NPIMap

Organization Active NPI

Jaclyn Kwan PA, Apc

  • Surgical Physician Assistant
  • Carlsbad, CA
National Provider Identifier
1164024881
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
JACLYN KWAN PA, APC
Practice address
6550 Ponto Dr SPC 140
Carlsbad, CA 92011-2317
Phone
(310) 619-1161
NPI assigned
Nov 9, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jaclyn Kwan, PANPI 1598172181
Title
Owner
Phone
(310) 619-1161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AS0400X Primary

Addresses

Primary practice location

6550 Ponto Dr SPC 140
Carlsbad, CA 92011-2317

Mailing address

6550 Ponto Dr SPC 140
Carlsbad, CA 92011-2317

Other identifiers 1

IdentifierTypeStateIssuer
PA51734OtherCAPHYSICIAN ASSISTANT BOARD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1164024881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 PONTO DR SPC 140",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920112317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 PONTO DR SPC 140",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920112317",
            "telephone_number": "310-619-1161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACLYN KWAN PA, APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-09",
        "last_updated": "2020-11-09",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "KWAN",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-619-1161",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT BOARD",
            "identifier": "PA51734",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlsbad, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.