Provider Demographics
NPI:1427315506
Name:HO, JENNY (DO)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10030 N 25TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1660
Mailing Address - Country:US
Mailing Address - Phone:602-726-8805
Mailing Address - Fax:602-944-4147
Practice Address - Street 1:5112 W OLIVE AVE STE C113
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4209
Practice Address - Country:US
Practice Address - Phone:623-939-8618
Practice Address - Fax:623-939-9184
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ006566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ055385Medicaid
R2095OtherRESIDENT TRAINING PERMIT NUMBER