Healthcare Provider Details

I. General information

NPI: 1245380013
Provider Name (Legal Business Name): JENNY CHEN GRISWOLD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR SUITE 830
SAN JOSE CA
95124-4100
US

IV. Provider business mailing address

2577 SAMARITAN DR SUITE 830
SAN JOSE CA
95124-4100
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-1319
  • Fax: 408-356-6296
Mailing address:
  • Phone: 408-356-1319
  • Fax: 408-356-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG84517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: