Healthcare Provider Details

I. General information

NPI: 1831628304
Provider Name (Legal Business Name): JENNIFER SUSAN WYGANT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PINE ST STE 1250
SAN FRANCISCO CA
94111-5235
US

IV. Provider business mailing address

109 W 27TH ST STE 5S
NEW YORK NY
10001-0265
US

V. Phone/Fax

Practice location:
  • Phone: 415-985-6697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A23425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: