Provider Demographics
NPI:1336806439
Name:JEROME NICHOLAS JEW
Entity Type:Organization
Organization Name:JEROME NICHOLAS JEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HO-JEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-982-4011
Mailing Address - Street 1:919 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1520
Mailing Address - Country:US
Mailing Address - Phone:415-982-4011
Mailing Address - Fax:415-982-6291
Practice Address - Street 1:919 CLAY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1520
Practice Address - Country:US
Practice Address - Phone:415-982-4011
Practice Address - Fax:415-982-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101312369401Medicaid