Provider Demographics
NPI:1467224790
Name:PAN, JENNY T (MFT TRAINEE)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:T
Last Name:PAN
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:T
Other - Last Name:YIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22459 STARLING DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-7461
Mailing Address - Country:US
Mailing Address - Phone:408-603-8988
Mailing Address - Fax:
Practice Address - Street 1:14375 SARATOGA AVE STE 206
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5989
Practice Address - Country:US
Practice Address - Phone:408-603-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health