Provider Demographics
NPI:1356504476
Name:JEW, JENNY F (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:F
Last Name:JEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:F
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3903 LONE TREE WAY
Mailing Address - Street 2:STE 205
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6249
Mailing Address - Country:US
Mailing Address - Phone:925-754-8710
Mailing Address - Fax:
Practice Address - Street 1:3903 LONE TREE WAY
Practice Address - Street 2:STE 205
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6249
Practice Address - Country:US
Practice Address - Phone:925-754-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110315207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology