Provider Demographics
NPI:1881039824
Name:CHUNG, JENNA (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MUIR RD BLDG FLOOR2
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4614
Mailing Address - Country:US
Mailing Address - Phone:925-372-1999
Mailing Address - Fax:925-372-1871
Practice Address - Street 1:200 MUIR RD BLDG FLOOR2
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4614
Practice Address - Country:US
Practice Address - Phone:925-372-1999
Practice Address - Fax:925-372-1871
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283139207Q00000X
CA20A15223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine