Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | A90933 | CA |
N | 208000000X | Pediatrician | A90933 | CA |
NPI | 1174527881 |
---|---|
Provider Name | Dr. Jenna A. Timm |
First Address | Oakland, CA 94611-5641 |
Second Address | Oakland, CA 94611-5641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 10/01/2022 |