Individual provider Active NPI

Jacob Nguyen

  • Physician Assistant
  • Chandler, AZ
National Provider Identifier
1679249098
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2201 W Fairview St Ste 9
Chandler, AZ 85224-4704
Phone
(480) 470-4000
NPI assigned
Aug 17, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2201 W Fairview St Ste 9
Chandler, AZ 85224-4704

Mailing address

2201 W Fairview St Ste 9
Chandler, AZ 85224-4704

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20220928000797 AZ Practitioner - Physician Assistant 2163808130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Institute for Liver Health LLCGroup PAC ID 3274898010, 20 clinicians

Practice addresses (Care Compare)

2201 W Fairview St
Suite 9
Chandler, AZ 85224-4704
Phone (480) 470-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8694AZMDPsychiatry Physician

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1679249098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 W FAIRVIEW ST STE 9",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 W FAIRVIEW ST STE 9",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244704",
            "telephone_number": "480-470-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-17",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

Verify at the official NPI Registry.