Provider Demographics
NPI:1114424553
Name:MA, JENNY FANG
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:FANG
Last Name:MA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 822336
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2336
Mailing Address - Country:US
Mailing Address - Phone:610-902-6092
Mailing Address - Fax:610-902-0986
Practice Address - Street 1:795 E MARSHALL ST STE 301
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-384-8300
Practice Address - Fax:610-384-8885
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481378207YX0007X
PAMT060990207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck