Individual
JENNIFER JEN-WEI WAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 S SAN MATEO DR, SAN MATEO, CA 94401-3805
(650) 696-4515
(650) 696-4626
Mailing address
PO BOX 6102, NOVATO, CA 94948-6102
(415) 884-3415
(415) 883-0877
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A128087
CA
2085R0204X
Vascular & Interventional Radiology Physician
A128087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356616544
—
CA
Enumeration date
03/20/2012
Last updated
03/19/2021
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