Provider Demographics
NPI:1770531170
Name:LEI, JERRY ZHEN (PA-C)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:ZHEN
Last Name:LEI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10104 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3510
Mailing Address - Country:US
Mailing Address - Phone:510-558-0886
Mailing Address - Fax:510-558-8504
Practice Address - Street 1:10104 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3510
Practice Address - Country:US
Practice Address - Phone:510-558-0886
Practice Address - Fax:510-558-8504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 13056363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical