Active NPI
Ryan Leland Jackson
- Rehabilitation Practitioner
- San Jose, CA
National Provider Identifier
1891665964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- E205069
- Practice address
- 1302 N 4TH St
San Jose, CA 95112-4713 - Phone
- (408) 379-3796
- NPI assigned
- Nov 5, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | E205069 | CA | Primary |
Addresses
Primary practice location
1302 N 4TH St
San Jose, CA 95112-4713
Mailing address
1302 N 4TH St
San Jose, CA 95112-4713
Phone (408) 379-3796
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E205069 | CA | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1762300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762300800000",
"number": "1891665964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 N 4TH ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951124713",
"telephone_number": "408-379-3796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 N 4TH ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951124713",
"telephone_number": "408-379-3796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RYAN",
"middle_name": "LELAND",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-11-05",
"last_updated": "2025-11-05",
"certification_date": "2025-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "E205069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.