Healthcare Provider Details

I. General information

NPI: 1386477115
Provider Name (Legal Business Name): JEE JEAN TOLENTINO DYKHENG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20260 MOBILE ST
WINNETKA CA
91306-4241
US

IV. Provider business mailing address

4134 GOLDEN FLEECE AVE
LAS VEGAS NV
89141-9107
US

V. Phone/Fax

Practice location:
  • Phone: 818-216-0761
  • Fax:
Mailing address:
  • Phone: 818-216-0761
  • Fax: 818-216-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032051
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number830158
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: