Provider Demographics
NPI:1114522612
Name:JAN, TEHSING
Entity Type:Individual
Prefix:
First Name:TEHSING
Middle Name:
Last Name:JAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DAPHNE CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4105
Mailing Address - Country:US
Mailing Address - Phone:908-294-1780
Mailing Address - Fax:
Practice Address - Street 1:519 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3332
Practice Address - Country:US
Practice Address - Phone:973-759-4181
Practice Address - Fax:973-759-5826
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01715200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist