Provider Demographics
NPI:1578900833
Name:KANE, JENNY WANG (DO)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:WANG
Last Name:KANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:M
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:323 SOQUEL WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4102
Mailing Address - Country:US
Mailing Address - Phone:408-665-3728
Mailing Address - Fax:
Practice Address - Street 1:323 SOQUEL WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4102
Practice Address - Country:US
Practice Address - Phone:408-665-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015198207Q00000X
CA20A15011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine