Healthcare Provider Details

I. General information

NPI: 1669471876
Provider Name (Legal Business Name): WEN-FENG JAN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E KATELLA AVE SUITE P
ORANGE CA
92867-5146
US

IV. Provider business mailing address

1920 E KATELLA AVE SUITE P
ORANGE CA
92867-5146
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-3060
  • Fax: 714-639-6471
Mailing address:
  • Phone: 714-639-3060
  • Fax: 714-639-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33039
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA33039
License Number StateCA

VIII. Authorized Official

Name: WEN FENG JAN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-639-3060