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LY KONG PHENG JALAO
NPI 1952884124
Nurse Practitioner - Primary Care in Sacramento, CA

Active since September 12, 2018PECOS Enrolled
2200 DEL PASO BLVD, SACRAMENTO, CA 95815(916) 642-1890 Get Directions Write a Review

NPPES record last updated: September 12, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ly Kong Pheng Jalao NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LY KONG PHENG JALAO (NPI 1952884124) is an individual primary care provider in Sacramento, California, licensed in California (NP95009751) and active in the NPI registry since September 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1952884124
Entity TypeIndividualMale
Primary Taxonomy363LP2300X
Provider Legal NameLY KONG PHENG JALAO
Location Address2200 DEL PASO BLVDSacramento, CA 95815-3102
Mailing Address6817 E Lane AveFresno, CA 93727-5814 · (209) 613-9089
Phone(916) 642-1890
Sole ProprietorYes
Enumeration DateSeptember 12, 2018
✔ NPI 1952884124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in CA · NP95009751
2200 DEL PASO BLVD, Sacramento, CA 95815
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ly Kong Pheng Jalao is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95815 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$92.61 typical visit price
range $60.44 – $180.85
Typical copayment $23.15 (range $15.11 – $45.21)
Most-billed visit code 99203
Established Patient
$105.95 typical visit price
range $19.88 – $148.15
Typical copayment $26.48 (range $4.97 – $37.03)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
5 suppliers25 claims31 services$3.61 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
5 suppliers11 claims11 services$0.62 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
1 supplier12 claims12 services$201.26 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TATIANA MONIQUE HURTADO PHYSICIAN ASSISTANT
Physician Assistant
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (916) 924-7988
HANNAH GULETZ
Physician Assistant
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (510) 407-6215
SARAH FENDER RN, NP-C
Nurse Practitioner
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (916) 924-7988
TINA BENAVENTE RAMOS MSN
Nurse Practitioner (Family)
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (916) 924-7988
HULDA KIM
Nurse Practitioner
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (916) 924-7988
M SHADI ANIS
Dentist
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (612) 407-6170
HEALTH AND LIFE ORGANIZATION, INC.
Clinic/Center (Federally Qualified Health Center (FQHC))
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (916) 924-7988
MR. NGHI C MAOKHAMPHIOU P.A.
Physician Assistant (Medical)
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Sacramento County (916) 924-7988

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ly Kong Pheng Jalao's NPI number?

The NPI number for Ly Kong Pheng Jalao is 1952884124. It was assigned to this individual provider in the NPPES registry on September 12, 2018.

Where is Ly Kong Pheng Jalao located?

Ly Kong Pheng Jalao practices at 2200 Del Paso Blvd, Sacramento, CA 95815. The listed phone number is (916) 642-1890.

What is Ly Kong Pheng Jalao's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Ly Kong Pheng Jalao enrolled in Medicare?

Yes. Ly Kong Pheng Jalao is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ly Kong Pheng Jalao was last updated on September 12, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.