Active NPI
Jennifer Fan
- Speech-Language Pathologist
- South San Francisco, CA
National Provider Identifier
1003596743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 29840
- Practice address
- 3924 Reston CT
South San Francisco, CA 94080-3946 - Phone
- (415) 408-8281
- NPI assigned
- Jul 18, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 29840 | CA | Primary |
Addresses
Primary practice location
3924 Reston CT
South San Francisco, CA 94080-3946
Mailing address
3924 Reston CT
South San Francisco, CA 94080-3946
Phone (415) 408-8281
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29840 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689638400000",
"number": "1003596743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3924 RESTON CT",
"city": "SOUTH SAN FRANCISCO",
"state": "CA",
"postal_code": "940803946",
"telephone_number": "415-408-8281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3924 RESTON CT",
"city": "SOUTH SAN FRANCISCO",
"state": "CA",
"postal_code": "940803946",
"telephone_number": "415-408-8281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-18",
"last_updated": "2023-07-18",
"certification_date": "2023-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "29840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.