Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1043821317 |
---|---|
Provider Name | Dr. Jennalyn Sujan Lew |
First Address | Oakland, CA 94610-1305 |
Second Address | Richmond, CA 94806-1949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2020 |
Last Update Date | 11/08/2020 |