Individual provider Active NPI

Jacqueline Diem Tran, PA-C

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1831220102
Registry record updated Jan 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18801 Issued in CA
Practice address
8635 W. Third Street, Suite 1060W
Los Angeles, CA 90048
Phone
(310) 423-3334
NPI assigned
Mar 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA18801 CA Primary

Addresses

Primary practice location

8635 W. Third Street, Suite 1060W
Los Angeles, CA 90048

Mailing address

9191 Westminster Ave
# 205
Garden Grove, CA 92844-2751
Phone (310) 423-3334

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080602000360 CA Practitioner - Physician Assistant 6002986114 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
In-Home Doctors IncGroup PAC ID 0547455156, 6 clinicians
Dao Medical Group IncGroup PAC ID 2466687728, 12 clinicians

Practice addresses (Care Compare)

17195 Newhope St
Fountain Valley, CA 92708-4211
Phone (714) 444-2414

9191 Westminster Ave
Garden Grove, CA 92844-2751
Phone (714) 899-2000

Hospital & facility affiliations

  • Stable Home Health, Inc Home health agency, Fountain Valley, CA, CCN 559779

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
18801CAMDAcupuncturist
PA18801CAMDPhysician Assistant

Practice roles (1 of 2)

OrganizationSpecialtyStatusNew patients
House Call Medical Associates, Inc. Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452124800000",
    "number": "1831220102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9191 WESTMINSTER AVE",
            "address_2": "# 205",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928442751",
            "telephone_number": "310-423-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8635 W. THIRD STREET, SUITE 1060W",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90048",
            "telephone_number": "310-423-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "JACQUELINE",
        "middle_name": "DIEM",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2016-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.