Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nevin Poolpuong

Individual provider Physical Therapist · NPI 1114643319

Nevin Poolpuong is a Physical Therapist in Private Practice in Baldwin Park, California. Qualified in 2022, 4 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2022
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Practice location Address checks out

1011 Baldwin Park Blvd
Baldwin Park, CA 91706-5806
Phone: (800) 464-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1114643319
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 18, 2022
Last updated in NPPESOctober 27, 2023
Certification dateOctober 18, 2022
Mailing address15275 Kenoak Dr, Baldwin Park, CA 91706-3427

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Baldwin Park