Active NPI
Jennifer Lee Quach
- Physician Assistant
- Manteca, CA
National Provider Identifier
1548008428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 165 Saint Dominics Dr Ste 120
Manteca, CA 95337-7802 - Phone
- (510) 241-2884
- NPI assigned
- Jul 16, 2024
- Last updated
- May 26, 2026
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | Primary |
Addresses
Primary practice location
165 Saint Dominics Dr Ste 120
Manteca, CA 95337-7802
Mailing address
165 Saint Dominics Dr Ste 120
Manteca, CA 95337-7802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250416000147 | NY | Order and Referring Only - Dermatology | 9830614585 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779753600000",
"number": "1548008428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 SAINT DOMINICS DR STE 120",
"city": "MANTECA",
"state": "CA",
"postal_code": "953377802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 SAINT DOMINICS DR STE 120",
"city": "MANTECA",
"state": "CA",
"postal_code": "953377802",
"telephone_number": "510-241-2884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE QUACH",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-16",
"last_updated": "2026-05-26",
"certification_date": "2026-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manteca, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.