Provider Demographics
NPI:1639245426
Name:KEYS, JENN (LAC)
Entity Type:Individual
Prefix:
First Name:JENN
Middle Name:
Last Name:KEYS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1105 PALOMA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3540
Mailing Address - Country:US
Mailing Address - Phone:415-205-4499
Mailing Address - Fax:
Practice Address - Street 1:200 N SAN MATEO DR STE B
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2609
Practice Address - Country:US
Practice Address - Phone:415-205-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9198171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist