Provider Demographics
NPI:1265455695
Name:LIN-NGUYEN, JENNIFER WEI (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WEI
Last Name:LIN-NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20790 MADRONA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3777
Mailing Address - Country:US
Mailing Address - Phone:310-781-2806
Mailing Address - Fax:310-781-2817
Practice Address - Street 1:20790 MADRONA AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-3777
Practice Address - Country:US
Practice Address - Phone:310-781-2806
Practice Address - Fax:310-781-2817
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91544208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A915440Medicaid
CAGR0053510Medicaid
CA00A915440Medicaid
CAWA91544AMedicare ID - Type Unspecified
CAW11810Medicare ID - Type UnspecifiedGROUP NUMBER