Individual provider Active NPI

Jennifer Chilyn Li Kaufman, MD

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1407818768
Registry record updated Aug 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G149974 Issued in CA
Practice address
5454 El Cajon Blvd
San Diego, CA 92115-3621
Phone
(691) 515-2300
NPI assigned
Apr 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 37187 MN
Family Medicine Physician 207Q00000X G149974 CA Primary

Addresses

Primary practice location

5454 El Cajon Blvd
San Diego, CA 92115-3621

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (691) 515-2300

Other practice location 1

4874 Polk Ave
San Diego, CA 92105-2026
Phone (619) 515-2426

Other identifiers 1

IdentifierTypeStateIssuer
753035800MedicaidMN

Other names 1

  • Jennifer Kaufman Other name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171009002764 CA Practitioner - Family Practice 1951594639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mayo Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8788 Jamacha Rd
Spring Valley, CA 91977-4035
Phone (619) 515-2555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G149974CAMDFamily Medicine Physician
37187MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince Sep 28, 2017 Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Sep 28, 2017 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients

Locations

4874 Polk Ave
San Diego, CA 92105
Phone (619) 515-2426

5454 El Cajon Blvd
San Diego, CA 92115
Phone (619) 515-2381

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1407818768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "691-515-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5454 EL CAJON BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921153621",
            "telephone_number": "691-515-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4874 Polk Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921052026",
            "country_code": "US",
            "telephone_number": "619-515-2426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAUFMAN",
        "first_name": "JENNIFER",
        "middle_name": "CHILYN LI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-03",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "37187",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G149974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "753035800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "KAUFMAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.