Healthcare Provider Details

I. General information

NPI: 1033464821
Provider Name (Legal Business Name): JESSICA TENNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

550 16TH STREET 4TH FLOOR, MISSION HALL #0706
SAN FRANCISCO CA
94143-1804
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberA117230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: