Healthcare Provider Details

I. General information

NPI: 1699301101
Provider Name (Legal Business Name): JESSICA CHIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HAYES ST
SAN FRANCISCO CA
94117-1128
US

IV. Provider business mailing address

2020 HAYES ST
SAN FRANCISCO CA
94117-1128
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5125
  • Fax: 415-221-2678
Mailing address:
  • Phone: 415-750-5125
  • Fax: 415-221-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: