Provider Demographics
NPI:1518986710
Name:FENG, JENNIFER JIANFANG (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JIANFANG
Last Name:FENG
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 1:822 KUMHO DR
Mailing Address - Street 2:STE 202
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9297
Mailing Address - Country:US
Mailing Address - Phone:330-576-0500
Mailing Address - Fax:330-576-0467
Practice Address - Street 1:822 KUMHO DR
Practice Address - Street 2:STE 202
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9297
Practice Address - Country:US
Practice Address - Phone:330-576-0500
Practice Address - Fax:330-576-0467
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086887208M00000X
OH35-086887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00340811OtherRAILROAD MEDICARE
OH7113896OtherAETNA
OH2675056Medicaid
OH000000518269OtherANTHEM
OH2675056Medicaid
OH$$$$$$$$$00OtherBWC
OH$$$$$$$$$00OtherBWC
OH000000518269OtherANTHEM