Provider Demographics
NPI:1154839207
Name:LI, WEN JIAN (RN)
Entity Type:Individual
Prefix:MR
First Name:WEN JIAN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W 25TH ST APT 19K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2142
Mailing Address - Country:US
Mailing Address - Phone:646-318-6495
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST STE 307
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4554
Practice Address - Country:US
Practice Address - Phone:646-653-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY736931163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse