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General NPI Number Information
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NPI Number | 1801420211
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Entity Type | Individual
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Provider Name | WEN SHEN LOOI
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Gender | Male
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 2015 JEFFERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-3531
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Country | US
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Telephone | 904-588-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 PRUDENTIAL DR UNIT 2261
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8191
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Country | US
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Telephone | 904-616-3677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | TRN30070
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License Number State | FL
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