Provider Demographics
NPI:1275554875
Name:AU, JENNY C
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:C
Last Name:AU
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:C
Other - Last Name:AU-HSIEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1101 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5948
Mailing Address - Country:US
Mailing Address - Phone:310-545-0061
Mailing Address - Fax:310-545-1569
Practice Address - Street 1:1101 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5948
Practice Address - Country:US
Practice Address - Phone:310-545-0061
Practice Address - Fax:310-545-1569
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice