Provider Demographics
NPI:1124373220
Name:CHEUNG, JENNIFER SHARI (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHARI
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SHARI
Other - Last Name:GONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3532 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6510
Mailing Address - Country:US
Mailing Address - Phone:650-561-9589
Mailing Address - Fax:
Practice Address - Street 1:3532 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-561-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist