Provider Demographics
NPI:1770511487
Name:DONG, JENNIFER S (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:DONG
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 1:9303 PINECROFT DR STE 270
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3183
Mailing Address - Country:US
Mailing Address - Phone:936-447-9618
Mailing Address - Fax:281-783-2628
Practice Address - Street 1:9303 PINECROFT DR STE 270
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3183
Practice Address - Country:US
Practice Address - Phone:936-447-9618
Practice Address - Fax:281-783-2628
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9769208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770190-01Medicaid
TXP00249023OtherMEDICARE RAILROAD
TXI02448Medicare UPIN
TX1770190-01Medicaid