Active NPI
Jackie Fan
- Physical Therapist
- La Palma, CA
National Provider Identifier
1326791815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 301637
- Practice address
- 7901 Walker St
La Palma, CA 90623-1722 - Phone
- (714) 670-6000
- NPI assigned
- Feb 3, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 301637 | CA | Primary |
Addresses
Primary practice location
7901 Walker St
La Palma, CA 90623-1722
Mailing address
7901 Walker St
La Palma, CA 90623-1722
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 |
|---|---|---|---|
| 301637 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685750400000",
"number": "1326791815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7901 WALKER ST",
"city": "LA PALMA",
"state": "CA",
"postal_code": "906231722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7901 WALKER ST",
"city": "LA PALMA",
"state": "CA",
"postal_code": "906231722",
"telephone_number": "714-670-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "JACKIE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-03",
"last_updated": "2023-06-03",
"certification_date": "2023-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "301637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Palma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.