Active NPI
Jennifer Tung, DDS, MS
- Pediatric Dentistry
- Novato, CA
National Provider Identifier
1366994014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 100458
- Practice address
- 987 Bel Marin Keys Blvd
Novato, CA 94949-5313 - Phone
- (650) 867-8833
- NPI assigned
- Oct 28, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 100458 | CA | Primary |
Addresses
Primary practice location
987 Bel Marin Keys Blvd
Novato, CA 94949-5313
Mailing address
987 Bel Marin Keys Blvd
Novato, CA 94949-5313
Phone (650) 867-8833
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100458 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477612800000",
"number": "1366994014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "987 BEL MARIN KEYS BLVD",
"city": "NOVATO",
"state": "CA",
"postal_code": "949495313",
"telephone_number": "650-867-8833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "987 BEL MARIN KEYS BLVD",
"city": "NOVATO",
"state": "CA",
"postal_code": "949495313",
"telephone_number": "650-867-8833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUNG",
"first_name": "JENNIFER",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-28",
"last_updated": "2016-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "100458",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.