Active NPI
Jennifer Thao Ngo
- Pediatrics Physician
- San Jose, CA
National Provider Identifier
1285210989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 20A22308
- Practice address
- 55 E Julian St
San Jose, CA 95112-4007 - Phone
- (084) 577-1004
- Fax
- (408) 918-2690
- NPI assigned
- Mar 23, 2021
- Last updated
- Feb 4, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Pediatrics Physician | 208000000X | 20A22308 | CA | Primary |
Addresses
Primary practice location
55 E Julian St
San Jose, CA 95112-4007
Mailing address
160 E Virginia St Ste 100
San Jose, CA 95112-5865
Phone (408) 938-2172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240927000346 | CA | Order and Referring Only - Pediatric Medicine | 3678004900 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22308 | CA | MD | Dentist |
| 20A22308 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738627200000",
"number": "1285210989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 E VIRGINIA ST STE 100",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951125865",
"telephone_number": "408-938-2172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 E JULIAN ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951124007",
"telephone_number": "084-577-1004",
"fax_number": "408-918-2690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGO",
"first_name": "JENNIFER",
"middle_name": "THAO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-23",
"last_updated": "2025-02-04",
"certification_date": "2025-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "20A22308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.