Provider Demographics
NPI:1679036719
Name:WANG, JENNY ZHUOYUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:ZHUOYUE
Last Name:WANG
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 1:12555 W JEFFERSON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7047
Mailing Address - Country:US
Mailing Address - Phone:424-543-0066
Mailing Address - Fax:
Practice Address - Street 1:12555 W JEFFERSON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7047
Practice Address - Country:US
Practice Address - Phone:424-543-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA179146207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology