Provider Demographics
NPI:1669471876
Name:WEN-FENG JAN, MD PC
Entity Type:Organization
Organization Name:WEN-FENG JAN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WEN FENG
Authorized Official - Middle Name:
Authorized Official - Last Name:JAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-3060
Mailing Address - Street 1:1920 E KATELLA AVE
Mailing Address - Street 2:SUITE P
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5146
Mailing Address - Country:US
Mailing Address - Phone:714-639-3060
Mailing Address - Fax:714-639-6471
Practice Address - Street 1:1920 E KATELLA AVE
Practice Address - Street 2:SUITE P
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5146
Practice Address - Country:US
Practice Address - Phone:714-639-3060
Practice Address - Fax:714-639-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33039208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A330390Medicaid
CAA33039Medicare ID - Type Unspecified
CA00A330390Medicaid