Provider Demographics
NPI:1427617703
Name:LUI, JENNY C (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:C
Last Name:LUI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 WATERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2254
Mailing Address - Country:US
Mailing Address - Phone:415-317-7752
Mailing Address - Fax:
Practice Address - Street 1:2199 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3303
Practice Address - Country:US
Practice Address - Phone:925-575-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist