Individual provider Active NPI

Jennifer Thi Le, PA-C

  • Physician Assistant
  • Chula Vista, CA
National Provider Identifier
1972384394
Registry record updated Aug 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA63815 Issued in CA
Practice address
880 Third Ave
Chula Vista, CA 91911-1305
Phone
(619) 205-4585
NPI assigned
Oct 11, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA63815 CA Primary

Addresses

Primary practice location

880 Third Ave
Chula Vista, CA 91911-1305

Mailing address

880 Third Ave
Chula Vista, CA 91911-1305
Phone (619) 205-4585

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
I20251025000319 CA Practitioner - Physician Assistant 0840789335 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1601 Precision Park LN
San Diego, CA 92173-1345

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63815CAMDPharmacist
PA63815CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Sep 22, 2025 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Sep 22, 2025 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients

Locations

880 Third Ave
#A
Chula Vista, CA 91911
Phone (619) 205-4585

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

880 Third Ave
Chula Vista, CA 91911
Phone (619) 205-4585

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

Interoperability endpoints

  • Direct secure messaging: jle60247@syhealth.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755907200000",
    "number": "1972384394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 THIRD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111305",
            "telephone_number": "619-205-4585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 THIRD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111305",
            "telephone_number": "619-205-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "JENNIFER",
        "middle_name": "THI",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-11",
        "last_updated": "2025-08-23",
        "certification_date": "2025-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.