Active NPI
Jennifer Kim Quan
- Student in an Organized Health Care Education/Training Program
- Oakland, CA
National Provider Identifier
1780183038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 99091
- Practice address
- 2828 Ford St
Oakland, CA 94601-2114 - Phone
- (510) 227-9652
- NPI assigned
- Feb 1, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 99091 | CA | Primary |
Addresses
Primary practice location
2828 Ford St
Oakland, CA 94601-2114
Mailing address
2828 Ford St
Oakland, CA 94601-2114
Other practice location 1
4892 San Pablo Dam Rd
El Sobrante, CA 94803-3222
Phone (510) 222-3946
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99091 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581379200000",
"number": "1780183038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2828 FORD ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2828 FORD ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012114",
"telephone_number": "510-227-9652"
}
],
"practiceLocations": [
{
"address_1": "4892 San Pablo Dam Rd",
"address_purpose": "LOCATION",
"city": "El Sobrante",
"state": "CA",
"postal_code": "948033222",
"country_code": "US",
"telephone_number": "510-222-3946",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "QUAN",
"first_name": "JENNIFER",
"middle_name": "KIM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-01",
"last_updated": "2020-02-11",
"certification_date": "2020-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "99091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.