Healthcare Provider Details

I. General information

NPI: 1518651744
Provider Name (Legal Business Name): ALEXIS JINA RO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS KIM

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

16300 SAND CANYON AVE STE 614
IRVINE CA
92618-3706
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-4624
  • Fax:
Mailing address:
  • Phone: 949-712-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95026206
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95103057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: