Provider Demographics
NPI:1801420211
Name:LOOI, WEN SHEN
Entity Type:Individual
Prefix:
First Name:WEN SHEN
Middle Name:
Last Name:LOOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 PRUDENTIAL DR UNIT 2261
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8191
Mailing Address - Country:US
Mailing Address - Phone:904-616-3677
Mailing Address - Fax:
Practice Address - Street 1:2015 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3531
Practice Address - Country:US
Practice Address - Phone:904-588-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN300702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology