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General NPI Number Information
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NPI Number | 1376562686
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Entity Type | Individual
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Provider Name | JENNIFER V. TOM M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 100 S SAN MATEO DR
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City | SAN MATEO
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State | CA
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Zip | 94401-3805
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Country | US
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Telephone | 650-696-4758
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Fax |
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 650-696-4758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD424980
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C179310
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License Number State | CA
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