Provider Demographics
NPI:1154071546
Name:CHAU, JENNY THANH (PA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:THANH
Last Name:CHAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 PARKRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3227
Mailing Address - Country:US
Mailing Address - Phone:405-651-7588
Mailing Address - Fax:
Practice Address - Street 1:1240 E PALM VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3202
Practice Address - Country:US
Practice Address - Phone:512-733-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17090363A00000X
OK4814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant