Individual provider Active NPI

Hung-Jie Jeng

  • Adult Health Nurse Practitioner
  • San Gabriel, CA
National Provider Identifier
1518367887
Registry record updated Jan 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
95001224 Issued in CA
Practice address
828 E Valley Blvd Ste C
San Gabriel, CA 91776-4600
Phone
(626) 307-8636
Fax
(626) 307-8705
NPI assigned
Aug 23, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 95001224 CA Primary

Addresses

Primary practice location

828 E Valley Blvd Ste C
San Gabriel, CA 91776-4600

Mailing address

828 E. Valley Blvd
San Gabriel, CA 91776-3596
Phone (626) 307-8636

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190913001252 CA Practitioner - Nurse Practitioner 2264761469 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95001224CAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emerald Seinmaya Tay M D a Professional Corporation CurrentSince Jul 11, 2019 Accepting new patients

Locations

828 E Valley Blvd
Ste C
San Gabriel, CA 91776
Phone (626) 307-8636

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: hjeng@estmd.adaptamed.direct-ci.com

Organizations & group practices 1

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": "1408752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1518367887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 E. VALLEY BLVD",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763596",
            "telephone_number": "626-307-8636",
            "fax_number": "626-307-8705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 E VALLEY BLVD STE C",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917764600",
            "telephone_number": "626-307-8636",
            "fax_number": "626-307-8705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENG",
        "first_name": "HUNG-JIE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-23",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95001224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Gabriel, CA

Sources for this page

Verify at the official NPI Registry.