Provider Demographics
NPI:1386606804
Name:JEIVEN, SUSAN D (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:JEIVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 YGNACIO VALLEY RD, STE. E200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3338
Mailing Address - Country:US
Mailing Address - Phone:925-939-7344
Mailing Address - Fax:925-939-7345
Practice Address - Street 1:2121 YGNACIO VALLEY RD, STE. E200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3338
Practice Address - Country:US
Practice Address - Phone:925-939-7344
Practice Address - Fax:925-939-7345
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA542022080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A542020OtherINDIVIDUAL PROVIDER #
CA00A542020OtherINDIVIDUAL PROVIDER #