Provider Demographics
NPI:1063616142
Name:GRUMLEY, JANIE GIA-LIN WENG (MD)
Entity type:Individual
Prefix:DR
First Name:JANIE GIA-LIN WENG
Middle Name:
Last Name:GRUMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:
Other - Last Name:WENG GRUMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-582-7100
Practice Address - Fax:310-829-8914
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60223684208600000X
CAA97413208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1063616142Medicaid
CAW932Medicare ID - Type UnspecifiedHEALTH CENTERS
WA1063616142Medicaid
CAW809FMedicare ID - Type UnspecifiedEL MONTE
WA8902632Medicare PIN
CAW809BMedicare ID - Type UnspecifiedHUDSON
WA8908895Medicare PIN