Provider Demographics
NPI:1245902857
Name:TRAN, JENNY (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W NEWMARK AVE APT B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2863
Mailing Address - Country:US
Mailing Address - Phone:626-374-9562
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLAZA SUITE 502
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6934
Practice Address - Country:US
Practice Address - Phone:310-794-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA34837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program