Jackai Alexis Siobhan Yip, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

20996 Issued in CA

Practice address

5454 El Cajon Blvd
San Diego, CA 92115-3621

Phone

(619) 515-2400

NPI assigned

Aug 9, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jackai Alexis Siobhan Smith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1558676171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8947 N COURTENAY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972033466",
            "telephone_number": "909-319-9919"
        },
        {
            "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": "619-515-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5329 NE Mlk Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972113237",
            "country_code": "US",
            "telephone_number": "503-988-6980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YIP",
        "first_name": "JACKAI",
        "middle_name": "ALEXIS SIOBHAN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-09",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA154862",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "20996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500639156",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKAI",
            "last_name": "SMITH",
            "middle_name": "ALEXIS SIOBHAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Xiaochen Yin, DDS
• Yu-Kang Ying, MD
• Jason Yingst
• Ephu Yip-Ngo, PHARMD
• Derek Yip, M.D.
• Leslie Yip, RN
• Samuel Yip, M.D,PH.D,FRCPC
• Valerie Yip, MS, OTR/L
• Gloria Yiu, SLP
• YMCA

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.