DR. JACK WILLIAM OSULLIVAN (NPI# 1952930570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952930570 |
| Entity Type | Individual |
| Full Name | DR. JACK WILLIAM OSULLIVAN |
| Credential | MD |
| Practice Address |
3801 Miranda Ave Uppr Va Palo Alto CA 94304-1207 |
| Mailing Address |
300 Pasteur Drive, Lane 154 Stanford CA 94305-5133 |
| Practice Telephone | 6504935000 |
| Mailing Telephone | 6507236661 |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2020-04-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
3801 MIRANDA AVE UPPR VA |
| City | PALO ALTO |
| State | CA |
| Zip Code | 94304-1207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477170611 | Richard Engdahl | Specialist/Technologist, Other | 820 Quarry Road, Mc1078 Hf006, Palo Alo, CA 94304 | 2020-07-04 |
| 1720603582 | Lily Wenya Zhou | Psychiatry & Neurology | 780 Welch Road, Suite 350, Stanford Stroke Center, Palo Alto, CA 94304 | 2020-06-08 |
| 1033738521 | Perry Seo Choi | Student in an Organized Health Care Education/Training Program | Dept of Cardiothoracic Surgery, Falk Building, 870 Quarry Rd, Palo Alto, CA 94304 | 2020-04-14 |
| 1073150355 | Tara Mcdermott | Nurse Practitioner | 500 Pasteur Drive, Cardiovascular Intensive Care Unit, Palo Alto, CA 94304 | 2019-12-05 |
| 1811542723 | Mark Henry Chubb | Pediatrics | Stanford Children's Health, 725 Welch Road, Palo Alto, CA 94304 | 2019-08-07 |
| 1194285114 | Cora Steindl | Nurse Practitioner | 300 Pasteur Drive Rm H2512, Stanford, CA 94304 | 2019-03-25 |
| 1407333057 | Deborah Menet Landi | Social Worker | Lucile Packard Children's Hospital Stanford, 725 Welch, Mc 5933, Palo Alto, CA 94304 | 2018-07-26 |
| 1982100798 | Jonathan Hootman | Student in an Organized Health Care Education/Training Program | 900 Quarry Road Extension, Palo Alto, CA 94304 | 2018-04-02 |
| 1093234254 | Adam C Maclellan | Psychiatry & Neurology | Stanford Stroke Center, 780 Welch Road, Suite 350, Palo Alto, CA 94304 | 2017-09-19 |
| 1194248153 | Chanel Beaudoin Cloutier | Plastic Surgery | 770 Welch Road, Suite 400, Palo Alto, CA 94304 | 2017-07-21 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033738521 | Perry Seo Choi | Student in an Organized Health Care Education/Training Program | Dept of Cardiothoracic Surgery, Falk Building, 870 Quarry Rd, Palo Alto, CA 94304 | 2020-04-14 |
| 1831727940 | Haley Vertelney | Student in an Organized Health Care Education/Training Program | 2381 Bryant St, Palo Alto, CA 94301-4103 | 2020-04-01 |
| 1154959773 | Natalia Eugenia Birgisson | Student in an Organized Health Care Education/Training Program | 300 Pasteur Dr Rm H362, Palo Alto, CA 94304-2203 | 2020-03-30 |
| 1053956896 | Timothy Michael Preston | Student in an Organized Health Care Education/Training Program | 586 Military Way, Palo Alto, CA 94306-3236 | 2019-11-15 |
| 1154883445 | Daniel Kwangsuk Lee | Student in an Organized Health Care Education/Training Program | Stanford Neuroscience Health Center, 213 Quarry Road, Palo Alto, CA 94304-5979 | 2019-04-04 |
| 1851853717 | Farrah Liu | Student in an Organized Health Care Education/Training Program | 770 Welch Rd Fl 4, Palo Alto, CA 94304-1511 | 2019-04-01 |
| 1952892762 | Yair Azoulay | Student in an Organized Health Care Education/Training Program | 3801 Miranda Ave Uppr, Palo Alto, CA 94304-1207 | 2018-05-29 |
| 1902303969 | Alanna Coughran | Student in an Organized Health Care Education/Training Program | 120 Melville Ave, Palo Alto, CA 94301-3540 | 2018-04-06 |
| 1144727223 | Kingsley Anuoluwapo Oladeji | Student in an Organized Health Care Education/Training Program | Stanford Health Care Dept. of Gme, 300 Pasteur Drive, Palo Alto, CA 94305 | 2018-04-06 |
| 1023514338 | Lisa Kanata Wong | Student in an Organized Health Care Education/Training Program | Department of Pathology, 300 Pasteur Drive, Edwards Building, R204, Mc: 5324, Palo Alto, CA 94305-4245 | 2018-04-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.