Healthcare Provider Details

I. General information

NPI: 1144802562
Provider Name (Legal Business Name): JENNIFER XU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

43925 S MORAY ST
FREMONT CA
94539-5942
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-6933
  • Fax:
Mailing address:
  • Phone: 510-396-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: