Provider Demographics
NPI:1376526228
Name:SZETO, JENNIFER TONGDONG (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TONGDONG
Last Name:SZETO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 E LAS TUNAS DR
Mailing Address - Street 2:#A
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1600
Mailing Address - Country:US
Mailing Address - Phone:626-287-2020
Mailing Address - Fax:626-287-0257
Practice Address - Street 1:937 E LAS TUNAS DR
Practice Address - Street 2:#A
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1600
Practice Address - Country:US
Practice Address - Phone:626-287-2020
Practice Address - Fax:626-287-0257
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11751TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117510Medicaid
CASD0117510Medicaid
5555110001Medicare NSC
U92009Medicare UPIN