Provider Demographics
NPI:1962674242
Name:BANH, JENNIFER (BA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:BANH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 N DELTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2634
Mailing Address - Country:US
Mailing Address - Phone:626-571-0072
Mailing Address - Fax:
Practice Address - Street 1:9353 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770
Practice Address - Country:US
Practice Address - Phone:626-780-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No251S00000XAgenciesCommunity/Behavioral Health