Provider Demographics
NPI:1639349202
Name:NECKIEN, JESSICA JIHAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JIHAN
Last Name:NECKIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 THOUSAND OAKS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3837
Mailing Address - Country:US
Mailing Address - Phone:805-371-9116
Mailing Address - Fax:
Practice Address - Street 1:4165 THOUSAND OAKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3837
Practice Address - Country:US
Practice Address - Phone:805-371-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18617Medicare PIN