Individual provider Active NPI

Jennifer Rebecca Leicht, RDHAP

  • Dental Hygienist
  • San Jose, CA
National Provider Identifier
1639842990
Registry record updated Jul 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
853 Issued in CA
Practice address
5349 Larchwood Dr
San Jose, CA 95118-3041
Phone
(408) 455-2239
NPI assigned
Jul 31, 2021
Last updated
Jul 31, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 853 CA Primary

Addresses

Primary practice location

5349 Larchwood Dr
San Jose, CA 95118-3041

Mailing address

5349 Larchwood Dr
San Jose, CA 95118-3041
Phone (408) 455-2239

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

LicenseStateTypeSpecialty
853CAMDDental Hygienist

NPI Registry JSON

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

{
    "created_epoch": "1627689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627689600000",
    "number": "1639842990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5349 LARCHWOOD DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951183041",
            "telephone_number": "408-455-2239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5349 LARCHWOOD DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951183041",
            "telephone_number": "408-455-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEICHT",
        "first_name": "JENNIFER",
        "middle_name": "REBECCA",
        "credential": "RDHAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-31",
        "last_updated": "2021-07-31",
        "certification_date": "2021-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2021; 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.