Individual provider Active NPI

Jacqueline Selim Antoun, MD

  • Pediatrics Physician
  • San Francisco, CA
National Provider Identifier
1700527629
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A187753 Issued in CA
Practice address
45 Castro St Ste 232
San Francisco, CA 94114-1027
Phone
(415) 565-6810
NPI assigned
Apr 5, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A187753 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

45 Castro St Ste 232
San Francisco, CA 94114-1027

Mailing address

4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Other practice location 1

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-2122

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250827003513 CA Practitioner - Pediatric Medicine 5193226629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Vanderbilt University School of Medicine, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2001 The Embarcadero
San Francisco, CA 94143-5200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A187753CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UCSF Health Medical Foundation Pediatrics CurrentSince Jun 5, 2025 Accepting new patients

Locations

570 Price Ave
Ste 100
Redwood City, CA 94063
Phone (650) 327-1258

1081 Market Pl
Ste 500
San Ramon, CA 94583
Phone (669) 235-4188

Interoperability endpoints

  • Direct secure messaging: jantoun744485@hisp.ehr.sutterhealth.org
  • Direct secure messaging: jantoun439756@direct-ucsfmedicalcenter.org

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": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1700527629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 CASTRO ST STE 232",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941141027",
            "telephone_number": "415-565-6810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4650 W Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900276062",
            "country_code": "US",
            "telephone_number": "323-361-2122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTOUN",
        "first_name": "JACQUELINE",
        "middle_name": "SELIM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A187753",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.