Provider Demographics
NPI:1477508927
Name:JACQ, JENNY E (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:E
Last Name:JACQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:E
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:320 LENNON LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2419
Mailing Address - Country:US
Mailing Address - Phone:925-906-2395
Mailing Address - Fax:
Practice Address - Street 1:320 LENNON LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2419
Practice Address - Country:US
Practice Address - Phone:925-906-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93018207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A930180Medicaid
CAI48391Medicare UPIN
CA00A930180Medicaid