Provider Demographics
NPI:1770512402
Name:JU, JENNIFER MEHEH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MEHEH
Last Name:JU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1830
Mailing Address - Country:US
Mailing Address - Phone:203-372-9002
Mailing Address - Fax:203-372-6747
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-372-9002
Practice Address - Fax:203-372-6747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT041404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86007Medicare UPIN