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NPI Code Detail

MEDICARE: GRACE YIN JENQ MD

MEDICARE: GRACE YIN JENQ MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician4301109141MI
2207RG0300XGeriatric Medicine (Internal Medicine) Physician4301109141MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790710382
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE YIN JENQ MD
Provider Business Mailing Address
First Line : 3621 S STATE ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-1633
Country : US
Telephone Number : 734-647-5299
Fax Number :
Provider Business Practice Location Address
First Line : 1200 EARHART RD
Second Line :
City : ANN ARBOR
State : MI
Zip : 48105-2768
Country : US
Telephone Number : 734-769-0177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 03/09/2020

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