1. Home
  2. Directory
  3. California
  4. San Diego
  5. Physician Assistant
  6. NPI Profile

JACKLYNNE PHAN
NPI 1649904210
Physician Assistant in San Diego, CA

Active since July 11, 2022PECOS EnrolledAccepts Medicare Assignment
4282 GENESEE AVE STE 201, SAN DIEGO, CA 92117(858) 746-7882(858) 505-1918 Get Directions Write a Review

NPPES record last updated: October 28, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jacklynne Phan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKLYNNE PHAN (NPI 1649904210) is an individual physician assistant in San Diego, California, licensed in California (PA6777) and active in the NPI registry since July 2022. She is enrolled in Medicare PECOS and is a graduate of University Of Southern California Keck School Of Medicine (2024).

NPPES Registry Identity

NPI1649904210
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameJACKLYNNE PHAN
Location Address4282 GENESEE AVE STE 201San Diego, CA 92117-4964
Mailing Address4282 Genesee Ave Ste 201San Diego, CA 92117-4964 · (858) 746-7882 · Fax (858) 505-1918
Phone(858) 746-7882
Fax(858) 505-1918
Sole ProprietorNo
Medical School CMSUniversity Of Southern California Keck School Of MedicineGraduated 2024
Enumeration DateJuly 11, 2022
Last NPPES UpdateOctober 28, 2025
NPPES CertifiedOctober 28, 2025
✔ NPI 1649904210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · PA6777
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
4282 GENESEE AVE STE 201, San Diego, CA 92117
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacklynne Phan is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3072049089
PECOS Enrollment IDI20241218001175
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92117 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DIEGO MENDEZ M.D.
Obstetrics & Gynecology
4282 GENESEE AVE STE 201
SAN DIEGO, CA 92117
San Diego County (858) 268-0300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacklynne Phan's NPI number?

The NPI number for Jacklynne Phan is 1649904210. It was assigned to this individual provider in the NPPES registry on July 11, 2022.

Where is Jacklynne Phan located?

Jacklynne Phan practices at 4282 Genesee Ave Ste 201, San Diego, CA 92117. The listed phone number is (858) 746-7882.

What is Jacklynne Phan's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Jacklynne Phan enrolled in Medicare?

Yes. Jacklynne Phan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Jacklynne Phan was last updated on October 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.