Healthcare Provider Details

I. General information

NPI: 1720241227
Provider Name (Legal Business Name): JADE-MING JENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W IMPERIAL HWY H-171
BREA CA
92821-4832
US

IV. Provider business mailing address

407 W IMPERIAL HWY H-171
BREA CA
92821-4832
US

V. Phone/Fax

Practice location:
  • Phone: 562-365-3540
  • Fax: 714-990-2754
Mailing address:
  • Phone: 562-365-3540
  • Fax: 714-990-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA115328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: