Active NPI
Jenny Phung
- Clinical Social Worker
- Santa Rosa, CA
National Provider Identifier
1730798273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 117713
- Practice address
- 2225 Challenger Way
Santa Rosa, CA 95407-5441 - Phone
- (707) 576-8181
- NPI assigned
- Jul 30, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 85539 | CA | |
| Clinical Social Worker | 1041C0700X | 117713 | CA | Primary |
Addresses
Primary practice location
2225 Challenger Way
Santa Rosa, CA 95407-5441
Mailing address
2225 Challenger Way
Santa Rosa, CA 95407-5441
Phone (707) 576-8181
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240807003417 | CA | Order and Referring Only - Clinical Social Worker | 2668919689 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85539 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700179200000",
"number": "1730798273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2225 CHALLENGER WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954075441",
"telephone_number": "707-576-8181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2225 CHALLENGER WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954075441",
"telephone_number": "707-576-8181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUNG",
"first_name": "JENNY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-30",
"last_updated": "2023-11-17",
"certification_date": "2023-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "85539",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "117713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.