Individual
NA JEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
701 S ATLANTIC BLVD STE 100, MONTEREY PARK, CA 91754-3845
(626) 300-9980
(626) 300-9322
Mailing address
701 S ATLANTIC BLVD STE 100, MONTEREY PARK, CA 91754-3845
(626) 300-9980
(626) 300-9322
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
20A16741
CA
390200000X
Student in an Organized Health Care Education/Training Program
DR.0059296
CO
390200000X
Student in an Organized Health Care Education/Training Program
OT015731
PA
Other
Enumeration date
06/23/2014
Last updated
05/29/2024
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