Jacqueline Tan, PA-C

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

64013 Issued in CA

Practice address

2211 Moorpark Ave Ste 130
San Jose, CA 95128-2655

Phone

(408) 286-1707

NPI assigned

Sep 12, 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

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.

• South Bay Allergy & Asthma Group Inc

  • Allergy Physician
  • San Jose, CA
  • NPI 1649467556
  Medicare reassignment
• El Camino Health Medical Network, LLC

  • Multi-Specialty Clinic/Center
  • San Jose, CA
  • NPI 1164880761
  NPD (past)

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1811619349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 MOORPARK AVE STE 130",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282655",
            "telephone_number": "408-286-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 MOORPARK AVE STE 130",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282655",
            "telephone_number": "408-286-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "JACQUELINE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "CA",
            "license": "64013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edrick Tan, DDS
• Eliane Tan
• Giselda M Tan, M.D.
• Greta C Tan, OTR-L
• Greta T Tan
• Jiahui Tan, L.AC.
• Kenneth Tan, M.D.
• Kenneth I-Chien Tan, M.D.
• Leon L Tan, MD
• Li Tan

• Allergy & Immunology Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• Allergy & Immunology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.