Provider Demographics
NPI:1699903583
Name:LOUIE-TANAKA, JENNIFER YU (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YU
Last Name:LOUIE-TANAKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:YU
Other - Last Name:LOUIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:19000 HOMESTEAD RD
Mailing Address - Street 2:BLDG 2 FLOOR 1
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0712
Mailing Address - Country:US
Mailing Address - Phone:408-366-4492
Mailing Address - Fax:408-366-4480
Practice Address - Street 1:19000 HOMESTEAD RD
Practice Address - Street 2:BLDG 2 FLOOR 1
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4492
Practice Address - Fax:408-366-4480
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily