MEDICARE: JENNY HO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	006566	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	R2095	OTHER		RESIDENT TRAINING PERMIT NUMBER

General Provider Information

NPI Number	:	1427315506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY HO D.O.

Provider Business Mailing Address
First Line	:	10030 N 25TH AVE STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-1660
Country	:	US
Telephone Number	:	602-726-8805
Fax Number	:	602-944-4147

Provider Business Practice Location Address
First Line	:	5112 W OLIVE AVE STE C113
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-4209
Country	:	US
Telephone Number	:	623-939-8618
Fax Number	:	623-939-9184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	10/18/2016

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