Provider Demographics
NPI:1831130574
Name:JINMEI WOAN MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JINMEI WOAN MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:JINMEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-833-0268
Mailing Address - Street 1:PO BOX 1955
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-1955
Mailing Address - Country:US
Mailing Address - Phone:209-833-0268
Mailing Address - Fax:209-833-7880
Practice Address - Street 1:530 W EATON AVE
Practice Address - Street 2:SUITE M
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3400
Practice Address - Country:US
Practice Address - Phone:209-833-0268
Practice Address - Fax:209-833-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG692222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G692220OtherMEDICARE PROVIDER ID
CA00G692221Medicaid
CA00G692221Medicaid