Provider Demographics
NPI:1073052049
Name:CHING, JENNIFER KW (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KW
Last Name:CHING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:KW
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10100 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10100 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-786-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005816363L00000X
OR1073052049207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner