Provider Demographics
NPI:1811915481
Name:JEN, WENCHENG (MD)
Entity type:Individual
Prefix:
First Name:WENCHENG
Middle Name:
Last Name:JEN
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 1:416 W LAS TUNAS DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1236
Mailing Address - Country:US
Mailing Address - Phone:626-416-3051
Mailing Address - Fax:616-478-1068
Practice Address - Street 1:416 W LAS TUNAS DR STE 305
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1236
Practice Address - Country:US
Practice Address - Phone:626-416-3051
Practice Address - Fax:616-478-1068
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A704810Medicaid
CAWA70481AMedicare PIN
CACB249758Medicare PIN
CAH53766Medicare UPIN