Jenny Pham

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

60770 Issued in CA

Practice address

4626 Willow Rd
Pleasanton, CA 94588-8517

Phone

(925) 463-0470

NPI assigned

Mar 2, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jpham697380@hisp.ehr.sutterhealth.org

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.

• Tri-Valley Orthopedic and Sports Medical Group Inc

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  • Pleasanton, CA
  • NPI 1184808156
  Medicare reassignment NPD
• Spine & Nerve Diagnostic Center

  • Physical Medicine & Rehabilitation Physician
  • Roseville, CA
  • NPI 1144628504
  Medicare reassignment
• Spine & Nerve Diagnostic Center

  • Physical Medicine & Rehabilitation Physician
  • Folsom, CA
  • NPI 1457902496
  NPD
• Spine & Nerve Diagnostic Center

  • Physical Medicine & Rehabilitation Physician
  • Sacramento, CA
  • NPI 1750789053
  NPD
• Bass Medical Group

  • Obstetrics & Gynecology Physician
  • Walnut Creek, CA
  • NPI 1174253405
  NPD (past)

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

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1730836487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 YELLOWLEAF CT",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951352029",
            "telephone_number": "408-387-2689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 WILLOW RD",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888517",
            "telephone_number": "925-463-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "JENNY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Petrak, P.T.
• Judith M Petrick, LMFT
• Patrick Vincent Petti, PH.D.
• Haleh Pezeshkan, M.S. CCC-SLP
• Apoorva Phadke, PT DPT
• Lilian Pham, PA-C
• Tuyen Pham
• Duy-Phu Phan, DDS
• Lauren Thuy-Vy Phan, D.D.S.
• Michelle V. Phillips, D.D.S

• Physician Assistant in Pleasanton, CA
• Providers in Pleasanton, 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 2, 2022; 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.

Verify at the official NPI Registry.