Provider Demographics
NPI:1619000791
Name:FU, JENNIFER M (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:FU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3655
Mailing Address - Country:US
Mailing Address - Phone:510-527-8865
Mailing Address - Fax:
Practice Address - Street 1:6431 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3655
Practice Address - Country:US
Practice Address - Phone:510-527-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94758207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology