Provider Demographics
NPI:1275570921
Name:WEN, JIAYING (MD)
Entity Type:Individual
Prefix:
First Name:JIAYING
Middle Name:
Last Name:WEN
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 1:45 WINSLOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-3419
Mailing Address - Country:US
Mailing Address - Phone:781-820-9897
Mailing Address - Fax:
Practice Address - Street 1:174 ARMSTICE BLVD
Practice Address - Street 2:COPPOLA MEDICAL ASSOCIATE
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-725-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160086207R00000X
RIMD10156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG98238Medicare UPIN
RI007007295Medicare ID - Type Unspecified