Provider Demographics
NPI:1144257627
Name:WOO, JENNIFER H (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:WOO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 LANKERSHIM BLVD
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1615
Mailing Address - Country:US
Mailing Address - Phone:818-762-1270
Mailing Address - Fax:818-726-1275
Practice Address - Street 1:6734 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1615
Practice Address - Country:US
Practice Address - Phone:818-762-1270
Practice Address - Fax:818-726-1275
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4226213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42260Medicaid
CA5587000001Medicare NSC
CAE4226Medicare PIN
CA000E42260Medicaid