Healthcare Provider Details

I. General information

NPI: 1306004361
Provider Name (Legal Business Name): CHRISTOPHER J JENNY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 OCEAN AVE LBBY 3
SAN FRANCISCO CA
94132-1623
US

IV. Provider business mailing address

2645 OCEAN AVE LBBY 3
SAN FRANCISCO CA
94132-1623
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5400
  • Fax: 415-375-4888
Mailing address:
  • Phone: 415-600-5400
  • Fax: 415-375-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: