Healthcare Provider Details

I. General information

NPI: 1144677956
Provider Name (Legal Business Name): XIAOJING JENNIFER HE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: XIAOJING JENNIFER HE PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 05/21/2016
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BON AIR RD STE 100
LARKSPUR CA
94939-1144
US

IV. Provider business mailing address

2 BON AIR RD STE 100
LARKSPUR CA
94939-1144
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-0666
  • Fax: 415-937-6159
Mailing address:
  • Phone: 415-927-0666
  • Fax: 415-937-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53330
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number53330
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: