Provider Demographics
NPI:1457384828
Name:JEN, TAOLIN C (MD)
Entity Type:Individual
Prefix:
First Name:TAOLIN
Middle Name:C
Last Name:JEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 WEMBLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROSSMOOR
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4235
Mailing Address - Country:US
Mailing Address - Phone:904-410-5517
Mailing Address - Fax:
Practice Address - Street 1:11711 WEMBLEY RD
Practice Address - Street 2:
Practice Address - City:ROSSMOOR
Practice Address - State:CA
Practice Address - Zip Code:90720-4235
Practice Address - Country:US
Practice Address - Phone:904-410-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0062966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
18511Medicare ID - Type Unspecified
C02848Medicare UPIN