	N/A	N/A	3727 W 6TH ST	210	LOS ANGELES	CA	90020	5105	00	06000	34.06358655	-118.3037656	Los Angeles County
325434	Ordering, Referring, Prescribing	N/A	1245090364	0	0	KIRKPATRICK, LARA C OT	4/10/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	10593	N/A	N/A	N/A	N/A	N/A	267 LUNETA DR	None	SAN LUIS OBISPO	CA	93405	1519	00	06000	35.29109143	-120.6813287	San Luis Obispo County
325454	Ordering, Referring, Prescribing	N/A	1245248160	0	0	KURRA, SURESHBABU	1/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53362	N/A	N/A	N/A	N/A	N/A	1840 S CENTRAL ST	None	VISALIA	CA	93277	4418	00	06000	36.314109	-119.3113755	Tulare County
325478	Ordering, Referring, Prescribing	N/A	1245355908	0	0	KRALL-CATRON, CAROLYNE LMFT	1/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45230	N/A	N/A	N/A	N/A	N/A	325 34TH STREET	SUITE 100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39041729	-119.0053621	Kern County
325491	Ordering, Referring, Prescribing	N/A	1245364991	0	0	KAGAN, FAY R MD	11/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G56762	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
325494	Ordering, Referring, Prescribing	N/A	1245370477	0	0	KEARNEY, LEANORA B LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT20155	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
325496	Ordering, Referring, Prescribing	N/A	1245373430	0	0	KAYA, JEFFERY LCSW	3/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62419	N/A	N/A	N/A	N/A	N/A	820 34TH ST	None	BAKERSFIELD	CA	93301	2283	00	06000	35.39053308	-119.0117133	Kern County
325502	Ordering, Referring, Prescribing	N/A	1245376615	0	0	KAFTARIAN, EDWARD L MD	4/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A98911	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
325520	Ordering, Referring, Prescribing	N/A	1245420009	0	0	KOEPPEN, KATHY A LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48981	N/A	N/A	N/A	N/A	N/A	3300 GLENWOOD ST	None	EUREKA	CA	95501	3463	00	06000	40.78641759	-124.1310057	Humboldt County
325540	Ordering, Referring, Prescribing	N/A	1245458520	0	0	KOLHATKAR, GAURI K MD FAAP	3/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94390	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD.	MS #76	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
325542	Ordering, Referring, Prescribing	N/A	1245465236	0	0	KRELLENSTEIN, RACHEL S LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69683	N/A	N/A	N/A	N/A	N/A	6221 GEARY BLVD	2ND FLOOR	SAN FRANCISCO	CA	94121	0079	00	06000	37.77994312	-122.4862014	San Francisco County
325615	Ordering, Referring, Prescribing	N/A	1245594167	0	0	KHOURDAJI, AYAD S MD	10/30/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153658	N/A	N/A	N/A	N/A	N/A	830 S HAM LN	STE 26	LODI	CA	95242	7510	00	06000	38.123568	-121.2882225	San Joaquin County
325699	Ordering, Referring, Prescribing	N/A	1245724608	0	0	KILPONEN, KELSEY	4/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101640	N/A	N/A	N/A	N/A	N/A	1405 LAKESIDE DR	None	OAKLAND	CA	94612	4306	00	06000	37.80117926	-122.2628701	Alameda County
325703	Ordering, Referring, Prescribing	N/A	1245732635	0	0	KILFORD, CHANTEL M NP	5/3/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008994	N/A	N/A	N/A	N/A	N/A	2213 BUCHANAN RD	103	ANTIOCH	CA	94509	4265	00	06000	37.99879828	-121.8360576	Contra Costa County
325724	Ordering, Referring, Prescribing	N/A	1245759745	0	0	KETCHUM, RENEE C LMFT	4/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125408	N/A	N/A	N/A	N/A	N/A	99 S ALMADEN BLVD,	STE 6	SANTA CLARA	CA	95113	1605	00	06000	37.33257807	-121.8940377	Santa Clara
325739	Ordering, Referring, Prescribing	N/A	1245769983	0	0	KHEDKAR, JANKI P PHARMD	3/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	74724	N/A	N/A	N/A	N/A	N/A	23072 ALICIA PARKWAY	None	MISSION VIEJO	CA	92692	0000	00	06000	33.62803407	-117.636481	Orange County
325801	Ordering, Referring, Prescribing	N/A	1245861772	0	0	KIANFAR, HAMASEH LMFT	4/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132550	N/A	N/A	N/A	N/A	N/A	250 BON AIR ROAD	None	GREENBRAE	CA	94912	2728	00	06000	37.9469952	-122.5373892	Marin County
325805	Ordering, Referring, Prescribing	N/A	1245869312	0	0	KLIM, CASIMIR C MD	1/23/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193189	N/A	N/A	N/A	N/A	N/A	6950 65TH ST	None	SACRAMENTO	CA	95823	2316	00	06000	38.50065	-121.4357265	Sacramento County
325814	Ordering, Referring, Prescribing	N/A	1245897883	0	0	KO, UNA	2/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	15853	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
325848	Ordering, Referring, Prescribing	N/A	1255005237	0	0	KAWATA, CAITLIN R PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84653	N/A	N/A	N/A	N/A	N/A	25825 S VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.7892965	-118.2937327	Los Angeles County
325875	Ordering, Referring, Prescribing	N/A	1255073748	0	0	KONDAN, CHRISTIAN M PA	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60948	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3052	00	06000	33.1292461	-117.0716509	San Diego County
325899	Ordering, Referring, Prescribing	N/A	1255400701	0	0	KANG, YUJEO PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49882	N/A	N/A	N/A	N/A	N/A	615 W AVE L	303	LANCASTER	CA	93534	1000	00	06000	34.6603515	-118.1419695	Los Angeles County
325944	Ordering, Referring, Prescribing	N/A	1255475638	0	0	KWON, YOO KYUNG PHD	6/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27917	N/A	N/A	N/A	N/A	N/A	1801 BUSH STREET	OFFICE 303	SAN FRANCISCO	CA	94019	5239	00	06000	37.78777536	-122.427321	San Francisco County
325994	Ordering, Referring, Prescribing	N/A	1255602108	0	0	KOSKO, AINE M NP	10/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	F12220767	N/A	N/A	N/A	N/A	N/A	1329 SPANOS COURT	C3	MODESTO	CA	95355	2704	00	06000	37.66976149	-120.9731145	Stanislaus County
325997	Ordering, Referring, Prescribing	N/A	1255611901	0	0	KOENIG, ERIC J	6/19/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102359	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
326008	Ordering, Referring, Prescribing	N/A	1255616520	0	0	KING, RENEE D PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47552	N/A	N/A	N/A	N/A	N/A	24081 EL TORO RD	None	LAGUNA HILLS	CA	92653	3103	00	06000	33.61279466	-117.7127914	Orange County
326019	Ordering, Referring, Prescribing	N/A	1255635553	0	0	KNAPP, MATTHEW A LCSW	4/10/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66424	N/A	N/A	N/A	N/A	N/A	1270 N LEMORE AVE	None	LEMOORE	CA	93245	2350	00	06000	36.314991	-119.780764	Kings County
326060	Ordering, Referring, Prescribing	N/A	1255715009	0	0	KANJ, RABIH PHARMD	1/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76043	N/A	N/A	N/A	N/A	N/A	8969 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4911	00	06000	34.08326871	-118.386603	Los Angeles County
326062	Ordering, Referring, Prescribing	N/A	1255717195	0	0	KOWALSKI, RICHARD C PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72855	N/A	N/A	N/A	N/A	N/A	7531 SANTA MONICA BLVD	SUITE 201	WEST HOLLYWOOD	CA	90046	6458	00	06000	34.09081315	-118.3541261	Los Angeles County
326098	Ordering, Referring, Prescribing	N/A	1255766515	0	0	KEILMAN, KATHLEEN LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89032	N/A	N/A	N/A	N/A	N/A	299 12TH ST	SUITE A	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
326102	Ordering, Referring, Prescribing	N/A	1255746145	0	0	KOHAN, ROZALIN R	6/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14409	N/A	N/A	N/A	N/A	N/A	1530 S. STREET OLIVE STR	None	LOS ANGELES	CA	90015	3023	00	06000	34.03724489	-118.2637253	Los Angeles County
326164	Ordering, Referring, Prescribing	N/A	1255871927	0	0	KESHISHIAN, AZNIV PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH75964	N/A	N/A	N/A	N/A	N/A	14885 TELEGRAPH RD	None	LA MIRADA	CA	90638	1060	00	06000	33.91748456	-118.0134841	Los Angeles County
326169	Ordering, Referring, Prescribing	N/A	1255880720	0	0	KHANDADASH, NILOOFAR PA-C	9/20/2017	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	53723	N/A	N/A	N/A	N/A	N/A	21001 SHERMAN WAY	SUITE 9	CANOGA PARK	CA	91303	1303	00	06000	34.20113553	-118.5912126	Los Angeles County
326176	Ordering, Referring, Prescribing	N/A	1255885190	0	0	KLING, AMANDA LCSW	8/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108773	N/A	N/A	N/A	N/A	N/A	1859 BIRD ST	None	OROVILLE	CA	95965	4854	00	06000	39.51259228	-121.5566418	Butte County
326204	Ordering, Referring, Prescribing	N/A	1255938940	0	0	KUAN, SHIRLEY NP	6/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030789	N/A	N/A	N/A	N/A	N/A	2417 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3040	00	06000	34.01413253	-118.1278906	Los Angeles County
326274	Ordering, Referring, Prescribing	N/A	1265091482	0	0	KWONG, MICHAEL PHARMD	7/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79318	N/A	N/A	N/A	N/A	N/A	1100 VAN NESS AVE	C	SAN FRANCISCO	CA	94109	6979	00	06000	37.78594176	-122.421322	San Francisco County
326303	Ordering, Referring, Prescribing	N/A	1265170229	0	0	KHACHOOMIAN, UONITA PHARMD	2/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85918	N/A	N/A	N/A	N/A	N/A	1625 SUNSET BLVD	None	LOS ANGELES	CA	90026	9136	00	06000	34.0770959	-118.2580592	Los Angeles County
326321	Ordering, Referring, Prescribing	N/A	1265295208	0	0	KOHZADI, ERFAN PHARMD	1/2/2024	Taxonomy not applicable	NA	n/a	000	Unknown	89179	N/A	N/A	N/A	N/A	N/A	12504 MAGNOLIA BLVD	None	VALLEY VILLAGE	CA	91607	0001	00	06000	34.1648545	-118.4056875	Los Angeles County
326352	Ordering, Referring, Prescribing	N/A	1265515548	0	0	KENNEDY, KELLEY M LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21285	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	SUITE 155	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
326388	Ordering, Referring, Prescribing	N/A	1265580112	0	0	KUNIN-RIDA, TERI MD	7/31/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G80071	N/A	N/A	N/A	N/A	N/A	165 S. FIRST ST	None	EL CAJON	CA	92019	4795	00	06000	32.794002	-116.944563	San Diego County
326420	Ordering, Referring, Prescribing	N/A	1265679567	0	0	KAHN, ABIGAIL C LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66428	N/A	N/A	N/A	N/A	N/A	760 HARRISON ST.	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
326468	Ordering, Referring, Prescribing	N/A	1265740724	0	0	KIM, EUNICE H LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74472	N/A	N/A	N/A	N/A	N/A	401 IMPERIAL HWY	None	FULLERTON	CA	92835	1145	00	06000	33.91748848	-117.925704	Orange County
326488	Ordering, Referring, Prescribing	N/A	1265776371	0	0	KANE, AMY LMFT	12/19/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86587	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
326492	Ordering, Referring, Prescribing	N/A	1265779318	0	0	KEENEY, RAEELLEN K LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74297	N/A	N/A	N/A	N/A	N/A	3132 JEFFERSON ST	None	SAN DIEGO	CA	92110	4421	00	06000	32.75567499	-117.203517	San Diego County
326494	Ordering, Referring, Prescribing	N/A	1265777684	0	0	KUO, JONATHAN MD	2/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116635	N/A	N/A	N/A	N/A	N/A	1200 NORTH STATE STREET	None	LOS ANGELES	CA	90033	1001	00	06000	34.05855992	-118.209755	Los Angeles County
326528	Ordering, Referring, Prescribing	N/A	1265842967	0	0	KOSKELO, MERRIT A MD	7/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139697	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
326536	Ordering, Referring, Prescribing	N/A	1265858138	0	0	KUO, SAMUEL E	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D63064	N/A	N/A	N/A	N/A	N/A	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	00	06000	36.98837145	-121.9802206	Santa Cruz County
326581	Ordering, Referring, Prescribing	N/A	1265914121	0	0	KEETON, DELORIS T RN PHN	10/9/2017	Taxonomy not applicable	NA	n/a	000	Unknown	761358	N/A	N/A	N/A	N/A	N/A	714 N WHITE ST	None	HANFORD	CA	93230	4029	00	06000	36.332613	-119.6395665	Kings County
326613	Ordering, Referring, Prescribing	N/A	1265975148	0	0	KLITH, DAISY NP	1/19/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	608178	N/A	N/A	N/A	N/A	N/A	6065 STATE HWY 193	None	GEORGETOWN	CA	95684	9623	00	06000	38.90808215	-120.8515816	El Dorado County
326640	Ordering, Referring, Prescribing	N/A	1275030397	0	0	KAR, ABHIPSA MD	9/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166961	N/A	N/A	N/A	N/A	N/A	1421 EAST 17TH	None	SANTA ANA	CA	92705	8505	00	06000	33.75994564	-117.847815	Orange County
326706	Ordering, Referring, Prescribing	N/A	1275166381	0	0	KAMAU, VERONICA	5/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014610	N/A	N/A	N/A	N/A	N/A	649 E ALBERTONI ST	100	CARSON	CA	90746	1538	00	06000	33.87194399	-118.2643054	Los Angeles County
326764	Ordering, Referring, Prescribing	N/A	1275557795	0	0	KATZ, ISRAEL MD	6/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G81599	N/A	N/A	N/A	N/A	N/A	2712 MISSION ST	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
326868	Ordering, Referring, Prescribing	N/A	1275789190	0	0	KUMAR, BOBBIE V MD	10/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C170652	N/A	N/A	N/A	N/A	N/A	23962 ALICIA PKWY	None	MISSION VIEJO	CA	92691	3940	00	06000	33.61418475	-117.6795692	Orange County
326949	Ordering, Referring, Prescribing	N/A	1275912917	0	0	KEARNEY, CASSANDRA L PA	6/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	52432	N/A	N/A	N/A	N/A	N/A	1685 E MAIN ST	301	EL CAJON	CA	92021	5225	00	06000	32.81132509	-116.9192044	San Diego County
326961	Ordering, Referring, Prescribing	N/A	1275930364	0	0	KALBA, SONTINE LCSW	4/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114813	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	STE 180	WEST SACRAMENTO	CA	95605	2394	00	06000	38.58811316	-121.5270471	Yolo County
326969	Ordering, Referring, Prescribing	N/A	1275941775	0	0	KHEMET GOUDJAYI, NEFERTITI K LCSW	7/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102830	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95841	3841	00	06000	38.55438	-121.3756965	Sacramento County
327037	Ordering, Referring, Prescribing	N/A	1285029256	0	0	KARLIN, JENNIFER MD	2/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144397	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
327044	Ordering, Referring, Prescribing	N/A	1285041475	0	0	KHODADADZADEH, SHAGHAYEGH DDS	6/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63674	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
327064	Ordering, Referring, Prescribing	N/A	1285069039	0	0	KALANTAR, AZITA LMFT	11/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106754	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
327107	Ordering, Referring, Prescribing	N/A	1285142547	0	0	KIM, MIN KYUNG LCSW	1/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108047	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	100	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
327113	Ordering, Referring, Prescribing	N/A	1285146555	0	0	KIM, HANKYUL PHARMD	7/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	77671	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	RM G35	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
327154	Ordering, Referring, Prescribing	N/A	1285220491	0	0	KHOSRAWI, SWEETA LPCC	5/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	13942	N/A	N/A	N/A	N/A	N/A	3150 18TH ST	350 202	SAN FRANCISCO	CA	94110	2074	00	06000	37.76218347	-122.4141845	San Francisco County
327159	Ordering, Referring, Prescribing	N/A	1285226092	0	0	KOENIG, SIBYLLE M NP	5/3/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018212	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
327190	Ordering, Referring, Prescribing	N/A	1285270611	0	0	KAUR, JASDEEP NP	10/17/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013105	N/A	N/A	N/A	N/A	N/A	58375 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	5813	00	06000	34.13141256	-116.3904357	San Bernardino County
327191	Ordering, Referring, Prescribing	N/A	1285276816	0	0	KARAY, SAMANTHA LMFT	10/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140351	N/A	N/A	N/A	N/A	N/A	17871 PARK PLAZA DRIVE	SUITE 140	CERRITOS	CA	90703	9500	00	06000	33.8692694	-118.0629284	Los Angeles County
327204	Ordering, Referring, Prescribing	N/A	1285298745	0	0	KIM, GA-AE H PHARMD	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76467	N/A	N/A	N/A	N/A	N/A	60 N HIGHLAND SPRINGS AV	None	BANNING	CA	92220	3048	00	06000	33.92988307	-116.9468586	Riverside County
327234	Ordering, Referring, Prescribing	N/A	1285479386	0	0	KINYON, ASHTON NP	6/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030786	N/A	N/A	N/A	N/A	N/A	1850 WALNUT ST	E	RED BLUFF	CA	96080	3611	00	06000	40.16904822	-122.2542817	Tehama County
327255	Ordering, Referring, Prescribing	N/A	1285676353	0	0	KUPIS, ROBERT J PA-C	10/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA58266	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
327259	Ordering, Referring, Prescribing	N/A	1285700336	0	0	KOLODZIEJ, MICHAEL K LMFT	4/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43472	N/A	N/A	N/A	N/A	N/A	5650 MOUNT ACKERLY DR	None	SAN DIEGO	CA	92111	4016	00	06000	32.80910151	-117.1793115	San Diego County
327270	Ordering, Referring, Prescribing	N/A	1285715052	0	0	KUDULIS, DEANNA L	5/31/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0572316	N/A	N/A	N/A	N/A	N/A	1350 E MAIN ST	None	GRASS VALLEY	CA	95945	5208	00	06000	39.23235232	-121.0454663	Nevada County
327273	Ordering, Referring, Prescribing	N/A	1285731638	0	0	KING, MICHELLE R MD	10/13/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144815	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
327308	Ordering, Referring, Prescribing	N/A	1285807933	0	0	KHAN, WAJEEHA Y LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97158	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVENUE	None	HAYWARD	CA	94544	2923	00	06000	37.64800936	-122.0758633	Alameda County
327339	Ordering, Referring, Prescribing	N/A	1285872507	0	0	KAVANAGH, RENEE C MSW LCSW	12/21/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW71892	N/A	N/A	N/A	N/A	N/A	170 W SAN JOSE AVE	None	CLAREMONT	CA	91711	5285	00	06000	34.0831314	-117.716556	Los Angeles County
327354	Ordering, Referring, Prescribing	N/A	1285903807	0	0	KOINANGE, PETER	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57985	N/A	N/A	N/A	N/A	N/A	416 ALVARADO ST	None	MONTEREY	CA	93940	2711	00	06000	36.59940067	-121.8945128	Monterey County
327373	Ordering, Referring, Prescribing	N/A	1285925214	0	0	KINGMAN, CHELSEA	4/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92676	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
327408	Ordering, Referring, Prescribing	N/A	1285983866	0	0	KONG, JOHN PHARMD	8/31/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67670	N/A	N/A	N/A	N/A	N/A	12 N 1ST AVE	None	ARCADIA	CA	91006	3205	00	06000	34.14041319	-118.0282852	Los Angeles County
327411	Ordering, Referring, Prescribing	N/A	1285998187	0	0	KAZI, LUBNA PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66446	N/A	N/A	N/A	N/A	N/A	1639 HERITAGE BAY PL	None	SAN JOSE	CA	95138	2749	00	06000	37.29000143	-121.7971957	Santa Clara County
327468	Ordering, Referring, Prescribing	N/A	1295107605	0	0	KIM, SAMUEL PHARMD	3/3/2019	Taxonomy not applicable	NA	n/a	000	Unknown	73144	N/A	N/A	N/A	N/A	N/A	1001 E LATHAM AVE	SUITE # P	HEMET	CA	92543	4435	00	06000	33.74937254	-116.961804	Riverside County
327517	Ordering, Referring, Prescribing	N/A	1295201382	0	0	KATCEF, DAVID	6/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	ND1024	N/A	N/A	N/A	N/A	N/A	2216 NEWPORT BLVD	None	COSTA MESA	CA	92627	1711	00	06000	33.65203681	-117.907714	Orange County
327518	Ordering, Referring, Prescribing	N/A	1295211969	0	0	KARASEK, LAUREN N NP	6/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009220	N/A	N/A	N/A	N/A	N/A	2200 TYDD STREET	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
327598	Ordering, Referring, Prescribing	N/A	1295318160	0	0	KUG, JAE EUN	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84234	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD.	MS SEC2-B	BOISE	ID	83706	0000	00	06000	43.59860438	-116.1806635	Ada County
327601	Ordering, Referring, Prescribing	N/A	1295334753	0	0	KAUR, MANPREET PHARMD	2/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	82844	N/A	N/A	N/A	N/A	N/A	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	00	06000	38.2629133	-122.0560176	Solano County
327645	Ordering, Referring, Prescribing	N/A	1295507036	0	0	KARELIUS, KATHRYN M NP	10/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027834	N/A	N/A	N/A	N/A	N/A	300 JUBILEE DR	None	PEABODY	MA	01960	4068	00	06000	42.522885	-70.9720605	Essex County
327648	Ordering, Referring, Prescribing	N/A	1295515658	0	0	KRAMM, LYNDSEY	7/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	830141	N/A	N/A	N/A	N/A	N/A	1559 WATASHEAMU RD	None	GARDNERVILLE	NV	89460	7455	00	06000	38.90016089	-119.7157447	Douglas County
327681	Ordering, Referring, Prescribing	N/A	1295778215	0	0	KHAN, MOHAMMAD MD	11/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C183205	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LANE	C	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
327701	Ordering, Referring, Prescribing	N/A	1295855021	0	0	KAY, AMY M LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40813	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
327717	Ordering, Referring, Prescribing	N/A	1295866408	0	0	KNOX, TERRESA L LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60522	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
327730	Ordering, Referring, Prescribing	N/A	1295880995	0	0	KRATZER, PAUL G MD	6/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	G58499	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
327736	Ordering, Referring, Prescribing	N/A	1295921963	0	0	KIRSZTAJN, AMY H MSW LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70172	N/A	N/A	N/A	N/A	N/A	45 FARALLONES ST	None	SAN FRANCISCO	CA	94112	3005	00	06000	37.71408691	-122.4538573	San Francisco County
327742	Ordering, Referring, Prescribing	N/A	1295936441	0	0	KING, TINA M	1/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	6596	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
327765	Ordering, Referring, Prescribing	N/A	1295984904	0	0	KARAPETYAN, SUZI LCSW	12/8/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75992	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2151	00	06000	34.06170677	-118.302787	Los Angeles County
327770	Ordering, Referring, Prescribing	N/A	1295996965	0	0	KERR, MILLER J MD	6/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153007	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400 STE. 202	SALINAS	CA	93906	3127	00	06000	36.696987	-121.633164	Monterey County
327779	Ordering, Referring, Prescribing	N/A	1306002050	0	0	KWOK, PEGGY C LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53519	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	0000	00	06000	37.545779	-122.3213093	San Mateo County
327822	Ordering, Referring, Prescribing	N/A	1306115001	0	0	KEYSTONE, JAY S MD	11/15/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C29865	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
327832	Ordering, Referring, Prescribing	N/A	1306125489	0	0	KYRIAS, CARRIE A CCC-SLP	11/15/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	21791	N/A	N/A	N/A	N/A	N/A	511 S ORCHARD AVE	None	UKIAH	CA	95482	5022	00	06000	39.14729048	-123.1987868	Mendocino County
327856	Ordering, Referring, Prescribing	N/A	1306155387	0	0	KELLEY, JAMIE G LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48430	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
327890	Ordering, Referring, Prescribing	N/A	1306217625	0	0	KNAPP, CRYSTAL L PT	9/14/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	292857	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
327904	Ordering, Referring, Prescribing	N/A	1306181854	0	0	KUILANOFF, ELIZABETH MD	9/8/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138920	N/A	N/A	N/A	N/A	N/A	1521 HIGHLAND AVE	None	LOS ANGELES	CA	92108	3808	00	06000	34.098444	-118.3386975	Los Angeles County
327977	Ordering, Referring, Prescribing	N/A	1306327622	0	0	KIM, CRYSTAL L PHARMD	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH78393	N/A	N/A	N/A	N/A	N/A	216 WESTLAKE CTR	None	DALY CITY	CA	94015	1430	00	06000	37.70123591	-122.4833751	San Mateo County
327979	Ordering, Referring, Prescribing	N/A	1306353859	0	0	KLIPSCH-ABUDU, KAITLIN LCSW	11/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98147	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
328065	Ordering, Referring, Prescribing	N/A	1306562681	0	0	KARAIAN, SARKIS S PHARMD	10/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87077	N/A	N/A	N/A	N/A	N/A	1141 W AVENUE L	None	LANCASTER	CA	93534	7077	00	06000	34.66039349	-118.1514285	Los Angeles County
328096	Ordering, Referring, Prescribing	N/A	1306848460	0	0	KAZMI, MOHAMMAD A G MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A41156	N/A	N/A	N/A	N/A	N/A	515 S FAIRMONT AVE	None	LODI	CA	95240	3834	00	06000	38.12786821	-121.2859247	San Joaquin County
328107	Ordering, Referring, Prescribing	N/A	1306905492	0	0	KAYES, MAX J LMFT	3/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	22998	N/A	N/A	N/A	N/A	N/A	12810 HEACOCK STREET	SUITE B202	MORENO VALLEY	CA	92553	2873	00	06000	33.934851	-117.2437635	Riverside County
328123	Ordering, Referring, Prescribing	N/A	1306931555	0	0	KUO, ANGEL C	1/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP10154	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
328128	Ordering, Referring, Prescribing	N/A	1306935564	0	0	KOOPER, KAREL W MD	5/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71166	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
328144	Ordering, Referring, Prescribing	N/A	1306979307	0	0	KAPILA, SUNIL DDS PHD	4/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	37681	N/A	N/A	N/A	N/A	N/A	10833 LE CONTE AVE.	CHS 20-140	LOS ANGELES	CA	90095	1668	00	06000	34.06373445	-118.443537	Los Angeles County
328147	Ordering, Referring, Prescribing	N/A	1306989017	0	0	KURTEEVA, KATERINA MD	5/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A98160	N/A	N/A	N/A	N/A	N/A	1441 AVOCADO AVE	SUITE 206	NEWPORT BEACH	CA	92660	7721	00	06000	33.61338536	-117.8693961	Orange County
328158	Ordering, Referring, Prescribing	N/A	1316005788	0	0	KIRKPATRICK, MATTHEW C PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51397	N/A	N/A	N/A	N/A	N/A	1425 SOUTH MAIN STREET	None	WALNUT CREEK	CA	94596	5300	00	06000	37.89189148	-122.057999	Contra Costa County
328171	Ordering, Referring, Prescribing	N/A	1316024227	0	0	KOO, KATHERINE PHARMD	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51566	N/A	N/A	N/A	N/A	N/A	1400 E 4TH ST	None	SANTA ANA	CA	92701	5114	00	06000	33.74806552	-117.850077	Orange County
328184	Ordering, Referring, Prescribing	N/A	1316057243	0	0	KIM, GENE PHARMD	12/17/2020	Taxonomy not applicable	NA	n/a	000	Unknown	54767	N/A	N/A	N/A	N/A	N/A	100 E MAIN ST	None	SAN JACINTO	CA	92583	4297	00	06000	33.78386623	-116.9586772	Riverside County
328243	Ordering, Referring, Prescribing	N/A	1316175110	0	0	KOREN, ELIZABETH A	1/20/2017	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	10718	N/A	N/A	N/A	N/A	N/A	24422 AVENIDA DE LA CARL	STE 100	LAGUNA HILLS	CA	92653	3648	00	06000	33.56726005	-117.705397	Orange County
328278	Ordering, Referring, Prescribing	N/A	1316247844	0	0	KESWANI, MONICA	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49944	N/A	N/A	N/A	N/A	N/A	6790 BERNAL AVE	None	PLEASANTON	CA	94566	1218	00	06000	37.65713003	-121.9002405	Alameda County
328329	Ordering, Referring, Prescribing	N/A	1316329568	0	0	KOCHHAR, RUNIT DDS	9/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	100203	N/A	N/A	N/A	N/A	N/A	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	00	06000	36.332757	-119.288682	Tulare County
328345	Ordering, Referring, Prescribing	N/A	1316362585	0	0	KNIPPER, ROBERT J	3/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH36610	N/A	N/A	N/A	N/A	N/A	1421 MANHATTAN AVE	None	FULLERTON	CA	92831	5221	00	06000	33.85701	-117.902438	Orange County
328350	Ordering, Referring, Prescribing	N/A	1316372568	0	0	KEALEY, KATHRYN R PHARMD	10/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	69457	N/A	N/A	N/A	N/A	N/A	1440 W 25TH ST	None	SAN PEDRO	CA	90732	4418	00	06000	33.72189523	-118.3111002	Los Angeles County
328378	Ordering, Referring, Prescribing	N/A	1316402191	0	0	KLINE, MARICELLA E MSW LCSW	1/31/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115728	N/A	N/A	N/A	N/A	N/A	2101 GEER RD	120	TURLOCK	CA	95382	2454	00	06000	37.512324	-120.8489985	Stanislaus County
328385	Ordering, Referring, Prescribing	N/A	1316419781	0	0	KHODAGULYAN, ALEN PHARMD	11/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75013	N/A	N/A	N/A	N/A	N/A	450 SOUTH VENTURA ROAD	None	OXNARD	CA	93030	0102	00	06000	34.19840042	-119.194659	Ventura County
328396	Ordering, Referring, Prescribing	N/A	1316438815	0	0	KIRKMAN-LIFF, EMMA Y LCSW	1/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120758	N/A	N/A	N/A	N/A	N/A	125 W MISSION AVE	SUITE 103	ESCONDIDO	CA	92025	1720	00	06000	33.12998866	-117.0864074	San Diego County
328408	Ordering, Referring, Prescribing	N/A	1316450885	0	0	KRPALEK, JOSEPH T	3/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55248	N/A	N/A	N/A	N/A	N/A	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	00	06000	34.1035953	-117.2563723	San Bernardino County
328410	Ordering, Referring, Prescribing	N/A	1316460215	0	0	KANDOLA, SAMANJIT K	9/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170070	N/A	N/A	N/A	N/A	N/A	65 N HOCKETT ST	None	PORTERVILLE	CA	93257	0000	00	06000	36.0663928	-119.01714	Tulare County
328485	Ordering, Referring, Prescribing	N/A	1316573389	0	0	KUNG, MICHAEL S MD	1/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL3319	N/A	N/A	N/A	N/A	N/A	505 S. MAIN STREET	SUITE 525	ORANGE	CA	92868	3284	00	06000	33.78004808	-117.8672472	Orange County
328505	Ordering, Referring, Prescribing	N/A	1316615313	0	0	KEMP, KATHRINE NP	4/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018497	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
328521	Ordering, Referring, Prescribing	N/A	1316646797	0	0	KIMBALL, CRYSTAL N NP	2/16/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024333	N/A	N/A	N/A	N/A	N/A	1050 N STATE ST	None	UKIAH	CA	95482	3414	00	06000	39.1623719	-123.2098216	Mendocino County
328536	Ordering, Referring, Prescribing	N/A	1316789126	0	0	KASHANI, SARA DMD	8/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110514	N/A	N/A	N/A	N/A	N/A	1400 MARKET ST STE 8103	STE 8103	REDDING	CA	96001	1050	00	06000	40.58499451	-122.3911682	Shasta County
328542	Ordering, Referring, Prescribing	N/A	1316947302	0	0	KOSEL, MATTHEW PA-C	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	17101	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
328570	Ordering, Referring, Prescribing	N/A	1326080060	0	0	KADES, WAGDY W MD	6/1/2019	Taxonomy not applicable	NA	n/a	000	Unknown	A56293	N/A	N/A	N/A	N/A	N/A	1245 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	4881	00	06000	34.05362775	-118.2661889	Los Angeles County
328584	Ordering, Referring, Prescribing	N/A	1326111824	0	0	KIM, MARTIN C	6/13/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	38130	N/A	N/A	N/A	N/A	N/A	3400 LOMITA BLVD	STE 102	TORRANCE	CA	90505	4911	00	06000	33.81309744	-118.3448635	Los Angeles County
328592	Ordering, Referring, Prescribing	N/A	1326122920	0	0	KAN, HOMER C PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49089	N/A	N/A	N/A	N/A	N/A	3801 HOWE ST	None	OAKLAND	CA	94611	5312	00	06000	37.8242732	-122.2568561	Alameda County
328613	Ordering, Referring, Prescribing	N/A	1326162744	0	0	KADI, FARNAZ LMFT	7/10/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44657	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
328629	Ordering, Referring, Prescribing	N/A	1326175878	0	0	KREMSDORF, ROSS B PHD	7/8/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY6271	N/A	N/A	N/A	N/A	N/A	676 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3945	00	06000	35.27640631	-120.6628883	San Luis Obispo County
328680	Ordering, Referring, Prescribing	N/A	1326285552	0	0	KHAN, SAMRA MD	11/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145516	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4841	00	06000	35.407179	-119.0208925	Kern County
328691	Ordering, Referring, Prescribing	N/A	1326299801	0	0	KIM, CHARLES C PHARMD	3/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	50017	N/A	N/A	N/A	N/A	N/A	28350 COPPERHILL DR	None	VALENCIA	CA	91354	1701	00	06000	34.4608794	-118.5628385	Los Angeles County
328698	Ordering, Referring, Prescribing	N/A	1326306622	0	0	KEHNER, CHERYL L LMFT	11/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105700	N/A	N/A	N/A	N/A	N/A	1330 ARNOLD DR	143	MARTINEZ	CA	94553	6538	00	06000	37.99302586	-122.0987252	Contra Costa County
328712	Ordering, Referring, Prescribing	N/A	1326316795	0	0	KAWASHIMA, KATHLEEN S PHARMD	8/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	42067	N/A	N/A	N/A	N/A	N/A	12490 CENTRAL AVE	None	CHINO	CA	91710	2603	00	06000	34.026831	-117.6895075	San Bernardino County
328735	Ordering, Referring, Prescribing	N/A	1326341454	0	0	KHACHATRYAN, LUSINE PHARMD	3/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	66303	N/A	N/A	N/A	N/A	N/A	7789 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2137	00	06000	34.25856597	-118.3021164	Los Angeles County
328739	Ordering, Referring, Prescribing	N/A	1326347873	0	0	KWON, GRACE E DO	2/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12013	N/A	N/A	N/A	N/A	N/A	1401 N TUSTIN AVE	225	SANTA ANA	CA	92705	8644	00	06000	33.757254	-117.8341425	Orange County
328753	Ordering, Referring, Prescribing	N/A	1326363300	0	0	KHATIBI, NIKAN H DO MD	8/8/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11914	N/A	N/A	N/A	N/A	N/A	1307 W 6TH ST	105	CORONA	CA	92882	1644	00	06000	33.87790309	-117.589666	Riverside County
328768	Ordering, Referring, Prescribing	N/A	1326391368	0	0	KHAN, SHANOOR PA-C	12/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA57883	N/A	N/A	N/A	N/A	N/A	2071 COMPTON AVE STE	None	CORONA	CA	92881	7972	00	06000	33.848487	-117.5361705	Riverside County
328776	Ordering, Referring, Prescribing	N/A	1326408048	0	0	KOVACS, ALEXIA M LMFT	9/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122158	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
328797	Ordering, Referring, Prescribing	N/A	1326435975	0	0	KWON, JANET PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71053	N/A	N/A	N/A	N/A	N/A	25821 S VERMONT AVE	4049	HARBOR CITY	CA	90710	3518	00	06000	33.78934581	-118.2936765	Los Angeles County
328919	Ordering, Referring, Prescribing	N/A	1326658089	0	0	KING, ANDREA PHARMD	2/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82760	N/A	N/A	N/A	N/A	N/A	1263 E ARQUES AVE	None	SUNNYVALE	CA	94085	4701	00	06000	37.38060846	-121.9896672	Santa Clara County
328937	Ordering, Referring, Prescribing	N/A	1326695156	0	0	KWON, SHARON LCSW	4/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114654	N/A	N/A	N/A	N/A	N/A	2933 EL NIDO DRIVE	None	ALTADENA	CA	91001	4599	00	06000	34.19549106	-118.1655134	Los Angeles County
329013	Ordering, Referring, Prescribing	N/A	1336238187	0	0	KONG, AMY PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55771	N/A	N/A	N/A	N/A	N/A	2 HOLTZ COURT	None	ALAMEDA	CA	94501	6402	00	06000	37.782135	-122.273652	Alameda County
329016	Ordering, Referring, Prescribing	N/A	1336246255	0	0	KIM, HUISOON LAC	12/8/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC9661	N/A	N/A	N/A	N/A	N/A	4131 MING AVE	None	BAKERSFIELD	CA	93309	4994	00	06000	35.33945463	-119.0506798	Kern County
329021	Ordering, Referring, Prescribing	N/A	1336249358	0	0	KAWAMURA, PETER Y	1/14/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D30936	N/A	N/A	N/A	N/A	N/A	1807 BAY RD	None	EAST PALO ALTO	CA	94303	1312	00	06000	37.47199121	-122.1344629	San Mateo County
329027	Ordering, Referring, Prescribing	N/A	1336265172	0	0	KAHN, ALEXANDRA M LMFT	4/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44987	N/A	N/A	N/A	N/A	N/A	190 SIERRA COURT	C4	PALMDALE	CA	93550	7607	00	06000	34.64013337	-118.1280539	Los Angeles County
329091	Ordering, Referring, Prescribing	N/A	1336396035	0	0	KANG, AE RAH NP	9/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	651990	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	STE 9A	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
329145	Ordering, Referring, Prescribing	N/A	1336494301	0	0	KEJRIWAL, PRATIMA	10/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	47122	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	101	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
329163	Ordering, Referring, Prescribing	N/A	1336520626	0	0	KALASHNIKOVA, MARIYA MD	5/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173282	N/A	N/A	N/A	N/A	N/A	2010 ZONAL AVE	None	LOS ANGELES	CA	90033	1026	00	06000	34.05986523	-118.2057472	Los Angeles County
329196	Ordering, Referring, Prescribing	N/A	1336547876	0	0	KANG, IN PHARMD	3/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69131	N/A	N/A	N/A	N/A	N/A	7373 WEST LANE	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
329204	Ordering, Referring, Prescribing	N/A	1336560242	0	0	KATRAGADDA, VIJAYALAKSHMI P DDS	1/12/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	63040	N/A	N/A	N/A	N/A	N/A	7210 MURRAY DR	None	STOCKTON	CA	95210	3339	00	06000	38.01572012	-121.3009247	San Joaquin County
329224	Ordering, Referring, Prescribing	N/A	1336593391	0	0	KIM, PETER E	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158981	N/A	N/A	N/A	N/A	N/A	4860 Y ST	3100	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
329236	Ordering, Referring, Prescribing	N/A	1336616291	0	0	KREITMAN, JORIE F PHARMD	7/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79622	N/A	N/A	N/A	N/A	N/A	30251 MURRIETA RD	None	MENIFEE	CA	92584	8385	00	06000	33.684399	-117.2060495	Riverside County
329241	Ordering, Referring, Prescribing	N/A	1336622695	0	0	KIM, ESTHER H PA-C	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56969	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN STREET	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
329276	Ordering, Referring, Prescribing	N/A	1336670249	0	0	KIM, ESTHER S MD	6/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160857	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
329294	Ordering, Referring, Prescribing	N/A	1336699933	0	0	KO, SARAH C	12/22/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	779190	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	SUITE 120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
329302	Ordering, Referring, Prescribing	N/A	1336695014	0	0	KY, DANIEL PHARMD	10/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	74395	N/A	N/A	N/A	N/A	N/A	4816 E 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
329306	Ordering, Referring, Prescribing	N/A	1336719186	0	0	KAUR, PARBJEET NP	4/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95017226	N/A	N/A	N/A	N/A	N/A	1739 COLORADO AVENUE	None	TURLOCK	CA	95382	2714	00	06000	37.508976	-120.835306	Stanislaus County
329321	Ordering, Referring, Prescribing	N/A	1336758085	0	0	KRUSE, DANIEL J LCSW	11/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126330	N/A	N/A	N/A	N/A	N/A	5472 EL CAJON BOULEVARD	#101	SAN DIEGO	CA	92115	3651	00	06000	32.75822774	-117.0768721	San Diego County
329342	Ordering, Referring, Prescribing	N/A	1336790203	0	0	KIM, DEISY LPCC	11/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC18010	N/A	N/A	N/A	N/A	N/A	189 AVENIDA LA CUESTA	None	SANTA ANA	CA	92672	3144	00	06000	33.436368	-117.6169455	Orange County
329345	Ordering, Referring, Prescribing	N/A	1336811561	0	0	KAUR, KIRANJEET NP	2/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018623	N/A	N/A	N/A	N/A	N/A	5562 PHILADELPHIA ST	310	CHINO	CA	91710	2466	00	06000	34.03370384	-117.6837291	San Bernardino County
329369	Ordering, Referring, Prescribing	N/A	1336968544	0	0	KONTEH, BINTU NP	10/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032447	N/A	N/A	N/A	N/A	N/A	5903 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4229	00	06000	34.11066158	-118.1906817	Los Angeles County
329383	Ordering, Referring, Prescribing	N/A	1346077351	0	0	KIM, JAE EUN NP	8/15/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031733	N/A	N/A	N/A	N/A	N/A	7592 BROADWAY	None	LEMON GROVE	CA	91945	1604	00	06000	32.74274487	-117.0345359	San Diego County
329391	Ordering, Referring, Prescribing	N/A	1346214889	0	0	KORMANN, JACQUELINE R	5/11/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104819	N/A	N/A	N/A	N/A	N/A	220 BARTON BLVD	UNIT C14	ROCKLEDGE	FL	32955	2742	00	06000	28.33088134	-80.72834273	Brevard County
329441	Ordering, Referring, Prescribing	N/A	1346369576	0	0	KING, JEFFREY LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22217	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
329446	Ordering, Referring, Prescribing	N/A	1346378239	0	0	KUBOJIRI, CHRISTINA LMFT	10/26/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80287	N/A	N/A	N/A	N/A	N/A	1500 HUGHES WAY	C100	LONG BEACH	CA	90810	1870	00	06000	33.82860528	-118.2124528	Los Angeles County
329461	Ordering, Referring, Prescribing	N/A	1346405990	0	0	KONDO, KEIKO NP	5/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	10005	N/A	N/A	N/A	N/A	N/A	6912 AJAX AVE	None	BELL GARDENS	CA	90201	4057	00	06000	33.96992365	-118.1629712	Los Angeles County
329469	Ordering, Referring, Prescribing	N/A	1346411477	0	0	KHAZAEIZADEH, ALIREZA MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100885	N/A	N/A	N/A	N/A	N/A	2507 EASTBLUFF DRIVE	STE C	NEWPORT BEACH	CA	92660	3504	00	06000	33.6393881	-117.8755685	Orange County
329541	Ordering, Referring, Prescribing	N/A	1346547866	0	0	KUBAL, VICTORIA T LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97693	N/A	N/A	N/A	N/A	N/A	49774 ROAD 426	SUITE D	OAKHURST	CA	93644	8690	00	06000	37.32548938	-119.6399043	Madera County
329612	Ordering, Referring, Prescribing	N/A	1346653664	0	0	KIM, THOMAS MD	1/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162168	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
329635	Ordering, Referring, Prescribing	N/A	1346701570	0	0	KHINE, AYE MD	4/8/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179180	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
329643	Ordering, Referring, Prescribing	N/A	1346713336	0	0	KIM, MIJEONG PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64391	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
329656	Ordering, Referring, Prescribing	N/A	1346733946	0	0	KIM, CHRISTINE SUE JUNG MD	4/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166127	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD	None	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
329683	Ordering, Referring, Prescribing	N/A	1346769981	0	0	KNADLER, SARAH B LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97273	N/A	N/A	N/A	N/A	N/A	222 E MAIN ST	117	BARSTOW	CA	92311	2361	00	06000	34.89870403	-117.025149	San Bernardino County
329711	Ordering, Referring, Prescribing	N/A	1346809027	0	0	KEMP, KENNETH W PHARMD	9/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	36790	N/A	N/A	N/A	N/A	N/A	5795 N 1ST ST	None	FRESNO	CA	93710	6203	00	06000	36.82267128	-119.7724044	Fresno County
329712	Ordering, Referring, Prescribing	N/A	1346821485	0	0	KLINER, AMY K RN	5/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	554400	N/A	N/A	N/A	N/A	N/A	1301 E ORANGETHORPE AVE	None	PLACENTIA	CA	92870	5302	00	06000	33.870375	-117.8378505	Orange County
329761	Ordering, Referring, Prescribing	N/A	1346962123	0	0	KIM, HYE JOO PHARMD	9/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86798	N/A	N/A	N/A	N/A	N/A	2640 LOMITA BLVD	None	TORRANCE	CA	90505	5214	00	06000	33.80800785	-118.332844	Los Angeles County
329773	Ordering, Referring, Prescribing	N/A	1346996436	0	0	KIEU, DONALD DDS	8/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108684	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
329821	Ordering, Referring, Prescribing	N/A	1356372924	0	0	KOOROS, KOOROSH MD	7/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C138035	N/A	N/A	N/A	N/A	N/A	5222 BALBOA AVE	42	SAN DIEGO	CA	92117	6904	00	06000	32.81873589	-117.1838368	San Diego County
329826	Ordering, Referring, Prescribing	N/A	1356393573	0	0	KONG, VICTOR H MD	3/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68276	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	SUITE 120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
329829	Ordering, Referring, Prescribing	N/A	1356401061	0	0	KHASHO, RAMSEY PSYD	12/6/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18575	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2340	00	06000	37.43949537	-122.1784133	Santa Clara County
329836	Ordering, Referring, Prescribing	N/A	1356416663	0	0	KHOLODOVA, MARIYA N PHD	7/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25103	N/A	N/A	N/A	N/A	N/A	1963 4TH AVE	None	SAN DIEGO	CA	92101	2394	00	06000	32.72572745	-117.1608615	San Diego County
329845	Ordering, Referring, Prescribing	N/A	1356420152	0	0	KYE, STELLA PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51916	N/A	N/A	N/A	N/A	N/A	25825 S. VERMONT AVE	None	HARBOR CITY	CA	90701	0000	00	06000	33.7892965	-118.2937327	Los Angeles County
329853	Ordering, Referring, Prescribing	N/A	1356463343	0	0	KAM, SANDRA PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57419	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	645	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
329906	Ordering, Referring, Prescribing	N/A	1356584106	0	0	KYLE, MICHAEL	1/17/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A115581	N/A	N/A	N/A	N/A	N/A	444 BRUCE STREET	None	YREKA	CA	96097	3450	00	06000	41.71863548	-122.6458755	Siskiyou County
329913	Ordering, Referring, Prescribing	N/A	1356577217	0	0	KUBOTA, CARRIE R OD	12/20/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	9907T	N/A	N/A	N/A	N/A	N/A	1030-B EAST LOS ANGELES	None	SIMI VALLEY	CA	93065	2868	00	06000	34.27162348	-118.7793	Ventura County
329915	Ordering, Referring, Prescribing	N/A	1356605836	0	0	KIM, JONGJIN MD	4/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133928	N/A	N/A	N/A	N/A	N/A	476 E WASHINGTON	None	EARLIMART	CA	93219	9694	00	06000	35.88434376	-119.2716517	Tulare County
329919	Ordering, Referring, Prescribing	N/A	1356611784	0	0	KAPADIA, ROOPA	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64308	N/A	N/A	N/A	N/A	N/A	925 ORANGE AVE	None	CORONADO	CA	92118	2609	00	06000	32.68677093	-117.1792108	San Diego County
329944	Ordering, Referring, Prescribing	N/A	1356643076	0	0	KANNEH-WARITAY, SAPHIE S NP	11/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002381	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
329957	Ordering, Referring, Prescribing	N/A	1356664189	0	0	KIANI, FARHAD L	3/19/2010	Taxonomy not applicable	NA	n/a	099	DENTIST	D59172	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
329993	Ordering, Referring, Prescribing	N/A	1356719421	0	0	KARIM, FROSAN LMFT	3/6/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145629	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	BUILDING F	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
330025	Ordering, Referring, Prescribing	N/A	1356766216	0	0	KERR, KIMBERLY	11/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113619	N/A	N/A	N/A	N/A	N/A	1119 E CUMBERLAND RD	None	ORANGE	CA	92865	3505	00	06000	33.82538372	-117.842042	Orange County
330039	Ordering, Referring, Prescribing	N/A	1356781132	0	0	KIM, PHILIP MD	1/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166209	N/A	N/A	N/A	N/A	N/A	21757 DEVONSHIRE ST	1	CHATSWORTH	CA	91311	2976	00	06000	34.25725894	-118.603595	Los Angeles County
330054	Ordering, Referring, Prescribing	N/A	1356800403	0	0	KAUFMAN-GOMEZ, CATHERINE L	4/5/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28003	N/A	N/A	N/A	N/A	N/A	1309 S. MARY AVENUE	SUITE 250	SUNNYVALE	CA	94087	3054	00	06000	37.34939241	-122.0505414	Santa Clara County
330063	Ordering, Referring, Prescribing	N/A	1356815831	0	0	KANEAKALAU, MARY L G RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	250408	N/A	N/A	N/A	N/A	N/A	1530 EAST 19TH STREET	None	BAKERSFIELD	CA	93305	5406	00	06000	35.37150365	-118.9798847	Kern County
330065	Ordering, Referring, Prescribing	N/A	1356824619	0	0	KOEBLER, SUZANNE O LCSW	9/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109281	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
330108	Ordering, Referring, Prescribing	N/A	1356903389	0	0	KOU, QI LAC	11/21/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	18549	N/A	N/A	N/A	N/A	N/A	2633 SAN BRUNO AVE	None	SAN FRANCISCO	CA	94134	1597	00	06000	37.72840413	-122.4039067	San Francisco County
330121	Ordering, Referring, Prescribing	N/A	1356928568	0	0	KELLY, MEGHAN R CNP	2/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016798	N/A	N/A	N/A	N/A	N/A	1039 W FLORENCE AVE	None	LOS ANGELES	CA	90044	2441	00	06000	33.97463885	-118.2933327	Los Angeles County
330126	Ordering, Referring, Prescribing	N/A	1356945059	0	0	KAUFMAN, ASHER LCSW	4/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114735	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
330145	Ordering, Referring, Prescribing	N/A	1356983670	0	0	KANG, SOO K NP	3/2/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016830	N/A	N/A	N/A	N/A	N/A	7273 14TH AVE	123 B	SACRAMENTO	CA	95820	3500	00	06000	38.540097	-121.419063	Sacramento County
330153	Ordering, Referring, Prescribing	N/A	1366002347	0	0	KOW, SEAN Y MD	4/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL2009	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
330167	Ordering, Referring, Prescribing	N/A	1366025975	0	0	KOMMINENI, VIVEK DPM	7/31/2023	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5977	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
330182	Ordering, Referring, Prescribing	N/A	1366058794	0	0	KIM, JOANNA J PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82034	N/A	N/A	N/A	N/A	N/A	1719 E WALNUT ST	None	PASADENA	CA	91106	1611	00	06000	34.14957646	-118.115019	Los Angeles County
330195	Ordering, Referring, Prescribing	N/A	1366086241	0	0	KHOSHAL, YASER PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80835	N/A	N/A	N/A	N/A	N/A	5800 DOWDELL AVENUE	378	ROHNERT PARK	CA	94928	1300	00	06000	38.354472	-122.7213135	Sonoma County
330202	Ordering, Referring, Prescribing	N/A	1366098725	0	0	KELLER, JULIE A LMFT	9/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134927	N/A	N/A	N/A	N/A	N/A	901 SUNRISE AVE.	SUITE A3	ROSEVILLE	CA	95661	3080	00	06000	38.732238	-121.2720325	Placer County
330230	Ordering, Referring, Prescribing	N/A	1366197600	0	0	KAUR, RUPINDER DDS	1/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107277	N/A	N/A	N/A	N/A	N/A	12586 AVENUE 408	None	OROSI	CA	93647	9454	00	06000	36.53030229	-119.2915122	Tulare County
330235	Ordering, Referring, Prescribing	N/A	1366204141	0	0	KNOBBE, MARY M LMFT	9/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141419	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
330270	Ordering, Referring, Prescribing	N/A	1366527533	0	0	KING, DANIEL P LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT37854	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY ST	G710	FREMONT	CA	94538	1525	00	06000	37.55123907	-121.9828956	Alameda County
330328	Ordering, Referring, Prescribing	N/A	1366658445	0	0	KEHOE, MOIRA J NP	10/24/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15686	N/A	N/A	N/A	N/A	N/A	5910 CLARK ROAD	None	PARADISE	CA	95969	4856	00	06000	39.75749014	-121.6070408	Butte County
330338	Ordering, Referring, Prescribing	N/A	1366683062	0	0	KOCH, BRADLEY LMFT	4/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46694	N/A	N/A	N/A	N/A	N/A	1900 S MCDOWELL BLVD	None	PETALUMA	CA	94954	5473	00	06000	38.230006	-122.5958952	Sonoma County
330443	Ordering, Referring, Prescribing	N/A	1366869265	0	0	KAUR, SANDEEP PA-C	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53659	N/A	N/A	N/A	N/A	N/A	1820 J ST	None	SACRAMENTO	CA	95811	3010	00	06000	38.57688	-121.4816625	Sacramento County
330504	Ordering, Referring, Prescribing	N/A	1366966327	0	0	KAJOS KINGSBY, JACQUELINE H LCSW	7/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116316	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
330545	Ordering, Referring, Prescribing	N/A	1376035600	0	0	KUO, TZU-CHI	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62746	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
330565	Ordering, Referring, Prescribing	N/A	1376074880	0	0	KUMAR, MANAV MD	3/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158976	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
330588	Ordering, Referring, Prescribing	N/A	1376121277	0	0	KWOK, VIVIAN LMFT	10/21/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150788	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
330591	Ordering, Referring, Prescribing	N/A	1376122390	0	0	KIANMAHD, SAMUEL SIMON DAVID	1/3/2025	Taxonomy not applicable	NA	n/a	000	Unknown	A200595	N/A	N/A	N/A	N/A	N/A	6120 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	2911	00	06000	33.98438021	-118.2226279	Los Angeles County
330600	Ordering, Referring, Prescribing	N/A	1376156323	0	0	KAY, MARCIE A	2/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131420	N/A	N/A	N/A	N/A	N/A	1303 SAN CARLOS AVENUE	None	SAN CARLOS	CA	94070	0000	00	06000	37.50572931	-122.2621879	San Mateo County
330601	Ordering, Referring, Prescribing	N/A	1376152991	0	0	KENNEDY, BRIAN	2/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	107650	N/A	N/A	N/A	N/A	N/A	3554 W MT WHITNEY	None	RIVERDALE	CA	93656	0000	00	06000	36.43083157	-119.8619557	Fresno County
330635	Ordering, Referring, Prescribing	N/A	1376234328	0	0	KELLEY, RACHEL CNP	1/29/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023965	N/A	N/A	N/A	N/A	N/A	690 OXFORD ST	H	CHULA VISTA	CA	91911	7111	00	06000	32.60532439	-117.0853713	San Diego County
330658	Ordering, Referring, Prescribing	N/A	1376387852	0	0	KHAN, HEJAB J PHARMD	7/12/2024	Taxonomy not applicable	NA	n/a	000	Unknown	89622	N/A	N/A	N/A	N/A	N/A	1200 4TH ST	244	SAN FRANCISCO	CA	94158	2392	00	06000	37.77252014	-122.3914171	San Francisco County
330667	Ordering, Referring, Prescribing	N/A	1376562314	0	0	KORR, KENNETH MD	1/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C147718	N/A	N/A	N/A	N/A	N/A	6100 REDWOOD BLVD	None	NOVATO	CA	94945	4501	00	06000	38.09578333	-122.5627508	Marin County
330792	Ordering, Referring, Prescribing	N/A	1376840199	0	0	KI, TRISH H	11/4/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0789329	N/A	N/A	N/A	N/A	N/A	6973 LINDA VISTA BLVD	None	SAN DIEGO	CA	92111	6342	00	06000	32.78725456	-117.1698028	San Diego County
330806	Ordering, Referring, Prescribing	N/A	1376878462	0	0	KIM, JANE LCSW	1/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75259	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD.	1ST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
330856	Ordering, Referring, Prescribing	N/A	1376947119	0	0	KEALOHA, CHANEL E PSYD	6/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31266	N/A	N/A	N/A	N/A	N/A	11650 IBERIA PL	130	SAN DIEGO	CA	92128	2406	00	06000	33.01582056	-117.0780483	San Diego County
330859	Ordering, Referring, Prescribing	N/A	1376956235	0	0	KAUR, MANDEEP MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145884	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
330868	Ordering, Referring, Prescribing	N/A	1376967869	0	0	KIMZEY, KAREN M	4/13/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D63512	N/A	N/A	N/A	N/A	N/A	1717 LAS VEGAS ST	None	MODESTO	CA	95358	5500	00	06000	37.6052798	-121.0027523	Stanislaus County
330874	Ordering, Referring, Prescribing	N/A	1376960260	0	0	KASTNER, DAVID B MD	9/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137580	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
330953	Ordering, Referring, Prescribing	N/A	1386084333	0	0	KIM, JIEUN NP	8/21/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005505	N/A	N/A	N/A	N/A	N/A	1122 S STREET	102	FRESNO	CA	93721	1430	00	06000	36.74185388	-119.7823667	Fresno County
330954	Ordering, Referring, Prescribing	N/A	1386087237	0	0	KENNEDY, DENISE LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87410	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	#125A	OAKLAND	CA	94605	0000	00	06000	37.768221	-122.17608	Alameda County
331043	Ordering, Referring, Prescribing	N/A	1386207421	0	0	KO, WAR WAR	12/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180258	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	200	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
331050	Ordering, Referring, Prescribing	N/A	1386224772	0	0	KHOURY, DINA MD	6/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187433	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	BUILDING 3	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
331058	Ordering, Referring, Prescribing	N/A	1386250355	0	0	KIM, AUDREY B DDS	3/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS105474	N/A	N/A	N/A	N/A	N/A	1872 N TUSTIN ST	None	ORANGE	CA	92865	4605	00	06000	33.81924041	-117.8359949	Orange County
331064	Ordering, Referring, Prescribing	N/A	1386252567	0	0	KIM, JAY B MD	9/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL3526	N/A	N/A	N/A	N/A	N/A	9990 COUNTY FARM RD	None	RIVERSIDE	CA	92503	3542	00	06000	33.9201112	-117.4577963	Riverside County
331086	Ordering, Referring, Prescribing	N/A	1386304608	0	0	KRONSTEIN, NORETTA A LMFT	2/26/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145336	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
331140	Ordering, Referring, Prescribing	N/A	1386645760	0	0	KARU, RANJIT N MD	2/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A41836	N/A	N/A	N/A	N/A	N/A	1900 ROYALTY DRIVE	STE 250	POMONA, CA	CA	91767	3028	00	06000	34.07754346	-117.7463466	Los Angeles County
331163	Ordering, Referring, Prescribing	N/A	1386742831	0	0	KUPISK, ASYA	6/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A35087	N/A	N/A	N/A	N/A	N/A	7779 SUNSET BLVD .	None	WEST HOLLYWOOD	CA	90046	3911	00	06000	34.09808552	-118.3590225	Los Angeles County
331164	Ordering, Referring, Prescribing	N/A	1386746477	0	0	KRALL, VICTOR G DPM	11/14/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E4033	N/A	N/A	N/A	N/A	N/A	3528 TORRANCE BLVD	100	TORRANCE	CA	90503	4827	00	06000	33.83755947	-118.3474935	Los Angeles County
331183	Ordering, Referring, Prescribing	N/A	1386768521	0	0	KERFOOT, STEPHANIE LMFT	8/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35052	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
331206	Ordering, Referring, Prescribing	N/A	1386783777	0	0	KERES, RENE M PSYD	6/7/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22708	N/A	N/A	N/A	N/A	N/A	303 E. VANDERBILT WAY	None	SAN BERNARDINO	CA	92415	0026	00	06000	34.06872265	-117.2775832	San Bernardino County
331218	Ordering, Referring, Prescribing	N/A	1386813350	0	0	KOLSTER, KRISTIN P LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38460	N/A	N/A	N/A	N/A	N/A	11716 ENTERPRISE DR	None	AUBURN	CA	95603	3732	00	06000	38.90720197	-121.0838099	Placer County
331231	Ordering, Referring, Prescribing	N/A	1386834091	0	0	KHALAFBEIGI, HELEN MD	7/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A103696	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4577	00	06000	34.67013731	-118.1222748	Los Angeles County
331233	Ordering, Referring, Prescribing	N/A	1386835163	0	0	KENNETH, ARLINE M MD	5/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C159185	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD 4	202	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
331239	Ordering, Referring, Prescribing	N/A	1386814663	0	0	KOSTANTAS, HELENA	5/17/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	349	N/A	N/A	N/A	N/A	N/A	2928 E CESAR CHAVEZ AVE	280	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
331263	Ordering, Referring, Prescribing	N/A	1386922797	0	0	KIM, DAVID D LCSW	1/27/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW128352	N/A	N/A	N/A	N/A	N/A	11100 ARTESIA BLVD	SUITE A	CERRITOS	CA	90703	2547	00	06000	33.87288108	-118.097253	Los Angeles County
331267	Ordering, Referring, Prescribing	N/A	1386917177	0	0	KAHLON, ANMOL MD	1/31/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143285	N/A	N/A	N/A	N/A	N/A	500 B JEFFERSON BOULEVAR	180 & 195	WEST SACRAMENTO	CA	95605	2394	00	06000	38.58758543	-121.5270475	Yolo County
331305	Ordering, Referring, Prescribing	N/A	1386998219	0	0	KELLY, WALTER	7/21/2019	Taxonomy not applicable	NA	n/a	013	HEARING AID DISPENSERS	HA7495	N/A	N/A	N/A	N/A	N/A	701 PALOMAR AIRPORT RD	STE 300	CARLSBAD	CA	92011	1028	00	06000	33.12205613	-117.3236305	San Diego County
331309	Ordering, Referring, Prescribing	N/A	1396004594	0	0	KAVEESHVAR, HIRSH DO	4/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A15212	N/A	N/A	N/A	N/A	N/A	23861 MCBEAN PKWY	STE A-1	VALENCIA	CA	91355	4489	00	06000	34.39567343	-118.5542698	Los Angeles County
331362	Ordering, Referring, Prescribing	N/A	1396108361	0	0	KAHAN, MADELINE D MD	1/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152993	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
331393	Ordering, Referring, Prescribing	N/A	1396154910	0	0	KLINGER, VENUS PSYD	8/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30888	N/A	N/A	N/A	N/A	N/A	1860 MOWRY AVE	SUITE 400	FREMONT	CA	94538	1730	00	06000	37.55887933	-121.9797796	Alameda County
331394	Ordering, Referring, Prescribing	N/A	1396127080	0	0	KHAN, SHAHLA R LMFT	11/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123293	N/A	N/A	N/A	N/A	N/A	777 NORTH FIRST STREET S	444	SAN JOSE	CA	95112	6339	00	06000	37.32422222	-121.881769	Santa Clara County
331410	Ordering, Referring, Prescribing	N/A	1396172540	0	0	KELLY, MEGAN F LMFT	8/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111006	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
331423	Ordering, Referring, Prescribing	N/A	1396185161	0	0	KUSNEZOV, NICHOLAS MD	2/11/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155908	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE B	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
331472	Ordering, Referring, Prescribing	N/A	1396266466	0	0	KOBE, BRIANNA N DO	9/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16784	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
331478	Ordering, Referring, Prescribing	N/A	1396276895	0	0	KONG, JEREMY MD	4/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159270	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
331492	Ordering, Referring, Prescribing	N/A	1396296752	0	0	KIM, SO HYUN PHD	12/6/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC17388	N/A	N/A	N/A	N/A	N/A	431 N BROOKHURST ST	100	ANAHEIM	CA	92801	5620	00	06000	33.837966	-117.9590565	Orange County
331524	Ordering, Referring, Prescribing	N/A	1396349395	0	0	KABORE, TALATO NP	5/30/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95016990	N/A	N/A	N/A	N/A	N/A	820 W BROADWAY ST	None	NEEDLES	CA	92363	2729	00	06000	34.83897407	-114.6052958	San Bernardino County
331527	Ordering, Referring, Prescribing	N/A	1396354890	0	0	KHALIL, KARIM M LMFT	11/29/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT143216	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
331528	Ordering, Referring, Prescribing	N/A	1396356010	0	0	KANDOW, MEGHAN R NP	1/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016413	N/A	N/A	N/A	N/A	N/A	847 W. CHILDS AVE.	SUITE C	MERCED	CA	95341	6862	00	06000	37.28825369	-120.4963159	Merced County
331544	Ordering, Referring, Prescribing	N/A	1396382461	0	0	KIM, JIN HEE	4/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80947	N/A	N/A	N/A	N/A	N/A	8021 SAN LUIS CIR	None	BUENA PARK	CA	90620	2832	00	06000	33.845805	-118.026678	Orange County
331603	Ordering, Referring, Prescribing	N/A	1396760138	0	0	KAISER, CRAIG A DO	12/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8306	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
331620	Ordering, Referring, Prescribing	N/A	1396811956	0	0	KANG, ANITA K PHARMD	4/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53500	N/A	N/A	N/A	N/A	N/A	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	00	06000	33.85429451	-117.8446551	Orange County
331625	Ordering, Referring, Prescribing	N/A	1396821864	0	0	KWON, SOONSI OD	6/17/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT10825	N/A	N/A	N/A	N/A	N/A	731 N EUCLID ST	None	ANAHEIM	CA	92801	4116	00	06000	33.842385	-117.9416385	Orange County
331663	Ordering, Referring, Prescribing	N/A	1396876264	0	0	KIMURA, MARILYN H MD	3/26/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G75440	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
331666	Ordering, Referring, Prescribing	N/A	1396879359	0	0	KRANTZ, CARL D LMFT	12/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38978	N/A	N/A	N/A	N/A	N/A	5628 E SLAUSON AVE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
331682	Ordering, Referring, Prescribing	N/A	1396898664	0	0	KIM, HANNAH L MD	12/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144927	N/A	N/A	N/A	N/A	N/A	345 E TRAVIS BLVD	None	FAIRFIELD	CA	94533	3958	00	06000	38.25820655	-122.0310675	Solano County
331696	Ordering, Referring, Prescribing	N/A	1396943692	0	0	KUSNIR, ROSARIO LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT27905	N/A	N/A	N/A	N/A	N/A	2484 SHATTUCK AVE	210	BERKELEY	CA	94704	2076	00	06000	37.8641716	-122.2676092	Alameda County
331703	Ordering, Referring, Prescribing	N/A	1396954384	0	0	KLEIN, STEPHEN M	2/21/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D33305	N/A	N/A	N/A	N/A	N/A	1125 E CALIFORNIA AVE	None	BAKERSFIELD	CA	93307	1201	00	06000	35.3683725	-118.9882125	Kern County
331723	Ordering, Referring, Prescribing	N/A	1396979175	0	0	KEKULAWELA, STEPHANIE P L MD	1/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153448	N/A	N/A	N/A	N/A	N/A	6 WOODLAND RD	STE 205	ST HELENA	CA	94574	9501	00	06000	38.54297115	-122.4754501	Napa County
331766	Ordering, Referring, Prescribing	N/A	1407110190	0	0	KISHIYAMA, KAREN L	5/4/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D61957	N/A	N/A	N/A	N/A	N/A	22331 MISSION BLVD	None	HAYWARD	CA	94541	3911	00	06000	37.67442187	-122.0867356	Alameda County
331767	Ordering, Referring, Prescribing	N/A	1407107196	0	0	KUIPER, MADELAINE C	3/14/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0672930	N/A	N/A	N/A	N/A	N/A	2020 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2023	00	06000	34.02901811	-118.4795396	Los Angeles County
331779	Ordering, Referring, Prescribing	N/A	1407130297	0	0	KANAGAWA, JILL PHARMD	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59766	N/A	N/A	N/A	N/A	N/A	3801 PELANDALE AVE	None	MODESTO	CA	95356	8300	00	06000	37.70013907	-121.0663275	Stanislaus County
331837	Ordering, Referring, Prescribing	N/A	1407245947	0	0	KAMATH, POORVA MD	2/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133456	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	SUITE 300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
331840	Ordering, Referring, Prescribing	N/A	1407249063	0	0	KLAUS-VINEYARD, TAYLOR LPCC	9/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10311	N/A	N/A	N/A	N/A	N/A	8920 WILSHIRE BLVD STE 4	STE 425	BEVERLY HILLS	CA	90211	2004	00	06000	34.06703599	-118.3863456	Los Angeles County
331878	Ordering, Referring, Prescribing	N/A	1407315690	0	0	KE, JASMINE C MD	7/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177156	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	320	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
331889	Ordering, Referring, Prescribing	N/A	1407328180	0	0	KIANIAN, RAIEKA LMFT	10/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150764	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD.	None	LONG BEACH	CA	90807	3941	00	06000	33.82086796	-118.18938	Los Angeles County
331891	Ordering, Referring, Prescribing	N/A	1407334428	0	0	KIM, LYDIA MD	10/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165624	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	STE 600	THOUSAND OAKS	CA	91360	4402	00	06000	34.17854676	-118.8805015	Ventura County
331925	Ordering, Referring, Prescribing	N/A	1407373087	0	0	KWON, RACHEL LMFT	8/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149091	N/A	N/A	N/A	N/A	N/A	11600 ELDRIDGE AVE	None	SYLMAR	CA	91342	6506	00	06000	34.28038404	-118.3838708	Los Angeles County
331950	Ordering, Referring, Prescribing	N/A	1407416811	0	0	KHAN, FATIMA DMD	6/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108858	N/A	N/A	N/A	N/A	N/A	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	00	06000	36.98837145	-121.9802206	Santa Cruz County
331979	Ordering, Referring, Prescribing	N/A	1407491871	0	0	KARIMI, NAHID NP	4/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012507	N/A	N/A	N/A	N/A	N/A	711 W. FLORENCE AVENUE	None	LOS ANGELES	CA	90004	6105	00	06000	33.9746755	-118.286415	Los Angeles County
331987	Ordering, Referring, Prescribing	N/A	1407559263	0	0	KENNY, DOROTHY X MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197343	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
332005	Ordering, Referring, Prescribing	N/A	1407589203	0	0	KANG, SUN YOUNG PA-C	7/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63070	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
332016	Ordering, Referring, Prescribing	N/A	1407818768	0	0	KAUFMAN, JENNIFER C MD	11/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G149974	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
332045	Ordering, Referring, Prescribing	N/A	1407927676	0	0	KIRKPATRICK, PAULINE PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51244	N/A	N/A	N/A	N/A	N/A	2500 MERCED STREET	322	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
332048	Ordering, Referring, Prescribing	N/A	1407927908	0	0	KIM, HAEJIN R PA	4/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	18683	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD STE	None	DAVIS	CA	95605	2394	00	06000	38.58811316	-121.5270471	Yolo County
332070	Ordering, Referring, Prescribing	N/A	1407982770	0	0	KERNES, CHRISTIANNE B LMFT	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47041	N/A	N/A	N/A	N/A	N/A	1900 LAKE TAHOE BLVD	None	SOUTH LAKE TAHOE	CA	96150	6305	00	06000	38.91165546	-120.0083802	El Dorado County
332098	Ordering, Referring, Prescribing	N/A	1417039637	0	0	KALKANIS, JAMES G MD	6/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A82979	N/A	N/A	N/A	N/A	N/A	341 MAGNOLIA AVE	206	CORONA	CA	92879	0000	00	06000	33.85291987	-117.5664344	Riverside County
332102	Ordering, Referring, Prescribing	N/A	1417036187	0	0	KASSAM, DIAMOND DO MD	12/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A31963	N/A	N/A	N/A	N/A	N/A	17800 CA-18	None	APPLE VALLEY	CA	92307	0106	00	06000	34.4719944	-117.115449	San Bernardino County
332131	Ordering, Referring, Prescribing	N/A	1417089665	0	0	KABAKIAN, VICKEN LMFT	11/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41453	N/A	N/A	N/A	N/A	N/A	15339 SATICOY STREET	None	VAN NUYS	CA	91406	3345	00	06000	34.2084865	-118.4678505	Los Angeles County
332138	Ordering, Referring, Prescribing	N/A	1417099474	0	0	KIM, ALEXANDER T OD	7/31/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT9649	N/A	N/A	N/A	N/A	N/A	3873 WILSHIRE BLVD.	None	LOS ANGELES	CA	90010	3202	00	06000	34.0617135	-118.31121	Los Angeles County
332150	Ordering, Referring, Prescribing	N/A	1417103961	0	0	KOSZEWNIK, LATASHA	3/11/2024	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5003	N/A	N/A	N/A	N/A	N/A	2200 DEL PASO BLVD	None	SACRAMENTO	CA	95815	3102	00	06000	38.609991	-121.4506125	Sacramento County
332205	Ordering, Referring, Prescribing	N/A	1417239476	0	0	KWOK, CASSIE K PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65681	N/A	N/A	N/A	N/A	N/A	2231 NORIEGA STREET	None	SAN FRANCISCO	CA	94122	4237	00	06000	37.75371338	-122.4877498	San Francisco County
332243	Ordering, Referring, Prescribing	N/A	1417318320	0	0	KWONG, MATTHEW W MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153027	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
332257	Ordering, Referring, Prescribing	N/A	1417330267	0	0	KERN, KRISTOPHER C PSYD	3/27/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	34117	N/A	N/A	N/A	N/A	N/A	9713 SANTA MONICA BLVD	SUITE 201	BEVERLY HILLS	CA	90210	4236	00	06000	34.06835061	-118.4076858	Los Angeles County
332288	Ordering, Referring, Prescribing	N/A	1417374786	0	0	KIM, STEPHANIE J MD	7/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138199	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
332314	Ordering, Referring, Prescribing	N/A	1417413568	0	0	KEEFE, KENDALL LCSW	9/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102380	N/A	N/A	N/A	N/A	N/A	137 N VIRGIL AVE	None	LOS ANGELES	CA	90004	4811	00	06000	34.07457287	-118.2868414	Los Angeles County
332319	Ordering, Referring, Prescribing	N/A	1417414905	0	0	KIBACK, JESSICA	8/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020897	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
332357	Ordering, Referring, Prescribing	N/A	1417488123	0	0	KELADA, ANDREW Y MD	7/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156915	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
332404	Ordering, Referring, Prescribing	N/A	1417580051	0	0	KAY, NICOLE LMFT	12/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143852	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY CT	None	RIVERSIDE	CA	92507	2155	00	06000	34.00024862	-117.32403	Riverside County
332427	Ordering, Referring, Prescribing	N/A	1417618794	0	0	KURITA, TOMOMI PHARMD	8/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84935	N/A	N/A	N/A	N/A	N/A	12001 EUCLID ST	None	GARDEN GROVE	CA	92840	3332	00	06000	33.78758768	-117.941271	Orange County
332428	Ordering, Referring, Prescribing	N/A	1417624842	0	0	KING, LILY	11/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	32653	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
332459	Ordering, Referring, Prescribing	N/A	1417799941	0	0	KIAR, MARCY LCSW	10/8/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112819	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92110	4711	00	06000	32.77025942	-117.2017196	San Diego County
332475	Ordering, Referring, Prescribing	N/A	1417984949	0	0	KAUSHIK, RENU MD	5/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67195	N/A	N/A	N/A	N/A	N/A	2801 MEADOW LARK DR	MS H 2	SAN DIEGO	CA	92123	2709	00	06000	32.793462	-117.154293	San Diego County
332556	Ordering, Referring, Prescribing	N/A	1427220417	0	0	KHIJNIAK, ANNA I MD	11/30/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114016	N/A	N/A	N/A	N/A	N/A	1000	W CARSON	TORRANCE	CA	90502	2004	00	06000	0	0	None
332562	Ordering, Referring, Prescribing	N/A	1427240647	0	0	KLEIN, OANA L MD	4/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54895	N/A	N/A	N/A	N/A	N/A	5 BON AIR RD	SUITE 117	LARKSPUR	CA	94939	1143	00	06000	37.9438204	-122.5395357	Marin County
332570	Ordering, Referring, Prescribing	N/A	1427253558	0	0	KATZ, GABRIEL MD	8/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C198611	N/A	N/A	N/A	N/A	N/A	949 PALM AVENUE	None	IMPERIAL BEACH	CA	91932	1000	00	06000	32.58380109	-117.1133687	San Diego County
332576	Ordering, Referring, Prescribing	N/A	1427269901	0	0	KELEME DAWIT, YEMSERACH BONNIE LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120331	N/A	N/A	N/A	N/A	N/A	500 AIRPORT WAY	None	CAMARILLO	CA	93010	8500	00	06000	34.2075752	-119.0762641	Ventura County
332642	Ordering, Referring, Prescribing	N/A	1427406198	0	0	KONG, JENNIFER Y LCSW	8/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96050	N/A	N/A	N/A	N/A	N/A	280 17TH ST	None	OAKLAND	CA	94612	4124	00	06000	37.80524764	-122.2655975	Alameda County
332690	Ordering, Referring, Prescribing	N/A	1427475821	0	0	KAUSEN, BRITTANY E MD	7/19/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138373	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	SUITE M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
332730	Ordering, Referring, Prescribing	N/A	1427531219	0	0	KIM, JESSICA PHARMD	3/3/2019	Taxonomy not applicable	NA	n/a	000	Unknown	74549	N/A	N/A	N/A	N/A	N/A	25875 BARTON RD	B108	LOMA LINDA	CA	92354	0020	00	06000	34.04825148	-117.2403315	San Bernardino County
332736	Ordering, Referring, Prescribing	N/A	1427537950	0	0	KOKOVA, MARINA MD	1/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174318	N/A	N/A	N/A	N/A	N/A	808 W. 58TH ST.	None	LOS ANGELES	CA	90037	4045	00	06000	33.98965917	-118.287673	Los Angeles County
332757	Ordering, Referring, Prescribing	N/A	1427577386	0	0	KELLEY, MELISA PHARMD	8/25/2019	Taxonomy not applicable	NA	n/a	000	Unknown	63901	N/A	N/A	N/A	N/A	N/A	480 CHADBOURNE ROAD	SUITE 101	FAIRFIELD	CA	94534	9641	00	06000	38.23538389	-122.0821428	Solano County
332775	Ordering, Referring, Prescribing	N/A	1427593490	0	0	KOLKMEYER, KELLY LCSW	6/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108502	N/A	N/A	N/A	N/A	N/A	1618 BEACH BOULEVARD	STE 215	HUNTINGTON BEACH	CA	92647	3816	00	06000	33.7171004	-117.9892305	Orange County
332808	Ordering, Referring, Prescribing	N/A	1427685882	0	0	KRACKELER, MARGARET L MD	5/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178641	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1460	00	06000	38.555181	-121.4566785	Sacramento County
332817	Ordering, Referring, Prescribing	N/A	1427695600	0	0	KIM, BO RAM PHARMD	11/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81249	N/A	N/A	N/A	N/A	N/A	2320 S BROADWAY	None	SANTA MARIA	CA	93454	7816	00	06000	34.91847	-120.435901	Santa Barbara County
332830	Ordering, Referring, Prescribing	N/A	1427751650	0	0	KHODAMARDI, KIMYA DMD	1/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	109818	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
332834	Ordering, Referring, Prescribing	N/A	1427773712	0	0	KUMAR, MARISSA S PHARMD	10/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86992	N/A	N/A	N/A	N/A	N/A	5021 LAGUNA BLVD	None	ELK GROVE	CA	95758	5262	00	06000	38.424069	-121.4461305	Sacramento County
332874	Ordering, Referring, Prescribing	N/A	1437217544	0	0	KATBAMNA, DHANESH S	7/13/1992	Taxonomy not applicable	NA	n/a	099	DENTIST	D39972	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
332913	Ordering, Referring, Prescribing	N/A	1437284577	0	0	KING-LICANO, PENNY E LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114472	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD	SUITE 100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
332925	Ordering, Referring, Prescribing	N/A	1437302890	0	0	KIM, KEJIA PHARMD	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53084	N/A	N/A	N/A	N/A	N/A	11080 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	9252	00	06000	33.90402176	-117.4750005	Riverside County
332932	Ordering, Referring, Prescribing	N/A	1437310273	0	0	KAZMI, SYED	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A33815	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
332961	Ordering, Referring, Prescribing	N/A	1437365400	0	0	KOETT, WILLIAM H DDS	11/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	24564	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
332974	Ordering, Referring, Prescribing	N/A	1437376175	0	0	KUMAI, EMILY H PA-C	5/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	11107	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
332998	Ordering, Referring, Prescribing	N/A	1437430733	0	0	KAWATA, MELANIE PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48091	N/A	N/A	N/A	N/A	N/A	121 E. EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2701	00	06000	37.37959628	-122.071458	Santa Clara County
333034	Ordering, Referring, Prescribing	N/A	1437474822	0	0	KIRIHARA, MICHAEL R LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99699	N/A	N/A	N/A	N/A	N/A	777 N 1ST ST	None	SAN JOSE	CA	95112	6337	00	06000	37.35064564	-121.9015633	Santa Clara County
333041	Ordering, Referring, Prescribing	N/A	1437501566	0	0	KIM, JAE D	12/16/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	102969	N/A	N/A	N/A	N/A	N/A	205 SOUTH ST	None	FORT BRAGG	CA	95437	5540	00	06000	39.43009931	-123.8032471	Mendocino County
333053	Ordering, Referring, Prescribing	N/A	1437506219	0	0	KUMBHANI, JIGNA PHARMD	11/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62425	N/A	N/A	N/A	N/A	N/A	16727 BEAR VALLEY RD	270/280	HESPERIA	CA	92394	1929	00	06000	34.47086108	-117.2989326	San Bernardino County
333079	Ordering, Referring, Prescribing	N/A	1437554029	0	0	KLEINER, HANNA LPCC	2/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	5855	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
333098	Ordering, Referring, Prescribing	N/A	1437580297	0	0	KWAN, IVETTE LMFT	6/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147774	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR #110	None	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
333114	Ordering, Referring, Prescribing	N/A	1437595741	0	0	KING, GLENCORA N LMFT	8/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT134161	N/A	N/A	N/A	N/A	N/A	444 LAUREL STREET, FRNT	None	SAN CARLOS	CA	94070	2421	00	06000	37.50816164	-122.2631897	San Mateo County
333124	Ordering, Referring, Prescribing	N/A	1437608361	0	0	KIM, CHRISTINE J	11/1/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65174	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
333136	Ordering, Referring, Prescribing	N/A	1437626371	0	0	KYU, AMY T PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81263	N/A	N/A	N/A	N/A	N/A	1862 ELKWOOD DR	None	CONCORD	CA	94519	1155	00	06000	37.98996749	-122.000294	Contra Costa County
333158	Ordering, Referring, Prescribing	N/A	1437659778	0	0	KANG, YOUNG I MD	5/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179014	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333172	Ordering, Referring, Prescribing	N/A	1437680261	0	0	KAPA, NANDAKISHOR MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157989	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333177	Ordering, Referring, Prescribing	N/A	1437683554	0	0	KUNG, ALISON Y PHARMD	10/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49219	N/A	N/A	N/A	N/A	N/A	2400 W COMMONWEALTH AVE	None	ALHAMBRA	CA	91803	1305	00	06000	34.08778681	-118.149982	Los Angeles County
333183	Ordering, Referring, Prescribing	N/A	1437685146	0	0	KHOUBIAN, STEVEN MD	7/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170853	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
333188	Ordering, Referring, Prescribing	N/A	1437693587	0	0	KWAN, TINA V PHARMD	8/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75522	N/A	N/A	N/A	N/A	N/A	830 3RD ST	None	SAN RAFAEL	CA	94901	3302	00	06000	37.97188236	-122.5255096	Marin County
333190	Ordering, Referring, Prescribing	N/A	1437704723	0	0	KANG, GRACE E LCSW	6/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107933	N/A	N/A	N/A	N/A	N/A	1888 MERIDIAN AVENUE	SUITE 150	SAN JOSE	CA	95125	5212	00	06000	37.28937754	-121.9134326	Santa Clara County
333192	Ordering, Referring, Prescribing	N/A	1437704673	0	0	KELLY, MELISSA LCSW	8/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102961	N/A	N/A	N/A	N/A	N/A	1300 17TH ST	None	BAKERSFIELD	CA	93301	4504	00	06000	35.37476047	-119.016774	Kern County
333204	Ordering, Referring, Prescribing	N/A	1437738309	0	0	KIM, TANYA PHARMD	1/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65820	N/A	N/A	N/A	N/A	N/A	6170 THORNTON AVE	E	NEWARK	CA	94560	3250	00	06000	37.5360754	-122.0311695	Alameda County
333231	Ordering, Referring, Prescribing	N/A	1437785433	0	0	KIM, JOANNE E	9/7/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81548	N/A	N/A	N/A	N/A	N/A	99 N LA CIENEGA BLVD	STE 200	BEVERLY HILLS	CA	90211	2285	00	06000	34.06736471	-118.3763201	Los Angeles County
333239	Ordering, Referring, Prescribing	N/A	1437797867	0	0	KIM, EUNICE S PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81167	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	CANOGA PARK	CA	91303	0000	00	06000	34.1722845	-118.5881913	Los Angeles County
333266	Ordering, Referring, Prescribing	N/A	1437876760	0	0	KUKAS, JASON N CNP	10/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95023040	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	STE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
333281	Ordering, Referring, Prescribing	N/A	1437928470	0	0	KOKHANETS, JIMIN	12/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH89138	N/A	N/A	N/A	N/A	N/A	1070 E CYPRESS AVE	None	REDDING	CA	96002	1114	00	06000	40.57107349	-122.3512425	Shasta County
333283	Ordering, Referring, Prescribing	N/A	1437933272	0	0	KIRKPATRICK, EMILY L CCC-SLP	9/11/2024	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP38034	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVENUE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
333294	Ordering, Referring, Prescribing	N/A	1447037452	0	0	KAUR, GURWINDER NP	10/4/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026884	N/A	N/A	N/A	N/A	N/A	1695 S SAN JACINTO AVE	SUITE # A	SAN JACINTO	CA	92583	5103	00	06000	33.770961	-116.954649	Riverside County
333304	Ordering, Referring, Prescribing	N/A	1447244868	0	0	KIMBLE, DAVID MD	2/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G156209	N/A	N/A	N/A	N/A	N/A	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	00	06000	34.06593048	-118.2708351	Los Angeles County
333325	Ordering, Referring, Prescribing	N/A	1447325584	0	0	KAMMAN, KARMA R LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88855	N/A	N/A	N/A	N/A	N/A	109 PARMAC RD	1, 2A	CHICO	CA	95926	2294	00	06000	39.75358764	-121.8505893	Butte County
333339	Ordering, Referring, Prescribing	N/A	1447356456	0	0	KENDALL, JUDITH L LMFT	10/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47481	N/A	N/A	N/A	N/A	N/A	1635 SOLANO AVE	None	BERKELEY	CA	94707	2108	00	06000	37.89115862	-122.2836132	Alameda County
333352	Ordering, Referring, Prescribing	N/A	1447376538	0	0	KERENDIAN, ANGELA OT	1/21/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT4420	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
333390	Ordering, Referring, Prescribing	N/A	1447457924	0	0	KROGSENG-ADAMS, NANCY PSYD	5/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18352	N/A	N/A	N/A	N/A	N/A	1000 S. MAIN ST. SUITE 2	None	SALINAS	CA	93901	2302	00	06000	36.66226091	-121.6578913	Monterey County
333391	Ordering, Referring, Prescribing	N/A	1447479928	0	0	KELLEY, KATHLEEN A NP	7/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009506	N/A	N/A	N/A	N/A	N/A	1041 ROSE AVE	None	SELMA	CA	93662	3240	00	06000	36.56879252	-119.596257	Fresno County
333400	Ordering, Referring, Prescribing	N/A	1447498472	0	0	KIM, TAE SOON MD	12/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114174	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
333448	Ordering, Referring, Prescribing	N/A	1447597455	0	0	KRUMHEUER, SETH D LMFT	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105341	N/A	N/A	N/A	N/A	N/A	1255 KENDALL RD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
333456	Ordering, Referring, Prescribing	N/A	1447612403	0	0	KAUR, PALWINDER OD	11/19/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT33649TLG	N/A	N/A	N/A	N/A	N/A	4080 W SHAW AVE	None	FRESNO	CA	93722	6220	00	06000	36.810936	-119.8642545	Fresno County
333461	Ordering, Referring, Prescribing	N/A	1447624911	0	0	KIM, PAUL D	4/10/2017	Taxonomy not applicable	NA	n/a	000	Unknown	53309	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
333515	Ordering, Referring, Prescribing	N/A	1447696380	0	0	KAUR, MANPREET DMD	10/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109558	N/A	N/A	N/A	N/A	N/A	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	00	06000	38.475585	-121.4285265	Sacramento County
333516	Ordering, Referring, Prescribing	N/A	1447692652	0	0	KAMADA, MATTHEW F PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69013	N/A	N/A	N/A	N/A	N/A	10820 183RD ST	None	CERRITOS	CA	90703	8010	00	06000	33.86553349	-118.1027115	Los Angeles County
333534	Ordering, Referring, Prescribing	N/A	1447712450	0	0	KOROTKIN, SCOTT D MD	7/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180374	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	SUITE 2100	SACRAMENTO	CA	94203	0000	00	06000	38.546127	-121.452669	Sacramento County
333537	Ordering, Referring, Prescribing	N/A	1447723036	0	0	KU, BEN C PHARMD	4/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	80073	N/A	N/A	N/A	N/A	N/A	1275 AIRPORT PARK BLVD	None	UKIAH	CA	95482	7400	00	06000	39.12708528	-123.1974697	Mendocino County
333620	Ordering, Referring, Prescribing	N/A	1447891536	0	0	KIM, IRENE J PA-C	5/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57268	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
333622	Ordering, Referring, Prescribing	N/A	1447903877	0	0	KINCAID, ASHLEY N NP	3/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020272	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
333625	Ordering, Referring, Prescribing	N/A	1447905120	0	0	KRAHN, OLGA LCSW	4/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	59959	N/A	N/A	N/A	N/A	N/A	2420 MARTIN RD	STE. 200	FAIRFIELD	CA	94534	8651	00	06000	38.27452806	-122.0511683	Solano County
333639	Ordering, Referring, Prescribing	N/A	1447979984	0	0	KHANGURA, ATINDERPAL NP	10/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022320	N/A	N/A	N/A	N/A	N/A	1649 VAN NESS AVE	None	FRESNO	CA	93721	1128	00	06000	36.74134612	-119.796548	Fresno County
333656	Ordering, Referring, Prescribing	N/A	1457028250	0	0	KOVACH, BRADLEY P OD	8/27/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34935	N/A	N/A	N/A	N/A	N/A	1700 S BRADLEY RD	None	SANTA MARIA	CA	93454	8001	00	06000	34.92801184	-120.4200671	Santa Barbara County
333659	Ordering, Referring, Prescribing	N/A	1457064206	0	0	KADY, SARAH PA	12/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62120	N/A	N/A	N/A	N/A	N/A	3224 W OLYMPIC BLVD	101	LOS ANGELES	CA	90006	2317	00	06000	34.05260149	-118.3069623	Los Angeles County
333679	Ordering, Referring, Prescribing	N/A	1457198699	0	0	KUOSHU, MELVINA NP	9/18/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032230	N/A	N/A	N/A	N/A	N/A	1870 LUNDY AVE	None	SAN JOSE	CA	95131	1826	00	06000	37.39271022	-121.8903238	Santa Clara County
333686	Ordering, Referring, Prescribing	N/A	1457303307	0	0	KLINE, DAVID M MD	4/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G30622	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
333688	Ordering, Referring, Prescribing	N/A	1457320905	0	0	KHOUZAM, HANI R MD	3/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C50701	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
333716	Ordering, Referring, Prescribing	N/A	1457438970	0	0	KELLER, VICKI LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW13085	N/A	N/A	N/A	N/A	N/A	982 MISSION ST.	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
333752	Ordering, Referring, Prescribing	N/A	1457513863	0	0	KAMAU, DORIS	3/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023248	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
333804	Ordering, Referring, Prescribing	N/A	1457631103	0	0	KIM, BO YOUNG PHARMD	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59215	N/A	N/A	N/A	N/A	N/A	303 2ND ST	None	LOS ALTOS	CA	94022	3622	00	06000	37.377242	-122.1157995	Santa Clara County
333805	Ordering, Referring, Prescribing	N/A	1457634719	0	0	KIM, LILY K	8/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH43510	N/A	N/A	N/A	N/A	N/A	100 W ONTARIO AVE	None	CORONA	CA	92882	5215	00	06000	33.85631483	-117.5699252	Riverside County
333877	Ordering, Referring, Prescribing	N/A	1457762593	0	0	KILLEEN, ANDREW PHARD	4/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	69981	N/A	N/A	N/A	N/A	N/A	120 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3007	00	06000	32.74828048	-117.1634535	San Diego County
333945	Ordering, Referring, Prescribing	N/A	1457833709	0	0	KAUR, GURPREET	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78727	N/A	N/A	N/A	N/A	N/A	602 10TH ST	None	MARYSVILLE	CA	95901	0007	00	06000	39.14550676	-121.5932806	Yuba County
334022	Ordering, Referring, Prescribing	N/A	1457965865	0	0	KIDWELL, MALLORY PHD	9/27/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	35369	N/A	N/A	N/A	N/A	N/A	2230 STOCKTON BLVD.	None	SACRAMENTO	CA	95817	1353	00	06000	38.555631	-121.459203	Sacramento County
334026	Ordering, Referring, Prescribing	N/A	1457971160	0	0	KIM-CHANG, KAREN NP	2/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014131	N/A	N/A	N/A	N/A	N/A	450 BAUCHET ST	None	LOS ANGELES	CA	90012	0000	00	06000	34.05925347	-118.230941	Los Angeles County
334064	Ordering, Referring, Prescribing	N/A	1467058537	0	0	KHINE, LWIN PHARMD	8/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	85683	N/A	N/A	N/A	N/A	N/A	2015 CLARIBEL RD	None	RIVERBANK	CA	95367	9001	00	06000	37.71111876	-120.9620959	Stanislaus County
334083	Ordering, Referring, Prescribing	N/A	1467085688	0	0	KUO, JESSICA DO	11/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21085	N/A	N/A	N/A	N/A	N/A	2130 NATIONAL AVENUE	None	SAN DIEGO	CA	92113	2209	00	06000	32.69800063	-117.1411927	San Diego County
334092	Ordering, Referring, Prescribing	N/A	1467097303	0	0	KALER, VANEET K NP	6/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013243	N/A	N/A	N/A	N/A	N/A	540 N SAN JACINTO ST	P	HEMET	CA	92543	3154	00	06000	33.755229	-116.9586405	Riverside County
334093	Ordering, Referring, Prescribing	N/A	1467102012	0	0	KLAHR, MAX MD	9/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190802	N/A	N/A	N/A	N/A	N/A	869 N CHERRY ST	None	TULARE	CA	93274	2207	00	06000	36.220932	-119.337698	Tulare County
334109	Ordering, Referring, Prescribing	N/A	1467122390	0	0	KURE, JOSHUA PA-C	9/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61709	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	8000	00	06000	0	0	None
334121	Ordering, Referring, Prescribing	N/A	1467257972	0	0	KERSHAW, CLINTON	1/16/2025	Taxonomy not applicable	NA	n/a	000	Unknown	65715	N/A	N/A	N/A	N/A	N/A	210 E MERCED ST	None	FOWLER	CA	93625	2313	00	06000	36.63067035	-119.6786702	Fresno County
334124	Ordering, Referring, Prescribing	N/A	1467289025	0	0	KATZ, RACHAEL LMFT	10/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150455	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	9710	00	06000	34.03321301	-118.4109122	Los Angeles County
334135	Ordering, Referring, Prescribing	N/A	1467418178	0	0	KODY, EDWARD J MD	7/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G60423	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
334138	Ordering, Referring, Prescribing	N/A	1467453282	0	0	KHANDABI-DANESHRAD, PEGAH	11/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68411	N/A	N/A	N/A	N/A	N/A	7138 VAN NUYS BLVD	None	VAN NUYS	CA	91405	3005	00	06000	34.200464	-118.4487407	Los Angeles County
334186	Ordering, Referring, Prescribing	N/A	1467611988	0	0	KURYLO, JOHN MD	11/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142617	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
334192	Ordering, Referring, Prescribing	N/A	1467617639	0	0	KAUR, HARINDER MD	11/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118479	N/A	N/A	N/A	N/A	N/A	1100 MAIN ST	200	DAVIS	CA	95618	7848	00	06000	0	0	None
334193	Ordering, Referring, Prescribing	N/A	1467620526	0	0	KNABB, ADRIENNE A LMFT	4/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52556	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY CT	525	RIVERSIDE	CA	92507	2155	00	06000	34.00024862	-117.32403	Riverside County
334220	Ordering, Referring, Prescribing	N/A	1467682260	0	0	KAUR, JAGDEEP MD	7/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C170263	N/A	N/A	N/A	N/A	N/A	13386 MARENGO RD	None	GALT	CA	95632	8429	00	06000	38.26647	-121.2836535	Sacramento County
334247	Ordering, Referring, Prescribing	N/A	1467732107	0	0	KIM, SAMANTHA Y PHARMD	1/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77409	N/A	N/A	N/A	N/A	N/A	4940 VAN NUYS BLVD	200	SHERMAN OAKS	CA	91403	1741	00	06000	34.160589	-118.4486715	Los Angeles County
334258	Ordering, Referring, Prescribing	N/A	1467740662	0	0	KENT, HUGH MD	4/17/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134487	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
334290	Ordering, Referring, Prescribing	N/A	1467799502	0	0	KINNEVEY, CHRISTINA MD	5/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138223	N/A	N/A	N/A	N/A	N/A	1143 MISSOURI ST	None	FAIRFIELD	CA	94533	6007	00	06000	38.24811247	-122.048307	Solano County
334303	Ordering, Referring, Prescribing	N/A	1467812131	0	0	KIM, MICHELLE PHARMD	8/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74433	N/A	N/A	N/A	N/A	N/A	2800 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3534	00	06000	37.92623641	-122.0178757	Contra Costa County
334304	Ordering, Referring, Prescribing	N/A	1467820571	0	0	KANG, JONGHAN LAC	3/8/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	16982	N/A	N/A	N/A	N/A	N/A	1321 N HARBOR BLVD STE 2	None	FULLERTON	CA	92835	4124	00	06000	33.88346929	-117.9251709	Orange County
334327	Ordering, Referring, Prescribing	N/A	1467845073	0	0	KADEMIAN, JACQUELINE LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101791	N/A	N/A	N/A	N/A	N/A	1020 S ARROYO PKWY	None	PASADENA	CA	91105	3911	00	06000	34.128351	-118.1471735	Los Angeles County
334332	Ordering, Referring, Prescribing	N/A	1467847236	0	0	KALEKA, KANWARDEEP S MD	10/23/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147353	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
334358	Ordering, Referring, Prescribing	N/A	1467889287	0	0	KENEALY, KATHRYN LCSW	5/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80604	N/A	N/A	N/A	N/A	N/A	444 HEGENBERGER RD	None	OAKLAND	CA	94621	1418	00	06000	37.73612669	-122.1969348	Alameda County
334365	Ordering, Referring, Prescribing	N/A	1467897942	0	0	KUMMERLING, MARISSA MD	2/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	A149373	N/A	N/A	N/A	N/A	N/A	3225 TIMBER FALL COURT	SUITE B	EUREKA	CA	95503	4892	00	06000	40.778955	-124.1356445	Humboldt County
334379	Ordering, Referring, Prescribing	N/A	1467911495	0	0	KARIHE, DIANA	2/20/2025	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95034078	N/A	N/A	N/A	N/A	N/A	961 E PHILLIPS BLVD	UNIT 10	POMONA	CA	91766	7553	00	06000	34.04452949	-117.737649	Los Angeles County
334380	Ordering, Referring, Prescribing	N/A	1467915629	0	0	KRADOLFER SCANLAN, SELENA LMFT	4/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132377	N/A	N/A	N/A	N/A	N/A	1012 MAIN ST	SUIT # 101	RAMONA	CA	92065	2170	00	06000	33.04181722	-116.8689096	San Diego County
334444	Ordering, Referring, Prescribing	N/A	1477015089	0	0	KHONG, ASIANNA LCSW	8/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125291	N/A	N/A	N/A	N/A	N/A	233 SOUTH QUINTANA DRIVE	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
334449	Ordering, Referring, Prescribing	N/A	1477026003	0	0	KHARVA, KRISHNA K LMFT	4/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132336	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	3312	00	06000	33.7831762	-118.1333125	Los Angeles County
334460	Ordering, Referring, Prescribing	N/A	1477047538	0	0	KAUR, PARNEET NP	2/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009101	N/A	N/A	N/A	N/A	N/A	7000 MICHAEL CANLIS WAY	None	FRENCH CAMP	CA	95231	9781	00	06000	37.8826497	-121.2974852	San Joaquin County
334467	Ordering, Referring, Prescribing	N/A	1477058980	0	0	KHAY, SATTHEA DO	2/14/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23849	N/A	N/A	N/A	N/A	N/A	200 JOSE FIGUERES AVE	315	SAN JOSE	CA	95116	1500	00	06000	37.36122014	-121.8505998	Santa Clara County
334471	Ordering, Referring, Prescribing	N/A	1477063642	0	0	KHAN, BUSHRA PHARMD	12/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77501	N/A	N/A	N/A	N/A	N/A	629 ARGUELLO BLVD	None	SAN FRANCISCO	CA	94118	4071	00	06000	37.77857905	-122.4587281	San Francisco County
334477	Ordering, Referring, Prescribing	N/A	1477067635	0	0	KIM, TAEJUNE	4/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77788	N/A	N/A	N/A	N/A	N/A	14555 VALLEY CENTER DR	None	VICTORVILLE	CA	92395	4216	00	06000	34.51554423	-117.3195841	San Bernardino County
334533	Ordering, Referring, Prescribing	N/A	1477183127	0	0	KELLY, KATELYN	4/14/2019	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3738	N/A	N/A	N/A	N/A	N/A	2440 TULARE ST	None	FRESNO	CA	93721	2269	00	06000	36.73727495	-119.7852493	Fresno County
334590	Ordering, Referring, Prescribing	N/A	1477557932	0	0	KANE, ELIZABETH LCSW	2/28/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121274	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
334594	Ordering, Referring, Prescribing	N/A	1477580595	0	0	KRAUS, JAMES A MD	3/25/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A91537	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
334599	Ordering, Referring, Prescribing	N/A	1477586899	0	0	KASIRYE, OLIVIA C	10/28/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A62413	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	1300	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
334601	Ordering, Referring, Prescribing	N/A	1477600369	0	0	KEIMER, ELIZABETH LCSW	11/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28724	N/A	N/A	N/A	N/A	N/A	365 FULTON STREET	None	SAN FRANCISCO	CA	94102	4489	00	06000	37.77881467	-122.4224952	San Francisco County
334606	Ordering, Referring, Prescribing	N/A	1477612281	0	0	KEYASHIAN, FARANGIS N	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57251	N/A	N/A	N/A	N/A	N/A	1425 SOUTH MAIN ST	None	WALNUT CREEK	CA	94596	5300	00	06000	37.89189148	-122.057999	Contra Costa County
334679	Ordering, Referring, Prescribing	N/A	1477730067	0	0	KUPPERMAN, STACEY D	3/6/2015	Taxonomy not applicable	NA	n/a	000	Unknown	342	N/A	N/A	N/A	N/A	N/A	1542 N MCCADDEN PL	None	LOS ANGELES	CA	90028	3921	00	06000	34.09931373	-118.3375945	Los Angeles County
334684	Ordering, Referring, Prescribing	N/A	1477764058	0	0	KURTZ, AYUMI Y	5/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43307	N/A	N/A	N/A	N/A	N/A	2406 ARMSTRONG ST	None	LIVERMORE	CA	94551	7617	00	06000	37.699371	-121.812038	Alameda County
334772	Ordering, Referring, Prescribing	N/A	1477910214	0	0	KOGOUT, OXANA NP	2/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95004052	N/A	N/A	N/A	N/A	N/A	2292 FARADAY AVE #100	None	CARSBAD	CA	92008	7238	00	06000	33.13490794	-117.2765569	San Diego County
334794	Ordering, Referring, Prescribing	N/A	1477939908	0	0	KODESIA, ADITI A	2/26/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D64827	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	STE 225	VENTURA	CA	93004	1382	00	06000	34.29321532	-119.1597424	Ventura County
334809	Ordering, Referring, Prescribing	N/A	1477973279	0	0	KLAUSNER, SARA D LMFT	1/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110396	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
334823	Ordering, Referring, Prescribing	N/A	1477994440	0	0	KUO, LINDA R	6/26/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D63085	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
334835	Ordering, Referring, Prescribing	N/A	1487007399	0	0	KENNY, HEATHER J LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118793	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	A-E	COVINA	CA	91723	3186	00	06000	34.079904	-117.8863235	Los Angeles County
334861	Ordering, Referring, Prescribing	N/A	1487041158	0	0	KOPSTEIN, JEFFREY S DO	9/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15232	N/A	N/A	N/A	N/A	N/A	2100 SOLAR DR	SUITE 202	OXNARD	CA	93036	0651	00	06000	34.22156515	-119.14488	Ventura County
334885	Ordering, Referring, Prescribing	N/A	1487067732	0	0	KIM, TAE K PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66566	N/A	N/A	N/A	N/A	N/A	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	00	06000	37.93684848	-122.361345	Contra Costa County
334891	Ordering, Referring, Prescribing	N/A	1487073607	0	0	KIM, JAE H MD	10/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140289	N/A	N/A	N/A	N/A	N/A	330 E LIVE OAK AVE	None	ARCADIA	CA	91006	5617	00	06000	34.10850998	-118.0219204	Los Angeles County
334917	Ordering, Referring, Prescribing	N/A	1487095501	0	0	KIM, JACQUELINE H PHD	5/24/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32623	N/A	N/A	N/A	N/A	N/A	200 MEDICAL PLAZA	#530	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
334933	Ordering, Referring, Prescribing	N/A	1487131967	0	0	KANG, YURI	1/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77883	N/A	N/A	N/A	N/A	N/A	27220 HEATHER RIDGE RD	None	LAGUNA NIGUEL	CA	92677	3418	00	06000	33.56677119	-117.7120863	Orange County
334959	Ordering, Referring, Prescribing	N/A	1487172912	0	0	KHAMBATTA, DEAN J LMFT	2/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131416	N/A	N/A	N/A	N/A	N/A	200 7TH AVE	STE 150	SANTA CRUZ	CA	95062	4669	00	06000	36.96438797	-121.998448	Santa Cruz County
334969	Ordering, Referring, Prescribing	N/A	1487193488	0	0	KAUR, PAVNEET NP	9/24/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95032315	N/A	N/A	N/A	N/A	N/A	4600 PANAMA LN	102B	BAKERSFIELD	CA	93313	3509	00	06000	35.29596129	-119.0543102	Kern County
334997	Ordering, Referring, Prescribing	N/A	1487230413	0	0	KAZAK, SAMARA M MD	10/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191387	N/A	N/A	N/A	N/A	N/A	1040 W MAIN ST	None	SANTA MARIA	CA	93458	4238	00	06000	34.95325767	-120.4511645	Santa Barbara County
335025	Ordering, Referring, Prescribing	N/A	1487283263	0	0	KRUG, KATHRYN LMFT	10/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110356	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS ROAD	None	SAN DIEGO	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego
335036	Ordering, Referring, Prescribing	N/A	1487317509	0	0	KING, SIMONE NP	1/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019084	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	SUITE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
335064	Ordering, Referring, Prescribing	N/A	1487384129	0	0	KIM, LAUREN E DDS	8/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109033	N/A	N/A	N/A	N/A	N/A	4415 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003413	-118.256519	Los Angeles County
335067	Ordering, Referring, Prescribing	N/A	1487433256	0	0	KONOP-DEFREITAS, MAALIK DDS	9/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109508	N/A	N/A	N/A	N/A	N/A	2680 SATURN AVE	None	HUNTINGTON PARK	CA	90255	4377	00	06000	33.9768845	-118.222884	Los Angeles County
335077	Ordering, Referring, Prescribing	N/A	1487639787	0	0	KONDO, LAUREN G	9/25/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D34511	N/A	N/A	N/A	N/A	N/A	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	00	06000	39.09746115	-121.5514942	Yuba County
335078	Ordering, Referring, Prescribing	N/A	1487649711	0	0	KULAWIAK, PATRICIA MD	7/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66816	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
335080	Ordering, Referring, Prescribing	N/A	1487657029	0	0	KOH, DOMINIC E NP	1/8/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8506	N/A	N/A	N/A	N/A	N/A	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	00	06000	34.098921	-118.287374	Los Angeles County
335098	Ordering, Referring, Prescribing	N/A	1487698304	0	0	KULKARNI, NITIN MD	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64906	N/A	N/A	N/A	N/A	N/A	2080 S E ST	None	SAN BERNARDINO	CA	92408	2773	00	06000	34.06448311	-117.2895975	San Bernardino County
335111	Ordering, Referring, Prescribing	N/A	1487733754	0	0	KIM, TAI WON MD	2/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C50240	N/A	N/A	N/A	N/A	N/A	451 W LINCOLN AVE	100	ANAHEIM	CA	92805	2927	00	06000	33.83445082	-117.9189372	Orange County
335159	Ordering, Referring, Prescribing	N/A	1487821336	0	0	KENNEDY, CAROLINA L LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52707	N/A	N/A	N/A	N/A	N/A	1900 ROYALTY DR.	180	POMONA	CA	91767	3032	00	06000	34.07754346	-117.7463466	Los Angeles County
335167	Ordering, Referring, Prescribing	N/A	1487845525	0	0	KHAJADOURIAN, SHANT MSW LCSW	6/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87318	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
335168	Ordering, Referring, Prescribing	N/A	1487854816	0	0	KANGWANPORNSIRI, ATIPON MD	1/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118291	N/A	N/A	N/A	N/A	N/A	150 TEJAS PL	None	NIPOMO	CA	93444	9123	00	06000	35.02661565	-120.4990048	San Luis Obispo County
335175	Ordering, Referring, Prescribing	N/A	1487879441	0	0	KEEGAN, JENNIFER R LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42867	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
335179	Ordering, Referring, Prescribing	N/A	1487883120	0	0	KAWAI, MARI PSYD	11/13/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26547	N/A	N/A	N/A	N/A	N/A	1171 HOMESTEAD ROAD	STE 250	SANTA CLARA	CA	95050	5485	00	06000	37.34826707	-121.94579	Santa Clara County
335185	Ordering, Referring, Prescribing	N/A	1487896585	0	0	KROOPF, LISA R MD	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A117523	N/A	N/A	N/A	N/A	N/A	172 EL DORADO STREET	None	MONTEREY	CA	93940	3118	00	06000	36.59326705	-121.8950995	Monterey County
335194	Ordering, Referring, Prescribing	N/A	1487922530	0	0	KWOK, THEA MARY B PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59257	N/A	N/A	N/A	N/A	N/A	199 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	4260	00	06000	37.7644964	-122.4523028	San Francisco County
335209	Ordering, Referring, Prescribing	N/A	1487932612	0	0	KYI, MOE M	11/15/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138014	N/A	N/A	N/A	N/A	N/A	4816 EAST 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
335267	Ordering, Referring, Prescribing	N/A	1497029656	0	0	KOTOPOULIS, EVAN G PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51868	N/A	N/A	N/A	N/A	N/A	27220 HEATHER RIDGE RD	None	LAGUNA NIGUEL	CA	92677	3418	00	06000	33.56677119	-117.7120863	Orange County
335276	Ordering, Referring, Prescribing	N/A	1497039861	0	0	KWAN, CHORMING	7/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54626	N/A	N/A	N/A	N/A	N/A	1333 CASTRO ST	None	SAN FRANCISCO	CA	94114	3620	00	06000	37.75083113	-122.4339936	San Francisco County
335305	Ordering, Referring, Prescribing	N/A	1497095947	0	0	KADIYALA, GEETHA RANI PHARMD	3/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68525	N/A	N/A	N/A	N/A	N/A	1000 C ST	35	GALT	CA	95632	1749	00	06000	38.252565	-121.298265	Sacramento County
335315	Ordering, Referring, Prescribing	N/A	1497108914	0	0	KALDUNSKI, ALENA LMFT	4/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125697	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
335324	Ordering, Referring, Prescribing	N/A	1497131395	0	0	KAPADIA, PRACHI K	10/21/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64715	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
335334	Ordering, Referring, Prescribing	N/A	1497138499	0	0	KOLANGARA, SHYAM MD	3/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184725	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
335344	Ordering, Referring, Prescribing	N/A	1497162192	0	0	KOVACICH, JEFFERY S	7/12/2016	Taxonomy not applicable	NA	n/a	000	Unknown	660	N/A	N/A	N/A	N/A	N/A	4121 BROCKTON AVE	SUITE 104	RIVERSIDE	CA	92501	3442	00	06000	33.98089267	-117.3813658	Riverside County
335367	Ordering, Referring, Prescribing	N/A	1497191316	0	0	KUANG, LESLIE PHARMD	10/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	50933	N/A	N/A	N/A	N/A	N/A	976 LENZEN AVE	None	SAN JOSE	CA	95126	2737	00	06000	37.33463902	-121.9121497	Santa Clara County
335368	Ordering, Referring, Prescribing	N/A	1497197594	0	0	KLADAR, KATHY K NP	4/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23302	N/A	N/A	N/A	N/A	N/A	1402 BAILEY AVE	None	NEEDLES	CA	92363	3104	00	06000	34.832781	-114.618349	San Bernardino County
335462	Ordering, Referring, Prescribing	N/A	1497376875	0	0	KISTLER, MONICA NP	4/6/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95219469	N/A	N/A	N/A	N/A	N/A	65 N HOCKETT ST	None	PORTERVILLE	CA	93257	0000	00	06000	36.0663928	-119.01714	Tulare County
335521	Ordering, Referring, Prescribing	N/A	1497705347	0	0	KOCH, GREGORY L PHD	6/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17893	N/A	N/A	N/A	N/A	N/A	500 CITY PKWY W	SUITE 200	ORANGE	CA	92868	2941	00	06000	33.78299346	-117.895788	Orange County
335537	Ordering, Referring, Prescribing	N/A	1497778393	0	0	KIM, MIRAN OD	3/10/2024	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT10702	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
335547	Ordering, Referring, Prescribing	N/A	1497821060	0	0	KATAHARA, MELINDA	2/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28800	N/A	N/A	N/A	N/A	N/A	3150 EL CAMINO REAL	C	CARLSBAD	CA	92008	2110	00	06000	33.17209501	-117.3227345	San Diego County
335561	Ordering, Referring, Prescribing	N/A	1497871230	0	0	KORNBLUTH, HILARY LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT27902	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
335622	Ordering, Referring, Prescribing	N/A	1508002577	0	0	KO, AMY H DDS	11/9/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	DDS57927	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
335640	Ordering, Referring, Prescribing	N/A	1508038704	0	0	KWAN, IRENE Y NP	4/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	775125	N/A	N/A	N/A	N/A	N/A	544 N GLENDALE AVE	None	GLENDALE	CA	91206	3311	00	06000	34.15454904	-118.2429872	Los Angeles County
335647	Ordering, Referring, Prescribing	N/A	1508051459	0	0	KRIL, MERVIN P MD	12/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A31299	N/A	N/A	N/A	N/A	N/A	120 N AUBURN ST	115	GRASS VALLEY	CA	95945	6277	00	06000	39.21970186	-121.0622716	Nevada County
335661	Ordering, Referring, Prescribing	N/A	1508094830	0	0	KUMARI, NEETA MD MPH	6/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122624	N/A	N/A	N/A	N/A	N/A	31764 CASINO DR	STE 300	LAKE ELSINORE	CA	92530	2312	00	06000	33.65724839	-117.29582	Riverside County
335668	Ordering, Referring, Prescribing	N/A	1508114679	0	0	KUMAR, ZENITRA DDS	6/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61631	N/A	N/A	N/A	N/A	N/A	164 KINMAN AVE	None	GOLETA	CA	93117	3481	00	06000	34.436277	-119.8222815	Santa Barbara County
335695	Ordering, Referring, Prescribing	N/A	1508148826	0	0	KAY, KAITLIN R LCSW	2/16/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75888	N/A	N/A	N/A	N/A	N/A	303 W LINCOLN AVE	#105	ANAHEIM	CA	92805	2936	00	06000	33.83508976	-117.9177981	Orange County
335718	Ordering, Referring, Prescribing	N/A	1508179607	0	0	KODALI, DHEERAJ MD	4/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172284	N/A	N/A	N/A	N/A	N/A	2626 N CALIFORNIA ST	SUITE B	STOCKTON	CA	95204	5500	00	06000	37.97724966	-121.2917368	San Joaquin County
335719	Ordering, Referring, Prescribing	N/A	1508178781	0	0	KIM, RACHEL M PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48933	N/A	N/A	N/A	N/A	N/A	900 S HARBOR BLVD	None	FULLERTON	CA	92832	3025	00	06000	33.862491	-117.921951	Orange County
335754	Ordering, Referring, Prescribing	N/A	1508242637	0	0	KIM, KRISTI DDS	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64685	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	STE 120	LOS ANGELES	CA	90010	1405	00	06000	34.0618166	-118.2932612	Los Angeles County
335770	Ordering, Referring, Prescribing	N/A	1508270463	0	0	KOCH, JESSA M PHARMD	9/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75756	N/A	N/A	N/A	N/A	N/A	11234 ANDERSON ST	6300	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
335804	Ordering, Referring, Prescribing	N/A	1508330960	0	0	KAUR, SIMRANJIT NP	1/16/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010905	N/A	N/A	N/A	N/A	N/A	1433 N ACACIA AVE	None	REEDLEY	CA	93654	2102	00	06000	36.60898603	-119.4510614	Fresno County
335826	Ordering, Referring, Prescribing	N/A	1508360256	0	0	KONERU, HARSHA MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165057	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	5820	00	06000	38.555181	-121.4566785	Sacramento County
335864	Ordering, Referring, Prescribing	N/A	1508427832	0	0	KNIGHT, MOSETTE LMFT	12/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137861	N/A	N/A	N/A	N/A	N/A	1170 INDUSTRIAL ST	None	REDDING	CA	96002	0734	00	06000	40.57474549	-122.3503065	Shasta County
335887	Ordering, Referring, Prescribing	N/A	1508483280	0	0	KALANGI, SREEVASTAV T MD	6/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186962	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	CARSON	CA	90810	1408	00	06000	33.83174719	-118.2070628	Los Angeles County
335894	Ordering, Referring, Prescribing	N/A	1508493917	0	0	KIM, ESTHER MD	12/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	5028	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
335895	Ordering, Referring, Prescribing	N/A	1508502105	0	0	KANDUL, EKATERINA PA	8/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61523	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	201	CHULA VISTA	CA	91911	2982	00	06000	32.60364599	-117.0786521	San Diego County
335964	Ordering, Referring, Prescribing	N/A	1508889064	0	0	KIM, DOSUN NP	11/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP15999	N/A	N/A	N/A	N/A	N/A	8399 GARVEY AVE.	None	ROSEMEAD	CA	91770	2650	00	06000	34.06268752	-118.086759	Los Angeles County
335971	Ordering, Referring, Prescribing	N/A	1508906827	0	0	KRESHA, STEVEN R LMFT	5/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132645	N/A	N/A	N/A	N/A	N/A	6428 EASTER LILY CT	None	BAKERSFIELD	CA	93313	6008	00	06000	35.29677195	-119.0685254	Kern County
335996	Ordering, Referring, Prescribing	N/A	1508972753	0	0	KIETZMAN, ROBIN M PHD	12/3/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21015	N/A	N/A	N/A	N/A	N/A	447 N EL MOLINO AVE	None	PASADENA	CA	91101	1403	00	06000	34.15365596	-118.1370318	Los Angeles County
336026	Ordering, Referring, Prescribing	N/A	1518032374	0	0	KOCSIS, AGNES B MD	12/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79733	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	S.PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
336074	Ordering, Referring, Prescribing	N/A	1518117324	0	0	KIM, ENOTH D	1/9/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D57566	N/A	N/A	N/A	N/A	N/A	323 WEST PUTNAM AVE	None	PORTERVILLE	CA	93257	3466	00	06000	36.06950858	-119.0242539	Tulare County
336140	Ordering, Referring, Prescribing	N/A	1518243989	0	0	KALAW, CAROLINE	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55417	N/A	N/A	N/A	N/A	N/A	3093 MARLOW RD	None	SANTA ROSA	CA	95403	2426	00	06000	38.466126	-122.751954	Sonoma County
336141	Ordering, Referring, Prescribing	N/A	1518245778	0	0	KIM, AH YOUNG MD	5/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155622	N/A	N/A	N/A	N/A	N/A	600 A STREET	None	DAVIS	CA	95616	3649	00	06000	38.5479381	-121.7477157	Yolo County
336157	Ordering, Referring, Prescribing	N/A	1518267848	0	0	KO, JAMIE PHARMD	3/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55217	N/A	N/A	N/A	N/A	N/A	2684 N TUSTIN ST	None	ORANGE	CA	92865	2438	00	06000	33.83337963	-117.8362596	Orange County
336186	Ordering, Referring, Prescribing	N/A	1518334663	0	0	KAFAEI, MANA A	1/29/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D64841	N/A	N/A	N/A	N/A	N/A	30300 CAMINO CAPISTRANO	None	SAN JUAN CAPO	CA	92675	1304	00	06000	33.5230101	-117.6683028	Orange County
336223	Ordering, Referring, Prescribing	N/A	1518386481	0	0	KANG, JESSICA LMFT	8/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100652	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD	800	LOS ANGELES	CA	90010	2501	00	06000	34.06170677	-118.302787	Los Angeles County
336262	Ordering, Referring, Prescribing	N/A	1518436278	0	0	KINCANNON, SEMETRAH A CCC-SLP	7/30/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP28180	N/A	N/A	N/A	N/A	N/A	15409 ANACAPA RD	409A	VICTORVILLE	CA	92392	2463	00	06000	34.50499906	-117.3255382	San Bernardino County
336299	Ordering, Referring, Prescribing	N/A	1518511021	0	0	KING, EFFIEN NP	11/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020818	N/A	N/A	N/A	N/A	N/A	822 E 88TH ST	None	LOS ANGELES	CA	90002	1029	00	06000	33.9573775	-118.2599398	Los Angeles County
336317	Ordering, Referring, Prescribing	N/A	1518554740	0	0	KUMAR, MANISH PHARMD	6/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82405	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD. M	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
336342	Ordering, Referring, Prescribing	N/A	1518664705	0	0	KING, JUSTIN NP	8/4/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026503	N/A	N/A	N/A	N/A	N/A	3082 MCMURRAY	None	ANDERSON	CA	96007	3544	00	06000	40.45499506	-122.2929002	Shasta County
336359	Ordering, Referring, Prescribing	N/A	1518692516	0	0	KNADLER, SYDNEY PT	6/24/2024	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT306186	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
336360	Ordering, Referring, Prescribing	N/A	1518732650	0	0	KAPLAN, SHARON CNP	7/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026348	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
336369	Ordering, Referring, Prescribing	N/A	1518920735	0	0	KIM, SUNDRA S MD	6/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G43226	N/A	N/A	N/A	N/A	N/A	1776 E CENTURY BLVD	None	LOS ANGELES	CA	90002	3050	00	06000	33.94556113	-118.2413137	Los Angeles County
336395	Ordering, Referring, Prescribing	N/A	1528075660	0	0	KEUNE, LYNNAIA LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36889	N/A	N/A	N/A	N/A	N/A	954 W. FOOTHILL BLVD.	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
336455	Ordering, Referring, Prescribing	N/A	1528245818	0	0	KARPMAN, JENNIFER LCSW	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52453	N/A	N/A	N/A	N/A	N/A	12510 VAN NUYS BLVD	201	PACOIMA	CA	91331	1338	00	06000	34.27814981	-118.4055414	Los Angeles County
336463	Ordering, Referring, Prescribing	N/A	1528255874	0	0	KUDLICK, SUSAN E LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47881	N/A	N/A	N/A	N/A	N/A	1529 E PALMDALE BLVD	None	PALMDALE	CA	93550	2034	00	06000	34.57966052	-118.102275	Los Angeles County
336538	Ordering, Referring, Prescribing	N/A	1528383833	0	0	KHAN, AKBAR DO	2/10/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13486	N/A	N/A	N/A	N/A	N/A	151 E WEBSTER ST	None	COLUSA	CA	95932	2949	00	06000	39.20745427	-122.0008341	Colusa County
336553	Ordering, Referring, Prescribing	N/A	1528422102	0	0	KOZMAN, MAGGIE MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150874	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
336558	Ordering, Referring, Prescribing	N/A	1528429057	0	0	KAVANAGH, PRISCILLA L LPCC	3/30/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7094	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST.	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
336656	Ordering, Referring, Prescribing	N/A	1528586716	0	0	KODIATH, EMILIA T	12/12/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101958	N/A	N/A	N/A	N/A	N/A	4305 UNIVERSITY AVE	STE 150	SAN DIEGO	CA	92105	1690	00	06000	32.74957853	-117.101439	San Diego County
336661	Ordering, Referring, Prescribing	N/A	1528591385	0	0	KAHN, LUCY DO	1/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16907	N/A	N/A	N/A	N/A	N/A	455 E COLUMBIA ST	SUITE 201	LONG BEACH	CA	90806	1620	00	06000	33.80900524	-118.1874314	Los Angeles County
336672	Ordering, Referring, Prescribing	N/A	1528601499	0	0	KNOWLES, ARIANNA F LMFT	2/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124563	N/A	N/A	N/A	N/A	N/A	1196 THIRD AVE	None	CHULA VISTA	CA	91911	3131	00	06000	32.61031228	-117.067833	San Diego County
336700	Ordering, Referring, Prescribing	N/A	1528651486	0	0	KOLANGIAN, ANI PHARMD	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82718	N/A	N/A	N/A	N/A	N/A	8510 BALBOA BLVD	150	NORTHRIDGE	CA	91325	3583	00	06000	34.224507	-118.5026015	Los Angeles County
336714	Ordering, Referring, Prescribing	N/A	1528687555	0	0	KHAN, ASSEES MD	5/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185977	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	SUITE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
336745	Ordering, Referring, Prescribing	N/A	1528774510	0	0	KIM, SOMANG P PSYD	12/6/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33847	N/A	N/A	N/A	N/A	N/A	120 S STATE COLLEGE BLVD	150	BREA	CA	92821	5834	00	06000	33.92111797	-117.8828786	Orange County
336751	Ordering, Referring, Prescribing	N/A	1528788775	0	0	KIM, REBECCA NP	8/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022097	N/A	N/A	N/A	N/A	N/A	3727 W 6TH ST	STE 200	LOS ANGELES	CA	90020	5105	00	06000	34.06358655	-118.3037656	Los Angeles County
336759	Ordering, Referring, Prescribing	N/A	1528891256	0	0	KRICK, SAMANTHA RDH	10/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	28401	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
336779	Ordering, Referring, Prescribing	N/A	1538192166	0	0	KADRI, MOHAMMAD B MD	9/4/2017	Taxonomy not applicable	NA	n/a	000	Unknown	A52479	N/A	N/A	N/A	N/A	N/A	3533 WEST PICO BLVD	None	LOS ANGELES	CA	90019	4534	00	06000	34.04721925	-118.3197384	Los Angeles County
336829	Ordering, Referring, Prescribing	N/A	1538292149	0	0	KUNIN, DOUGLAS K LMFT	10/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49698	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD	102	VAN NUYS	CA	91405	3980	00	06000	34.19649	-118.448787	Los Angeles County
336834	Ordering, Referring, Prescribing	N/A	1538305396	0	0	KUNS, KIRSTEN J LMFT	4/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51933	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVE.	SUITE A	SOUTH PASADENA	CA	91030	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
336919	Ordering, Referring, Prescribing	N/A	1538456108	0	0	KADKHODA, AFSANEH DDS	3/26/2024	Taxonomy not applicable	NA	n/a	000	Unknown	60406	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	4100	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
336946	Ordering, Referring, Prescribing	N/A	1538502638	0	0	KWONG, TIFFANY E LCSW	7/30/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70631	N/A	N/A	N/A	N/A	N/A	8841 GARVEY AVE	None	ROSEMEAD	CA	91770	3358	00	06000	34.06276591	-118.07587	Los Angeles County
336949	Ordering, Referring, Prescribing	N/A	1538512025	0	0	KING, TRISTRAM LMFT	5/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93998	N/A	N/A	N/A	N/A	N/A	140 GREGORY LANE	SUITE 250	PLEASANT HILL	CA	94523	3360	00	06000	37.94794183	-122.0649162	Contra Costa County
336951	Ordering, Referring, Prescribing	N/A	1538502794	0	0	KOSCIELAK, NICOLE D MSW LCSW	2/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80467	N/A	N/A	N/A	N/A	N/A	11731 E TELEGRAPH RD	K	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
336991	Ordering, Referring, Prescribing	N/A	1538566047	0	0	KIM, CALVIN A MD	8/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A148130	N/A	N/A	N/A	N/A	N/A	2101 7TH ST	None	WASCO	CA	93280	1502	00	06000	35.59426049	-119.3498955	Kern County
337033	Ordering, Referring, Prescribing	N/A	1538634423	0	0	KELEM, THOMAS B LMFT	4/4/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	30406	N/A	N/A	N/A	N/A	N/A	550 E WASHINGTON BLVD.	SUITE 100	CRESCENT CITY	CA	95531	8160	00	06000	41.77274546	-124.19892	Del Norte County
337078	Ordering, Referring, Prescribing	N/A	1538711791	0	0	KALER, MANEEK MD	7/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180111	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
337102	Ordering, Referring, Prescribing	N/A	1538778261	0	0	KARIMI AFSHAR, ARASH DO	6/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21301	N/A	N/A	N/A	N/A	N/A	14427 CHASE ST.	SUITE 100	PANORAMA CITY	CA	91402	3020	00	06000	34.22477664	-118.4478733	Los Angeles County
337113	Ordering, Referring, Prescribing	N/A	1538801469	0	0	KUUSKVERE, KEVIN	11/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22261	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	MED STAFF OFFICE A2250	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
337118	Ordering, Referring, Prescribing	N/A	1538822382	0	0	KAUR, AMANDEEP CNP	9/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021230	N/A	N/A	N/A	N/A	N/A	8787 HALL ROAD	None	LAMONT	CA	93241	1953	00	06000	35.25969451	-118.908099	Kern County
337122	Ordering, Referring, Prescribing	N/A	1538854112	0	0	KOUR, GURSHARAN	3/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024739	N/A	N/A	N/A	N/A	N/A	5595 W FARRIN AVE	None	FRESNO	CA	93722	1169	00	06000	36.78886109	-119.8911776	Fresno County
337153	Ordering, Referring, Prescribing	N/A	1548010424	0	0	KADIVAR, ARMITA	8/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL15220	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
337175	Ordering, Referring, Prescribing	N/A	1548231764	0	0	KIM, KAREN MD	1/21/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87257	N/A	N/A	N/A	N/A	N/A	1127 WILSHIRE BLVD	403	LOS ANGELES	CA	90017	3905	00	06000	34.05270508	-118.2641005	Los Angeles County
337194	Ordering, Referring, Prescribing	N/A	1548301831	0	0	KWAN, VICKY LCSW	1/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26349	N/A	N/A	N/A	N/A	N/A	9353 E VALLEY BLVD,	C	ROSEMEAD	CA	91770	1923	00	06000	34.08115618	-118.0651957	Los Angeles County
337216	Ordering, Referring, Prescribing	N/A	1548355878	0	0	KEARNEY, JENNIFER MD	12/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G57306	N/A	N/A	N/A	N/A	N/A	8950 VILLA LA JOLLA DR.	C217	LA JOLLA	CA	92037	1714	00	06000	32.870934	-117.2338765	San Diego County
337256	Ordering, Referring, Prescribing	N/A	1548449044	0	0	KRONENBERG, ANNA L LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW59640	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
337280	Ordering, Referring, Prescribing	N/A	1548509235	0	0	KEEFFE, ANNA B LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104521	N/A	N/A	N/A	N/A	N/A	391 TAYLOR BLVD	100	PLEASANT HILL	CA	94523	2294	00	06000	37.96119614	-122.070409	Contra Costa County
337314	Ordering, Referring, Prescribing	N/A	1548568413	0	0	KLEGAR, EUNJIE K MD	7/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C180385	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
337339	Ordering, Referring, Prescribing	N/A	1548621915	0	0	KO, SURAN LMFT	1/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103990	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	3RD FL	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
337353	Ordering, Referring, Prescribing	N/A	1548642663	0	0	KAUR, SANDEEP PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62799	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
337366	Ordering, Referring, Prescribing	N/A	1548649361	0	0	KONG, ANNA MD	11/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151239	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
337386	Ordering, Referring, Prescribing	N/A	1548708456	0	0	KAIKHOSROWZADEH, FARIN PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76077	N/A	N/A	N/A	N/A	N/A	1111 THIRD AVE	None	CHULA VISTA	CA	91911	3105	00	06000	32.61310923	-117.0688372	San Diego County
337407	Ordering, Referring, Prescribing	N/A	1548740426	0	0	KOMAR, KRISTINA M NP	6/29/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009337	N/A	N/A	N/A	N/A	N/A	1025 NORTH DOUTY ST	None	HANFORD	CA	93230	3722	00	06000	36.33611794	-119.6460191	Kings County
337420	Ordering, Referring, Prescribing	N/A	1548755754	0	0	KIM, JEONGHOON MD	7/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174213	N/A	N/A	N/A	N/A	N/A	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	00	06000	40.14921426	-122.2216794	Tehama County
337474	Ordering, Referring, Prescribing	N/A	1548874381	0	0	KHALIL, MAHMOUD F	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78513	N/A	N/A	N/A	N/A	N/A	1344 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3356	00	06000	33.89151984	-118.299757	Los Angeles County
337492	Ordering, Referring, Prescribing	N/A	1548912660	0	0	KODJANIAN, ARIK PA	6/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62884	N/A	N/A	N/A	N/A	N/A	1080 N. WESTERN AVE.	None	LOS ANGELES	CA	90029	2310	00	06000	34.090281	-118.3091425	Los Angeles County
337532	Ordering, Referring, Prescribing	N/A	1558090498	0	0	KIM, YVETTE YOON	6/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	F06220317	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD	10	STANTON	CA	90680	3935	00	06000	33.78298855	-117.9927453	Orange County
337609	Ordering, Referring, Prescribing	N/A	1558496208	0	0	KWOK, RAYMOND V	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D56529	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	STE 200	LOS ANGELES	CA	90012	2365	00	06000	34.06255157	-118.2397077	Los Angeles County
337619	Ordering, Referring, Prescribing	N/A	1558544577	0	0	KAI, EMILY M PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60352	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	None	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
337639	Ordering, Referring, Prescribing	N/A	1558590943	0	0	KYU, PRISCILLA LCSW	8/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81012	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
337692	Ordering, Referring, Prescribing	N/A	1558689018	0	0	KWOK, KING MAN K	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50107	N/A	N/A	N/A	N/A	N/A	2120 POLK ST	None	SAN FRANCISCO	CA	94109	2507	00	06000	37.79633377	-122.4218183	San Francisco County
337709	Ordering, Referring, Prescribing	N/A	1558711051	0	0	KIM, KIIN MD	5/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155353	N/A	N/A	N/A	N/A	N/A	417 S ASSOCIATED RD	STE 285	BREA	CA	92821	5802	00	06000	33.91335481	-117.8789543	Orange County
337710	Ordering, Referring, Prescribing	N/A	1558715110	0	0	KIM, KI-YOON MD	11/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151164	N/A	N/A	N/A	N/A	N/A	4060 FOURTH AVENUE	240	SAN DIEGO	CA	92103	2120	00	06000	32.75053673	-117.1616539	San Diego County
337712	Ordering, Referring, Prescribing	N/A	1558715771	0	0	KIM, SHUN-MI M	11/16/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	46783	N/A	N/A	N/A	N/A	N/A	7655 CLAIRMONT MESA BLVD	STE 306	SAN DIEGO	CA	92111	1517	00	06000	32.83270769	-117.15516	San Diego County
337721	Ordering, Referring, Prescribing	N/A	1558728220	0	0	KANG, ANNIE NP	8/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN785258	N/A	N/A	N/A	N/A	N/A	1725 W 17TH ST	102F	SANTA ANA	CA	92706	2316	00	06000	33.75999552	-117.892593	Orange County
337781	Ordering, Referring, Prescribing	N/A	1558837872	0	0	KASHTRIYA, SAPNA LMFT	12/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152337	N/A	N/A	N/A	N/A	N/A	2513 YOUNGSTOWN RD	None	TURLOCK	CA	95380	9707	00	06000	37.469493	-120.8239245	Stanislaus County
337813	Ordering, Referring, Prescribing	N/A	1558884833	0	0	KIM, EUN JUNG LMFT	3/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131879	N/A	N/A	N/A	N/A	N/A	160 E HOLT AVE	#B	POMONA	CA	91767	5407	00	06000	34.06239649	-117.7489613	Los Angeles County
337826	Ordering, Referring, Prescribing	N/A	1558908277	0	0	KALICK, TIFFANY K	4/3/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	3544	N/A	N/A	N/A	N/A	N/A	3150 EL CAMINO REAL	SUITE E	CARLSBAD	CA	92008	2110	00	06000	33.17209501	-117.3227345	San Diego County
337829	Ordering, Referring, Prescribing	N/A	1558909408	0	0	KIM, STEPHEN PHARMD	6/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78986	N/A	N/A	N/A	N/A	N/A	12700 DAY ST	None	MORENO VALLEY	CA	92553	7521	00	06000	33.935724	-117.275922	Riverside County
337894	Ordering, Referring, Prescribing	N/A	1568061109	0	0	KONG, NICOLE Y PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	80824	N/A	N/A	N/A	N/A	N/A	1600 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	1206	00	06000	37.66509923	-122.4496367	San Mateo County
337899	Ordering, Referring, Prescribing	N/A	1568074029	0	0	KIM, SARAH M PHARMD	5/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	82850	N/A	N/A	N/A	N/A	N/A	28505 HESPERIAN BLVD	None	HAYWARD	CA	94545	5008	00	06000	37.61653109	-122.0880046	Alameda County
337911	Ordering, Referring, Prescribing	N/A	1568099257	0	0	KHONG, ANTHONY A MD	9/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181695	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1460	00	06000	38.555181	-121.4566785	Sacramento County
337919	Ordering, Referring, Prescribing	N/A	1568133585	0	0	KAUR, RAJDEEP PA-C	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59759	N/A	N/A	N/A	N/A	N/A	1790 E MANNING AVE	None	REEDLEY	CA	93654	9467	00	06000	36.60411951	-119.428434	Fresno County
337927	Ordering, Referring, Prescribing	N/A	1568163087	0	0	KASHEM-GUALE, SHAILA NP	2/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024316	N/A	N/A	N/A	N/A	N/A	2017 FIRST AVE	100	SAN DIEGO	CA	92101	0000	00	06000	32.72646147	-117.1638767	San Diego County
337947	Ordering, Referring, Prescribing	N/A	1568233229	0	0	KUFFOUR, ISAAC O NP	1/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028664	N/A	N/A	N/A	N/A	N/A	3947 LENNANE DR	SUITE 110	SACRAMENTO	CA	95834	1957	00	06000	38.641428	-121.4923455	Sacramento County
337952	Ordering, Referring, Prescribing	N/A	1568410496	0	0	KULDANEK, GREGORY A MD	9/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G130383	N/A	N/A	N/A	N/A	N/A	68555 RAMON RD	D103 & D104	CATHEDRAL CITY	CA	92234	3310	00	06000	33.8158285	-116.4648113	Riverside County
337985	Ordering, Referring, Prescribing	N/A	1568520740	0	0	KADABA, SUNILKUMAR R	11/23/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D50931	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
337998	Ordering, Referring, Prescribing	N/A	1568551992	0	0	KOSH, TALLY PHARMD	4/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49899	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE.	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
338052	Ordering, Referring, Prescribing	N/A	1568662062	0	0	KIRKHART, CASEY A DO	12/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9782	N/A	N/A	N/A	N/A	N/A	21507 E CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
338085	Ordering, Referring, Prescribing	N/A	1568733947	0	0	KAPADIA, BIMAL K	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55612	N/A	N/A	N/A	N/A	N/A	12710 EVERSHAM DR	None	BAKERSFIELD	CA	93311	8593	00	06000	35.33380884	-119.1436158	Kern County
338093	Ordering, Referring, Prescribing	N/A	1568748390	0	0	KY, JAMIE PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66128	N/A	N/A	N/A	N/A	N/A	4950 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5822	00	06000	34.09812092	-118.2980246	Los Angeles County
338104	Ordering, Referring, Prescribing	N/A	1568762474	0	0	KO-WONG, PEARL PHARMD	1/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH42946	N/A	N/A	N/A	N/A	N/A	5500 WOODRUFF AVE	None	LAKEWOOD	CA	90713	1535	00	06000	33.85687042	-118.1170346	Los Angeles County
338131	Ordering, Referring, Prescribing	N/A	1568808590	0	0	KRYSIAK, ROBYN C	6/4/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0835633	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
338142	Ordering, Referring, Prescribing	N/A	1568819480	0	0	KING, KIMBERLY A LMFT	3/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126262	N/A	N/A	N/A	N/A	N/A	11512 B AVE	None	AUBURN	CA	95603	2605	00	06000	38.93969517	-121.1046397	Placer County
338152	Ordering, Referring, Prescribing	N/A	1568826410	0	0	KORIE, IJENDU P MD	11/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170427	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
338167	Ordering, Referring, Prescribing	N/A	1568847366	0	0	KING, JUSTINE LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101245	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
338218	Ordering, Referring, Prescribing	N/A	1568913820	0	0	KIM, JOHNNY LCSW	5/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93241	N/A	N/A	N/A	N/A	N/A	30 LIVERMORE AVE	None	VENTURA	CA	93004	3802	00	06000	34.28219237	-119.1911345	Ventura County
338221	Ordering, Referring, Prescribing	N/A	1568919355	0	0	KWOK, KIMBERLY PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71353	N/A	N/A	N/A	N/A	N/A	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
338266	Ordering, Referring, Prescribing	N/A	1568991990	0	0	KALEKA, KEVIN MD	10/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164006	N/A	N/A	N/A	N/A	N/A	106 E MAIN ST	None	FOWLER	CA	93625	2433	00	06000	36.62899034	-119.6785493	Fresno County
338277	Ordering, Referring, Prescribing	N/A	1578016283	0	0	KIRSCH, HANNAH MSW LCSW	9/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW118046	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
338281	Ordering, Referring, Prescribing	N/A	1578022901	0	0	KAMALIMOTLAGH, SHARIFEH MD	8/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178934	N/A	N/A	N/A	N/A	N/A	7592 BROADWAY	None	LEMON GROVE	CA	91945	1604	00	06000	32.74274487	-117.0345359	San Diego County
338312	Ordering, Referring, Prescribing	N/A	1578073813	0	0	KNEPLER-FOSS, TOBI A PHARMD	5/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77531	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
338322	Ordering, Referring, Prescribing	N/A	1578085866	0	0	KOUSSAYAN, ANI OD	2/26/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT33731	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	SUITE 230	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
338328	Ordering, Referring, Prescribing	N/A	1578092144	0	0	KHO, YINTAT W PHARMD	3/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49713	N/A	N/A	N/A	N/A	N/A	8010 2ND ST	None	PARAMOUNT	CA	90723	3404	00	06000	33.89819155	-118.159623	Los Angeles County
338349	Ordering, Referring, Prescribing	N/A	1578127049	0	0	KOUNTZ, JACOB LMFT	3/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138831	N/A	N/A	N/A	N/A	N/A	661 ROBERTS LN	None	BAKERSFIELD	CA	93308	4723	00	06000	35.40859551	-119.033532	Kern County
338402	Ordering, Referring, Prescribing	N/A	1578284600	0	0	KRETSCHMER, TORI NP	8/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022396	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVENUE	None	COSTAMESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
338404	Ordering, Referring, Prescribing	N/A	1578285870	0	0	KAUR, MANPREET PHARMD	8/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	86511	N/A	N/A	N/A	N/A	N/A	1445 R ST	None	MERCED	CA	95340	5850	00	06000	37.303164	-120.4974855	Merced County
338411	Ordering, Referring, Prescribing	N/A	1578299665	0	0	KELLOGG, KATLIN G NP	10/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020610	N/A	N/A	N/A	N/A	N/A	1644 CENTRAL AVE	SUITES A-F	MCKINLEYVILLE	CA	95519	4342	00	06000	40.935078	-124.100947	Humboldt County
338420	Ordering, Referring, Prescribing	N/A	1578397402	0	0	KOTYANKAR, ADITI DDS	9/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110830	N/A	N/A	N/A	N/A	N/A	124 S A STREET	None	MADERA	CA	93638	3631	00	06000	36.96397997	-120.0545315	Madera County
338426	Ordering, Referring, Prescribing	N/A	1578521423	0	0	KERR, CHRISTINE A MD	3/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C168372	N/A	N/A	N/A	N/A	N/A	818 WEST SEVENTH STREET	SUITE 930	LOS ANGELES	CA	90017	3407	00	06000	34.04892591	-118.259182	Los Angeles County
338428	Ordering, Referring, Prescribing	N/A	1578531885	0	0	KAYGUSUZ, MURAT MD	11/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C52850	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
338433	Ordering, Referring, Prescribing	N/A	1578515979	0	0	KISHAN, SUNIL R MD	11/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A82716	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	00	06000	37.97021462	-121.7841321	Contra Costa County
338468	Ordering, Referring, Prescribing	N/A	1578678728	0	0	KO, HARRY DO	11/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	MEDO5605	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
338471	Ordering, Referring, Prescribing	N/A	1578685962	0	0	KUZIO, AMANDA N LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48659	N/A	N/A	N/A	N/A	N/A	50 DOUGLAS DR.	None	MARTINEZ	CA	94553	8507	00	06000	37.99347206	-122.1247162	Contra Costa County
338520	Ordering, Referring, Prescribing	N/A	1578751061	0	0	KHO, HENDY NP	1/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016453	N/A	N/A	N/A	N/A	N/A	1436 GOODRICH BLVD	None	COMMERCE	CA	90022	5111	00	06000	34.01117577	-118.1585527	Los Angeles County
338523	Ordering, Referring, Prescribing	N/A	1578754008	0	0	KIM, MINA M	7/19/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106071	N/A	N/A	N/A	N/A	N/A	5125 SKYWAY	None	PARADISE	CA	95969	5624	00	06000	39.74598961	-121.640736	Butte County
338536	Ordering, Referring, Prescribing	N/A	1578770921	0	0	KHURANA, ANITA DO	1/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9471	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	1009	00	06000	34.06300636	-118.2054784	Los Angeles County
338559	Ordering, Referring, Prescribing	N/A	1578816252	0	0	KO, PAUL H PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67474	N/A	N/A	N/A	N/A	N/A	323 N SANBORN RD	A	SALINAS	CA	93905	2247	00	06000	36.67816118	-121.6259169	Monterey County
338627	Ordering, Referring, Prescribing	N/A	1578915666	0	0	KAHLON, NIMARPAL K MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164247	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
338688	Ordering, Referring, Prescribing	N/A	1578986543	0	0	KOH, ROY DDS	6/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	63143	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
338695	Ordering, Referring, Prescribing	N/A	1578998530	0	0	KIM, CHRISTINE H OT	12/4/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT14319	N/A	N/A	N/A	N/A	N/A	3751 STOCKER STREET	None	LOS ANGELES	CA	90008	5101	00	06000	34.00616017	-118.3385751	Los Angeles County
338696	Ordering, Referring, Prescribing	N/A	1588002851	0	0	KNUPPEL, KYLE A MD	1/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C171422	N/A	N/A	N/A	N/A	N/A	9024 SNIKTAW LN	None	FORT JONES	CA	96032	9408	00	06000	41.59983924	-122.9748122	Siskiyou County
338760	Ordering, Referring, Prescribing	N/A	1588066732	0	0	KIM, GINNIE M PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72263	N/A	N/A	N/A	N/A	N/A	3516 GRAND AVE	APT 3	OAKLAND	CA	94610	2010	00	06000	37.81458534	-122.2460276	Alameda County
338864	Ordering, Referring, Prescribing	N/A	1588229926	0	0	KUSIAK, ELISABETH PA	6/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59126	N/A	N/A	N/A	N/A	N/A	4501 MISSION BAY DR	#1 C&D	SAN DIEGO	CA	92109	4923	00	06000	32.80307971	-117.2166446	San Diego County
338875	Ordering, Referring, Prescribing	N/A	1588281158	0	0	KANNER, ARIELLE S DO	2/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20677	N/A	N/A	N/A	N/A	N/A	400 WEST PUEBLO ST.	689	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
338880	Ordering, Referring, Prescribing	N/A	1588290589	0	0	KIRKHAM-GARCIA, CALI L MD	2/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184489	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
338899	Ordering, Referring, Prescribing	N/A	1588368922	0	0	KOLPIKOVA, ELENA MD	7/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197869	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
338905	Ordering, Referring, Prescribing	N/A	1588393664	0	0	KRIEGER, AMANDA DDS	1/26/2025	Taxonomy not applicable	NA	n/a	000	Unknown	111204	N/A	N/A	N/A	N/A	N/A	198 N G STREET	None	EMPIRE	CA	95319	5132	00	06000	37.64084134	-120.9011164	Stanislaus County
338918	Ordering, Referring, Prescribing	N/A	1588395214	0	0	KEY, SAM R PA-C	7/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61225	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD ST	100	VENTURA	CA	93004	1378	00	06000	34.29321532	-119.1597424	Ventura County
339034	Ordering, Referring, Prescribing	N/A	1588906952	0	0	KEARNEY ISAACS, NATALIA LCSW	10/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75948	N/A	N/A	N/A	N/A	N/A	29775 HAUN RD	None	MENIFEE	CA	92586	6540	00	06000	33.68839122	-117.1750902	Riverside County
339077	Ordering, Referring, Prescribing	N/A	1588964456	0	0	KHAN, KHADEER NP	5/15/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19864	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
339102	Ordering, Referring, Prescribing	N/A	1588988703	0	0	KING, KRISTI A NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0643159	N/A	N/A	N/A	N/A	N/A	1075 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3538	00	06000	32.76444721	-117.1537188	San Diego County
339185	Ordering, Referring, Prescribing	N/A	1598127912	0	0	KEPHART, DONALD T MD	3/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152566	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
339209	Ordering, Referring, Prescribing	N/A	1598147308	0	0	KIM, EUNSUN LMFT	5/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100532	N/A	N/A	N/A	N/A	N/A	1215 W. WEST COVINA PARK	None	WEST COVINA	CA	91790	2815	00	06000	34.06877078	-117.9349578	Los Angeles County
339222	Ordering, Referring, Prescribing	N/A	1598172181	0	0	KWAN, JACLYN PA-C	1/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51734	N/A	N/A	N/A	N/A	N/A	905 CALLE AMANECER	SUITE 115	SAN CLEMENTE	CA	92673	6883	00	06000	33.44951265	-117.6075825	Orange County
339258	Ordering, Referring, Prescribing	N/A	1598232159	0	0	KO, JUSTIN PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78936	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
339269	Ordering, Referring, Prescribing	N/A	1598242620	0	0	KIM, JEEHYE LMFT	7/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT148449	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	300	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
339321	Ordering, Referring, Prescribing	N/A	1598361420	0	0	KARIMI, ELMIRA PHARMD	8/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83541	N/A	N/A	N/A	N/A	N/A	1300 W SAN CARLOS ST	None	SAN JOSE	CA	95126	3444	00	06000	37.32340818	-121.911926	Santa Clara County
339335	Ordering, Referring, Prescribing	N/A	1598378911	0	0	KUYPER, SEAN N LMFT	12/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT143843	N/A	N/A	N/A	N/A	N/A	353 PARK MARINA CIR	None	REDDING	CA	96001	0965	00	06000	40.57650059	-122.3737972	Shasta County
339366	Ordering, Referring, Prescribing	N/A	1598489379	0	0	KIM, STACEY S PHARMD	9/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86800	N/A	N/A	N/A	N/A	N/A	2655 W OLYMPIC BLVD	104	LOS ANGELES	CA	90006	2800	00	06000	34.05243121	-118.289956	Los Angeles County
339369	Ordering, Referring, Prescribing	N/A	1598493694	0	0	KAZATO, MEREDITH NP	7/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021850	N/A	N/A	N/A	N/A	N/A	1031 25TH ST	None	SAN DIEGO	CA	92102	2102	00	06000	32.716404	-117.1402635	San Diego County
339401	Ordering, Referring, Prescribing	N/A	1598800906	0	0	KOEHLER, KRISTIN L LMFT	6/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126284	N/A	N/A	N/A	N/A	N/A	1700 MCHENRY AVE	None	MODESTO	CA	95350	4373	00	06000	37.668681	-120.991734	Stanislaus County
339420	Ordering, Referring, Prescribing	N/A	1598862583	0	0	KHANNA, POORNIMA MD	12/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70714	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
339431	Ordering, Referring, Prescribing	N/A	1598884959	0	0	KAPLOWITZ, TYLER LMFT	11/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38895	N/A	N/A	N/A	N/A	N/A	1500 HUGHES WAY	C-100	LONG BEACH	CA	90810	1870	00	06000	33.82860528	-118.2124528	Los Angeles County
339468	Ordering, Referring, Prescribing	N/A	1598957490	0	0	KADAKIA, ANKITA S MD	2/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126366	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	MS P576	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
339514	Ordering, Referring, Prescribing	N/A	1609067511	0	0	KNOX, KELLIE LMFT	12/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35644	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVENUE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
339520	Ordering, Referring, Prescribing	N/A	1609081454	0	0	KHAN, FARAH S	7/26/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D55085	N/A	N/A	N/A	N/A	N/A	1127 WILSHIRE BLVD	STE 1504	LOS ANGELES	CA	90017	4006	00	06000	34.05270508	-118.2641005	Los Angeles County
339526	Ordering, Referring, Prescribing	N/A	1609109495	0	0	KEEFE, NICOLE M LCSW	3/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69878	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
339555	Ordering, Referring, Prescribing	N/A	1609151729	0	0	KIANG, ANDREW P	11/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50283	N/A	N/A	N/A	N/A	N/A	2345 E VALLEY PKWY	None	ESCONDIDO	CA	92027	2715	00	06000	33.14045456	-117.0453396	San Diego County
339662	Ordering, Referring, Prescribing	N/A	1609311042	0	0	KHALID, HASAN W	5/28/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	101097	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
339698	Ordering, Referring, Prescribing	N/A	1609372366	0	0	KABBARA, SAMI MD	4/30/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195896	N/A	N/A	N/A	N/A	N/A	8577 HAVEN AVE	208	RANCHO CUCAMONGA	CA	91730	6606	00	06000	34.09785087	-117.5756964	San Bernardino County
339750	Ordering, Referring, Prescribing	N/A	1609468222	0	0	KASTEN-ARIAS, CASSANDRA MD	9/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190267	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
339802	Ordering, Referring, Prescribing	N/A	1609819663	0	0	KURTZ, ROBERT I MD	7/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G18897	N/A	N/A	N/A	N/A	N/A	30 E SAN JOAQUIN	102	SALINAS	CA	93901	2946	00	06000	36.65855693	-121.6578301	Monterey County
339804	Ordering, Referring, Prescribing	N/A	1609840826	0	0	KELLNER, MARIA MD	6/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88925	N/A	N/A	N/A	N/A	N/A	1900 N. SYCAMORE CANYON	None	SAN DIMAS	CA	91773	1220	00	06000	34.13204802	-117.7975027	Los Angeles County
339820	Ordering, Referring, Prescribing	N/A	1609908730	0	0	KOHANBASH, BETHIE K LMFT	11/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48582	N/A	N/A	N/A	N/A	N/A	5601 W SLAUSON AVE	192	CULVER CITY	CA	90230	6582	00	06000	33.98900447	-118.37979	Los Angeles County
339858	Ordering, Referring, Prescribing	N/A	1609981125	0	0	KLEE, RENAE H NP	6/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF12434	N/A	N/A	N/A	N/A	N/A	650 HOWE AVE	None	SACRAMENTO	CA	95825	4731	00	06000	38.577294	-121.4146395	Sacramento County
339862	Ordering, Referring, Prescribing	N/A	1609978618	0	0	KIM, ANDREW C MD	12/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G45641	N/A	N/A	N/A	N/A	N/A	3800 JANES RD	None	ARCATA	CA	95521	4742	00	06000	40.89645172	-124.0930637	Humboldt County
339884	Ordering, Referring, Prescribing	N/A	1619028990	0	0	KACERGUIS, MARY A	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT29097	N/A	N/A	N/A	N/A	N/A	2225 BUCHANAN RD	None	ANTIOCH	CA	94509	4209	00	06000	37.99862519	-121.8375728	Contra Costa County
339963	Ordering, Referring, Prescribing	N/A	1619188075	0	0	KLEIN, SHOSHANA LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18517	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	125-D	OAKLAND	CA	94605	2415	00	06000	37.768221	-122.17608	Alameda County
339967	Ordering, Referring, Prescribing	N/A	1619190907	0	0	KLAPPER, CHIAKI CNM	12/5/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0630104	N/A	N/A	N/A	N/A	N/A	1075 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3538	00	06000	32.76444721	-117.1537188	San Diego County
340028	Ordering, Referring, Prescribing	N/A	1619292737	0	0	KO, ANGELA W PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57445	N/A	N/A	N/A	N/A	N/A	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3300	00	06000	37.78305866	-122.4421313	San Francisco County
340039	Ordering, Referring, Prescribing	N/A	1619323987	0	0	KESHISHIAN, KARINA	8/10/2017	Taxonomy not applicable	NA	n/a	000	Unknown	45815	N/A	N/A	N/A	N/A	N/A	8441 FOOTHILL BLVD	None	SUNLAND	CA	91040	2811	00	06000	34.25971749	-118.317204	Los Angeles County
340058	Ordering, Referring, Prescribing	N/A	1619354321	0	0	KING, TERRI MD	8/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169885	N/A	N/A	N/A	N/A	N/A	1890 ALCATRAZ AVE	None	BERKELEY	CA	94703	2715	00	06000	37.84893892	-122.2696251	Alameda County
340078	Ordering, Referring, Prescribing	N/A	1619372281	0	0	KLABACHA, RITA PA-C	1/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA52097	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
340106	Ordering, Referring, Prescribing	N/A	1619413622	0	0	KNIGHT, BRIGITTE LCSW	3/17/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27073	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	200	SAN MATEO	CA	94403	1269	00	06000	37.54524373	-122.3205511	San Mateo County
340119	Ordering, Referring, Prescribing	N/A	1619430386	0	0	KAHLON, NAVNEET K MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL679	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAN	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
340133	Ordering, Referring, Prescribing	N/A	1619450640	0	0	KROTIN-SAGI, JESSICA MSW LCSW	2/21/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112376	N/A	N/A	N/A	N/A	N/A	679 S NEW HAMPSHIRE AVE	None	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
340182	Ordering, Referring, Prescribing	N/A	1619545928	0	0	KAUR, JASKARAN NP	6/8/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017509	N/A	N/A	N/A	N/A	N/A	1275 THARP RD	None	YUBA CITY	CA	95993	2645	00	06000	39.14572609	-121.6484225	Sutter County
340190	Ordering, Referring, Prescribing	N/A	1619582202	0	0	KAMALI-GRIGORIAN, MELISA NP	1/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014782	N/A	N/A	N/A	N/A	N/A	2020 SANTA MONICA BLVD	SUITE 600	SANTA MONICA	CA	90404	2131	00	06000	34.02901811	-118.4795396	Los Angeles County
340231	Ordering, Referring, Prescribing	N/A	1619754025	0	0	KYI, MYA T NP	1/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95023819	N/A	N/A	N/A	N/A	N/A	217 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	00	06000	32.68298968	-117.1005464	San Diego County
340244	Ordering, Referring, Prescribing	N/A	1619987054	0	0	KIM, WAYNE W DO	9/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A6649	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	00	06000	33.78298855	-117.9927453	Orange County
340247	Ordering, Referring, Prescribing	N/A	1619987070	0	0	KNIGHT, BETTY A LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48858	N/A	N/A	N/A	N/A	N/A	9412 BIG HORN BLVD	SUITE 6	ELK GROVE	CA	95758	1101	00	06000	38.415861	-121.407957	Sacramento County
340250	Ordering, Referring, Prescribing	N/A	1619759727	0	0	KING, JAMES MD	5/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C196350	N/A	N/A	N/A	N/A	N/A	4211 SOUTH AVALON BLVD	None	LOS ANGELES	CA	90011	9998	00	06000	34.007238	-118.2653065	Los Angeles County
340286	Ordering, Referring, Prescribing	N/A	1629115811	0	0	KERWOOD, DENISE K LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21640	N/A	N/A	N/A	N/A	N/A	730 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6618	00	06000	32.61881028	-117.0245596	San Diego County
340307	Ordering, Referring, Prescribing	N/A	1629150834	0	0	KENDRICK, BRIAN A LCSW	5/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25089	N/A	N/A	N/A	N/A	N/A	1465 30TH ST	STE K	SAN DIEGO	CA	92154	3497	00	06000	32.72113554	-117.1302118	San Diego County
340356	Ordering, Referring, Prescribing	N/A	1629289400	0	0	KIM, YUHEE MD	11/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107323	N/A	N/A	N/A	N/A	N/A	7592 BROADWAY	None	LEMON GROVE	CA	91945	1604	00	06000	32.74274487	-117.0345359	San Diego County
340363	Ordering, Referring, Prescribing	N/A	1629308135	0	0	KHAN, OMAR A NP	11/24/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008495	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
340370	Ordering, Referring, Prescribing	N/A	1629320882	0	0	KINTZ, SARAH A LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81015	N/A	N/A	N/A	N/A	N/A	2440 6TH ST.	None	EUREKA	CA	95501	0788	00	06000	40.80368802	-124.1456878	Humboldt County
340430	Ordering, Referring, Prescribing	N/A	1629407929	0	0	KASTRUP, JESSICA	7/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109143	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	SUITE 207	SANTA ROSA	CA	95407	9122	00	06000	38.425266	-122.749875	Sonoma County
340440	Ordering, Referring, Prescribing	N/A	1629415104	0	0	KERR, KATHERINE E MD	6/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149891	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
340443	Ordering, Referring, Prescribing	N/A	1629423512	0	0	KREIDL, RENEE A MD	3/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155739	N/A	N/A	N/A	N/A	N/A	12865 MAIN ST	STE 105	GARDEN GROVE	CA	92840	8205	00	06000	33.7757526	-117.9410457	Orange County
340451	Ordering, Referring, Prescribing	N/A	1629446612	0	0	KAINTH, KAMALDEEP S PHARMD	12/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	73136	N/A	N/A	N/A	N/A	N/A	4177 W SHAW AVE	109	FRESNO	CA	93722	6221	00	06000	36.80806699	-119.8672717	Fresno County
340458	Ordering, Referring, Prescribing	N/A	1629459540	0	0	KRUSZEWSKI-DUFT, VALERIE E PHARMD	1/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43936	N/A	N/A	N/A	N/A	N/A	23850 COPPERHILL DR	None	VALENCIA	CA	91354	1701	00	06000	34.46315853	-118.5566175	Los Angeles County
340483	Ordering, Referring, Prescribing	N/A	1629503990	0	0	KAUR, GURDEEP NP	10/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015734	N/A	N/A	N/A	N/A	N/A	2811 H ST	None	BAKERSFIELD	CA	93301	1913	00	06000	35.38526604	-119.021172	Kern County
340498	Ordering, Referring, Prescribing	N/A	1629525464	0	0	KENNEDY, REBECCA A LCSW	7/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95510	N/A	N/A	N/A	N/A	N/A	1328 2ND ST	None	SANTA MONICA	CA	90401	2235	00	06000	34.01557114	-118.497924	Los Angeles County
340580	Ordering, Referring, Prescribing	N/A	1629635743	0	0	KASHANI, NICOLE MD	11/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183314	N/A	N/A	N/A	N/A	N/A	4141 STATE STREET	STE 6	SANTA BARBARA	CA	93110	1898	00	06000	34.4404695	-119.7612045	Santa Barbara County
340604	Ordering, Referring, Prescribing	N/A	1629693098	0	0	KRYGIER, ALEXI LPCC	9/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14694	N/A	N/A	N/A	N/A	N/A	12810 HEACOCK ST	UNIT 202-B	MORENO VALLEY	CA	92553	2854	00	06000	33.934851	-117.2437635	Riverside County
340607	Ordering, Referring, Prescribing	N/A	1629695986	0	0	KAUR, SUKHDEEP CNP	2/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	830676	N/A	N/A	N/A	N/A	N/A	1945 N FINE AVE	116	FRESNO	CA	93727	1528	00	06000	36.76832721	-119.7290143	Fresno County
340615	Ordering, Referring, Prescribing	N/A	1629725148	0	0	KOH, DOUG K	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84127	N/A	N/A	N/A	N/A	N/A	5451 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5613	00	06000	34.0981319	-118.3087069	Los Angeles County
340635	Ordering, Referring, Prescribing	N/A	1629809967	0	0	KWON, NUREE NP	8/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031552	N/A	N/A	N/A	N/A	N/A	1304 ELLA ST	STE A	SAN LUIS OBISPO	CA	93401	0001	00	06000	35.27704692	-120.6496857	San Luis Obispo County
340642	Ordering, Referring, Prescribing	N/A	1639108319	0	0	KANEKO, CAROLYN L LCSW	1/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22197	N/A	N/A	N/A	N/A	N/A	919 1ST STREET	None	SAN FERNANDO	CA	91340	2957	00	06000	34.28328995	-118.4389224	Los Angeles County
340676	Ordering, Referring, Prescribing	N/A	1639240757	0	0	KRASNOVA, MARGARITA M MD	5/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100645	N/A	N/A	N/A	N/A	N/A	16255 VENTURA BLVD.	500	ENCINO	CA	91436	2310	00	06000	34.15693902	-118.4876816	Los Angeles County
340688	Ordering, Referring, Prescribing	N/A	1639256928	0	0	KHER, KANWAL K MD	11/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C148058	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE,	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
340734	Ordering, Referring, Prescribing	N/A	1639391337	0	0	KONG, JULIUS M	10/27/2003	Taxonomy not applicable	NA	n/a	099	DENTIST	D15094	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
340738	Ordering, Referring, Prescribing	N/A	1639396302	0	0	KATZ, STEPHANIE E PSYD	6/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28745	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
340760	Ordering, Referring, Prescribing	N/A	1639428741	0	0	KAKAR, NADIEH LMFT	8/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97448	N/A	N/A	N/A	N/A	N/A	191 SAND CREEK ROAD	SUITE 202N	BRENTWOOD	CA	94513	0121	00	06000	37.94665949	-121.7001303	Contra Costa County
340779	Ordering, Referring, Prescribing	N/A	1639459456	0	0	KAUR, RAMAN D LCSW	10/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87446	N/A	N/A	N/A	N/A	N/A	871 ENBORG CT	SUITE 400	SAN JOSE	CA	95128	2645	00	06000	37.311489	-121.933817	Santa Clara County
340802	Ordering, Referring, Prescribing	N/A	1639490709	0	0	KO, KEVIN PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54814	N/A	N/A	N/A	N/A	N/A	2700 PARK AVE	None	TUSTIN	CA	92782	2708	00	06000	33.69923603	-117.821646	Orange County
340817	Ordering, Referring, Prescribing	N/A	1639512759	0	0	KOBASHIGAWA, WESLEY N LMFT	11/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96152	N/A	N/A	N/A	N/A	N/A	400 EDMONDS RD	None	REDWOOD CITY	CA	94062	3803	00	06000	37.47261402	-122.2862935	San Mateo County
340818	Ordering, Referring, Prescribing	N/A	1639516347	0	0	KAO, CHIHSUN S PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	52709	N/A	N/A	N/A	N/A	N/A	2640 LOMITA BLVD	None	TORRANCE	CA	90505	5214	00	06000	33.80800785	-118.332844	Los Angeles County
340828	Ordering, Referring, Prescribing	N/A	1639525215	0	0	KETTLER, MARIAN S LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96337	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	SUITE 125	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
340830	Ordering, Referring, Prescribing	N/A	1639521404	0	0	KHAMO, TARA K	7/29/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100221	N/A	N/A	N/A	N/A	N/A	165 S 1ST ST	None	EL CAJON	CA	92019	4795	00	06000	32.794002	-116.944563	San Diego County
340849	Ordering, Referring, Prescribing	N/A	1639553480	0	0	KANG, SUSAN PHARMD	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	46306	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
340856	Ordering, Referring, Prescribing	N/A	1639567175	0	0	KIANG, LEO PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69917	N/A	N/A	N/A	N/A	N/A	975 SERENO DR.	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
340903	Ordering, Referring, Prescribing	N/A	1639633084	0	0	KIRBY, IAN W	12/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010787	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
340907	Ordering, Referring, Prescribing	N/A	1639639875	0	0	KIM, RACHEL A MD	4/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177842	N/A	N/A	N/A	N/A	N/A	195 E VIRGINIA ST	None	SAN JOSE	CA	95112	5844	00	06000	37.32593057	-121.8777002	Santa Clara County
340945	Ordering, Referring, Prescribing	N/A	1639683394	0	0	KWAK, MEE H	1/25/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	101999	N/A	N/A	N/A	N/A	N/A	3415 MARTIN LUTHER KING	JR BLVD	SACRAMENTO	CA	95817	3648	00	06000	38.54376	-121.4644095	Sacramento County
340954	Ordering, Referring, Prescribing	N/A	1639717085	0	0	KIM, JISU PHARMD	4/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	81253	N/A	N/A	N/A	N/A	N/A	3800 ROSEDALE HWY	None	BAKERSFIELD	CA	93308	6235	00	06000	35.38336645	-119.0492391	Kern County
340977	Ordering, Referring, Prescribing	N/A	1639788185	0	0	KIM, GINA H NP	8/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95014864	N/A	N/A	N/A	N/A	N/A	502 W HOLT AVE	None	POMONA	CA	91768	3604	00	06000	34.06219961	-117.7571033	Los Angeles County
340981	Ordering, Referring, Prescribing	N/A	1639790843	0	0	KALEECKAL RAJALAKSHMI, APARNA MD	7/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187845	N/A	N/A	N/A	N/A	N/A	45124 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
341027	Ordering, Referring, Prescribing	N/A	1639958044	0	0	KNIGHTON, JACEE D NP	9/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027047	N/A	N/A	N/A	N/A	N/A	1111 N NAGLE ST	None	ALTURAS	CA	96101	3840	00	06000	41.48746641	-120.5528507	Modoc County
341047	Ordering, Referring, Prescribing	N/A	1649230988	0	0	KHAN, MOHAMED H MD	8/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49275	N/A	N/A	N/A	N/A	N/A	2425 SONOMA ST	None	REDDING	CA	96001	3026	00	06000	40.5730743	-122.4016681	Shasta County
341050	Ordering, Referring, Prescribing	N/A	1649237884	0	0	KASHANI, ABBAS MD	3/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A82220	N/A	N/A	N/A	N/A	N/A	1234 E NORTH STREET	SUITE 202	MANTECA	CA	95336	4948	00	06000	37.80105524	-121.1968581	San Joaquin County
341082	Ordering, Referring, Prescribing	N/A	1649333550	0	0	KARDOUSLY, JILL A NP	10/26/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8907	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	9A	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
341097	Ordering, Referring, Prescribing	N/A	1649359720	0	0	KHACHATRYAN, SUSANNA MD	11/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66915	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
341099	Ordering, Referring, Prescribing	N/A	1649356122	0	0	KESHISHZADEH, HAMZIK LCSW	1/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29439	N/A	N/A	N/A	N/A	N/A	14659 OLIVE VIEW DR	None	SYLMAR	CA	91342	1652	00	06000	34.32412624	-118.4525494	Los Angeles County
341108	Ordering, Referring, Prescribing	N/A	1649390741	0	0	KLASSEN, DIANA C LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87383	N/A	N/A	N/A	N/A	N/A	1350 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2422	00	06000	35.12076617	-120.6044977	San Luis Obispo County
341116	Ordering, Referring, Prescribing	N/A	1649399940	0	0	KAMIKIHARA, JANET S LMFT	12/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48615	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD.	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
341132	Ordering, Referring, Prescribing	N/A	1649444027	0	0	KIM, GRACE H PHARMD	9/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	49285	N/A	N/A	N/A	N/A	N/A	260 W FOOTHILL PKWY	None	CORONA	CA	92882	8540	00	06000	33.8448074	-117.5736088	Riverside County
341140	Ordering, Referring, Prescribing	N/A	1649466160	0	0	KAPLAN, LESLIE M LCSW	6/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18146	N/A	N/A	N/A	N/A	N/A	280 17TH STREET	None	OAKLAND	CA	94612	4124	00	06000	37.80524764	-122.2655975	Alameda County
341148	Ordering, Referring, Prescribing	N/A	1649480468	0	0	KRISHNAN, JYOTHI MD	4/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55866	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
341180	Ordering, Referring, Prescribing	N/A	1649544289	0	0	KOUKLAN, GOLZAR PSYD	5/16/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30945	N/A	N/A	N/A	N/A	N/A	501 S IDAHO ST	250	LA HABRA	CA	90631	6047	00	06000	33.927525	-117.959216	Orange County
341183	Ordering, Referring, Prescribing	N/A	1649548769	0	0	KWAN, PEGGY PHARMD	1/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55281	N/A	N/A	N/A	N/A	N/A	20629 REDWOOD RD	None	CASTRO VALLEY	CA	94546	5621	00	06000	37.69600591	-122.0739616	Alameda County
341220	Ordering, Referring, Prescribing	N/A	1649609447	0	0	KIM, JUNGWON LCSW	8/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LMFT113142	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE ST	None	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
341286	Ordering, Referring, Prescribing	N/A	1649709775	0	0	KAVANAGH, CANDACE J LMFT	2/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131131	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
341289	Ordering, Referring, Prescribing	N/A	1649715152	0	0	KOONG, WILLIAM PHARMD	6/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH75978	N/A	N/A	N/A	N/A	N/A	10331 W GOSHEN AVE	STE B	VISALIA	CA	93291	8778	00	06000	36.341388	-119.40633	Tulare County
341315	Ordering, Referring, Prescribing	N/A	1649757741	0	0	KELLOGG, KRISTEN J CNP	5/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009180	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
341328	Ordering, Referring, Prescribing	N/A	1649777988	0	0	KIM, MARIE MD	7/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164090	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
341356	Ordering, Referring, Prescribing	N/A	1649833120	0	0	KAHLY, BROOKE N LCSW	5/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84367	N/A	N/A	N/A	N/A	N/A	855 E MADISON AVE	None	EL CAJON	CA	92020	3819	00	06000	32.80046744	-116.9522315	San Diego County
341358	Ordering, Referring, Prescribing	N/A	1649832528	0	0	KUANG, HUI YU PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79014	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95864	0601	00	06000	38.594898	-121.3884765	Sacramento County
341363	Ordering, Referring, Prescribing	N/A	1649846007	0	0	KURUPATI, JAHNAVI S MD	4/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188911	N/A	N/A	N/A	N/A	N/A	1414 NORTH CALIFORNIA ST	SUITE #A, B, C	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
341370	Ordering, Referring, Prescribing	N/A	1649858580	0	0	KIM, BLAIR Y MD	2/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184516	N/A	N/A	N/A	N/A	N/A	14515 HAMLIN ST	102	VAN NUYS	CA	91411	1686	00	06000	34.18869729	-118.4492498	Los Angeles County
341373	Ordering, Referring, Prescribing	N/A	1649858325	0	0	KELLY, BRITTANY M NP	3/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016841	N/A	N/A	N/A	N/A	N/A	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
341374	Ordering, Referring, Prescribing	N/A	1649859570	0	0	KIM, YULIYA MD	1/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193474	N/A	N/A	N/A	N/A	N/A	1508 GARCES HWY	SUITE 1	DELANO	CA	93215	3607	00	06000	35.76141641	-119.2369096	Kern County
341401	Ordering, Referring, Prescribing	N/A	1649942343	0	0	KAUR, POMAL P CNP	5/7/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030055	N/A	N/A	N/A	N/A	N/A	5901 GREEN VALLEY CIR	405	CULVER CITY	CA	90230	6938	00	06000	33.98409358	-118.3923715	Los Angeles County
341410	Ordering, Referring, Prescribing	N/A	1649960881	0	0	KANIMIAN, NATALIE N PHARMD	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86470	N/A	N/A	N/A	N/A	N/A	1000 S FREMONT AVE	10150	ALHAMBRA	CA	91803	1323	00	06000	34.081452	-118.1518515	Los Angeles County
341416	Ordering, Referring, Prescribing	N/A	1649973405	0	0	KAREER, ATISA MD	12/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL14297	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
341493	Ordering, Referring, Prescribing	N/A	1659414365	0	0	KELLY, PATRICK A PSYD	11/25/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20750	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	LOS ANGELES	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
341545	Ordering, Referring, Prescribing	N/A	1659526655	0	0	KIM, SEAN S PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52967	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
341551	Ordering, Referring, Prescribing	N/A	1659547222	0	0	KAMARUDDIN, TIFFANIE	5/28/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT9974	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	7M8	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
341580	Ordering, Referring, Prescribing	N/A	1659611234	0	0	KEMP, JAVON J LPCC	12/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC12829	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4113	00	06000	35.3830369	-118.9680991	Kern County
341603	Ordering, Referring, Prescribing	N/A	1659649770	0	0	KASULA, PRIYANAINA R MD	5/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120213	N/A	N/A	N/A	N/A	N/A	400 E OAK AVE	None	VISALIA	CA	93291	5034	00	06000	36.332253	-119.288691	Tulare County
341636	Ordering, Referring, Prescribing	N/A	1659698447	0	0	KWOK-OLEKSY, CHRISTINA DPM	4/17/2023	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E4886	N/A	N/A	N/A	N/A	N/A	815 ATLANTIC AVE	STE 100	ALAMEDA	CA	94501	2298	00	06000	37.78029595	-122.2721534	Alameda County
341679	Ordering, Referring, Prescribing	N/A	1659751121	0	0	KLEINFELDER, RAYMOND E DO	6/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19863	N/A	N/A	N/A	N/A	N/A	5333 HOLLISTER AVE	STE 105	SANTA BARBARA	CA	93111	3309	00	06000	34.43491982	-119.8105484	Santa Barbara County
341688	Ordering, Referring, Prescribing	N/A	1659764728	0	0	KLEN, ROBERT J PHARMD	4/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH39818	N/A	N/A	N/A	N/A	N/A	600 S BROADWAY	None	WALNUT CREEK	CA	94596	5208	00	06000	37.89749614	-122.057329	Contra Costa County
341710	Ordering, Referring, Prescribing	N/A	1659802064	0	0	KAY, FATEMEH PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75000	N/A	N/A	N/A	N/A	N/A	840 EL CAMINO AVE	None	SACRAMENTO	CA	95815	2513	00	06000	38.610864	-121.4477595	Sacramento County
341725	Ordering, Referring, Prescribing	N/A	1659821320	0	0	KIM, CYNTHIA	12/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75369	N/A	N/A	N/A	N/A	N/A	2000 MARKET PLACE DR	None	MONTEREY PARK	CA	91755	7402	00	06000	34.03672674	-118.1057236	Los Angeles County
341741	Ordering, Referring, Prescribing	N/A	1659845600	0	0	KATAN, INDIRA LCSW	11/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110955	N/A	N/A	N/A	N/A	N/A	200 N LA CUMBRE RD	H	SANTA BARBARA	CA	93110	1577	00	06000	34.44255908	-119.7510269	Santa Barbara County
341747	Ordering, Referring, Prescribing	N/A	1659854743	0	0	KUO, APRIL PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78937	N/A	N/A	N/A	N/A	N/A	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
341778	Ordering, Referring, Prescribing	N/A	1659899664	0	0	KERN, MARY CNM	8/21/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	235893	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN	None	ORANGE	CA	92626	3425	00	06000	33.77685748	-117.8357804	Orange County
341780	Ordering, Referring, Prescribing	N/A	1659909901	0	0	KIM, MIN JEONG PHARMD	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80400	N/A	N/A	N/A	N/A	N/A	150 LAWRENCE STATION RD	None	SUNNYVALE	CA	94086	5309	00	06000	37.371906	-121.9959845	Santa Clara County
341808	Ordering, Referring, Prescribing	N/A	1659978534	0	0	KENNEDY, JESSICA M RN BS	12/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	95026236	N/A	N/A	N/A	N/A	N/A	5225 KELSO VALLEY RD	None	WELDON	CA	93283	1400	00	06000	35.646561	-118.2741795	Kern County
341816	Ordering, Referring, Prescribing	N/A	1669011151	0	0	KIM, HEATHER H NP	8/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012604	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVENUE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
341820	Ordering, Referring, Prescribing	N/A	1669020988	0	0	KAMPLAIN, SIERRA CCC-SLP	3/21/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	31214	N/A	N/A	N/A	N/A	N/A	3722 KATELLA AVE	SUITE C	LOS ALAMITOS	CA	90720	3102	00	06000	33.8029617	-118.0678946	Orange County
341829	Ordering, Referring, Prescribing	N/A	1669034732	0	0	KULKARNI, NISHAT MD	6/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187134	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
341830	Ordering, Referring, Prescribing	N/A	1669041901	0	0	KWON, RACHEL DO	3/15/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	DOSR-534	N/A	N/A	N/A	N/A	N/A	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1100	00	06000	21.30030321	-157.8342762	Honolulu County
341863	Ordering, Referring, Prescribing	N/A	1669148904	0	0	KIM, CATHY H PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84129	N/A	N/A	N/A	N/A	N/A	8044 LIMONITE AVE	None	RIVERSIDE	CA	92509	0001	00	06000	33.97764677	-117.4608873	Riverside County
341877	Ordering, Referring, Prescribing	N/A	1669172078	0	0	KOMAK, MARGHALERA DMD	11/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109043	N/A	N/A	N/A	N/A	N/A	101 WEST COAST RD	None	REDWAY	CA	95560	0769	00	06000	40.11704433	-123.8133408	Humboldt County
341886	Ordering, Referring, Prescribing	N/A	1669211546	0	0	KALER, KIRANDEEP NP	3/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95210026	N/A	N/A	N/A	N/A	N/A	1159 COUNTRY CLUB DRIVE	None	MADERA	CA	93638	0000	00	06000	36.9762055	-120.0741461	Madera County
341891	Ordering, Referring, Prescribing	N/A	1669247284	0	0	KAILLAY, MEENA	10/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027847	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
341919	Ordering, Referring, Prescribing	N/A	1669507851	0	0	KIM, GRACE S PSYD	12/6/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26795	N/A	N/A	N/A	N/A	N/A	3600 WILSHIRE BLVD.	2200	LOS ANGELES	CA	90010	2632	00	06000	34.0617065	-118.3036455	Los Angeles County
341946	Ordering, Referring, Prescribing	N/A	1669577896	0	0	KING, AUBREY A MD	2/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G56023	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	None	COVINA	CA	91723	3186	00	06000	34.079904	-117.8863235	Los Angeles County
341960	Ordering, Referring, Prescribing	N/A	1669611950	0	0	KIDWELL, DAVID W MD	6/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63810	N/A	N/A	N/A	N/A	N/A	560 COHASSET RD	175	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
342023	Ordering, Referring, Prescribing	N/A	1669755427	0	0	KONG, STEVE	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46534	N/A	N/A	N/A	N/A	N/A	3315 S H ST	None	BAKERSFIELD	CA	93304	6533	00	06000	35.32441296	-119.0213709	Kern County
342076	Ordering, Referring, Prescribing	N/A	1669865549	0	0	KERMISH-WELLS, LEAH E LMFT	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114126	N/A	N/A	N/A	N/A	N/A	2255 CHALLENGER WAY	SUITE 107	SANTA ROSA	CA	95407	5423	00	06000	38.424924	-122.7512565	Sonoma County
342080	Ordering, Referring, Prescribing	N/A	1669873949	0	0	KYAW, HTOO MD	4/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139325	N/A	N/A	N/A	N/A	N/A	625 34TH STREET	STE 100 & 200	BAKERSFIELD	CA	93301	2207	00	06000	35.39046051	-119.0092725	Kern County
342135	Ordering, Referring, Prescribing	N/A	1669979761	0	0	KING, JENNIFER H NP	9/21/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013657	N/A	N/A	N/A	N/A	N/A	3861 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4605	00	06000	34.01133074	-118.4159833	Los Angeles County
342149	Ordering, Referring, Prescribing	N/A	1669995890	0	0	KORE, MIRANDA H	8/21/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101530	N/A	N/A	N/A	N/A	N/A	82934 CIVIC CENTER DR	None	INDIO	CA	92201	4308	00	06000	33.71864703	-116.2178997	Riverside County
342175	Ordering, Referring, Prescribing	N/A	1679041966	0	0	KEYVANI, AZIN PHARMD	2/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77726	N/A	N/A	N/A	N/A	N/A	5205 MELROSE AVE	None	LOS ANGELES	CA	90038	3144	00	06000	34.08354051	-118.314009	Los Angeles County
342208	Ordering, Referring, Prescribing	N/A	1679079560	0	0	KLEBER, KARA T MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164143	N/A	N/A	N/A	N/A	N/A	2170 SOUTH AVE	9578	SOUTH LAKE TAHOE	CA	96150	7008	00	06000	38.91229842	-119.9978133	El Dorado County
342221	Ordering, Referring, Prescribing	N/A	1679094981	0	0	KIM, DAE YONG MD	7/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169506	N/A	N/A	N/A	N/A	N/A	50249 CESAR CHAVEZ ST	UNIT K	COACHELLA	CA	92236	1530	00	06000	33.68245553	-116.1816607	Riverside County
342228	Ordering, Referring, Prescribing	N/A	1679109391	0	0	KAUR, JASMEEN	2/5/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153043	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
342231	Ordering, Referring, Prescribing	N/A	1679111637	0	0	KINMONT, ERIN CNM	12/2/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236088	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES ROAD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
342242	Ordering, Referring, Prescribing	N/A	1679133789	0	0	KANETA, KELLI MD	3/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176966	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD.	MS #68	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
342250	Ordering, Referring, Prescribing	N/A	1679139471	0	0	KWON, AHRUM LMFT	11/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT151360	N/A	N/A	N/A	N/A	N/A	9353 E. VALLEY BLVD	SUITE C	ROSEMEAD	CA	91770	1923	00	06000	34.08115618	-118.0651957	Los Angeles County
342264	Ordering, Referring, Prescribing	N/A	1679194567	0	0	KIM, SEONGJO LAC	4/26/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	18840	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD	10	STANTON	CA	90680	3944	00	06000	33.78298855	-117.9927453	Orange County
342268	Ordering, Referring, Prescribing	N/A	1679200729	0	0	KARKI, REKHA	11/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95021411	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
342275	Ordering, Referring, Prescribing	N/A	1679209365	0	0	KATTA, ANUSHA DDS	2/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107332	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	225	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
342344	Ordering, Referring, Prescribing	N/A	1679653026	0	0	KAO, LING M PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56011	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
342376	Ordering, Referring, Prescribing	N/A	1679709729	0	0	KNUDSEN, RACHEL E LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88194	N/A	N/A	N/A	N/A	N/A	23461 S POINTE DR	220	LAGUNA HILLS	CA	92653	1547	00	06000	33.62535142	-117.7206568	Orange County
342424	Ordering, Referring, Prescribing	N/A	1679816938	0	0	KATSUURA, JULIA R MD	1/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C170569	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
342428	Ordering, Referring, Prescribing	N/A	1679821383	0	0	KHOSRAVI, PARDIS PSYD	5/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31264	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
342451	Ordering, Referring, Prescribing	N/A	1679862262	0	0	KING, JON Y DC	3/30/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	31962	N/A	N/A	N/A	N/A	N/A	210 N GARFIELD AVE	203	ALHAMBRA	CA	91801	2560	00	06000	34.09723599	-118.1282787	Los Angeles County
342453	Ordering, Referring, Prescribing	N/A	1679868574	0	0	KUO-WANG, JOANNE PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59113	N/A	N/A	N/A	N/A	N/A	12462 PUTNAM ST STE 105	None	WHITTIER	CA	90602	0000	00	06000	33.9709236	-118.0460596	Los Angeles County
342491	Ordering, Referring, Prescribing	N/A	1679918262	0	0	KUZNETSOVA, MARINA LAC	9/16/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	7753	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
342516	Ordering, Referring, Prescribing	N/A	1679987887	0	0	KETABCHI, MAHMOOD E LMFT	8/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106345	N/A	N/A	N/A	N/A	N/A	3700 DELTA FAIR BLVD.	SUITE 202	ANTIOCH	CA	94509	7043	00	06000	38.0038852	-121.8448833	Contra Costa County
342526	Ordering, Referring, Prescribing	N/A	1679997365	0	0	KIM, ESTHER Y PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH69764	N/A	N/A	N/A	N/A	N/A	1745 UNIVERSITY AVENUE	None	RIVERSIDE	CA	92507	0000	00	06000	33.97576049	-117.349551	Riverside County
342532	Ordering, Referring, Prescribing	N/A	1689007015	0	0	KIANG, JACQUELINE G PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH69110	N/A	N/A	N/A	N/A	N/A	3801 HOWE ST	FABIOLA BLDG, RM G-84	OAKLAND	CA	94611	5312	00	06000	37.8242732	-122.2568561	Alameda County
342550	Ordering, Referring, Prescribing	N/A	1689036139	0	0	KIM, JEREMY MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168403	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	STOCKTON	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
342560	Ordering, Referring, Prescribing	N/A	1689053373	0	0	KIM, SUNYOUNG	3/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	CA62391	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
342623	Ordering, Referring, Prescribing	N/A	1689157943	0	0	KIM, ESTHER S LCSW	8/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125335	N/A	N/A	N/A	N/A	N/A	628 SAN JULIAN STREET	None	LOS ANGELES	CA	90014	2412	00	06000	34.04203464	-118.2467644	Los Angeles County
342627	Ordering, Referring, Prescribing	N/A	1689166258	0	0	KESHISHYAN, EMIN	8/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55871	N/A	N/A	N/A	N/A	N/A	301 SCIENCE DRIVE	STE 150	MOORPARK	CA	93021	2097	00	06000	34.27992368	-118.8694411	Ventura County
342628	Ordering, Referring, Prescribing	N/A	1689163990	0	0	KEMEI, JOASH K NP	6/17/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008918	N/A	N/A	N/A	N/A	N/A	101 N. FRONT ST.	B	CHOWCHILLA	CA	93610	0092	00	06000	37.12503251	-120.2591627	Madera County
342640	Ordering, Referring, Prescribing	N/A	1689186256	0	0	KAUR, ANUDEEP PHARMD	3/11/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77630	N/A	N/A	N/A	N/A	N/A	1804 E ASHLAN AVE	None	FRESNO	CA	93726	2019	00	06000	36.792711	-119.789226	Fresno County
342689	Ordering, Referring, Prescribing	N/A	1689271587	0	0	KONDRASHOV, VERA P	11/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58808	N/A	N/A	N/A	N/A	N/A	155 15TH STREET	A	WEST SACRAMENTO	CA	95691	3737	00	06000	38.57104661	-121.5260133	Yolo County
342702	Ordering, Referring, Prescribing	N/A	1689304669	0	0	KAO, KEVIN NP	6/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020472	N/A	N/A	N/A	N/A	N/A	1642 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1800	00	06000	37.3061289	-121.8119182	Santa Clara County
342733	Ordering, Referring, Prescribing	N/A	1689429250	0	0	KOHN, CASEY M LMFT	12/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143292	N/A	N/A	N/A	N/A	N/A	3 CORPORATE PARK	SUITE 170	IRVINE	CA	92606	5162	00	06000	33.69055394	-117.8260389	Orange County
342769	Ordering, Referring, Prescribing	N/A	1689720575	0	0	KHASHAYAR, SHAHIN MD	2/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92124	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
342774	Ordering, Referring, Prescribing	N/A	1689732646	0	0	KRAFT, JUDITH E MD	9/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A65463	N/A	N/A	N/A	N/A	N/A	1009 N AVALON BLVD	None	WILMINGTON	CA	90744	4505	00	06000	33.78320457	-118.2627263	Los Angeles County
342778	Ordering, Referring, Prescribing	N/A	1689727125	0	0	KING, STEPHANIE D LCSW	12/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76771	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
342793	Ordering, Referring, Prescribing	N/A	1689791568	0	0	KINSMAN, KELLY M LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93668	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
342818	Ordering, Referring, Prescribing	N/A	1689845307	0	0	KAMP, BONNIE LCSW	2/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18862	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
342864	Ordering, Referring, Prescribing	N/A	1689932881	0	0	KING, CHERYL	2/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58595	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
342867	Ordering, Referring, Prescribing	N/A	1689941791	0	0	KIM, MIN JOO LAC	5/27/2021	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	13813	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
342876	Ordering, Referring, Prescribing	N/A	1689945297	0	0	KABLI, SALMA	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49715	N/A	N/A	N/A	N/A	N/A	550 N VENTU PARK RD	None	NEWBURY PARK	CA	91320	2709	00	06000	34.18715094	-118.911061	Ventura County
342893	Ordering, Referring, Prescribing	N/A	1689979452	0	0	KUA, STEPHANIE MD	2/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114548	N/A	N/A	N/A	N/A	N/A	500 CITY PKWY W	200	ORANGE	CA	92868	2941	00	06000	33.78299346	-117.895788	Orange County
342905	Ordering, Referring, Prescribing	N/A	1699009589	0	0	KONOVALOVA, LANA LMFT	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80431	N/A	N/A	N/A	N/A	N/A	851 N OAKLAND AVE	None	PASADENA	CA	91104	4343	00	06000	34.16031813	-118.1403347	Los Angeles County
342922	Ordering, Referring, Prescribing	N/A	1699050351	0	0	KIRKPATRICK, WALKER J	4/13/2015	Taxonomy not applicable	NA	n/a	000	Unknown	611	N/A	N/A	N/A	N/A	N/A	1020 PINE STREET	None	PASO ROBLES	CA	93446	2520	00	06000	35.62509992	-120.6886853	San Luis Obispo County
342929	Ordering, Referring, Prescribing	N/A	1699056655	0	0	KHAN, NEHA LCSW	9/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101575	N/A	N/A	N/A	N/A	N/A	506 WEST JACKMAN ST	None	LANCASTER	CA	90000	5110	00	06000	34.70193469	-118.1377582	Los Angeles County
342930	Ordering, Referring, Prescribing	N/A	1699059253	0	0	KLIPPER, DEBRA NP	12/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14457	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC AVE	370	LONG BEACH	CA	90806	2657	00	06000	33.805854	-118.1936805	Los Angeles County
342933	Ordering, Referring, Prescribing	N/A	1699058180	0	0	KWONG, SHELLY LCSW	4/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81669	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
342951	Ordering, Referring, Prescribing	N/A	1699076968	0	0	KARKAR, SAMIA PHARMD	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	61692	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD.	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
342956	Ordering, Referring, Prescribing	N/A	1699089508	0	0	KHAWAR, TALHA MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114544	N/A	N/A	N/A	N/A	N/A	1975 VERDUGO BLVD	None	LA CANADA	CA	91011	3022	00	06000	34.20501855	-118.219857	Los Angeles County
342973	Ordering, Referring, Prescribing	N/A	1699119792	0	0	KELLY, ELIZABETH PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68656	N/A	N/A	N/A	N/A	N/A	230 BOYCE ST	None	SANTA ROSA	CA	95401	5426	00	06000	38.440026	-122.7267495	Sonoma County
343029	Ordering, Referring, Prescribing	N/A	1699219329	0	0	KHALID, MUSTAFA W	5/28/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	101089	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
343101	Ordering, Referring, Prescribing	N/A	1699371591	0	0	KAPRIELIAN, VATCHE PA-C	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA59300	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	STE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
343107	Ordering, Referring, Prescribing	N/A	1699378299	0	0	KAUR, PUSHPINDER PHARMD	11/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83605	N/A	N/A	N/A	N/A	N/A	46848 MISSION BLVD	None	FREMONT	CA	94539	7943	00	06000	37.49001935	-121.9292205	Alameda County
343108	Ordering, Referring, Prescribing	N/A	1699384107	0	0	KASHYAP, SHIVEK PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82727	N/A	N/A	N/A	N/A	N/A	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	0000	00	06000	37.23948065	-121.8005798	Santa Clara County
343113	Ordering, Referring, Prescribing	N/A	1699390914	0	0	KOPATZ, MATTHEW E CCC-SLP	6/30/2019	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	28252	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE STE 170-	STE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
343139	Ordering, Referring, Prescribing	N/A	1699436394	0	0	KIM, ANGELA PA	6/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62972	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
343150	Ordering, Referring, Prescribing	N/A	1699461970	0	0	KNOX, MARISA NP	4/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024856	N/A	N/A	N/A	N/A	N/A	5519 DEL AMO BLVD	None	LAKEWOOD	CA	90713	2307	00	06000	33.8471395	-118.1244195	Los Angeles County
343195	Ordering, Referring, Prescribing	N/A	1699803049	0	0	KOO, BERNARD W	9/6/1989	Taxonomy not applicable	NA	n/a	099	DENTIST	D37437	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	STE 200	LOS ANGELES	CA	90012	2365	00	06000	34.06255157	-118.2397077	Los Angeles County
343208	Ordering, Referring, Prescribing	N/A	1699826479	0	0	KIANOURI, SHADROUZ M	1/14/2008	Taxonomy not applicable	NA	n/a	099	DENTIST	D51177	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
343210	Ordering, Referring, Prescribing	N/A	1699823104	0	0	KIR, CHUN P	12/21/1985	Taxonomy not applicable	NA	n/a	099	DENTIST	D32335	N/A	N/A	N/A	N/A	N/A	814 BROADWAY	None	SAN FRANCISCO	CA	94133	4219	00	06000	37.79743143	-122.4104655	San Francisco County
343226	Ordering, Referring, Prescribing	N/A	1699844670	0	0	KELLEY, PATSY LMFT	11/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40697	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
343248	Ordering, Referring, Prescribing	N/A	1699897470	0	0	KING, URSULA M LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	81041	N/A	N/A	N/A	N/A	N/A	540 NORTH 1ST STREET	None	SAN JOSE	CA	95112	5319	00	06000	37.34571835	-121.8975601	Santa Clara County
343274	Ordering, Referring, Prescribing	N/A	1699963801	0	0	KRYNSKY, KARINA LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26175	N/A	N/A	N/A	N/A	N/A	28490 AVENUE STANFORD	None	VALENCIA	CA	91355	0921	00	06000	34.44085174	-118.5994533	Los Angeles County
343287	Ordering, Referring, Prescribing	N/A	1700031648	0	0	KENNISON, YAJAIRA M LCSW	11/7/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79259	N/A	N/A	N/A	N/A	N/A	1145 E COMPTON BLVD	None	COMPTON	CA	90221	3307	00	06000	33.89606151	-118.2106125	Los Angeles County
343293	Ordering, Referring, Prescribing	N/A	1700037991	0	0	KEHOE, PETER A LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38880	N/A	N/A	N/A	N/A	N/A	18217 HALE AVE	None	MORGAN HILL	CA	95037	3550	00	06000	37.13761496	-121.6664813	Santa Clara County
343296	Ordering, Referring, Prescribing	N/A	1700041431	0	0	KRAMER, REBECCA E LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT29599	N/A	N/A	N/A	N/A	N/A	4545 NORTH WEST AVENUE	None	FRESNO	CA	93705	0946	00	06000	36.799623	-119.8264355	Fresno County
343324	Ordering, Referring, Prescribing	N/A	1700108297	0	0	KOCHUVELI, JOSEPH MD	1/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109889	N/A	N/A	N/A	N/A	N/A	2801 BRISTOL ST	2ND FLOOR	COSTA MESA	CA	92626	5996	00	06000	33.67474907	-117.889122	Orange County
343327	Ordering, Referring, Prescribing	N/A	1700108891	0	0	KIMURA, JEFFREY DDS	3/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	39429	N/A	N/A	N/A	N/A	N/A	6994 EL CAMINO REAL	108	CARLSBAD	CA	92008	0562	00	06000	33.10361662	-117.2666073	San Diego County
343334	Ordering, Referring, Prescribing	N/A	1700124161	0	0	KARTONO WINARDI, BERNARDUS G MD	12/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135298	N/A	N/A	N/A	N/A	N/A	150 TEJAS PL	None	NIPOMO	CA	93444	9123	00	06000	35.02661565	-120.4990048	San Luis Obispo County
343345	Ordering, Referring, Prescribing	N/A	1700134830	0	0	KARMUR, AMIT B DO	1/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14549	N/A	N/A	N/A	N/A	N/A	1000 W. CARSON ST.	461	TORRANCE	CA	90509	2059	00	06000	33.83155851	-118.2920625	Los Angeles County
343350	Ordering, Referring, Prescribing	N/A	1700143104	0	0	KOLAHI, KOUROSH M MD	9/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127417	N/A	N/A	N/A	N/A	N/A	3633 LONG BEACH BLVD	STE 100	LONG BEACH	CA	90807	6027	00	06000	33.82333337	-118.1893738	Los Angeles County
343361	Ordering, Referring, Prescribing	N/A	1700159159	0	0	KWAN, BERNICE K PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66891	N/A	N/A	N/A	N/A	N/A	3001 TARAVAL ST	None	SAN FRANCISCO	CA	94116	2106	00	06000	37.74200588	-122.4987236	San Francisco County
343386	Ordering, Referring, Prescribing	N/A	1700187655	0	0	KOZYCZ, NICOLE M LCSW	2/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61951	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
343428	Ordering, Referring, Prescribing	N/A	1700248531	0	0	KALLMAN, JOSHUA R MD	2/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162267	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	MS #76	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
343442	Ordering, Referring, Prescribing	N/A	1700271731	0	0	KUMAR, DWIJAVANTHI MD	11/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143993	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
343459	Ordering, Referring, Prescribing	N/A	1700309168	0	0	KARNATI, TEJAS MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163230	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
343509	Ordering, Referring, Prescribing	N/A	1700371200	0	0	KENENI, ANA M LCSW	12/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119780	N/A	N/A	N/A	N/A	N/A	175 W COURT ST	None	WOODLAND	CA	95695	2913	00	06000	38.67889514	-121.7923678	Yolo County
343516	Ordering, Referring, Prescribing	N/A	1700375169	0	0	KRYGSMAN, AMY M LMFT	7/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120195	N/A	N/A	N/A	N/A	N/A	1907 BOYS REPUBLIC DR	None	CHINO HILLS	CA	91709	5447	00	06000	33.993846	-117.725661	San Bernardino County
343532	Ordering, Referring, Prescribing	N/A	1700398963	0	0	KOBELY, HEERAL B PHARMD	8/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77002	N/A	N/A	N/A	N/A	N/A	1300 W SAN CARLOS ST	None	SAN JOSE	CA	95126	3444	00	06000	37.32340818	-121.911926	Santa Clara County
343583	Ordering, Referring, Prescribing	N/A	1700507431	0	0	KIEU, HAN N PHARMD	8/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86643	N/A	N/A	N/A	N/A	N/A	3365 DEER VALLEY RD	None	ANTIOCH	CA	94531	6664	00	06000	37.98789856	-121.7855921	Contra Costa County
343588	Ordering, Referring, Prescribing	N/A	1700529344	0	0	KAUR, RAMANPREET PA-C	9/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60943	N/A	N/A	N/A	N/A	N/A	2611 N DINUBA BLVD	None	VISALIA	CA	93291	9003	00	06000	36.352935	-119.297565	Tulare County
343600	Ordering, Referring, Prescribing	N/A	1700558566	0	0	KYI, AMY LCSW	10/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95997	N/A	N/A	N/A	N/A	N/A	1450 NORIEGA ST	None	SAN FRANCISCO	CA	94122	4432	00	06000	37.75412598	-122.4794467	San Francisco County
343622	Ordering, Referring, Prescribing	N/A	1700831815	0	0	KALICH, LISA M	7/12/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	21500	N/A	N/A	N/A	N/A	N/A	201 SPEAR ST	1100	SAN FRANCISCO	CA	94105	1630	00	06000	37.79106231	-122.3921956	San Francisco County
343623	Ordering, Referring, Prescribing	N/A	1700835196	0	0	KAZI, WASEEMUDDIN MD	7/6/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49554	N/A	N/A	N/A	N/A	N/A	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	00	06000	33.61350847	-117.1691225	Riverside County
343626	Ordering, Referring, Prescribing	N/A	1700807542	0	0	KO, LILA K LCSW	5/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW8709	N/A	N/A	N/A	N/A	N/A	515 E 1ST ST STE D	None	TUSTIN	CA	92780	3335	00	06000	33.74583051	-117.8188245	Orange County
343643	Ordering, Referring, Prescribing	N/A	1700901543	0	0	KUNKLE, ROBERT L NP	11/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013803	N/A	N/A	N/A	N/A	N/A	3710 HIGHWAY 45	None	COLUSA	CA	95932	0000	00	06000	39.25060345	-122.0314303	Colusa County
343668	Ordering, Referring, Prescribing	N/A	1700951621	0	0	KILLING, SUSANNE I NP	2/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	557976	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	A	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
343676	Ordering, Referring, Prescribing	N/A	1700974680	0	0	KAUFMAN, GREGORY J DC	4/19/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC19864	N/A	N/A	N/A	N/A	N/A	1100 ROSE DRIVE	STE. 230	BENICIA	CA	94510	3618	00	06000	38.08145422	-122.1918425	Solano County
343689	Ordering, Referring, Prescribing	N/A	1710004072	0	0	KIMBROUGH, JASON LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37207	N/A	N/A	N/A	N/A	N/A	350 90TH ST	None	DALY CITY	CA	94015	1879	00	06000	37.69111548	-122.473143	San Mateo County
343693	Ordering, Referring, Prescribing	N/A	1710009808	0	0	KHAMISEH, GHASSAN MD	11/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A60718	N/A	N/A	N/A	N/A	N/A	2800 PACIFIC AVE	STE D	LONG BEACH	CA	90806	1468	00	06000	33.808167	-118.1936915	Los Angeles County
343809	Ordering, Referring, Prescribing	N/A	1710263660	0	0	KOLB, REBECCA R NP	5/24/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010092	N/A	N/A	N/A	N/A	N/A	1601 MONTE VISTA AVE	240	CLAREMONT	CA	91711	2962	00	06000	34.112259	-117.698539	Los Angeles County
343848	Ordering, Referring, Prescribing	N/A	1710312129	0	0	KIM, EUGENE H MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137234	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
343853	Ordering, Referring, Prescribing	N/A	1710331228	0	0	KOTHIA, PRIYANKA PHARMD	10/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62453	N/A	N/A	N/A	N/A	N/A	618 W CHAPMAN AVE	None	PLACENTIA	CA	92870	5705	00	06000	33.8732939	-117.8764029	Orange County
343885	Ordering, Referring, Prescribing	N/A	1710374277	0	0	KNEPPEL, REBECCA LMFT	12/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116008	N/A	N/A	N/A	N/A	N/A	7001 EAST PARKWAY	300	SACRAMENTO	CA	95823	2501	00	06000	38.497293	-121.4504235	Sacramento County
343898	Ordering, Referring, Prescribing	N/A	1710399449	0	0	KIM, MYOUNG M NP	12/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23151	N/A	N/A	N/A	N/A	N/A	920 N LONG BEACH BLVD	SUITE 1	COMPTON	CA	90221	2260	00	06000	33.90236003	-118.2082841	Los Angeles County
343902	Ordering, Referring, Prescribing	N/A	1710401252	0	0	KIMURA, LINDA T PHARMD	4/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62733	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
343907	Ordering, Referring, Prescribing	N/A	1710410451	0	0	KEYOUMARSI, JESSICA	9/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100226	N/A	N/A	N/A	N/A	N/A	2040 CAMFIELD AVE.	None	LOS ANGELES	CA	90040	1501	00	06000	34.00861575	-118.1559052	Los Angeles County
343911	Ordering, Referring, Prescribing	N/A	1710422126	0	0	KALFELL, PAUL D	10/2/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	482475	N/A	N/A	N/A	N/A	N/A	41820 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	00	06000	34.24651473	-116.8897879	San Bernardino County
343916	Ordering, Referring, Prescribing	N/A	1710416425	0	0	KINCAID, RACHEL LMFT	12/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99773	N/A	N/A	N/A	N/A	N/A	TOWN AND COUNTRY DRIVE	115-A	DANVILLE	CA	94526	3960	00	06000	37.81361883	-122.0001604	Contra Costa County
343950	Ordering, Referring, Prescribing	N/A	1710479712	0	0	KOESTER, RUSSELL J LAC	3/11/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	18068	N/A	N/A	N/A	N/A	N/A	144 STONY POINT ROAD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
343975	Ordering, Referring, Prescribing	N/A	1710519202	0	0	KHORRAMDIN, MAHSA PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81596	N/A	N/A	N/A	N/A	N/A	741 WOODHAMS ROAD	None	SANTA CLARA	CA	95051	5633	00	06000	37.33629614	-121.9794929	Santa Clara County
344031	Ordering, Referring, Prescribing	N/A	1710761135	0	0	KELLY, ELYSE CNM	8/14/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236389	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
344042	Ordering, Referring, Prescribing	N/A	1710945340	0	0	KORNBLUH, REBECCA A MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79844	N/A	N/A	N/A	N/A	N/A	158 GENTRY ST	None	POMONA	CA	91767	2100	00	06000	34.09147818	-117.7506278	Los Angeles County
344072	Ordering, Referring, Prescribing	N/A	1720104292	0	0	KIM, RYAN R	9/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	43187	N/A	N/A	N/A	N/A	N/A	10230 ARTESIA BLVD	STE 101	BELLFLOWER	CA	90706	6763	00	06000	33.8728276	-118.1160403	Los Angeles County
344108	Ordering, Referring, Prescribing	N/A	1720164627	0	0	KRUPA, GARY M DDS	1/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	29333	N/A	N/A	N/A	N/A	N/A	19969 GREENLEY RD	SUITE C AND D	SONORA	CA	95370	5908	00	06000	37.98497262	-120.3669198	Tuolumne County
344116	Ordering, Referring, Prescribing	N/A	1720178601	0	0	KAMBOJ, PRADEEP K MD	10/15/2017	Taxonomy not applicable	NA	n/a	000	Unknown	A53364	N/A	N/A	N/A	N/A	N/A	1008 N CHERRY ST	None	TULARE	CA	93274	2212	00	06000	36.22217583	-119.3376171	Tulare County
344123	Ordering, Referring, Prescribing	N/A	1720188253	0	0	KHAN, NAZIRAH MD	4/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A51274	N/A	N/A	N/A	N/A	N/A	3591 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2654	00	06000	33.93048952	-118.205541	Los Angeles County
344136	Ordering, Referring, Prescribing	N/A	1720225584	0	0	KELLY, HEIDI C LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46480	N/A	N/A	N/A	N/A	N/A	751 E. DAILY DRIVE	SUITE 320	CAMARILLO	CA	93010	6044	00	06000	34.21880533	-119.0593374	Ventura County
344143	Ordering, Referring, Prescribing	N/A	1720245095	0	0	KUNKEL, BETZABEL MD	5/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107540	N/A	N/A	N/A	N/A	N/A	215 W. BEAMER STREET	None	DAVIS	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
344149	Ordering, Referring, Prescribing	N/A	1720265028	0	0	KENEVAN, BRIDGET LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42573	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
344180	Ordering, Referring, Prescribing	N/A	1720318132	0	0	KOOGER, GIANA R LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86206	N/A	N/A	N/A	N/A	N/A	302 CHERRY LN	201	MANTECA	CA	95337	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
344217	Ordering, Referring, Prescribing	N/A	1720368244	0	0	KIZITO, JALIA N NP	2/11/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012015	N/A	N/A	N/A	N/A	N/A	4521 ELWELL CT	None	ELK GROVE	CA	95758	4017	00	06000	38.41695	-121.451796	Sacramento County
344222	Ordering, Referring, Prescribing	N/A	1720375629	0	0	KANG, HYEJUNG S	8/2/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D62287	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
344227	Ordering, Referring, Prescribing	N/A	1720382864	0	0	KELAITA, SHANNON LCSW	11/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69741	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
344241	Ordering, Referring, Prescribing	N/A	1720400740	0	0	KEEHR, BARBARA A LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48877	N/A	N/A	N/A	N/A	N/A	1045 9TH AVE	None	SAN DIEGO	CA	92101	5504	00	06000	32.71607643	-117.1564968	San Diego County
344244	Ordering, Referring, Prescribing	N/A	1720406119	0	0	KWONG, CALVIN MD	1/8/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139761	N/A	N/A	N/A	N/A	N/A	2574 SAN BRUNO AVE	None	SAN FRANCISCO	CA	94134	1505	00	06000	37.72907852	-122.4042585	San Francisco County
344268	Ordering, Referring, Prescribing	N/A	1720433162	0	0	KELLY, BRITTANY L LCSW	2/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95143	N/A	N/A	N/A	N/A	N/A	250 JOANN ST	None	COSTA MESA	CA	92626	6455	00	06000	33.65767408	-117.9100144	Orange County
344284	Ordering, Referring, Prescribing	N/A	1720452485	0	0	KAUR, GURTARNPREET PHARMD	4/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	71304	N/A	N/A	N/A	N/A	N/A	6898 RALEIGH RD	None	SAN JOSE	CA	95119	1730	00	06000	37.2429835	-121.7845232	Santa Clara County
344291	Ordering, Referring, Prescribing	N/A	1720461403	0	0	KRAGER, EDWARD LMFT	1/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111665	N/A	N/A	N/A	N/A	N/A	2829 TRANSWORLD DR	None	STOCKTON	CA	95206	3950	00	06000	37.90770281	-121.2309823	San Joaquin County
344299	Ordering, Referring, Prescribing	N/A	1720466261	0	0	KOKENGE, KATIE LCSW	12/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85598	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	9TH FLOOR	LOS ANGELES	CA	90020	1102	00	06000	34.064091	-118.2916225	Los Angeles County
344313	Ordering, Referring, Prescribing	N/A	1720484835	0	0	KIM, SARAH F	9/28/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64201	N/A	N/A	N/A	N/A	N/A	2800 LINCOLN ST	None	OROVILLE	CA	95966	5961	00	06000	39.50159288	-121.5513942	Butte County
344349	Ordering, Referring, Prescribing	N/A	1720538283	0	0	KACI, KAHINA LCSW	1/4/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60749	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
344404	Ordering, Referring, Prescribing	N/A	1720618903	0	0	KAGAN, MELISSA R LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT89064	N/A	N/A	N/A	N/A	N/A	4955 ALTA ST.	None	SIMI VALLEY	CA	93063	0000	00	06000	34.28440504	-118.6967314	Ventura County
344424	Ordering, Referring, Prescribing	N/A	1720652449	0	0	KIM, JANET B LMFT	6/28/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147751	N/A	N/A	N/A	N/A	N/A	18623 GALE AVE	154	LOS ANGELES	CA	91748	1342	00	06000	33.9945603	-117.8965305	Los Angeles
344506	Ordering, Referring, Prescribing	N/A	1730205709	0	0	KIRSHBAUM, GERALD M	12/21/1985	Taxonomy not applicable	NA	n/a	099	DENTIST	D17110	N/A	N/A	N/A	N/A	N/A	5400 BALBOA BLVD	SUITE 308	ENCINO	CA	91316	1502	00	06000	34.169283	-118.501072	Los Angeles County
344519	Ordering, Referring, Prescribing	N/A	1730221730	0	0	KHARIT, TATYANA MD	10/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88429	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	4 TH FLOOR	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
344604	Ordering, Referring, Prescribing	N/A	1730382250	0	0	KAPLAN, LISA S LMFT	9/9/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT37021	N/A	N/A	N/A	N/A	N/A	12304 SANTA MONICA	SUITE 108A	LOS ANGELES	CA	90025	2586	00	06000	34.03948285	-118.4656304	Los Angeles County
344661	Ordering, Referring, Prescribing	N/A	1730504358	0	0	KU, CHIUNGWEN LCSW	1/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87943	N/A	N/A	N/A	N/A	N/A	9353 VALLEY BLVD	None	ROSEMEAD	CA	91770	1923	00	06000	34.08115618	-118.0651957	Los Angeles County
344663	Ordering, Referring, Prescribing	N/A	1730512633	0	0	KIM, SOO JEE LMFT	12/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123569	N/A	N/A	N/A	N/A	N/A	310 HARBOR BLVD	BUILDING E	BELMONT	CA	94002	4018	00	06000	37.52045283	-122.2680405	San Mateo County
344665	Ordering, Referring, Prescribing	N/A	1730500893	0	0	KIM, JENNIFER MIN K	3/5/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D62877	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
344678	Ordering, Referring, Prescribing	N/A	1730533530	0	0	KUBOTA, BRITTNEY M PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72965	N/A	N/A	N/A	N/A	N/A	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	00	06000	38.576079	-121.2938325	Sacramento County
344703	Ordering, Referring, Prescribing	N/A	1730579640	0	0	KANG, SOJEONG NP	2/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001032	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
344762	Ordering, Referring, Prescribing	N/A	1730686692	0	0	KHAN, NOSHEEN DPM	4/10/2022	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5740	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
344766	Ordering, Referring, Prescribing	N/A	1730691114	0	0	KIM, JESSICA	12/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77344	N/A	N/A	N/A	N/A	N/A	8810 TAMPA AVE	None	NORTHRIDGE	CA	91324	3519	00	06000	34.230771	-118.5510825	Los Angeles County
344767	Ordering, Referring, Prescribing	N/A	1730691627	0	0	KUDREYKO, JOHN PT	8/25/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT294289	N/A	N/A	N/A	N/A	N/A	1201 EAST OCEAN AVE.	A	LOMPOC	CA	93436	7081	00	06000	34.63888288	-120.4436487	Santa Barbara County
344783	Ordering, Referring, Prescribing	N/A	1730716135	0	0	KITCHIN, SPENCER MD	4/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185866	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
344799	Ordering, Referring, Prescribing	N/A	1730740762	0	0	KANG-HANS, ROBIN P MD MPH	6/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179193	N/A	N/A	N/A	N/A	N/A	2333 S MOONEY BLVD	None	VISALIA	CA	93277	6228	00	06000	36.308682	-119.3154255	Tulare County
344808	Ordering, Referring, Prescribing	N/A	1730760513	0	0	KAO, TIFFANY L MD	4/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195673	N/A	N/A	N/A	N/A	N/A	525 N. GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	00	06000	34.06794352	-118.1229278	Los Angeles County
344811	Ordering, Referring, Prescribing	N/A	1730768805	0	0	KUO, MARISSA PA	11/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59731	N/A	N/A	N/A	N/A	N/A	6090 REDWOOD BLVD	None	NOVATO	CA	94945	4569	00	06000	38.09578333	-122.5627508	Marin County
344813	Ordering, Referring, Prescribing	N/A	1730775958	0	0	KILGORE, MATIA	7/29/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95031378	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
344828	Ordering, Referring, Prescribing	N/A	1730820085	0	0	KONO, KARA E DO	2/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21494	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
344890	Ordering, Referring, Prescribing	N/A	1740277227	0	0	KHAN, TASNIM A MD	3/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55560	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
344931	Ordering, Referring, Prescribing	N/A	1740363282	0	0	KHAJAVI, SHARMIN PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48156	N/A	N/A	N/A	N/A	N/A	3801 HOWE ST	ROOM G80	OAKLAND	CA	94611	5312	00	06000	37.8242732	-122.2568561	Alameda County
344948	Ordering, Referring, Prescribing	N/A	1740416916	0	0	KUO, JENNIFER M PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62105	N/A	N/A	N/A	N/A	N/A	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	00	06000	37.48892015	-122.218747	San Mateo County
344950	Ordering, Referring, Prescribing	N/A	1740416619	0	0	KULLBACK, MARCIA LCSW	5/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW10162	N/A	N/A	N/A	N/A	N/A	5284 ADOLFO RD	100	CAMARILLO	CA	93012	6787	00	06000	34.21515637	-118.9970881	Ventura County
344954	Ordering, Referring, Prescribing	N/A	1740442664	0	0	KATZ GOLDSTEIN, GIL LMFT	10/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97598	N/A	N/A	N/A	N/A	N/A	5520 EMBER CT	None	AGOURA HILLS	CA	91301	2062	00	06000	34.15225164	-118.7851441	Los Angeles County
344959	Ordering, Referring, Prescribing	N/A	1740446087	0	0	KAPOOR-MOHIMEN, BONU MD	6/30/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C161937	N/A	N/A	N/A	N/A	N/A	701 5TH AVE	STE 2300	SEATTLE	WA	98104	0002	00	06000	47.60478542	-122.3301801	King County
344974	Ordering, Referring, Prescribing	N/A	1740490267	0	0	KUMELACHEW, HIRUTH	5/1/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA15250	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
344980	Ordering, Referring, Prescribing	N/A	1740514645	0	0	KEHL, RONALD J	1/20/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105921	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
345057	Ordering, Referring, Prescribing	N/A	1740632421	0	0	KISSICK, HANNAH N LCSW	2/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87310	N/A	N/A	N/A	N/A	N/A	9445 FAIRWAY VIEW PL	100	RANCHO CUCAMONGA	CA	91730	0929	00	06000	34.08193054	-117.5597308	San Bernardino County
345081	Ordering, Referring, Prescribing	N/A	1740679216	0	0	KEMP, DELASHAWN Y LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108565	N/A	N/A	N/A	N/A	N/A	3125 MYERS ST	BUILDING #3	RIVERSIDE	CA	92503	5527	00	06000	33.90932558	-117.4428095	Riverside County
345115	Ordering, Referring, Prescribing	N/A	1740721737	0	0	KHATER, ABDELRAHMAN H PHARMD	8/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76200	N/A	N/A	N/A	N/A	N/A	7000 INDIANA AVE	112	RIVERSIDE	CA	92506	4153	00	06000	33.94079162	-117.3949924	Riverside County
345116	Ordering, Referring, Prescribing	N/A	1740724616	0	0	KONG, KA YING M PHARMD	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75584	N/A	N/A	N/A	N/A	N/A	745 W NAOMI AVE	None	ARCADIA	CA	91007	7517	00	06000	34.12373262	-118.0574689	Los Angeles County
345138	Ordering, Referring, Prescribing	N/A	1740752062	0	0	KUBAI, JOHN NP	11/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025445	N/A	N/A	N/A	N/A	N/A	27699 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	2697	00	06000	33.51449799	-117.1593524	Riverside County
345140	Ordering, Referring, Prescribing	N/A	1740760115	0	0	KIERNAN, TANYA A LMFT	11/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46804	N/A	N/A	N/A	N/A	N/A	255 LEWIS AVE	None	SAN ANDREAS	CA	95249	0067	00	06000	38.19859655	-120.677603	Calaveras County
345166	Ordering, Referring, Prescribing	N/A	1740800671	0	0	KAUR, KARANJOT DPM	3/1/2023	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5941	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
345179	Ordering, Referring, Prescribing	N/A	1740818103	0	0	KIM, MOONJUNG A PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82289	N/A	N/A	N/A	N/A	N/A	121 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2797	00	06000	37.37959628	-122.071458	Santa Clara County
345188	Ordering, Referring, Prescribing	N/A	1740838374	0	0	KO, JACQUELINE LMFT	10/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150385	N/A	N/A	N/A	N/A	N/A	2635 ZANKER RD	None	SAN JOSE	CA	95134	2107	00	06000	37.38911415	-121.9253145	Santa Clara County
345191	Ordering, Referring, Prescribing	N/A	1740840487	0	0	KREIDT, MICHELLE PA-C	6/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56893	N/A	N/A	N/A	N/A	N/A	620 SOUTH MAIN STREET	None	SANTA ANA	CA	92701	5716	00	06000	33.73988621	-117.8677331	Orange County
345212	Ordering, Referring, Prescribing	N/A	1740893858	0	0	KIANG, ESTHER	9/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014937	N/A	N/A	N/A	N/A	N/A	2470 ALVIN AVE	60	SAN JOSE	CA	95121	1664	00	06000	37.31946663	-121.8268813	Santa Clara County
345225	Ordering, Referring, Prescribing	N/A	1740943174	0	0	KHANAL, ANU NP	8/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018595	N/A	N/A	N/A	N/A	N/A	1642 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1800	00	06000	37.3061289	-121.8119182	Santa Clara County
345227	Ordering, Referring, Prescribing	N/A	1740939321	0	0	KIM, GRACE MD	7/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188106	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
345239	Ordering, Referring, Prescribing	N/A	1740992288	0	0	KEELER, TRENTON PHARMD	12/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87484	N/A	N/A	N/A	N/A	N/A	67 LINCOLN BLVD	None	LINCOLN	CA	95648	9389	00	06000	38.87853574	-121.2956801	Placer County
345250	Ordering, Referring, Prescribing	N/A	1750024238	0	0	KIM, SUK WON DDS	7/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108979	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
345270	Ordering, Referring, Prescribing	N/A	1750146536	0	0	KIM, SAMUEL NP	1/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95028798	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0518	00	06000	39.03521526	-120.9755343	Placer County
345279	Ordering, Referring, Prescribing	N/A	1750165684	0	0	KARAGYAN, ANNA M	8/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026433	N/A	N/A	N/A	N/A	N/A	519 EAST BROADWAY BLVD	None	GLENDALE	CA	91205	1110	00	06000	34.14636593	-118.2492244	Los Angeles County
345286	Ordering, Referring, Prescribing	N/A	1750336095	0	0	KWON, HOSUN LMFT	8/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40611	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2805	00	06000	34.07380397	-118.20586	Los Angeles County
345288	Ordering, Referring, Prescribing	N/A	1750373189	0	0	KHAN, SHAGUFTA N	4/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	21837	N/A	N/A	N/A	N/A	N/A	3567 W MT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	00	06000	36.43078218	-119.8620732	Fresno County
345289	Ordering, Referring, Prescribing	N/A	1750389375	0	0	KHALIQ, HUMA	10/17/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65263	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
345300	Ordering, Referring, Prescribing	N/A	1750404794	0	0	KUFNER, JOHN C LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103591	N/A	N/A	N/A	N/A	N/A	1560 MARKET ST	None	REDDING	CA	96001	1023	00	06000	40.58346871	-122.390608	Shasta County
345350	Ordering, Referring, Prescribing	N/A	1750500641	0	0	KIMBANG, SUNWOOK LCSW	5/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23634	N/A	N/A	N/A	N/A	N/A	8745 AERO DR	330	SAN DIEGO	CA	92123	1761	00	06000	32.80965551	-117.1391563	San Diego County
345364	Ordering, Referring, Prescribing	N/A	1750535928	0	0	KEELER, LINDA J LCSW	10/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76271	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR	SUITE 200	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
345380	Ordering, Referring, Prescribing	N/A	1750566154	0	0	KUMMATI, DEEPA L MD	12/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C153084	N/A	N/A	N/A	N/A	N/A	4844 N FIRST ST	STE 101	FRESNO	CA	93726	0529	00	06000	36.80569286	-119.7720261	Fresno County
345387	Ordering, Referring, Prescribing	N/A	1750595195	0	0	KHODAPANAH, ELMIRA DDS	8/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	43989	N/A	N/A	N/A	N/A	N/A	1717 LAS VEGAS ST	None	MODESTO	CA	95358	5500	00	06000	37.6052798	-121.0027523	Stanislaus County
345417	Ordering, Referring, Prescribing	N/A	1750664256	0	0	KONG, FU KWO PATRICK	10/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47632	N/A	N/A	N/A	N/A	N/A	3655 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3912	00	06000	37.9984807	-122.1321299	Contra Costa County
345424	Ordering, Referring, Prescribing	N/A	1750682845	0	0	KNIGHT, ELIZABETH LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77403	N/A	N/A	N/A	N/A	N/A	3960 WALNUT DR	None	EUREKA	CA	95503	8938	00	06000	40.77058956	-124.1429884	Humboldt County
345434	Ordering, Referring, Prescribing	N/A	1750694352	0	0	KAYE, MICHELLE C	11/13/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68049	N/A	N/A	N/A	N/A	N/A	2730 BRYANT ST	None	SAN FRANCISCO	CA	94110	4226	00	06000	37.75046131	-122.4089651	San Francisco County
345473	Ordering, Referring, Prescribing	N/A	1750751608	0	0	KANG, TAEREE K NP	9/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002938	N/A	N/A	N/A	N/A	N/A	7223 FAIR AVE	None	SUN VALLEY	CA	91352	4964	00	06000	34.201944	-118.374718	Los Angeles County
345494	Ordering, Referring, Prescribing	N/A	1750775219	0	0	KROLL, ELIZABETH A LCSW	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83631	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
345528	Ordering, Referring, Prescribing	N/A	1750829206	0	0	KWOK, JOYCE	10/15/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	9053	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2006	00	06000	37.86680859	-122.2969443	Alameda County
345553	Ordering, Referring, Prescribing	N/A	1750875258	0	0	KINOSHITA, DANIEL M LMFT	10/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122550	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	None	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
345586	Ordering, Referring, Prescribing	N/A	1750902003	0	0	KIM, PETER MD	3/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185019	N/A	N/A	N/A	N/A	N/A	808 W. 58TH ST.	None	LOS ANGELES	CA	90037	4045	00	06000	33.98965917	-118.287673	Los Angeles County
345593	Ordering, Referring, Prescribing	N/A	1750946364	0	0	KNIGHT-ORTIZ, KIMBERLY A LCSW	8/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96609	N/A	N/A	N/A	N/A	N/A	1029 N BROADWAY	None	ESCONDIDO	CA	92026	3043	00	06000	33.13421302	-117.0870941	San Diego County
345612	Ordering, Referring, Prescribing	N/A	1760004378	0	0	KARKODORIAN, LOREE V PHARMD	6/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81077	N/A	N/A	N/A	N/A	N/A	12509 VICTORY BLVD.	None	NORTH HOLLYWOOD	CA	91606	3135	00	06000	34.18670353	-118.405791	Los Angeles County
345615	Ordering, Referring, Prescribing	N/A	1760002919	0	0	KALPATHI, KAMNI	11/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21870	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE ST.	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
345759	Ordering, Referring, Prescribing	N/A	1760577183	0	0	KELLY-STRONG, KIMBERLY M	4/10/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	295988	N/A	N/A	N/A	N/A	N/A	5100 SIERRA COLLEGE BLVD	None	ROCKLIN	CA	95677	3855	00	06000	38.790306	-121.214862	Placer County
345760	Ordering, Referring, Prescribing	N/A	1760571608	0	0	KANOF, PHILIP D MD	12/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G87632	N/A	N/A	N/A	N/A	N/A	4760 S. SEPULVEDA BLVD.	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
345792	Ordering, Referring, Prescribing	N/A	1760677231	0	0	KALANTARI, SEPEHR M LCSW	3/18/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27659	N/A	N/A	N/A	N/A	N/A	670 E. CARNEGIE DRIVE	None	SAN BERNARDINO	CA	92408	3519	00	06000	34.06950941	-117.2704758	San Bernardino County
345797	Ordering, Referring, Prescribing	N/A	1760679633	0	0	KEMSLEY, PAOLA LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53099	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
345804	Ordering, Referring, Prescribing	N/A	1760705867	0	0	KUMAR, NINA NP	3/16/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17878	N/A	N/A	N/A	N/A	N/A	903 E DEVONSHIRE AVE	SUITE D	HEMET	CA	92543	3000	00	06000	33.75116958	-116.9627485	Riverside County
345811	Ordering, Referring, Prescribing	N/A	1760710834	0	0	KRUPANSKY, CASSANDRA DDS	3/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54892	N/A	N/A	N/A	N/A	N/A	3100 PONTE MORINO DR	None	CAMERON PARK	CA	95682	7432	00	06000	38.66252014	-120.9672091	El Dorado County
345825	Ordering, Referring, Prescribing	N/A	1760734065	0	0	KANERIA, PRITI M PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67910	N/A	N/A	N/A	N/A	N/A	110 N LA BREA AVE	None	INGLEWOOD	CA	90301	1708	00	06000	33.96345848	-118.3533454	Los Angeles County
345834	Ordering, Referring, Prescribing	N/A	1760756514	0	0	KRONENBERG, DENNIELLE LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68250	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
345844	Ordering, Referring, Prescribing	N/A	1760768170	0	0	KLUJ, JULIE A PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	39427	N/A	N/A	N/A	N/A	N/A	11440 WINDEMERE PKWY	None	SAN RAMON	CA	94582	5179	00	06000	37.76322364	-121.9047731	Contra Costa County
345854	Ordering, Referring, Prescribing	N/A	1760780456	0	0	KORGAONKAR, ALKA A	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	49300	N/A	N/A	N/A	N/A	N/A	43621 PACIFIC COMMONS BL	None	FREMONT	CA	94538	3809	00	06000	37.50266787	-121.9716761	Alameda County
345885	Ordering, Referring, Prescribing	N/A	1760831176	0	0	KRUTSINGER, SARAH LCSW	9/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61384	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
345886	Ordering, Referring, Prescribing	N/A	1760838601	0	0	KARAPETYAN, LUSINE LCSW	10/26/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83728	N/A	N/A	N/A	N/A	N/A	1721 E. 120TH STREET, #6	None	LOS ANGELES	CA	90059	0001	00	06000	33.92464172	-118.2429544	Los Angeles County
345902	Ordering, Referring, Prescribing	N/A	1760852891	0	0	KAUFFMAN, CHRISTOPHER LCSW	3/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91919	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE	SUITE 200	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
345921	Ordering, Referring, Prescribing	N/A	1760873236	0	0	KIM, SHANNON C LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103817	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 120	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
345923	Ordering, Referring, Prescribing	N/A	1760880546	0	0	KIM, SAEMIN PHARMD	3/6/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82172	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
345928	Ordering, Referring, Prescribing	N/A	1760891071	0	0	KERR, RITA H MD	10/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G72170	N/A	N/A	N/A	N/A	N/A	10877 CONDUCTOR BLVD	400	SUTTER CREEK	CA	95685	9687	00	06000	38.36440771	-120.8174749	Amador County
345934	Ordering, Referring, Prescribing	N/A	1760897201	0	0	KESHISHIAN, TALENE MD	3/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129687	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
345946	Ordering, Referring, Prescribing	N/A	1760914642	0	0	KIM, IAN MD	9/11/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157098	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
346007	Ordering, Referring, Prescribing	N/A	1770009953	0	0	KUUKKA, NIINA LMFT	1/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130671	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
346090	Ordering, Referring, Prescribing	N/A	1770190969	0	0	KING, MALLORY PA-C	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA58844	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
346097	Ordering, Referring, Prescribing	N/A	1770196644	0	0	KRISMAN, KIMBERLY A PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76443	N/A	N/A	N/A	N/A	N/A	1800 CONCORD AVE	None	CONCORD	CA	94520	2301	00	06000	37.97782892	-122.0384093	Contra Costa County
346113	Ordering, Referring, Prescribing	N/A	1770233314	0	0	KIM, ELIZABETH MD	4/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188962	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
346117	Ordering, Referring, Prescribing	N/A	1770280646	0	0	KULABAKO, STELLAH CNP	6/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025583	N/A	N/A	N/A	N/A	N/A	1560 MARKET ST	None	REDDING	CA	96001	1023	00	06000	40.58346871	-122.390608	Shasta County
346125	Ordering, Referring, Prescribing	N/A	1770291569	0	0	KAUR, JASMEEN NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022583	N/A	N/A	N/A	N/A	N/A	726 N. MEDICAL CENTER DR	SUITE 205	CLOVIS	CA	93611	6886	00	06000	36.84186593	-119.6624867	Fresno County
346134	Ordering, Referring, Prescribing	N/A	1770355752	0	0	KOSCHEL, DEANNA NP	9/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027301	N/A	N/A	N/A	N/A	N/A	23161 MILL CREEK DRIVE	230	LAGUNA HILLS	CA	92853	7908	00	06000	33.62655796	-117.7352122	Orange County
346241	Ordering, Referring, Prescribing	N/A	1770816381	0	0	KOSOFF, ANNA LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52802	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD.	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
346307	Ordering, Referring, Prescribing	N/A	1770924078	0	0	KIANIDEHKIAN, ALYSSA H LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94679	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
346314	Ordering, Referring, Prescribing	N/A	1770938201	0	0	KHARADJIAN, TALAR B MD	3/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161276	N/A	N/A	N/A	N/A	N/A	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	00	06000	33.18081595	-117.3156434	San Diego County
346328	Ordering, Referring, Prescribing	N/A	1770955155	0	0	KIM, AESUN PHARMD	8/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH69739	N/A	N/A	N/A	N/A	N/A	2424 MISSION STREET	None	SAN FRANCISCO	CA	94110	2415	00	06000	37.75816928	-122.4190376	San Francisco County
346331	Ordering, Referring, Prescribing	N/A	1770963621	0	0	KWACHAK HALL, JODY LMFT	5/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115414	N/A	N/A	N/A	N/A	N/A	1900 LAKE TAHOE BLVD	None	SOUTH LAKE TAHOE	CA	96150	4208	00	06000	38.91165546	-120.0083802	El Dorado County
346380	Ordering, Referring, Prescribing	N/A	1780032862	0	0	KURANI, NALINKANT	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49394	N/A	N/A	N/A	N/A	N/A	3027 RANCHO VISTA BLVD	None	PALMDALE	CA	93551	3582	00	06000	34.60188906	-118.1846656	Los Angeles County
346389	Ordering, Referring, Prescribing	N/A	1780051938	0	0	KANE, EMILY LCSW	12/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99112	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
346440	Ordering, Referring, Prescribing	N/A	1780124172	0	0	KAHAL, SANDEEP MD	4/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172452	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
346455	Ordering, Referring, Prescribing	N/A	1780142380	0	0	KIM, SEJUNG NP	11/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014460	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
346472	Ordering, Referring, Prescribing	N/A	1780187344	0	0	KAMBOJ, MUNISH	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76173	N/A	N/A	N/A	N/A	N/A	1640 LINCOLN RD	None	YUBA CITY	CA	95993	5901	00	06000	39.11269554	-121.645017	Sutter County
346489	Ordering, Referring, Prescribing	N/A	1780233098	0	0	KIM, CRISTINA	11/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012722	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
346498	Ordering, Referring, Prescribing	N/A	1780248542	0	0	KATHOK, EVA H LCSW	2/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86515	N/A	N/A	N/A	N/A	N/A	1452 26TH ST.	SUITE 103	SANTA MONICA	CA	90404	3042	00	06000	34.03218119	-118.4730364	Los Angeles County
346501	Ordering, Referring, Prescribing	N/A	1780257246	0	0	KIVETT, JOSEPH NP	9/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027272	N/A	N/A	N/A	N/A	N/A	201 N CIVIC DR	SUITE 183	WALNUT CREEK	CA	94596	3864	00	06000	37.91024298	-122.0593495	Contra Costa County
346522	Ordering, Referring, Prescribing	N/A	1780323857	0	0	KENNEDY, NATALIE T LCSW	10/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126778	N/A	N/A	N/A	N/A	N/A	7171 BOWLING DRIVE	300	SACRAMENTO	CA	95823	2034	00	06000	38.497527	-121.455297	Sacramento County
346539	Ordering, Referring, Prescribing	N/A	1780356402	0	0	KIRAKASIAN, SONA NP	10/13/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007013	N/A	N/A	N/A	N/A	N/A	14735 VENTURA BLVD	None	SHERMAN OAKS	CA	91403	3679	00	06000	34.15187275	-118.4543653	Los Angeles County
346592	Ordering, Referring, Prescribing	N/A	1780714105	0	0	KIM, HANNA LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85175	N/A	N/A	N/A	N/A	N/A	8300 UTICA AVE	None	RANCHO CUCAMONGA	CA	91730	3879	00	06000	34.10227306	-117.5715643	San Bernardino County
346649	Ordering, Referring, Prescribing	N/A	1780829135	0	0	KARIM, SHANNON LMFT	1/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78385	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	100	LONG BEACH	CA	90804	3312	00	06000	33.7831762	-118.1333125	Los Angeles County
346659	Ordering, Referring, Prescribing	N/A	1780873885	0	0	KOCHENDORFER, ADAM B DDS	12/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60995	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
346660	Ordering, Referring, Prescribing	N/A	1780870295	0	0	KAVIANI, SHARZAD LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78929	N/A	N/A	N/A	N/A	N/A	727 SHASTA ST	None	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
346671	Ordering, Referring, Prescribing	N/A	1780841510	0	0	KIRAMIJYAN, SARKIS MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110211	N/A	N/A	N/A	N/A	N/A	1700 E CESAR CHAVEZ AVE	STE 2700	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
346682	Ordering, Referring, Prescribing	N/A	1780916924	0	0	KIM, STEVE PHARMD	6/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60898	N/A	N/A	N/A	N/A	N/A	888 E EASY ST	UNIT C	SIMI VALLEY	CA	93065	3177	00	06000	34.27364648	-118.7818695	Ventura County
346716	Ordering, Referring, Prescribing	N/A	1780969915	0	0	KING, MARILEE	1/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53791	N/A	N/A	N/A	N/A	N/A	1125 MISSOURI STREET	#202	FAIRFIELD	CA	94533	6000	00	06000	38.24811048	-122.047884	Solano County
346758	Ordering, Referring, Prescribing	N/A	1790053874	0	0	KRASNIKOV, KSENIA LMFT	9/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84597	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	300	SACRAMENTO	CA	95823	0000	00	06000	38.497689	-121.4498385	Sacramento County
346799	Ordering, Referring, Prescribing	N/A	1790094878	0	0	KAO, ANA T PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61075	N/A	N/A	N/A	N/A	N/A	9961 SIERRA AVE	None	FONTANA	CA	92335	4060	00	06000	34.072245	-117.4319685	San Bernardino County
346819	Ordering, Referring, Prescribing	N/A	1790115301	0	0	KOUFOS, MITCHELL T LMFT	5/9/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102824	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	BUILDING A	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
346857	Ordering, Referring, Prescribing	N/A	1790175859	0	0	KIM, EVAN Y J DO	4/19/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13764	N/A	N/A	N/A	N/A	N/A	505 S VIRGIL AVE	None	LOS ANGELES	CA	90020	1406	00	06000	34.064883	-118.287086	Los Angeles County
346870	Ordering, Referring, Prescribing	N/A	1790206407	0	0	KAUR, SIMRANJEET MD	5/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169547	N/A	N/A	N/A	N/A	N/A	2740 S ELM AVE	None	FRESNO	CA	93706	5435	00	06000	36.70101129	-119.7908643	Fresno County
346906	Ordering, Referring, Prescribing	N/A	1790246478	0	0	KIM, MIYONG NP	10/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010459	N/A	N/A	N/A	N/A	N/A	3727 W 6TH ST	STE 200	LOS ANGELES	CA	90020	1505	00	06000	34.06358655	-118.3037656	Los Angeles County
346975	Ordering, Referring, Prescribing	N/A	1790354868	0	0	KAPLAN, ELY M DMD	11/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107409	N/A	N/A	N/A	N/A	N/A	6301 3RD ST	None	SAN FRANCISCO	CA	94124	3501	00	06000	37.72070671	-122.3963144	San Francisco County
347009	Ordering, Referring, Prescribing	N/A	1790469369	0	0	KANE, KELSI LMFT	7/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148336	N/A	N/A	N/A	N/A	N/A	3050 BEACON BLVD	None	WEST SACRAMENTO	CA	95691	3467	00	06000	38.57221637	-121.5512902	Yolo County
347036	Ordering, Referring, Prescribing	N/A	1790554855	0	0	KANAVALOV, ALLISON M NP	10/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027913	N/A	N/A	N/A	N/A	N/A	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
347053	Ordering, Referring, Prescribing	N/A	1790809713	0	0	KIRSHBAUM, NADINE H PSYD	11/7/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	22515	N/A	N/A	N/A	N/A	N/A	6368 HOLLYWOOD BLVD	2ND FLOOR	LOS ANGELES	CA	90028	6320	00	06000	34.1015865	-118.328976	Los Angeles County
347121	Ordering, Referring, Prescribing	N/A	1790967594	0	0	KRISHNAN, VIDYA MD	4/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A96938	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
347127	Ordering, Referring, Prescribing	N/A	1790968659	0	0	KALANTARI, GITA J MD	5/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A95847	N/A	N/A	N/A	N/A	N/A	26137 LA PAZ ROAD	200	MISSION VIEJO	CA	92691	5309	00	06000	33.60038172	-117.6735855	Orange County
347141	Ordering, Referring, Prescribing	N/A	1790985042	0	0	KESSLER, MICHAEL C LCSW	5/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73368	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY, STE.	None	SANTA ROSA	CA	95407	5486	00	06000	38.425266	-122.749875	Sonoma County
347142	Ordering, Referring, Prescribing	N/A	1790993004	0	0	KIM, MELANIE MD	10/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89944	N/A	N/A	N/A	N/A	N/A	921 E COMPTON BLVD	None	LOS ANGELES	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles
347161	Ordering, Referring, Prescribing	N/A	1801039292	0	0	KANU, ABDUL S MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126557	N/A	N/A	N/A	N/A	N/A	12830 HESPERIA ROAD	SUITE C-D-E	VICTORVILLE	CA	92395	7788	00	06000	34.48395212	-117.2903629	San Bernardino County
347178	Ordering, Referring, Prescribing	N/A	1801075163	0	0	KWAN, LUWIN LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100069	N/A	N/A	N/A	N/A	N/A	1509 W. CAMERON AVE.	SUITE 230	WEST COVINA	CA	91790	2725	00	06000	34.06870559	-117.9422297	Los Angeles County
347211	Ordering, Referring, Prescribing	N/A	1801134275	0	0	KELLY, KATHERINE CNM	4/19/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW235997	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
347220	Ordering, Referring, Prescribing	N/A	1801149877	0	0	KASKY, DANIKA LMFT	5/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107797	N/A	N/A	N/A	N/A	N/A	505 N EUCLID ST	SUITE 300	ANAHEIM	CA	92801	5506	00	06000	33.8379454	-117.9416147	Orange County
347278	Ordering, Referring, Prescribing	N/A	1801222922	0	0	KULUKJIAN, ERICA L LCSW	6/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101993	N/A	N/A	N/A	N/A	N/A	455 1ST STREET	None	WOODLAND	CA	95695	4023	00	06000	38.675781	-121.773122	Yolo County
347297	Ordering, Referring, Prescribing	N/A	1801256995	0	0	KHAN, ANGELA LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82568	N/A	N/A	N/A	N/A	N/A	851 N OAKLAND AVE	None	PASADENA	CA	91104	4343	00	06000	34.16031813	-118.1403347	Los Angeles County
347303	Ordering, Referring, Prescribing	N/A	1801267828	0	0	KHAN, IMRAN NP	11/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025725	N/A	N/A	N/A	N/A	N/A	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	00	06000	32.71482507	-117.0098243	San Diego County
347326	Ordering, Referring, Prescribing	N/A	1801290697	0	0	KIRBY, ELIZABETH	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82161	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
347354	Ordering, Referring, Prescribing	N/A	1801329792	0	0	KERMGARD, ELIZABETH M MD	1/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160075	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
347372	Ordering, Referring, Prescribing	N/A	1801349014	0	0	KAPPER, VICTORIA B LCSW	3/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100449	N/A	N/A	N/A	N/A	N/A	3665 KEARNY VILLA RD	SUITE 101	SAN DIEGO	CA	92123	1953	00	06000	32.80816826	-117.1510112	San Diego County
347399	Ordering, Referring, Prescribing	N/A	1801418041	0	0	KIM, THOMAS DO	8/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23278	N/A	N/A	N/A	N/A	N/A	3601 W SUNFLOWER AVE STE	STE 100	SANTA ANA	CA	92704	7916	00	06000	33.69568151	-117.918072	Orange County
347414	Ordering, Referring, Prescribing	N/A	1801449343	0	0	KAUR, SATVIR DO	8/26/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL3872	N/A	N/A	N/A	N/A	N/A	501 J ST	None	SACRAMENTO	CA	95814	2325	00	06000	38.582118	-121.499325	Sacramento County
347426	Ordering, Referring, Prescribing	N/A	1801475785	0	0	KURATOR, KEVIN S MD	7/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181129	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
347429	Ordering, Referring, Prescribing	N/A	1801451364	0	0	KARAMI, PAYAM PHARMD	1/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	76243	N/A	N/A	N/A	N/A	N/A	4029 43RD ST	STE 700	SAN DIEGO	CA	92105	8538	00	06000	32.75012697	-117.1019424	San Diego County
347437	Ordering, Referring, Prescribing	N/A	1801491154	0	0	KENT, RACHEL O OT	1/13/2024	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT21863	N/A	N/A	N/A	N/A	N/A	2686 SPRING ST	None	REDWOOD CITY	CA	94063	3522	00	06000	37.48231745	-122.2081659	San Mateo County
347456	Ordering, Referring, Prescribing	N/A	1801537535	0	0	KAM, HEATHER	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	68359	N/A	N/A	N/A	N/A	N/A	2100 DR MARTIN LUTHER KI	None	CHICO	CA	95928	4422	00	06000	39.721077	-121.811508	Butte County
347457	Ordering, Referring, Prescribing	N/A	1801559471	0	0	KONG, EDMUND PHARMD	10/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85417	N/A	N/A	N/A	N/A	N/A	1351 W CAPITOL AVE	None	WEST SACRAMENTO	CA	95691	3213	00	06000	38.58078833	-121.5255797	Yolo County
347482	Ordering, Referring, Prescribing	N/A	1801855861	0	0	KIRSHBAUM, DAVID J PA-C	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA14700	N/A	N/A	N/A	N/A	N/A	8283 GROVE AVE.	SUITE 201	RANCHO CUCAMONGA	CA	91730	3140	00	06000	34.10380433	-117.6285116	San Bernardino County
347492	Ordering, Referring, Prescribing	N/A	1801907100	0	0	KIMBALL, KATHLEEN A NP	5/28/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	228653	N/A	N/A	N/A	N/A	N/A	650 N FULTON	None	FRESNO	CA	93728	3404	00	06000	36.75213	-119.800333	Fresno County
347515	Ordering, Referring, Prescribing	N/A	1801949912	0	0	KIM, SUN H	6/14/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	44263	N/A	N/A	N/A	N/A	N/A	4881 LA PALMA AVE	None	LA PALMA	CA	90623	2019	00	06000	33.84635449	-118.0476675	Orange County
347537	Ordering, Referring, Prescribing	N/A	1811013501	0	0	KANG, KIMBERLY LCSW	3/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21440	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
347559	Ordering, Referring, Prescribing	N/A	1811048630	0	0	KIFF, NATALIE M LCSW	8/13/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27304	N/A	N/A	N/A	N/A	N/A	350 MAIN STREET	#H-9	PLEASANTON	CA	94566	7373	00	06000	37.659395	-121.8764346	Alameda County
347564	Ordering, Referring, Prescribing	N/A	1811057839	0	0	KITZES, MICHAEL S LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT27289	N/A	N/A	N/A	N/A	N/A	1119 E. MONTE VISTA AVE	None	VACAVILLE	CA	95688	3009	00	06000	38.36024633	-121.9763983	Solano County
347587	Ordering, Referring, Prescribing	N/A	1811096837	0	0	KRAMER, LAURA K MD	12/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G138102	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
347588	Ordering, Referring, Prescribing	N/A	1811101413	0	0	KIM, STEVEN Y	12/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49310	N/A	N/A	N/A	N/A	N/A	2207 W COMMONWEALTH AVE	None	ALHAMBRA	CA	91803	1302	00	06000	34.08785952	-118.1488918	Los Angeles County
347609	Ordering, Referring, Prescribing	N/A	1811180797	0	0	KERIMIAN, EVELINA LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51972	N/A	N/A	N/A	N/A	N/A	1509 W CAMERON AVE	STE 230	WEST COVINA	CA	91790	2725	00	06000	34.06870559	-117.9422297	Los Angeles County
347628	Ordering, Referring, Prescribing	N/A	1811214737	0	0	KAMBLE, NITIN	6/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21254	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	207	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
347633	Ordering, Referring, Prescribing	N/A	1811223555	0	0	KOE, LAI YI PA	4/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	59503	N/A	N/A	N/A	N/A	N/A	3401 AERO JET AVE	None	EL MONTE	CA	91731	2801	00	06000	34.070031	-118.068778	Los Angeles County
347642	Ordering, Referring, Prescribing	N/A	1811237530	0	0	KERLESHI, ARDA PHARMD	5/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67641	N/A	N/A	N/A	N/A	N/A	2955 ALPINE BLVD	None	ALPINE	CA	91901	2392	00	06000	32.83443413	-116.7499452	San Diego County
347651	Ordering, Referring, Prescribing	N/A	1811249923	0	0	KANG, NANCY PHARMD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64815	N/A	N/A	N/A	N/A	N/A	21255 BURBANK BLVD	150	WOODLAND HILLS	CA	91367	0000	00	06000	34.17331011	-118.5940107	Los Angeles County
347659	Ordering, Referring, Prescribing	N/A	1811263734	0	0	KHOSHBIN, SARA	11/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	59934	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	None	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
347660	Ordering, Referring, Prescribing	N/A	1811262405	0	0	KOUSARI, JHALEH	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0638972	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
347663	Ordering, Referring, Prescribing	N/A	1811265820	0	0	KIM, JI-HYEUN	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59285	N/A	N/A	N/A	N/A	N/A	3460 EL CAMINO REAL	None	SANTA CLARA	CA	95051	2809	00	06000	37.35225555	-121.9921875	Santa Clara County
347683	Ordering, Referring, Prescribing	N/A	1811288079	0	0	KEIM, COURTNEY H LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26393	N/A	N/A	N/A	N/A	N/A	5225 N LAKE BLVD	None	CARNELIAN BAY	CA	96140	0000	00	06000	39.22688547	-120.078288	Placer County
347691	Ordering, Referring, Prescribing	N/A	1811310857	0	0	KUOCH, MELINDA LCSW	2/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94148	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVENUE	6TH FL	LONG BEACH	CA	90806	0001	00	06000	33.806097	-118.151378	Los Angeles County
347710	Ordering, Referring, Prescribing	N/A	1811358930	0	0	KAO, JOHNATHAN MD	7/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168305	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	SUITE 302	LONG BEACH	CA	90813	3295	00	06000	33.779655	-118.1880065	Los Angeles County
347736	Ordering, Referring, Prescribing	N/A	1811377369	0	0	KIM, CHIHEE PHARMD	3/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58287	N/A	N/A	N/A	N/A	N/A	1571 SAN ELIJO RD S	None	SAN MARCOS	CA	92078	2044	00	06000	33.09729386	-117.2002867	San Diego County
347758	Ordering, Referring, Prescribing	N/A	1811411713	0	0	KHOURI, MICHELLE G	12/5/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101718	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
347771	Ordering, Referring, Prescribing	N/A	1811424468	0	0	KAUR, MANINDER MD	2/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171718	N/A	N/A	N/A	N/A	N/A	1062 S K ST	None	TULARE	CA	93274	6422	00	06000	36.19548226	-119.3433058	Tulare County
347797	Ordering, Referring, Prescribing	N/A	1811471014	0	0	KIM, HYUN J PHARMD	4/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79013	N/A	N/A	N/A	N/A	N/A	4950 W SUNSET BLVD	6TH FLOOR HEMATOLOGY/ONC	LOS ANGELES	CA	90027	5822	00	06000	34.09812092	-118.2980246	Los Angeles County
347820	Ordering, Referring, Prescribing	N/A	1811499221	0	0	KUO, CHRISTOPHER MD	1/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160105	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS#54	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
347821	Ordering, Referring, Prescribing	N/A	1811496235	0	0	KENDRICK, ELIZABETH E NP	12/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015815	N/A	N/A	N/A	N/A	N/A	825 N SAN VICENTE BLVD	None	WEST HOLLYWOOD	CA	90069	4505	00	06000	34.0855723	-118.3845783	Los Angeles County
347833	Ordering, Referring, Prescribing	N/A	1811536295	0	0	KIM, SUN HYOUNG NP	7/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012474	N/A	N/A	N/A	N/A	N/A	10953 RAMONA BLVD	None	EL MONTE	CA	91731	2629	00	06000	34.07205148	-118.0372365	Los Angeles County
347840	Ordering, Referring, Prescribing	N/A	1811542863	0	0	KLECK, EMMA K NP	8/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012350	N/A	N/A	N/A	N/A	N/A	250 LOCUST ST	None	SANTA CRUZ	CA	95060	3813	00	06000	36.97493323	-122.028799	Santa Cruz County
347855	Ordering, Referring, Prescribing	N/A	1811588189	0	0	KNEEBONE, DARSHANA NP	6/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016325	N/A	N/A	N/A	N/A	N/A	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	00	06000	33.12123297	-117.1199417	San Diego County
347873	Ordering, Referring, Prescribing	N/A	1811651052	0	0	KELLY, JACQUELINE M RN PNP	11/16/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022538	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DRIVE	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
347880	Ordering, Referring, Prescribing	N/A	1811661382	0	0	KLAPOVA, KARIN LMFT	11/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126420	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
347889	Ordering, Referring, Prescribing	N/A	1811669849	0	0	KANWAR, ANIL	9/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	81880	N/A	N/A	N/A	N/A	N/A	12832 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	2524	00	06000	33.77717962	-118.0346285	Orange County
347894	Ordering, Referring, Prescribing	N/A	1811696529	0	0	KAUR, RIMANDEEP NP	10/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022939	N/A	N/A	N/A	N/A	N/A	726 N. MEDICAL CENTER DR	SUITE 205	CLOVIS	CA	93611	6886	00	06000	36.84186593	-119.6624867	Fresno County
347903	Ordering, Referring, Prescribing	N/A	1811766017	0	0	KAUR, HARMEET NP	12/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028324	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
347923	Ordering, Referring, Prescribing	N/A	1821012279	0	0	KUGHN, JOHN C LMFT	9/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37183	N/A	N/A	N/A	N/A	N/A	291 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	2093	00	06000	38.02243532	-122.5239302	Marin County
347956	Ordering, Referring, Prescribing	N/A	1821126392	0	0	KALAN, DEBRA R MD	1/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63158	N/A	N/A	N/A	N/A	N/A	370 S CRENSHAW BLVD	SUITE E100	TORRANCE	CA	90503	1728	00	06000	33.84549	-118.3287415	Los Angeles County
347960	Ordering, Referring, Prescribing	N/A	1821129909	0	0	KONG, LIN MIN LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53671	N/A	N/A	N/A	N/A	N/A	3741 STOCKER ST.	STE. 100	LOS ANGELES	CA	90008	5109	00	06000	34.00623019	-118.3384304	Los Angeles County
348032	Ordering, Referring, Prescribing	N/A	1821287855	0	0	KARP, TARA DO	12/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11135	N/A	N/A	N/A	N/A	N/A	1330 LAS TABLAS RD	None	TEMPLETON	CA	93465	9758	00	06000	35.55442548	-120.723759	San Luis Obispo County
348033	Ordering, Referring, Prescribing	N/A	1821287889	0	0	KHALAF, ELAINE S LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44152	N/A	N/A	N/A	N/A	N/A	368 IMPERIAL WAY #339	None	DALY CITY	CA	94015	2513	00	06000	37.665284	-122.4633945	San Mateo County
348062	Ordering, Referring, Prescribing	N/A	1821342783	0	0	KIM, JULIE NP	10/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22460	N/A	N/A	N/A	N/A	N/A	3325 PALO VERDE AVE	203	LONG BEACH	CA	90808	4132	00	06000	33.81701249	-118.1078791	Los Angeles County
348072	Ordering, Referring, Prescribing	N/A	1821363011	0	0	KIM, DIANE D PHARMD	9/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	59072	N/A	N/A	N/A	N/A	N/A	12582 CENTRAL AVE.	None	CHINO	CA	91710	3507	00	06000	34.024617	-117.6894795	San Bernardino County
348099	Ordering, Referring, Prescribing	N/A	1821411521	0	0	KIM, MAN	4/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	50704	N/A	N/A	N/A	N/A	N/A	14501 HINDRY AVE	None	HAWTHORNE	CA	90250	6748	00	06000	33.89988119	-118.3721861	Los Angeles County
348120	Ordering, Referring, Prescribing	N/A	1821441551	0	0	KIM, JOHN H NP	5/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017119	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
348122	Ordering, Referring, Prescribing	N/A	1821439902	0	0	KELLEY, BETHANY LCSW	1/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108173	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
348157	Ordering, Referring, Prescribing	N/A	1821491721	0	0	KINDBERG, ISABEL LCSW	12/7/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83129	N/A	N/A	N/A	N/A	N/A	6762 LEXINGTON AVENUE	None	LOS ANGELES	CA	90038	1217	00	06000	34.09253848	-118.3378635	Los Angeles County
348197	Ordering, Referring, Prescribing	N/A	1821551953	0	0	KAUR, GAGANPREET NP	4/4/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011552	N/A	N/A	N/A	N/A	N/A	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
348236	Ordering, Referring, Prescribing	N/A	1821611138	0	0	KHROUD, NAVNEET MD	11/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187359	N/A	N/A	N/A	N/A	N/A	1830 S CENTRAL ST	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
348239	Ordering, Referring, Prescribing	N/A	1821620477	0	0	KUMPF, SAMANTHA L PA	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59836	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD	LOS ANGELES CA 90028	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
348244	Ordering, Referring, Prescribing	N/A	1821633082	0	0	KAUR, RAVNEET NP	11/12/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013180	N/A	N/A	N/A	N/A	N/A	6069 N. FIRST STREET	SUITE 103	FRESNO	CA	93710	5467	00	06000	36.824463	-119.7723855	Fresno County
348258	Ordering, Referring, Prescribing	N/A	1821672429	0	0	KELLEY, MARTHA RN BS	6/9/2020	Taxonomy not applicable	NA	n/a	000	Unknown	496542	N/A	N/A	N/A	N/A	N/A	27332 CATALA AVE	None	SANTA CLARITA	CA	91350	2146	00	06000	34.44053213	-118.5239568	Los Angeles County
348268	Ordering, Referring, Prescribing	N/A	1821686387	0	0	KOLBOW, JENNIFER LMFT	7/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140262	N/A	N/A	N/A	N/A	N/A	765 N MAIN ST	#129	CORONA	CA	92878	1440	00	06000	33.8919027	-117.5637532	Riverside County
348501	Ordering, Referring, Prescribing	N/A	1831562412	0	0	KAYEKJIAN, NAZIG LMFT	10/23/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89709	N/A	N/A	N/A	N/A	N/A	16055 VENTURA BLVD	719	ENCINO	CA	91436	4590	00	06000	34.15632563	-118.4832351	Los Angeles County
348544	Ordering, Referring, Prescribing	N/A	1831617893	0	0	KUSHIDA, LESLIE LMFT	2/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138142	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
348571	Ordering, Referring, Prescribing	N/A	1831661578	0	0	KOELEWYN, KRISTOPHER DPM	9/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	E5785	N/A	N/A	N/A	N/A	N/A	833 N. SEQUOIA AVE	None	LINDSAY	CA	93247	1424	00	06000	36.212967	-119.0961185	Tulare County
348580	Ordering, Referring, Prescribing	N/A	1831670454	0	0	KRISTIANSEN, ALLAN S NP	7/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009503	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DR	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
348589	Ordering, Referring, Prescribing	N/A	1831678465	0	0	KASHALLA, MARTINA N	7/20/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009537	N/A	N/A	N/A	N/A	N/A	405 E BUENA VISTA ST	None	BARSTOW	CA	92311	2815	00	06000	34.89563451	-117.0233145	San Bernardino County
348626	Ordering, Referring, Prescribing	N/A	1831728724	0	0	KHEDRAKI, AHMAD MD	7/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185457	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
348642	Ordering, Referring, Prescribing	N/A	1831753292	0	0	KELLER, VICKIE LCSW	1/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120576	N/A	N/A	N/A	N/A	N/A	3780 ROSIN CT	110	SACRAMENTO	CA	95834	1646	00	06000	38.636478	-121.473081	Sacramento County
348647	Ordering, Referring, Prescribing	N/A	1831769512	0	0	KOGAN, ROSALIE VERED MD	12/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192284	N/A	N/A	N/A	N/A	N/A	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
348746	Ordering, Referring, Prescribing	N/A	1841313384	0	0	KONOVER, KIMBERLE LCSW	3/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28102	N/A	N/A	N/A	N/A	N/A	770 53RD ST	None	OAKLAND	CA	94609	1814	00	06000	37.8380933	-122.2688598	Alameda County
348756	Ordering, Referring, Prescribing	N/A	1841332384	0	0	KYAW, ZAY Y	5/12/2003	Taxonomy not applicable	NA	n/a	099	DENTIST	D49918	N/A	N/A	N/A	N/A	N/A	5807 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4227	00	06000	34.11037123	-118.1912932	Los Angeles County
348777	Ordering, Referring, Prescribing	N/A	1841377561	0	0	KARAYAN, SOOREN MD	12/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A31692	N/A	N/A	N/A	N/A	N/A	1510 S CENTRAL AVE	500	GLENDALE	CA	91204	2540	00	06000	34.12709764	-118.2577911	Los Angeles County
348781	Ordering, Referring, Prescribing	N/A	1841386885	0	0	KISSELOVICH, TERRI L LCSW	2/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27673	N/A	N/A	N/A	N/A	N/A	1250 MORENA BLVD	None	SAN DIEGO	CA	92110	3815	00	06000	32.76963745	-117.2036361	San Diego County
348814	Ordering, Referring, Prescribing	N/A	1841447505	0	0	KERBY, CARA LPCC	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	8071	N/A	N/A	N/A	N/A	N/A	412 RED HILL AVE	None	SAN ANSELMO	CA	94960	2450	00	06000	37.97656446	-122.55876	Marin County
348880	Ordering, Referring, Prescribing	N/A	1841552056	0	0	KRASSNER, DAVID MD	12/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78728	N/A	N/A	N/A	N/A	N/A	58383 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	5890	00	06000	34.13159539	-116.3901072	San Bernardino County
348946	Ordering, Referring, Prescribing	N/A	1841661980	0	0	KELLY, NANCY L NP	4/19/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95079750	N/A	N/A	N/A	N/A	N/A	1310 HANNA AVE	STE 1 & 3	CORCORAN	CA	93212	2314	00	06000	36.09975818	-119.5641426	Kings County
348972	Ordering, Referring, Prescribing	N/A	1841698958	0	0	KIEWEL, TIMM R PHARMD	11/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	71693	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
348986	Ordering, Referring, Prescribing	N/A	1841718483	0	0	KIM, ELLE E	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58061	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
348995	Ordering, Referring, Prescribing	N/A	1841723442	0	0	KALIKA, ELI B MD	3/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162540	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
349003	Ordering, Referring, Prescribing	N/A	1841744208	0	0	KHALEEL, AMMAR LCSW	9/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110302	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
349012	Ordering, Referring, Prescribing	N/A	1841743648	0	0	KANDILIAN, REBECCA PHARMD	3/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71021	N/A	N/A	N/A	N/A	N/A	10990 SAN DIEGO MISSION	BUILDING A	SAN DIEGO	CA	92108	2417	00	06000	32.7850186	-117.1023292	San Diego County
349035	Ordering, Referring, Prescribing	N/A	1841786241	0	0	KING, APRIL L LMFT	10/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122649	N/A	N/A	N/A	N/A	N/A	2621 OSWELL ST	None	BAKERSFIELD	CA	93306	3172	00	06000	35.393283	-118.9496505	Kern County
349044	Ordering, Referring, Prescribing	N/A	1841798865	0	0	KETCHAM, SHAUNA L LCSW	2/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99975	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
349122	Ordering, Referring, Prescribing	N/A	1841979333	0	0	KIM, MICHAEL S MD	8/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188748	N/A	N/A	N/A	N/A	N/A	200 MEDICAL PLAZA	#530	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
349126	Ordering, Referring, Prescribing	N/A	1851025449	0	0	KIM, ANDREW D PHARMD	6/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86159	N/A	N/A	N/A	N/A	N/A	1719 E WALNUT ST	None	PASADENA	CA	91106	1611	00	06000	34.14957646	-118.115019	Los Angeles County
349127	Ordering, Referring, Prescribing	N/A	1851027254	0	0	KIM, KIBUM DMD	1/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108481	N/A	N/A	N/A	N/A	N/A	808 W. 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
349140	Ordering, Referring, Prescribing	N/A	1851094791	0	0	KWONG, JANE DO	9/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23413	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
349144	Ordering, Referring, Prescribing	N/A	1851085260	0	0	KAPLAN, GABRIEL E LCSW	6/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24600	N/A	N/A	N/A	N/A	N/A	1200 CONCORD AVE	450	CONCORD	CA	94520	4959	00	06000	37.98072455	-122.0545603	Contra Costa County
349154	Ordering, Referring, Prescribing	N/A	1851300677	0	0	KAUSAR, AHMAD LCSW	4/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW13989	N/A	N/A	N/A	N/A	N/A	921 EAST COMPTON BLVD,	1ST FLOOR	COMPTON	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles County
349168	Ordering, Referring, Prescribing	N/A	1851405955	0	0	KAMSI, ALEX DC	12/11/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	28966	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
349202	Ordering, Referring, Prescribing	N/A	1851453732	0	0	KWON, UN-KYUNG L PHARMD	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45038	N/A	N/A	N/A	N/A	N/A	3430 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	00	06000	33.852105	-117.8444835	Orange County
349252	Ordering, Referring, Prescribing	N/A	1851573554	0	0	KNIGHT, MARK A MD	7/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94460	N/A	N/A	N/A	N/A	N/A	2130 NATIONAL AVE	None	SAN DIEGO	CA	92113	2209	00	06000	32.69800063	-117.1411927	San Diego County
349256	Ordering, Referring, Prescribing	N/A	1851575773	0	0	KHURANA, MONIKA PT	3/9/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT30164	N/A	N/A	N/A	N/A	N/A	650 HOWE AVE	505	SACRAMENTO	CA	95825	4731	00	06000	38.577294	-121.4146395	Sacramento County
349269	Ordering, Referring, Prescribing	N/A	1851607568	0	0	KARVON, LARISA LCSW	5/23/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76966	N/A	N/A	N/A	N/A	N/A	1790 EDUCATIONAL PARK DR	None	SAN JOSE	CA	95133	1703	00	06000	37.36917	-121.857768	Santa Clara County
349313	Ordering, Referring, Prescribing	N/A	1851669550	0	0	KHUU, JUDY PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48647	N/A	N/A	N/A	N/A	N/A	440 BLOSSOM HILL ROAD	None	SAN JOSE	CA	95123	1234	00	06000	37.25120454	-121.829967	Santa Clara County
349330	Ordering, Referring, Prescribing	N/A	1851691752	0	0	KHAMSING, KIRA	3/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	58398	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
349361	Ordering, Referring, Prescribing	N/A	1851734610	0	0	KILDARE, SHANNON A LCSW	7/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69742	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
349379	Ordering, Referring, Prescribing	N/A	1851765119	0	0	KIM, JOSEPH MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157608	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
349414	Ordering, Referring, Prescribing	N/A	1851804009	0	0	KIM, MELISSA S PHARMD	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65255	N/A	N/A	N/A	N/A	N/A	1028 S SAN FERNANDO BLVD	None	BURBANK	CA	91502	1537	00	06000	34.17397411	-118.2992136	Los Angeles County
349432	Ordering, Referring, Prescribing	N/A	1851834287	0	0	KLINGER, NEIL PHARMD	3/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75832	N/A	N/A	N/A	N/A	N/A	7815 N LAKE BLVD	None	TAHOE VISTA	CA	96148	0000	00	06000	39.23829399	-120.0341126	Placer County
349437	Ordering, Referring, Prescribing	N/A	1851843817	0	0	KENDERES, EMIKO	1/29/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125772	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
349443	Ordering, Referring, Prescribing	N/A	1851852164	0	0	KAUR, SIMRANVIR MD	9/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182283	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
349463	Ordering, Referring, Prescribing	N/A	1851884688	0	0	KRAUSE, LARISSA LCSW	12/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100011	N/A	N/A	N/A	N/A	N/A	2313 I ST	None	EUREKA	CA	95501	4244	00	06000	40.78679534	-124.1601037	Humboldt County
349465	Ordering, Referring, Prescribing	N/A	1851887558	0	0	KETTYLS, DONALD MD	7/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173802	N/A	N/A	N/A	N/A	N/A	311 WEST I STREET	None	LOS BANOS	CA	93635	3479	00	06000	37.06343055	-120.8570545	Merced County
349491	Ordering, Referring, Prescribing	N/A	1851936256	0	0	KEENE, RYAN LMFT	5/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139547	N/A	N/A	N/A	N/A	N/A	232 E CANON PERDIDO ST	None	SANTA BARBARA	CA	93101	2242	00	06000	34.42349188	-119.6973758	Santa Barbara County
349544	Ordering, Referring, Prescribing	N/A	1861067282	0	0	KANG, CONNIE PHARMD	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82483	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	100	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
349555	Ordering, Referring, Prescribing	N/A	1861094419	0	0	KRISHNA, ASHNEEL A PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83609	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
349565	Ordering, Referring, Prescribing	N/A	1861110041	0	0	KATIGBAK, SABRINA NP	12/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022045	N/A	N/A	N/A	N/A	N/A	1220 E 4TH ST	None	LONG BEACH	CA	90802	1831	00	06000	33.77171549	-118.175652	Los Angeles County
349579	Ordering, Referring, Prescribing	N/A	1861194508	0	0	KRACKE, STEVEN A MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197333	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
349596	Ordering, Referring, Prescribing	N/A	1861427528	0	0	KHAN-VARIBA, JOHN A MD	1/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A30544	N/A	N/A	N/A	N/A	N/A	77 CASA ST	201	SAN LUIS OBISPO	CA	93405	5803	00	06000	35.29306786	-120.6650709	San Luis Obispo County
349613	Ordering, Referring, Prescribing	N/A	1861514531	0	0	KHAN, IMRAN A MD	2/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94558	N/A	N/A	N/A	N/A	N/A	1035 PLACER ST	None	REDDING	CA	96001	1125	00	06000	40.58349378	-122.3853903	Shasta County
349615	Ordering, Referring, Prescribing	N/A	1861524035	0	0	KWANELE, BABALWA I LMFT	5/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47295	N/A	N/A	N/A	N/A	N/A	3282 ADELINE ST	None	BERKELEY	CA	94703	2439	00	06000	37.84898491	-122.2715711	Alameda County
349631	Ordering, Referring, Prescribing	N/A	1861544694	0	0	KARSH, ANITA M LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT42437	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
349664	Ordering, Referring, Prescribing	N/A	1861621963	0	0	KWON, PHEBE S PHARMD	6/23/2019	Taxonomy not applicable	NA	n/a	000	Unknown	61060	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
349727	Ordering, Referring, Prescribing	N/A	1861767386	0	0	KRUEGER, KELLY D PSYD	3/29/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24823	N/A	N/A	N/A	N/A	N/A	4631 TELLER AVE	STE 100	NEWPORT BEACH	CA	92660	8105	00	06000	33.66641504	-117.857408	Orange County
349750	Ordering, Referring, Prescribing	N/A	1861800724	0	0	KATTENGELL, DIANNA OD	12/7/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15038	N/A	N/A	N/A	N/A	N/A	615 N PALM AVE	None	ONTARIO	CA	91762	3219	00	06000	34.069761	-117.65376	San Bernardino County
349759	Ordering, Referring, Prescribing	N/A	1861805756	0	0	KALIDASU, SAILAJA MD	11/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166467	N/A	N/A	N/A	N/A	N/A	7373 WEST LANE	None	STOCKTON	CA	95201	3210	00	06000	38.017701	-121.297869	San Joaquin County
349760	Ordering, Referring, Prescribing	N/A	1861811424	0	0	KHAN, AAZIB MD	4/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168622	N/A	N/A	N/A	N/A	N/A	2425 SONOMA STREET	None	REDDING	CA	96001	3026	00	06000	40.5730743	-122.4016681	Shasta County
349763	Ordering, Referring, Prescribing	N/A	1861811705	0	0	KADI, WENDY	8/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14698	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
349793	Ordering, Referring, Prescribing	N/A	1861858573	0	0	KIM, ANNA A PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73341	N/A	N/A	N/A	N/A	N/A	13052 NEWPORT AVE	None	TUSTIN	CA	92780	0000	00	06000	33.74896613	-117.8112946	Orange County
349803	Ordering, Referring, Prescribing	N/A	1861846982	0	0	KULIG-KORT, OLIVIA E NP	5/2/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	765053	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
349814	Ordering, Referring, Prescribing	N/A	1861885378	0	0	KIM, DANIELLE A PHARMD	6/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH68995	N/A	N/A	N/A	N/A	N/A	18339 COLIMA ROAD	A	ROWLAND HEIGHTS	CA	91748	2792	00	06000	33.98851675	-117.9050378	Los Angeles County
349834	Ordering, Referring, Prescribing	N/A	1861924730	0	0	KARAKASHIAN, NIKOS MD	5/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157085	N/A	N/A	N/A	N/A	N/A	2150 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1337	00	06000	38.557287	-121.461444	Sacramento County
349846	Ordering, Referring, Prescribing	N/A	1861943854	0	0	KO, AHRA C LCSW	11/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98670	N/A	N/A	N/A	N/A	N/A	631 MAPLE AVE	B	LOS ANGELES	CA	90014	2211	00	06000	34.04323075	-118.2485358	Los Angeles County
349850	Ordering, Referring, Prescribing	N/A	1861946683	0	0	KIM, HAN S	11/8/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65331	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
349923	Ordering, Referring, Prescribing	N/A	1871053447	0	0	KELLEY, KEVIN W MD	6/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179488	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
349983	Ordering, Referring, Prescribing	N/A	1871153874	0	0	KOYANI, PRASHANT A PHARMD	10/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77902	N/A	N/A	N/A	N/A	N/A	1530 PALM AVE	None	SAN DIEGO	CA	92154	1016	00	06000	32.58396649	-117.10053	San Diego County
350022	Ordering, Referring, Prescribing	N/A	1871248286	0	0	KIM, RONALD NP	6/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019960	N/A	N/A	N/A	N/A	N/A	1 HOPE DRIVE	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
350029	Ordering, Referring, Prescribing	N/A	1871262527	0	0	KINDER, KATELYN LMFT	2/11/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT153137	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
350074	Ordering, Referring, Prescribing	N/A	1871609271	0	0	KOH, JOSHUA K MD	1/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A50936	N/A	N/A	N/A	N/A	N/A	954 W FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
350096	Ordering, Referring, Prescribing	N/A	1871639872	0	0	KUNG, JENNY L LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36300	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE.	STE. 125A	OAKLAND	CA	94605	2457	00	06000	37.768221	-122.17608	Alameda County
350106	Ordering, Referring, Prescribing	N/A	1871660399	0	0	KRIVITSKY, VALENTIN DC	5/25/2020	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	25733	N/A	N/A	N/A	N/A	N/A	3701 J ST	201	SACRAMENTO	CA	95816	5562	00	06000	38.571237	-121.4566245	Sacramento County
350112	Ordering, Referring, Prescribing	N/A	1871664466	0	0	KIM, JULIE J LCSW	4/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24420	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
350114	Ordering, Referring, Prescribing	N/A	1871666487	0	0	KWON, KIMBERLEE PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58966	N/A	N/A	N/A	N/A	N/A	13652 CANTARA STREE	MOB4 AREA 105	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
350116	Ordering, Referring, Prescribing	N/A	1871680116	0	0	KHAWAJA, CHRISTINE E LCSW	3/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28352	N/A	N/A	N/A	N/A	N/A	17800 WOODRUFF AVE	None	BELLFLOWER	CA	90706	7079	00	06000	33.87127861	-118.1172501	Los Angeles County
350122	Ordering, Referring, Prescribing	N/A	1871688721	0	0	KELLER, SUSAN	10/2/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	16445	N/A	N/A	N/A	N/A	N/A	347 CYPRESS ST	D	FORT BRAGG	CA	95437	5458	00	06000	39.43270236	-123.8026618	Mendocino County
350178	Ordering, Referring, Prescribing	N/A	1871807933	0	0	KHURANA, ANIL NP	5/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19739	N/A	N/A	N/A	N/A	N/A	301 N PRAIRIE AVE	311	INGLEWOOD	CA	90301	4507	00	06000	33.965712	-118.3439965	Los Angeles County
350185	Ordering, Referring, Prescribing	N/A	1871821066	0	0	KIM, MYO YOUNG J PHARMD	10/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	57421	N/A	N/A	N/A	N/A	N/A	7789 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2137	00	06000	34.25856597	-118.3021164	Los Angeles County
350200	Ordering, Referring, Prescribing	N/A	1871844001	0	0	KIM, NANCY B	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66014	N/A	N/A	N/A	N/A	N/A	1674 KENSINGTON PL	None	ROHNERT PARK	CA	94928	5029	00	06000	38.34797678	-122.6767411	Sonoma County
350201	Ordering, Referring, Prescribing	N/A	1871843656	0	0	KWONG, MARCIA K	8/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67914	N/A	N/A	N/A	N/A	N/A	3201 DIVISADERO ST	None	SAN FRANCISCO	CA	94123	2501	00	06000	37.79924295	-122.4427197	San Francisco County
350211	Ordering, Referring, Prescribing	N/A	1871859900	0	0	KOBARA, JENNA K OT	3/5/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	13803	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MAIL STOP #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
350212	Ordering, Referring, Prescribing	N/A	1871858126	0	0	KALT, JEFFREY M PSYD	3/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26543	N/A	N/A	N/A	N/A	N/A	301 THE CITY DRIVE SOUTH	SUITE 2090	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
350225	Ordering, Referring, Prescribing	N/A	1871873406	0	0	KOCHARIANS, ANAHID PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44848	N/A	N/A	N/A	N/A	N/A	2605 MIDDLEFIELD RD	None	PALO ALTO	CA	94306	2516	00	06000	37.43410933	-122.1303843	Santa Clara County
350226	Ordering, Referring, Prescribing	N/A	1871875641	0	0	KORIMILLI, USHASRI	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51942	N/A	N/A	N/A	N/A	N/A	3860 DECOTO RD	None	FREMONT	CA	94555	3112	00	06000	37.57147949	-122.031738	Alameda County
350270	Ordering, Referring, Prescribing	N/A	1871940940	0	0	KRIGSTEIN, KELSEY L MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152092	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
350274	Ordering, Referring, Prescribing	N/A	1871945196	0	0	KOLF, ADRIENNE R NP	1/25/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005512	N/A	N/A	N/A	N/A	N/A	2101 TENAYA DRIVE	None	MODESTO	CA	95354	3930	00	06000	37.6324545	-120.956463	Stanislaus County
350330	Ordering, Referring, Prescribing	N/A	1881021822	0	0	KIM, JEONG HYEE LAC	12/20/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	LAC 8841	N/A	N/A	N/A	N/A	N/A	5475 E LA PALMA AVE	None	ANAHEIM	CA	92807	2075	00	06000	33.85997926	-117.7958236	Orange County
350336	Ordering, Referring, Prescribing	N/A	1881043362	0	0	KIM, MIN J PHARMD	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	74242	N/A	N/A	N/A	N/A	N/A	3901 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	2522	00	06000	34.014087	-118.3351265	Los Angeles County
350390	Ordering, Referring, Prescribing	N/A	1881095776	0	0	KRUTEL, LILY S LCSW	2/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100095	N/A	N/A	N/A	N/A	N/A	755 SO. VAN NESS	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
350407	Ordering, Referring, Prescribing	N/A	1881129369	0	0	KING, LISA M NP	8/14/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	755684	N/A	N/A	N/A	N/A	N/A	1441 N TRACY BLVD	None	TRACY	CA	95376	3445	00	06000	37.744731	-121.4350375	San Joaquin County
350422	Ordering, Referring, Prescribing	N/A	1881154888	0	0	KHATIWALA, ROSHNI V MD	4/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178072	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
350427	Ordering, Referring, Prescribing	N/A	1881161974	0	0	KAPRIELIAN, ANTRANIG	6/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH78254	N/A	N/A	N/A	N/A	N/A	4849 VAN NUYS BLVD	101 A	SHERMAN OAKS	CA	91403	2110	00	06000	34.159113	-118.4487465	Los Angeles County
350441	Ordering, Referring, Prescribing	N/A	1881176436	0	0	KOZEL, KELLIE A NP	8/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012314	N/A	N/A	N/A	N/A	N/A	144 STONY POINT ROAD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
350460	Ordering, Referring, Prescribing	N/A	1881212397	0	0	KANG, VESHUDHA PA-C	12/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA58452	N/A	N/A	N/A	N/A	N/A	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	00	06000	36.80840238	-119.8594473	Fresno County
350462	Ordering, Referring, Prescribing	N/A	1881220234	0	0	KASRAVI, SHIVA PA	7/9/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58307	N/A	N/A	N/A	N/A	N/A	3701 J STREET	SUITE 201	SACRAMENTO	CA	95816	5542	00	06000	38.571237	-121.4566245	Sacramento County
350519	Ordering, Referring, Prescribing	N/A	1881386266	0	0	KAUR, TAJINDER NP	7/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025979	N/A	N/A	N/A	N/A	N/A	811 GRAND AVE	None	SACRAMENTO	CA	95838	3466	00	06000	38.637621	-121.4470125	Sacramento County
350531	Ordering, Referring, Prescribing	N/A	1881461739	0	0	KERMANSHAHI, FARIBA CNP	10/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027699	N/A	N/A	N/A	N/A	N/A	1900 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	00	06000	33.9891357	-118.2389609	Los Angeles County
350538	Ordering, Referring, Prescribing	N/A	1881609741	0	0	KAMELL, RALPH M MD	9/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G24865	N/A	N/A	N/A	N/A	N/A	36867 COOK STREET	SUITE 101	PALM DESERT	CA	92211	6064	00	06000	33.781293	-116.3586555	Riverside County
350544	Ordering, Referring, Prescribing	N/A	1881621621	0	0	KRAEMER, ERIC MD	7/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113036	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
350545	Ordering, Referring, Prescribing	N/A	1881653285	0	0	KUMAR, PRATIBHA MD	1/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40351	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8506	00	06000	33.91695337	-117.2672536	Riverside County
350576	Ordering, Referring, Prescribing	N/A	1881727519	0	0	KAPPELER, FRANCIA LMFT	5/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109192	N/A	N/A	N/A	N/A	N/A	2245 CHALLENGER WAY	100	SANTA ROSA	CA	95407	5418	00	06000	38.42559	-122.751243	Sonoma County
350621	Ordering, Referring, Prescribing	N/A	1881842151	0	0	KENT, MANISHA C PSYD	6/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25734	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	200	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
350627	Ordering, Referring, Prescribing	N/A	1881852432	0	0	KIM, YOUNG W NP	12/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17067	N/A	N/A	N/A	N/A	N/A	3533 W PICO BLVD	None	LOS ANGELES	CA	90019	4534	00	06000	34.04721925	-118.3197384	Los Angeles County
350633	Ordering, Referring, Prescribing	N/A	1881872802	0	0	KHURANA-BROWN, BINDU LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45389	N/A	N/A	N/A	N/A	N/A	101 JOSE FIGUERES AVE	None	SAN JOSE	CA	95116	2068	00	06000	37.35869865	-121.8481586	Santa Clara County
350658	Ordering, Referring, Prescribing	N/A	1881943058	0	0	KAMEL, HIBA S PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66796	N/A	N/A	N/A	N/A	N/A	3222 UNIVERSITY AVE	None	SAN DIEGO	CA	92104	2010	00	06000	32.74852553	-117.124866	San Diego County
350710	Ordering, Referring, Prescribing	N/A	1891014601	0	0	KITAGO, MAKIKO PHARMD	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61973	N/A	N/A	N/A	N/A	N/A	3398 MISSION ST	None	SAN FRANCISCO	CA	94110	5009	00	06000	37.7424724	-122.4219457	San Francisco County
350725	Ordering, Referring, Prescribing	N/A	1891048500	0	0	KHAJAVI, SUZAN DDS	12/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61587	N/A	N/A	N/A	N/A	N/A	4415 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003413	-118.256519	Los Angeles County
350730	Ordering, Referring, Prescribing	N/A	1891059630	0	0	KOSKI, GABE LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110673	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
350738	Ordering, Referring, Prescribing	N/A	1891070702	0	0	KIM, SANG	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50146	N/A	N/A	N/A	N/A	N/A	5829 LAKEWOOD BLVD	None	LAKEWOOD	CA	90712	1001	00	06000	33.86147305	-118.1427711	Los Angeles County
350743	Ordering, Referring, Prescribing	N/A	1891050167	0	0	KANERIA, MAHESHKUMAR PHARMD	9/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	64526	N/A	N/A	N/A	N/A	N/A	19409 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91351	1672	00	06000	34.41580034	-118.4750661	Los Angeles County
350747	Ordering, Referring, Prescribing	N/A	1891078390	0	0	KANG, JU HWA PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH64823	N/A	N/A	N/A	N/A	N/A	5005 BALL RD	None	CYPRESS	CA	90630	2722	00	06000	33.81701014	-118.0450115	Orange County
350750	Ordering, Referring, Prescribing	N/A	1891083895	0	0	KAO, PETER NP	6/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95002801	N/A	N/A	N/A	N/A	N/A	35324 HIGHWAY 41	None	COARSEGOLD	CA	93614	8302	00	06000	37.26242065	-119.6987402	Madera County
350773	Ordering, Referring, Prescribing	N/A	1891123709	0	0	KULIKOV-RAMIREZ, BRANDI LMFT	8/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134149	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	SUITE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
350803	Ordering, Referring, Prescribing	N/A	1891161741	0	0	KIM, KYONG OHK LCSW	7/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93644	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	#300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
350861	Ordering, Referring, Prescribing	N/A	1891244422	0	0	KIRIAZES, COLLEEN M PA-C	4/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53996	N/A	N/A	N/A	N/A	N/A	3415 MARTIN LUTHER KING	None	SACRAMENTO	CA	95817	3648	00	06000	38.54376	-121.4644095	Sacramento County
350957	Ordering, Referring, Prescribing	N/A	1891488615	0	0	KAILEY, JASMINE NP	2/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95204423	N/A	N/A	N/A	N/A	N/A	760 E ALMOND AVE	None	MADERA	CA	93637	5617	00	06000	36.94546284	-120.04872	Madera County
350964	Ordering, Referring, Prescribing	N/A	1891567376	0	0	KHWAJA, SHAKEEL PHARMD	7/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	77163	N/A	N/A	N/A	N/A	N/A	1410 W ALONDRA BLVD	None	COMPTON	CA	90220	3533	00	06000	33.88839148	-118.2446201	Los Angeles County
351043	Ordering, Referring, Prescribing	N/A	1891935672	0	0	KIM DOCTOLERO, SUE PHARMD	7/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62695	N/A	N/A	N/A	N/A	N/A	3005 MIDWAY DR.	None	SAN DIEGO	CA	92110	4502	00	06000	32.74999864	-117.2067973	San Diego County
351064	Ordering, Referring, Prescribing	N/A	1891966651	0	0	KOGA, DONNA K LMFT	6/3/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44897	N/A	N/A	N/A	N/A	N/A	2007 CEDAR AVE	None	MANHATTAN BEACH	CA	90266	2955	00	06000	33.89257088	-118.3948606	Los Angeles County
351086	Ordering, Referring, Prescribing	N/A	1902020688	0	0	KANER, SARA D MD	4/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G62087	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD	102	VAN NUYS	CA	91405	3937	00	06000	34.19649	-118.448787	Los Angeles County
351105	Ordering, Referring, Prescribing	N/A	1902060916	0	0	KIM, JOHN C MD	5/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116415	N/A	N/A	N/A	N/A	N/A	6201 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4661	00	06000	34.01625175	-118.1374784	Los Angeles County
351113	Ordering, Referring, Prescribing	N/A	1902086770	0	0	KOLETH, JOHN MD	9/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	C147616	N/A	N/A	N/A	N/A	N/A	769 BLAINE ST	None	RIVERSIDE	CA	92507	2158	00	06000	33.98300646	-117.327555	Riverside County
351129	Ordering, Referring, Prescribing	N/A	1902107626	0	0	KRIER, MARGARET	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43584	N/A	N/A	N/A	N/A	N/A	368 FELL STREET	None	SAN FRANCISCO	CA	94102	5144	00	06000	37.77587758	-122.4234278	San Francisco County
351137	Ordering, Referring, Prescribing	N/A	1902126642	0	0	KIM, MINKYUNG	1/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63225	N/A	N/A	N/A	N/A	N/A	160 E. ARTESIA ST SUITE	None	POMONA	CA	91767	2924	00	06000	34.07556833	-117.7507835	Los Angeles County
351138	Ordering, Referring, Prescribing	N/A	1902128390	0	0	KOBAYASHI, ROXANNE N	6/4/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D37436	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
351153	Ordering, Referring, Prescribing	N/A	1902153356	0	0	KERIMIAN, ARTAK PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67283	N/A	N/A	N/A	N/A	N/A	615 WEST AVE L	303	LANCASTER	CA	93534	7211	00	06000	34.6603515	-118.1419695	Los Angeles County
351179	Ordering, Referring, Prescribing	N/A	1902182017	0	0	KSYNKINA, IRINA LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110883	N/A	N/A	N/A	N/A	N/A	5385 HOLLISTER AVE	BLDG 14, STE 102	SANTA BARBARA	CA	93111	2389	00	06000	34.432173	-119.81187	Santa Barbara County
351181	Ordering, Referring, Prescribing	N/A	1902181159	0	0	KRAEMER-COLE, ABIGAIL PA	10/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	23129	N/A	N/A	N/A	N/A	N/A	2271 S DEPOT ST	None	SANTA MARIA	CA	93455	0001	00	06000	34.91728273	-120.4435243	Santa Barbara County
351183	Ordering, Referring, Prescribing	N/A	1902189152	0	0	KIM, SOO M	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53955	N/A	N/A	N/A	N/A	N/A	7155 VAN NUYS BLVD	None	VAN NUYS	CA	91405	3006	00	06000	34.20063829	-118.4487784	Los Angeles County
351207	Ordering, Referring, Prescribing	N/A	1902223951	0	0	KANESHIRO, MAI T PHARMD	3/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70262	N/A	N/A	N/A	N/A	N/A	2640 LOMITA BLVD	None	TORRANCE	CA	90505	5214	00	06000	33.80800785	-118.332844	Los Angeles County
351230	Ordering, Referring, Prescribing	N/A	1902276272	0	0	KAUR, BALPREET DDS PC	5/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS100689	N/A	N/A	N/A	N/A	N/A	705 W PECAN AVE	None	MADERA	CA	93637	6254	00	06000	36.941103	-120.06729	Madera County
351240	Ordering, Referring, Prescribing	N/A	1902287089	0	0	KANIARU, DAPHINE K	5/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139320	N/A	N/A	N/A	N/A	N/A	140 C ST	None	LEMOORE	CA	93245	2929	00	06000	36.30111141	-119.7823533	Kings County
351247	Ordering, Referring, Prescribing	N/A	1902299688	0	0	KALAJIAN, HOURIG LMFT	3/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99925	N/A	N/A	N/A	N/A	N/A	37 AUBURN AVE	5	SIERRA MADRE	CA	91024	1845	00	06000	34.1626081	-118.0549869	Los Angeles County
351251	Ordering, Referring, Prescribing	N/A	1902300452	0	0	KRINARD, TRACY E DO	4/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17950	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
351267	Ordering, Referring, Prescribing	N/A	1902327240	0	0	KHAN, PROTIVA S DO	8/26/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34680	N/A	N/A	N/A	N/A	N/A	5192 HOSPITAL ROAD	None	MARIPOSA	CA	95338	0939	00	06000	37.50087707	-119.977128	Mariposa County
351293	Ordering, Referring, Prescribing	N/A	1902376445	0	0	KANG, SUN LMFT	10/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127408	N/A	N/A	N/A	N/A	N/A	1310 WILSHIRE BLVD.	None	LOS ANGELES	CA	90017	1705	00	06000	34.0539383	-118.267018	Los Angeles County
351294	Ordering, Referring, Prescribing	N/A	1902376981	0	0	KORSAN, JESSICA M LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52877	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1375	00	06000	34.44240122	-119.7765542	Santa Barbara County
351344	Ordering, Referring, Prescribing	N/A	1902505423	0	0	KAUR, TANJIT	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022619	N/A	N/A	N/A	N/A	N/A	726 N. MEDICAL CENTER DR	SUITE 205	CLOVIS	CA	93611	6886	00	06000	36.84186593	-119.6624867	Fresno County
351364	Ordering, Referring, Prescribing	N/A	1902686918	0	0	KAUR, AMANDEEP K	6/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025501	N/A	N/A	N/A	N/A	N/A	17830 TAFT DR	None	LATHROP	CA	95330	7100	00	06000	37.7986348	-121.3366603	San Joaquin County
351387	Ordering, Referring, Prescribing	N/A	1902903669	0	0	KUNUKKASSERIL, MERIN J	11/9/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D51405	N/A	N/A	N/A	N/A	N/A	4700 N RIVER RD	STE B	OCEANSIDE	CA	92057	6043	00	06000	33.24542735	-117.3092006	San Diego County
351390	Ordering, Referring, Prescribing	N/A	1902918295	0	0	KANEHIRA-MAR, SHAWN K	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51991	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
351442	Ordering, Referring, Prescribing	N/A	1902992829	0	0	KIM, MICHELLE M	1/28/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0499392	N/A	N/A	N/A	N/A	N/A	916 W BURBANK BLVD	STE M	BURBANK	CA	91506	1450	00	06000	34.18397121	-118.3225966	Los Angeles County
351460	Ordering, Referring, Prescribing	N/A	1912034141	0	0	KAMBAM, PRAVEEN R MD	12/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100457	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
351480	Ordering, Referring, Prescribing	N/A	1912060716	0	0	KIM, MYONG-WON MD	4/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A36586	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
351501	Ordering, Referring, Prescribing	N/A	1912099557	0	0	KAUFMAN-SCANNA, TIFFANY S	8/6/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA20229	N/A	N/A	N/A	N/A	N/A	24910 LAS BRISAS RD	105	MURRIETA	CA	92562	4010	00	06000	33.57522424	-117.1828078	Riverside County
351517	Ordering, Referring, Prescribing	N/A	1912141391	0	0	KAUR, JATINDER MD	2/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120771	N/A	N/A	N/A	N/A	N/A	128 N BROADWAY	None	ESCONDIDO	CA	92025	2714	00	06000	33.12249406	-117.0818384	San Diego County
351536	Ordering, Referring, Prescribing	N/A	1912197690	0	0	KAPLOWITZ, NEIL MD	2/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G29269	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
351547	Ordering, Referring, Prescribing	N/A	1912213893	0	0	KAPAI, SUJATA B PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46797	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 372/360	SANTA CLARA	CA	95051	5051	00	06000	37.33636857	-121.9958111	Santa Clara County
351550	Ordering, Referring, Prescribing	N/A	1912227638	0	0	KHOBIARIAN, RAFI PHARMD	6/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59674	N/A	N/A	N/A	N/A	N/A	337 E MAGNOLIA BLVD	None	BURBANK	CA	91502	1132	00	06000	34.18477403	-118.3099272	Los Angeles County
351571	Ordering, Referring, Prescribing	N/A	1912265299	0	0	KARRAS, MARI J	4/18/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	D43177	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
351594	Ordering, Referring, Prescribing	N/A	1912288945	0	0	KUSOLVISITKUL, ALISA	8/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66994	N/A	N/A	N/A	N/A	N/A	1902 MARENGO ST	SUITE 105	LOS ANGELES	CA	90033	1378	00	06000	34.05770831	-118.2099519	Los Angeles County
351621	Ordering, Referring, Prescribing	N/A	1912323767	0	0	KITCHENS, ANGELA M LPCC	2/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC3158	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
351634	Ordering, Referring, Prescribing	N/A	1912339631	0	0	KIM, VIOLETA LCSW	2/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74071	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	208	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
351725	Ordering, Referring, Prescribing	N/A	1912473547	0	0	KAUR, PRABHKAMAL NP	6/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	NP95010253	N/A	N/A	N/A	N/A	N/A	505 E ALMOND AVE	101	MADERA	CA	93637	5742	00	06000	36.94551349	-120.0508739	Madera County
351753	Ordering, Referring, Prescribing	N/A	1912519893	0	0	KERR, CECILIA G LCSW	9/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW125890	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
351756	Ordering, Referring, Prescribing	N/A	1912524034	0	0	KAUNANG, JURIAN MD	4/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185609	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	190	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
351785	Ordering, Referring, Prescribing	N/A	1912568874	0	0	KAMIKAWA, MELANIE PHARMD	6/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH41059	N/A	N/A	N/A	N/A	N/A	915 MONTGOMERY VILLAGE C	None	SANTA ROSA	CA	95405	6759	00	06000	38.44763746	-122.6840703	Sonoma County
351792	Ordering, Referring, Prescribing	N/A	1912619313	0	0	KASSERMAN, KATHERINE LCSW	12/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101052	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
351798	Ordering, Referring, Prescribing	N/A	1912640053	0	0	KUIOKA, TROY H PT	11/2/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	42665	N/A	N/A	N/A	N/A	N/A	875 EL CAJON BLVD	None	EL CAJON	CA	92020	5714	00	06000	32.78535272	-116.9770049	San Diego County
351849	Ordering, Referring, Prescribing	N/A	1922051846	0	0	KOLADE, AKINDELE E MD	6/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84300	N/A	N/A	N/A	N/A	N/A	4955 ALTA STREET	None	SIMI VALLEY	CA	93063	2452	00	06000	34.28440504	-118.6967314	Ventura County
351856	Ordering, Referring, Prescribing	N/A	1922097054	0	0	KARAM, JOSEPH A MD	3/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88497	N/A	N/A	N/A	N/A	N/A	18300 ROSCOE BL	None	NORTHRIDGE	CA	91325	4105	00	06000	34.22073847	-118.532988	Los Angeles County
351873	Ordering, Referring, Prescribing	N/A	1922130707	0	0	KOOPMANS-HEMPTON, SHARON A LCSW	1/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24429	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
351887	Ordering, Referring, Prescribing	N/A	1922167766	0	0	KIM, RUTH K PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55245	N/A	N/A	N/A	N/A	N/A	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	00	06000	34.03833368	-118.3726622	Los Angeles County
351906	Ordering, Referring, Prescribing	N/A	1922206135	0	0	KIM, JIYEON MD	7/3/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144212	N/A	N/A	N/A	N/A	N/A	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	7710	00	06000	33.61235015	-117.8704573	Orange County
351918	Ordering, Referring, Prescribing	N/A	1922257278	0	0	KISE, LISA A CNP	3/11/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	3005673	N/A	N/A	N/A	N/A	N/A	1559 WATASHEAMU RD	None	GARDNERVILLE	NV	89460	7455	00	06000	38.90016089	-119.7157447	Douglas County
351927	Ordering, Referring, Prescribing	N/A	1922267772	0	0	KALMANSON, KIMBERLY R MA OTR	12/11/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	4170	N/A	N/A	N/A	N/A	N/A	1339 20TH ST.	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
351932	Ordering, Referring, Prescribing	N/A	1922286582	0	0	KAPOOR, KATHRYN N LCSW	10/1/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78832	N/A	N/A	N/A	N/A	N/A	2970 HILLTOP MALL RD	307	RICHMOND	CA	94806	1947	00	06000	37.97819764	-122.329244	Contra Costa County
351952	Ordering, Referring, Prescribing	N/A	1922316918	0	0	KARIYA, REBECCA M LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT81253	N/A	N/A	N/A	N/A	N/A	170 S SPRUCE AVE	SUITE 200	SOUTH SAN FRANCIS	CA	94080	4557	00	06000	37.64883531	-122.4187311	San Mateo County
351965	Ordering, Referring, Prescribing	N/A	1922346261	0	0	KONSTANTINIDIS, ANTHONY LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107111	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	3312	00	06000	33.7831762	-118.1333125	Los Angeles County
351992	Ordering, Referring, Prescribing	N/A	1922388172	0	0	KIEFABER, BRIDGET LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78750	N/A	N/A	N/A	N/A	N/A	6160 MISSION GORGE RD	None	SAN DIEGO	CA	92120	3410	00	06000	32.7868143	-117.0977635	San Diego County
352008	Ordering, Referring, Prescribing	N/A	1922412758	0	0	KING, RUBY A LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119686	N/A	N/A	N/A	N/A	N/A	760 HARRISON STREET	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
352012	Ordering, Referring, Prescribing	N/A	1922414382	0	0	KLUWE, MARIA I LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87760	N/A	N/A	N/A	N/A	N/A	1221 E DYER RD	220	SANTA ANA	CA	92705	5600	00	06000	33.70872153	-117.857052	Orange County
352015	Ordering, Referring, Prescribing	N/A	1922423201	0	0	KOPINGA, ELAINE A CNM	9/17/2020	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	2073	N/A	N/A	N/A	N/A	N/A	16147 E WHITTIER BLVD	None	WHITTIER	CA	90603	2560	00	06000	33.94157588	-117.9859969	Los Angeles County
352025	Ordering, Referring, Prescribing	N/A	1922448935	0	0	KRAEMER, GEOFFREY DPM	10/16/2024	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E6090	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LANE	C	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
352030	Ordering, Referring, Prescribing	N/A	1922421783	0	0	KLAZ, SHAUDAY PSYD	8/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31970	N/A	N/A	N/A	N/A	N/A	5110 W GOLDLEAF CIR	None	LOS ANGELES	CA	90056	1282	00	06000	33.98790164	-118.367233	Los Angeles County
352049	Ordering, Referring, Prescribing	N/A	1922476944	0	0	KILROY, ANDREA K LMFT	6/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126485	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
352053	Ordering, Referring, Prescribing	N/A	1922485408	0	0	KIM, ANDREW A	10/3/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	100615	N/A	N/A	N/A	N/A	N/A	200 E ANAHEIM ST	None	WILMINGTON	CA	90744	4516	00	06000	33.78003976	-118.2608958	Los Angeles County
352112	Ordering, Referring, Prescribing	N/A	1922549849	0	0	KIPLEY, NICOLE LCSW	12/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86511	N/A	N/A	N/A	N/A	N/A	619 E 5TH ST	None	LOS ANGELES	CA	90013	2109	00	06000	34.0432666	-118.2422934	Los Angeles County
352121	Ordering, Referring, Prescribing	N/A	1922564871	0	0	KHENG, MEYNA LMFT	3/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138911	N/A	N/A	N/A	N/A	N/A	711 E. BALL RD.	SUITE 201	ANAHEIM	CA	92805	5930	00	06000	33.81811751	-117.90108	Orange County
352137	Ordering, Referring, Prescribing	N/A	1922588862	0	0	KALLIN, DANIELLE W LMFT	8/23/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98048	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
352170	Ordering, Referring, Prescribing	N/A	1922685221	0	0	KHODE, AKSHITA M	5/14/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106139	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
352174	Ordering, Referring, Prescribing	N/A	1922706357	0	0	KALILI, MEGAN L LMFT	2/20/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153364	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	SUITE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
352183	Ordering, Referring, Prescribing	N/A	1922734961	0	0	KING, KRISTIN S LMFT	11/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142734	N/A	N/A	N/A	N/A	N/A	127 JEWELL ST	None	SANTA CRUZ	CA	95060	1717	00	06000	36.9882732	-122.025701	Santa Cruz County
352244	Ordering, Referring, Prescribing	N/A	1932230554	0	0	KEYTON, KOREY E PSYD	6/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22752	N/A	N/A	N/A	N/A	N/A	951 BLANCO CIR	SUITE B	SALINAS	CA	93901	4451	00	06000	36.65589725	-121.6366313	Monterey County
352323	Ordering, Referring, Prescribing	N/A	1932412319	0	0	KANG, MERRY S PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63154	N/A	N/A	N/A	N/A	N/A	8010 PARKWAY DRIVE	None	LA MESA	CA	91942	2104	00	06000	32.7749024	-117.0246371	San Diego County
352333	Ordering, Referring, Prescribing	N/A	1932434628	0	0	KAUFMAN, JENYA A MD	4/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109755	N/A	N/A	N/A	N/A	N/A	1990 41ST AVE	None	SAN FRANCISCO	CA	94116	1101	00	06000	37.74984135	-122.4997872	San Francisco County
352410	Ordering, Referring, Prescribing	N/A	1932551082	0	0	KREPS, CHRISTOPHER DPM	10/14/2019	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5585	N/A	N/A	N/A	N/A	N/A	400 NEWPORT CENTER DRIVE	SUITE 706	NEWPORT BEACH	CA	92660	7661	00	06000	33.6142606	-117.8726808	Orange County
352414	Ordering, Referring, Prescribing	N/A	1932567617	0	0	KU, KAI LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117688	N/A	N/A	N/A	N/A	N/A	2990 INLAND EMPIRE BLVD	101	ONTARIO	CA	91764	4899	00	06000	34.069824	-117.5873175	San Bernardino County
352439	Ordering, Referring, Prescribing	N/A	1932594637	0	0	KIM, YEONG B NP	11/15/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95063600	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
352507	Ordering, Referring, Prescribing	N/A	1932708468	0	0	KAUR, HARPREET	10/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83350	N/A	N/A	N/A	N/A	N/A	1801 W 11TH ST	None	TRACY	CA	95376	3727	00	06000	37.73945553	-121.449447	San Joaquin County
352551	Ordering, Referring, Prescribing	N/A	1932781846	0	0	KAUR, GAGANDEEP DO	12/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21489	N/A	N/A	N/A	N/A	N/A	4094 4TH AVENUE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
352586	Ordering, Referring, Prescribing	N/A	1932915626	0	0	KUBINSKI, RAQUEL LCSW	2/3/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114552	N/A	N/A	N/A	N/A	N/A	300 BRADFORD ST	None	REDWOOD CITY	CA	94063	1530	00	06000	37.48767403	-122.2323005	San Mateo County
352619	Ordering, Referring, Prescribing	N/A	1942290937	0	0	KNIGHT-COOPER, JANICE M PHARMD	11/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	40781	N/A	N/A	N/A	N/A	N/A	600 W. MANCHESTER AVE.	None	LOS ANGELES	CA	90044	5770	00	06000	33.96003353	-118.2845745	Los Angeles County
352648	Ordering, Referring, Prescribing	N/A	1942354907	0	0	KEEGAN, LORI M LCSW	9/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96830	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
352652	Ordering, Referring, Prescribing	N/A	1942357991	0	0	KWAN, STEPHANIE OD	5/12/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	10937	N/A	N/A	N/A	N/A	N/A	2101 STONE BLVD	STE 150	WEST SACRAMENTO	CA	95691	4054	00	06000	38.56318049	-121.5379228	Yolo County
352687	Ordering, Referring, Prescribing	N/A	1942450697	0	0	KIM, VANDA LCSW	9/26/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78829	N/A	N/A	N/A	N/A	N/A	7275 E SOUTHGATE DR	204	SACRAMENTO	CA	95823	2629	00	06000	38.493576	-121.436559	Sacramento County
352718	Ordering, Referring, Prescribing	N/A	1942500640	0	0	KIM, KRIS PHARMD	3/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	50276	N/A	N/A	N/A	N/A	N/A	16830 SAN FERNANDO MISSI	None	GRANADA HILLS	CA	91344	4247	00	06000	34.27201051	-118.500093	Los Angeles County
352724	Ordering, Referring, Prescribing	N/A	1942521620	0	0	KIRSCHER, JONATHAN MD	8/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146134	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
352763	Ordering, Referring, Prescribing	N/A	1942602701	0	0	KENNEDY, KELLIE R LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116624	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	STE 1500	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
352766	Ordering, Referring, Prescribing	N/A	1942610670	0	0	KACHELMEYER, LAURA LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105938	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
352826	Ordering, Referring, Prescribing	N/A	1942688387	0	0	KAUR, MANPREET LMFT	11/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123138	N/A	N/A	N/A	N/A	N/A	5755 COTTLE RD	UNIT 24	SAN JOSE	CA	95123	3640	00	06000	37.246896	-121.8040865	Santa Clara County
352853	Ordering, Referring, Prescribing	N/A	1942728118	0	0	KNIGHT, LYNMARIE NP	7/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009487	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2006	00	06000	37.86680859	-122.2969443	Alameda County
352879	Ordering, Referring, Prescribing	N/A	1942767330	0	0	KARAPETYAN, VARDUHI NP	1/7/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010803	N/A	N/A	N/A	N/A	N/A	1311 NORTH SAN FERNANDO	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
352888	Ordering, Referring, Prescribing	N/A	1942782404	0	0	KIGANO, RACHEL NP	2/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013232	N/A	N/A	N/A	N/A	N/A	3111 NORTH MILLBROOK AVE	None	FRESNO	CA	93650	0000	00	06000	36.77748094	-119.76358	Fresno County
352894	Ordering, Referring, Prescribing	N/A	1942786678	0	0	KOWALCZYK, KRISTEN LCSW	10/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126731	N/A	N/A	N/A	N/A	N/A	23461 S. POINTE DR.	100	LAGUNA HILLS	CA	92653	1523	00	06000	33.62535142	-117.7206568	Orange County
352907	Ordering, Referring, Prescribing	N/A	1942821970	0	0	KARIMI, TUBA N PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80939	N/A	N/A	N/A	N/A	N/A	3800 DALE ROAD	None	MODESTO	CA	95356	8539	00	06000	37.69395556	-121.0499498	Stanislaus County
352910	Ordering, Referring, Prescribing	N/A	1942824503	0	0	KROCHMAL, JOHN J OD	6/29/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34564	N/A	N/A	N/A	N/A	N/A	211B EL CAMINO REAL	None	GREENFIELD	CA	93927	5125	00	06000	36.32123296	-121.2438342	Monterey County
353009	Ordering, Referring, Prescribing	N/A	1952327355	0	0	KARODY, RAMESH MD	5/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A39790	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
353029	Ordering, Referring, Prescribing	N/A	1952425225	0	0	KARAN, SARLA MD	9/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53712	N/A	N/A	N/A	N/A	N/A	BALBOA BLVD	150	NORTHRIDGE	CA	91325	2003	00	06000	34.23556798	-118.5025103	Los Angeles County
353045	Ordering, Referring, Prescribing	N/A	1952436719	0	0	KURODA, KEN LMFT	3/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43795	N/A	N/A	N/A	N/A	N/A	1000 GOODRICH BLVD	None	COMMERCE	CA	90022	5103	00	06000	34.01730604	-118.1549572	Los Angeles County
353059	Ordering, Referring, Prescribing	N/A	1952475600	0	0	KIM, SEUNG B PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56948	N/A	N/A	N/A	N/A	N/A	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	00	06000	34.072245	-117.4319685	San Bernardino County
353101	Ordering, Referring, Prescribing	N/A	1952577181	0	0	KLOTZ, TINA LPCC	6/1/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC348	N/A	N/A	N/A	N/A	N/A	2950 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1205	00	06000	32.7554583	-117.1305855	San Diego County
353137	Ordering, Referring, Prescribing	N/A	1952646200	0	0	KNOWLSON, TESSA C LMFT	1/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137120	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD., STE.	None	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
353165	Ordering, Referring, Prescribing	N/A	1952701773	0	0	KIM, LYDIA PSYD	3/30/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28713	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LA	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
353247	Ordering, Referring, Prescribing	N/A	1952832909	0	0	KOBASHIGAWA, ERIN A MD	9/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158707	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
353274	Ordering, Referring, Prescribing	N/A	1952864183	0	0	KABLANIAN, ANDREA MD	5/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180561	N/A	N/A	N/A	N/A	N/A	21840 SOUTH NORMANDIE AV	PROFESSIONAL BUILDING- S	TORRANCE	CA	90502	2047	00	06000	33.82982744	-118.2991395	Los Angeles County
353280	Ordering, Referring, Prescribing	N/A	1952870511	0	0	KOWALEWICZ, EVA A PHD	12/18/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28381	N/A	N/A	N/A	N/A	N/A	819 W IOWA AVE	None	SUNNYVALE	CA	94086	5926	00	06000	37.37432124	-122.0405899	Santa Clara County
353285	Ordering, Referring, Prescribing	N/A	1952877052	0	0	KIM, SANG MIN PHARMD	11/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78987	N/A	N/A	N/A	N/A	N/A	1071 11TH ST	None	LAKEPORT	CA	95453	4105	00	06000	39.04902974	-122.9257209	Lake County
353299	Ordering, Referring, Prescribing	N/A	1952912131	0	0	KIER, NORMAN I CNP	1/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016379	N/A	N/A	N/A	N/A	N/A	1820 J ST	None	SACRAMENTO	CA	95811	3010	00	06000	38.57688	-121.4816625	Sacramento County
353308	Ordering, Referring, Prescribing	N/A	1952930349	0	0	KOZAL, JARED MD	4/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195286	N/A	N/A	N/A	N/A	N/A	2 UPPER RAGSDALE DR	STE A	MONTEREY	CA	93940	5736	00	06000	36.57940327	-121.8142876	Monterey County
353325	Ordering, Referring, Prescribing	N/A	1952950230	0	0	KEANE, JESSICA LMFT	9/17/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129151	N/A	N/A	N/A	N/A	N/A	6043 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	5411	00	06000	34.1016835	-118.321569	Los Angeles County
353342	Ordering, Referring, Prescribing	N/A	1962004762	0	0	KIM, HYUN JOO LAC	11/2/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	18974	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD.	SUITE 10	STANTON	CA	90680	3944	00	06000	33.78298855	-117.9927453	Orange County
353368	Ordering, Referring, Prescribing	N/A	1962054981	0	0	KING, ALEXIS LMFT	11/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125967	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
353396	Ordering, Referring, Prescribing	N/A	1962134692	0	0	KAMBA, SANDRA NP	7/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021536	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR.	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
353509	Ordering, Referring, Prescribing	N/A	1962638700	0	0	KENKEL, LAURA MD	2/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116412	N/A	N/A	N/A	N/A	N/A	2150 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1337	00	06000	38.557287	-121.461444	Sacramento County
353523	Ordering, Referring, Prescribing	N/A	1962662395	0	0	KIM, LISA LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49076	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS 53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
353529	Ordering, Referring, Prescribing	N/A	1962676361	0	0	KASLE, DOUGLAS T PHD	6/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20824	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400 SUITE 200	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
353547	Ordering, Referring, Prescribing	N/A	1962707083	0	0	KERES, GEORGE DC	7/14/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	23859	N/A	N/A	N/A	N/A	N/A	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
353572	Ordering, Referring, Prescribing	N/A	1962752089	0	0	KIM, YOON HEE P	12/3/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103593	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 EAST	None	ROUND MOUNTAIN	CA	96084	0000	00	06000	40.80385331	-121.9397745	Shasta County
353580	Ordering, Referring, Prescribing	N/A	1962768986	0	0	KIM, MINA J LCSW	10/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92575	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	9A	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
353645	Ordering, Referring, Prescribing	N/A	1962837666	0	0	KUNG, JENNIFER LCSW	1/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76149	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
353665	Ordering, Referring, Prescribing	N/A	1962867705	0	0	KOCH, HEATHER J LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95875	N/A	N/A	N/A	N/A	N/A	12141 BROOKHURST ST	None	GARDEN GROVE	CA	92840	2865	00	06000	33.78614503	-117.9587915	Orange County
353677	Ordering, Referring, Prescribing	N/A	1962886572	0	0	KALUHIOKALANI, JENNIFER L LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88625	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	350	INGLEWOOD	CA	90301	4502	00	06000	33.966333	-118.3439975	Los Angeles County
353689	Ordering, Referring, Prescribing	N/A	1962895714	0	0	KISTNER, DAVID PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63864	N/A	N/A	N/A	N/A	N/A	12184 PALMDALE RD	None	VICTORVILLE	CA	92392	8538	00	06000	34.50671077	-117.3988281	San Bernardino County
353693	Ordering, Referring, Prescribing	N/A	1962900530	0	0	KIANFARD, NIMA DC	7/31/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	34074	N/A	N/A	N/A	N/A	N/A	1303 W 6TH ST	105	CORONA	CA	92882	3196	00	06000	33.87785815	-117.5891694	Riverside County
353709	Ordering, Referring, Prescribing	N/A	1962933895	0	0	KIM, DIANA LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118380	N/A	N/A	N/A	N/A	N/A	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
353713	Ordering, Referring, Prescribing	N/A	1962948463	0	0	KHAN, MAARIA LMFT	8/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127500	N/A	N/A	N/A	N/A	N/A	1411 N GRAND AVE	SUITE 100	COVINA	CA	91724	1001	00	06000	34.105149	-117.87435	Los Angeles County
353727	Ordering, Referring, Prescribing	N/A	1962966309	0	0	KRAINTZ, TASHINA J PA	12/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56420	N/A	N/A	N/A	N/A	N/A	220 EUCLID AVENUE	SUITE 30	SAN DIEGO	CA	92114	0000	00	06000	32.706387	-117.085098	San Diego County
353760	Ordering, Referring, Prescribing	N/A	1972020824	0	0	KIM, HAESOOK	8/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004733	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
353773	Ordering, Referring, Prescribing	N/A	1972037406	0	0	KIM, CAROLE H MD	2/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158894	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
353782	Ordering, Referring, Prescribing	N/A	1972062271	0	0	KILPATRICK, CARMEN F MD	6/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL752	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
353786	Ordering, Referring, Prescribing	N/A	1972071553	0	0	KAUR, RAVINDER	10/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	68179	N/A	N/A	N/A	N/A	N/A	989 SUNRISE AVE	None	ROSEVILLE	CA	95661	4506	00	06000	38.73110774	-121.272042	Placer County
353790	Ordering, Referring, Prescribing	N/A	1972083517	0	0	KUYAMA, KATIE H LCSW	1/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99729	N/A	N/A	N/A	N/A	N/A	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	2237	00	06000	34.01581788	-118.3348506	Los Angeles County
353854	Ordering, Referring, Prescribing	N/A	1972226512	0	0	KAUR, HARKIRANJEET PHARMD	9/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86891	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
353857	Ordering, Referring, Prescribing	N/A	1972231793	0	0	KUIZON, STEFANIE C OT	12/2/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT24415	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
353880	Ordering, Referring, Prescribing	N/A	1972341170	0	0	KIM, PRISCILLA	7/5/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030940	N/A	N/A	N/A	N/A	N/A	965 EL CAMINO AVE	None	SACRAMENTO	CA	95815	2530	00	06000	38.611638	-121.4444745	Sacramento County
353890	Ordering, Referring, Prescribing	N/A	1972541654	0	0	KOUSHAKJIAN, HOURY M	7/26/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D45479	N/A	N/A	N/A	N/A	N/A	4618 FOUNTAIN AVE	None	LOS ANGELES	CA	90029	1830	00	06000	34.095582	-118.290195	Los Angeles County
353894	Ordering, Referring, Prescribing	N/A	1972567238	0	0	KHUU, KENNETH K DDS	1/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS41437	N/A	N/A	N/A	N/A	N/A	4900 CALIFORNIA AVE	SUITE 100B	BAKERSFIELD	CA	93309	7081	00	06000	35.36440586	-119.0562732	Kern County
353895	Ordering, Referring, Prescribing	N/A	1972555274	0	0	KHOURY, ERIC J MD	2/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G86109	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
353898	Ordering, Referring, Prescribing	N/A	1972554160	0	0	KHWAJA, SAMIA A MD	7/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A30635	N/A	N/A	N/A	N/A	N/A	3621 MARTIN LUTHER KING	STE 6	LYNWOOD	CA	90262	3512	00	06000	33.93082719	-118.2024698	Los Angeles County
353901	Ordering, Referring, Prescribing	N/A	1972388585	0	0	KUMAR, PRARTHANA A DDS	8/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109251	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
353940	Ordering, Referring, Prescribing	N/A	1972671196	0	0	KAISER, CAMERON MD MPH	10/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A91013	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
353980	Ordering, Referring, Prescribing	N/A	1972747384	0	0	KELLERMANN, ALAN S MD	10/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A24844	N/A	N/A	N/A	N/A	N/A	500 CROWN POINT CIRCLE	STE 110	GRASS VALLEY	CA	95945	9561	00	06000	39.22028885	-121.0316663	Nevada County
354025	Ordering, Referring, Prescribing	N/A	1972837086	0	0	KUWAHARA, STACY L LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85648	N/A	N/A	N/A	N/A	N/A	2001 28TH ST	None	BAKERSFIELD	CA	93301	1924	00	06000	35.38486605	-119.0251102	Kern County
354037	Ordering, Referring, Prescribing	N/A	1972845451	0	0	KOLDOBSKAYA, YELENA MD	6/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132732	N/A	N/A	N/A	N/A	N/A	222 S HILL ST	None	LOS ANGELES	CA	90012	9998	00	06000	34.0525918	-118.2482081	Los Angeles County
354057	Ordering, Referring, Prescribing	N/A	1972886208	0	0	KOKOSINSKI, MADELINE	12/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84127	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
354117	Ordering, Referring, Prescribing	N/A	1972956381	0	0	KAUR, RAMNIK MD	8/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164296	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
354138	Ordering, Referring, Prescribing	N/A	1972985901	0	0	KIRSCHENBAUM, KELE C PSYD	2/7/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29121	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
354155	Ordering, Referring, Prescribing	N/A	1982004560	0	0	KWON, NICOLE PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71232	N/A	N/A	N/A	N/A	N/A	4723 GROVELAND LN	None	LA CANADA FLINTRI	CA	91011	2536	00	06000	34.20746438	-118.1974701	Los Angeles County
354183	Ordering, Referring, Prescribing	N/A	1982059515	0	0	KHATIB, ABEER A	9/21/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101732	N/A	N/A	N/A	N/A	N/A	1845 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
354231	Ordering, Referring, Prescribing	N/A	1982137287	0	0	KHANANIAN, ANNA MD	7/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147675	N/A	N/A	N/A	N/A	N/A	1450 TREAT BLVD	200	CITY IS NOT LISTE	CA	94597	2168	00	06000	37.92643968	-122.0521822	Contra Costa County
354256	Ordering, Referring, Prescribing	N/A	1982179396	0	0	KAYE, KERRI L	10/19/2017	Taxonomy not applicable	NA	n/a	000	Unknown	523293	N/A	N/A	N/A	N/A	N/A	1965 BIRKMONT DR	None	RANCHO CORDOVA	CA	95742	6407	00	06000	38.633634	-121.1991885	Sacramento County
354300	Ordering, Referring, Prescribing	N/A	1982249835	0	0	KASHFIAN, SHARON L	7/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100737	N/A	N/A	N/A	N/A	N/A	5601 W SLAUSON AVE	SUITE 192	CULVER CITY	CA	90230	0011	00	06000	33.98900447	-118.37979	Los Angeles County
354346	Ordering, Referring, Prescribing	N/A	1982468583	0	0	KATZ, JULIA	10/15/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032600	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
354353	Ordering, Referring, Prescribing	N/A	1982619664	0	0	KLAIR, JASLEEN R	6/26/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D50943	N/A	N/A	N/A	N/A	N/A	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	00	06000	37.47644946	-122.2110919	San Mateo County
354361	Ordering, Referring, Prescribing	N/A	1982640371	0	0	KUMAR, SARASA MD	9/12/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49540	N/A	N/A	N/A	N/A	N/A	13768 ROSWELL AVE	205	CHINO	CA	91710	1400	00	06000	34.0038	-117.7218555	San Bernardino County
354382	Ordering, Referring, Prescribing	N/A	1982727350	0	0	KENWORTHY, RUTH	2/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	50939	N/A	N/A	N/A	N/A	N/A	515 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8342	00	06000	41.77269652	-124.199019	Del Norte County
354404	Ordering, Referring, Prescribing	N/A	1982756102	0	0	KOOBA, AUSTIN	5/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71262	N/A	N/A	N/A	N/A	N/A	330 S MAGNOLIA AVE	301	EL CAJON	CA	92020	5290	00	06000	32.79218212	-116.9623617	San Diego County
354415	Ordering, Referring, Prescribing	N/A	1982764106	0	0	KINDELL-VANDERMOLEN, CLAUDIA LCSW	10/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81492	N/A	N/A	N/A	N/A	N/A	303 S C ST	None	LOMPOC	CA	93436	7305	00	06000	34.63525845	-120.451628	Santa Barbara County
354425	Ordering, Referring, Prescribing	N/A	1982803813	0	0	KANG, DANA B MD	3/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97267	N/A	N/A	N/A	N/A	N/A	1577 E CHEVY CHASE DR	320	GLENDALE	CA	91206	4172	00	06000	34.15313959	-118.2299467	Los Angeles County
354450	Ordering, Referring, Prescribing	N/A	1982852059	0	0	KARUNAKARAN, PAULINE M	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D57619	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
354462	Ordering, Referring, Prescribing	N/A	1982885414	0	0	KANE, TARA S NP	7/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015265	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	STE 100	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
354535	Ordering, Referring, Prescribing	N/A	1992005888	0	0	KIEU, DAVID D PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61202	N/A	N/A	N/A	N/A	N/A	9460 NO NAME UNO	STE 100	GILROY	CA	95020	3536	00	06000	37.037781	-121.570965	Santa Clara County
354575	Ordering, Referring, Prescribing	N/A	1992075485	0	0	KWOK, LYNN M PHARMD	7/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53363	N/A	N/A	N/A	N/A	N/A	934 N HACIENDA BLVD	None	LA PUENTE	CA	91744	2845	00	06000	34.03680643	-117.9498888	Los Angeles County
354620	Ordering, Referring, Prescribing	N/A	1992136683	0	0	KOUHKAN, MEHRNAZ DPM	3/12/2019	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5132	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
354643	Ordering, Referring, Prescribing	N/A	1992168298	0	0	KSHIRSAGAR, RIJUL S MD	11/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151198	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	FL 4 STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
354648	Ordering, Referring, Prescribing	N/A	1992169643	0	0	KAMEL, BISHOY MD	7/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156933	N/A	N/A	N/A	N/A	N/A	2080 CENTURY PARK EAST	608	LOS ANGELES	CA	90067	2009	00	06000	34.05887194	-118.4122914	Los Angeles County
354716	Ordering, Referring, Prescribing	N/A	1992312904	0	0	KIM, SAE NP	8/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015173	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE ST	None	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
354788	Ordering, Referring, Prescribing	N/A	1992471353	0	0	KIM, HAESOOK PHARMD	11/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58238	N/A	N/A	N/A	N/A	N/A	1000 VALE TERRACE DRIVE	None	VISTA	CA	92084	5218	00	06000	33.20904502	-117.2286439	San Diego County
354799	Ordering, Referring, Prescribing	N/A	1992560304	0	0	KIM, CHANG SOOK NP	7/16/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031133	N/A	N/A	N/A	N/A	N/A	912 FREMONT ST.	None	DELANO	CA	93215	2713	00	06000	35.76763031	-119.2498143	Kern County
354811	Ordering, Referring, Prescribing	N/A	1992739254	0	0	KING, BRYAN MD	2/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A77678	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
354890	Ordering, Referring, Prescribing	N/A	1992912505	0	0	KRTEK, MISTY LMFT	11/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49737	N/A	N/A	N/A	N/A	N/A	1560 MARKET ST.	None	REDDING	CA	96001	1023	00	06000	40.58346871	-122.390608	Shasta County
354920	Ordering, Referring, Prescribing	N/A	1992978589	0	0	KIPE, BRIAN J MD	4/24/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	MD445738	N/A	N/A	N/A	N/A	N/A	112 N 7TH STREET	None	CHAMBERSBURG	PA	17201	1720	00	06000	39.93466303	-77.6475955	Franklin County
354926	Ordering, Referring, Prescribing	N/A	1992989305	0	0	KUSHNIRENKO, TATYANA A NP	1/16/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17653	N/A	N/A	N/A	N/A	N/A	405 E BUENA VISTA ST	None	BARSTOW	CA	92311	2815	00	06000	34.89563451	-117.0233145	San Bernardino County