1699394809 NPI number — DR. JORDAN PAUL EMONT MD MPH SCM

Table of content: DR. JORDAN PAUL EMONT MD MPH SCM (NPI 1699394809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699394809 NPI number — DR. JORDAN PAUL EMONT MD MPH SCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMONT
Provider First Name:
JORDAN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD MPH SCM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699394809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 VILLA ST APT 349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94041-1593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-828-5368
Provider Business Mailing Address Fax Number:
844-522-6060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1885 BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94303-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-330-7400
Provider Business Practice Location Address Fax Number:
650-323-1406
Provider Enumeration Date:
04/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A192120 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com