Provider Demographics
NPI:1518367887
Name:JENG, HUNG-JIE
Entity Type:Individual
Prefix:
First Name:HUNG-JIE
Middle Name:
Last Name:JENG
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 1:828 E. VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3596
Mailing Address - Country:US
Mailing Address - Phone:626-307-8636
Mailing Address - Fax:626-307-8705
Practice Address - Street 1:828 E VALLEY BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-4600
Practice Address - Country:US
Practice Address - Phone:626-307-8636
Practice Address - Fax:626-307-8705
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001224363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health