Provider Demographics
NPI:1811208556
Name:SHEPHERD, JENNIFER LYND (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYND
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:#31
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-5939
Mailing Address - Fax:323-361-7927
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:#31
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-5939
Practice Address - Fax:323-361-7927
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics