Provider Demographics
NPI:1336554526
Name:CHAU, JENNIFER LAN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAN
Last Name:CHAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CREEKSIDE WAY APT 911
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3973
Mailing Address - Country:US
Mailing Address - Phone:214-335-0712
Mailing Address - Fax:
Practice Address - Street 1:1467 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5165
Practice Address - Country:US
Practice Address - Phone:972-869-3789
Practice Address - Fax:972-619-7622
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice