Provider Demographics
NPI:1992162960
Name:IRWAN, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:IRWAN
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 1:5293 PROSPECT RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5037
Mailing Address - Country:US
Mailing Address - Phone:408-248-2545
Mailing Address - Fax:408-248-2125
Practice Address - Street 1:5293 PROSPECT RD STE D
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5037
Practice Address - Country:US
Practice Address - Phone:408-248-2545
Practice Address - Fax:408-248-2125
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7994237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist