=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235607508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEE NAMGOONG PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2018
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2712 AUGUSTINE DR STE 120
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-2941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-786-9636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 LEAVESLEY RD STE 102
-----------------------------------------------------
City | GILROY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95020-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 56238
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------