Provider Demographics
NPI:1760925739
Name:JHA, WEN-JYE C
Entity Type:Individual
Prefix:
First Name:WEN-JYE
Middle Name:C
Last Name:JHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:JHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80-75 208 STREET
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80-75 208 STREET
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1006
Practice Address - Country:US
Practice Address - Phone:718-753-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY885915171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator