Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 12829T | CA |
NPI | 1013069616 |
---|---|
Provider Name | Joan Jen |
First Address | Sunnyvale, CA 94086-6249 |
Second Address | Sunnyvale, CA 94086-6249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 14/01/2013 |