Basic Information
| Provider Information | |||||||||
| NPI: | 1043821317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEW | ||||||||
| FirstName: | JENNALYN | ||||||||
| MiddleName: | SUJAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 612 MARIPOSA AVE APT 301 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946101305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155330721 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2970 HILLTOP MALL RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948061949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102228000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2020 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.