Provider Demographics
NPI:1760141998
Name:AU, JENNIFER (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:AU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 W LINGAN LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2437
Mailing Address - Country:US
Mailing Address - Phone:657-445-8920
Mailing Address - Fax:
Practice Address - Street 1:3441 ALMA ST STE 200
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3508
Practice Address - Country:US
Practice Address - Phone:650-323-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2994582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic