Provider Demographics
NPI:1710140140
Name:WANG, JENNY Q (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:Q
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 GALLOWS RD STE 640
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3300
Mailing Address - Country:US
Mailing Address - Phone:703-776-4001
Mailing Address - Fax:703-776-7113
Practice Address - Street 1:1407 UNION AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3627
Practice Address - Country:US
Practice Address - Phone:901-866-8813
Practice Address - Fax:901-302-2120
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47568207V00000X
VA0101262198207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology