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JACQUELINE TAN PA-C
NPI 1811619349
Allergy & Immunology in San Jose, CA

Active since September 12, 2022PECOS Enrolled
2211 MOORPARK AVE STE 130, SAN JOSE, CA 95128(408) 286-1707 Get Directions Write a Review

NPPES record last updated: September 26, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 26, 2024, Sep 12, 2022 (2 updates tracked since 2022).

About Jacqueline Tan Pa-c NPPES

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

JACQUELINE TAN PA-C (NPI 1811619349) is an individual allergy & immunology provider in San Jose, California, licensed in California (64013) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1811619349
Entity TypeIndividualFemale
Primary Taxonomy207K00000X
Provider Legal NameJACQUELINE TANCredential: PA-C
Location Address2211 MOORPARK AVE STE 130San Jose, CA 95128-2655
Mailing Address2211 Moorpark Ave Ste 130San Jose, CA 95128-2655 · (408) 286-1707
Phone(408) 286-1707
Sole ProprietorYes
Enumeration DateSeptember 12, 2022
Last NPPES UpdateSeptember 26, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 26, 2024
✔ NPI 1811619349 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAllergy & ImmunologyAllopathic & Osteopathic Physicians
Taxonomy Code207K00000X
License✔ Licensed in CA · 64013
Definition
An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system.
2211 MOORPARK AVE STE 130, San Jose, CA 95128
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Tan Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Other Providers at the Same Location NPPES

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

AMANDA LYNN DIMECH
Physician Assistant
2211 MOORPARK AVE STE 130
SAN JOSE, CA 95128
Santa Clara County (408) 286-1707

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 Jacqueline Tan's NPI number?

The NPI number for Jacqueline Tan is 1811619349. It was assigned to this individual provider in the NPPES registry on September 12, 2022.

Where is Jacqueline Tan located?

Jacqueline Tan practices at 2211 Moorpark Ave Ste 130, San Jose, CA 95128. The listed phone number is (408) 286-1707.

What is Jacqueline Tan's specialty?

The primary specialty registered for this NPI is Allergy & Immunology with taxonomy code 207K00000X.

Is Jacqueline Tan enrolled in Medicare?

Yes. Jacqueline Tan is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacqueline Tan was last updated on September 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.