Provider Demographics
NPI:1366994014
Name:TUNG, JENNIFER (DDS, MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TUNG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 BEL MARIN KEYS BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5313
Mailing Address - Country:US
Mailing Address - Phone:650-867-8833
Mailing Address - Fax:
Practice Address - Street 1:987 BEL MARIN KEYS BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5313
Practice Address - Country:US
Practice Address - Phone:650-867-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1004581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry