Provider Demographics
NPI:1265165302
Name:MA, JENNY (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 W EL CAMINO REAL UNIT 149
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1667
Mailing Address - Country:US
Mailing Address - Phone:425-286-4581
Mailing Address - Fax:
Practice Address - Street 1:990 W FREMONT AVE STE Q
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3065
Practice Address - Country:US
Practice Address - Phone:408-738-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist