Provider Demographics
NPI:1659789626
Name:DU, JENNIFER CHANG (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHANG
Last Name:DU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHANG
Other - Middle Name:
Other - Last Name:DU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 PALM VALLEY BLVD APT 1150
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1062
Mailing Address - Country:US
Mailing Address - Phone:832-866-8080
Mailing Address - Fax:
Practice Address - Street 1:1672 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1235
Practice Address - Country:US
Practice Address - Phone:408-272-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice