Provider Demographics
NPI:1447149331
Name:CHAU, JACQUELYN JANE (DDS)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:JANE
Last Name:CHAU
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 1:43984 ROSEMERE DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5966
Mailing Address - Country:US
Mailing Address - Phone:510-396-7472
Mailing Address - Fax:
Practice Address - Street 1:680 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2904
Practice Address - Country:US
Practice Address - Phone:510-569-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1117871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice