Healthcare Provider Details

I. General information

NPI: 1063641660
Provider Name (Legal Business Name): WENWU JIN MD PHD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 CLAY ST SUITE 505
SAN FRANCISCO CA
94108-1556
US

IV. Provider business mailing address

929 CLAY ST SUITE 505
SAN FRANCISCO CA
94108-1500
US

V. Phone/Fax

Practice location:
  • Phone: 415-392-9690
  • Fax: 415-392-9695
Mailing address:
  • Phone: 415-392-9690
  • Fax: 415-392-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WENWU JIN
Title or Position: OWNER
Credential: MD
Phone: 415-392-9690