Provider Demographics
NPI:1245324201
Name:JENGO, JAMES ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:JENGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1045 ATLANTIC AVE STE 611
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3414
Mailing Address - Country:US
Mailing Address - Phone:562-432-0111
Mailing Address - Fax:562-276-0799
Practice Address - Street 1:1045 ATLANTIC AVE STE 611
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3414
Practice Address - Country:US
Practice Address - Phone:562-432-0111
Practice Address - Fax:562-276-0799
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG24864207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42426Medicare UPIN