Provider Demographics
NPI:1508555780
Name:WEN, JIARONG (NP)
Entity Type:Individual
Prefix:
First Name:JIARONG
Middle Name:
Last Name:WEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37388 SAND DRIFT RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-7326
Mailing Address - Country:US
Mailing Address - Phone:650-996-6769
Mailing Address - Fax:
Practice Address - Street 1:150 SPEAR ST STE 500
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1537
Practice Address - Country:US
Practice Address - Phone:415-603-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024954363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health