Provider Demographics
NPI:1942250709
Name:FENG, JAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIN
Middle Name:
Last Name:FENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MANITOBA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3885
Mailing Address - Country:US
Mailing Address - Phone:509-925-6100
Mailing Address - Fax:509-925-7604
Practice Address - Street 1:700 E MANITOBA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3885
Practice Address - Country:US
Practice Address - Phone:509-925-6100
Practice Address - Fax:509-925-7604
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1079185Medicaid
WAF35455Medicare UPIN
WA8854164Medicare ID - Type Unspecified