MEDICARE: DR. WENYI JIA DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	D7606	OR

General Provider Information

NPI Number	:	1942294954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENYI JIA DDS MS

Provider Business Mailing Address
First Line	:	9370 SW GREENBURG RD
Second Line	:	SUITE 413
City	:	PORTLAND
State	:	OR
Zip	:	97223-5442
Country	:	US
Telephone Number	:	503-892-8959
Fax Number	:	503-892-8270

Provider Business Practice Location Address
First Line	:	9370 SW GREENBURG RD
Second Line	:	SUITE 413
City	:	PORTLAND
State	:	OR
Zip	:	97223-5442
Country	:	US
Telephone Number	:	503-892-8959
Fax Number	:	503-892-8270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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