Active NPI
Jordan Wan, M.T., TAI NA
- Massage Therapist
- Roseville, OH
National Provider Identifier
1326695495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 71847798
- Practice address
- 1141 Smith Lane Ste #3
Ste #3
Roseville, OH 95661-4123 - Phone
- (916) 783-3003
- Fax
- (916) 783-4799
- NPI assigned
- Aug 22, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 71847798 | CA | Primary |
Addresses
Primary practice location
1141 Smith Lane Ste #3
Ste #3
Roseville, OH 95661-4123
Mailing address
1141 Smith Lane Ste #3
Ste #3
Roseville, OH 95661-4123
Phone (916) 783-3003
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71847798 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566432000000",
"number": "1326695495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1141 SMITH LANE STE #3",
"address_2": "STE #3",
"city": "ROSEVILLE",
"state": "OH",
"postal_code": "956614123",
"telephone_number": "916-783-3003",
"fax_number": "916-783-4799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1141 SMITH LANE STE #3",
"address_2": "STE #3",
"city": "ROSEVILLE",
"state": "OH",
"postal_code": "956614123",
"telephone_number": "916-783-3003",
"fax_number": "916-783-4799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAN",
"first_name": "JORDAN",
"name_prefix": "Mr.",
"credential": "M.T., TAI NA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-22",
"last_updated": "2019-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "71847798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.