Healthcare Provider Details

I. General information

NPI: 1235744764
Provider Name (Legal Business Name): JENNIFER VU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 IRVING ST
SAN FRANCISCO CA
94122-1609
US

IV. Provider business mailing address

2131 IRVING ST
SAN FRANCISCO CA
94122-1609
US

V. Phone/Fax

Practice location:
  • Phone: 415-494-3165
  • Fax:
Mailing address:
  • Phone: 415-494-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number64328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: