Jess H Ghannam, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY9261 Issued in CA

Practice address

1335 Stanford
Emeryville, CA 94608-2536

Phone

(510) 647-5101

Fax

(510) 647-5105

NPI assigned

Dec 28, 2006

Last updated

Sep 5, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 7

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jess H. Ghannam, PHD, Inc.

  • Psychologist
  • San Francisco, CA
  • NPI 1730438722
  Authorized official Same address or phone

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346803200000",
    "number": "1285790154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1939 DIVISADERO ST",
            "address_2": "# 3",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941152507",
            "telephone_number": "415-921-8096",
            "fax_number": "415-354-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 STANFORD",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082536",
            "telephone_number": "510-647-5101",
            "fax_number": "510-647-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANNAM",
        "first_name": "JESS",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2012-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY9261",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY9261",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY9261",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": "PSY9261",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "PSY9261",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "CA",
            "license": "PSY9261",
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "CA",
            "license": "PSY9261",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP ID NUMBER",
            "identifier": "ZZZ20562Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine Marie Garza, PA-C
• Denise Gatchel
• Heather Gee
• Ce'Andra George
• Helina Bisrat Getachew
• Frankie Nicole Gilbert
• Elias A Giraldo, MD
• Joshua M Gitter, M.D.
• Edwin M Gituma
• Melissa Kehaulani Inouye Glass, PT

• Clinical Psychologist in Emeryville, CA
• Providers in Emeryville, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; 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.