Healthcare Provider Details

I. General information

NPI: 1881129732
Provider Name (Legal Business Name): JENNY JEAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 CLAY ST
RIVERSIDE CA
92509-6005
US

IV. Provider business mailing address

6250 CLAY ST
RIVERSIDE CA
92509-6005
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-5265
  • Fax: 951-360-6276
Mailing address:
  • Phone: 951-360-5265
  • Fax: 951-360-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA172775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: