Provider Demographics
NPI:1447734439
Name:CHAN, JENNIFER TZE-KEI (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TZE-KEI
Last Name:CHAN
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 1:1080 S OAK KNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4439
Mailing Address - Country:US
Mailing Address - Phone:626-215-7655
Mailing Address - Fax:
Practice Address - Street 1:120 W BONITA AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-5000
Practice Address - Country:US
Practice Address - Phone:909-599-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002275152W00000X
CA34409TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist