Physician Compare National (NPI:1205938115)

HEALTHCARE PROVIDER: JEN CHIN WANG MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1205938115
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7315131059
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101027000451
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WANG
	Individual professional last name
Provider First Name	JEN
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1969
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HEMATOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HEMATOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	5 E WALNUT ST
	Group Practice or individual's line 1 address
City	LONG BEACH
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	115613515
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5168897447
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330233
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BROOKDALE HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330198
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SOUTH NASSAU COMMUNITIES HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M