Basic Information
Provider Information | |||||||||
NPI: | 1710137872 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GUY | ||||||||
FirstName: | JENNIFER | ||||||||
MiddleName: | ELLEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 325 DISTEL CIR | ||||||||
Address2: |   | ||||||||
City: | LOS ALTOS | ||||||||
State: | CA | ||||||||
PostalCode: | 940221408 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4156001000 | ||||||||
FaxNumber: | 4155587051 | ||||||||
Practice Location | |||||||||
Address1: | 1100 VAN NESS AVE | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941096978 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4156001000 | ||||||||
FaxNumber: | 4155587051 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/25/2008 | ||||||||
LastUpdateDate: | 11/16/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/16/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | A86055 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0008X | A86055 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RT0003X | A86055 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
ID | Type | State | Issuer | Description | A86055 | 01 | CA | STATE MEDICAL LICENSE | OTHER |