MEDICARE: JENNY WOO

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1871288563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY WOO

Provider Business Mailing Address
First Line	:	1406 N FORMOSA AVE APT 1/2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 N FORMOSA AVE APT 1/2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4408
Country	:	US
Telephone Number	:	818-518-4396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2023
Last Update Date	:	04/07/2023

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Directions to “ JENNY WOO ” Practice Location

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