Provider Demographics
NPI:1902663578
Name:FONG, JENI
Entity Type:Individual
Prefix:
First Name:JENI
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENI
Other - Middle Name:
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:667 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2528
Mailing Address - Country:US
Mailing Address - Phone:925-381-1834
Mailing Address - Fax:
Practice Address - Street 1:667 41ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2528
Practice Address - Country:US
Practice Address - Phone:925-381-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula