Provider Demographics
NPI:1083290787
Name:CHAU, JENNY MEI MEI
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MEI MEI
Last Name:CHAU
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 1:1762 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4302
Mailing Address - Country:US
Mailing Address - Phone:415-713-0177
Mailing Address - Fax:
Practice Address - Street 1:88 SPEAR ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1550
Practice Address - Country:US
Practice Address - Phone:415-856-0733
Practice Address - Fax:415-856-0736
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH45962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist