Provider Demographics
NPI:1124769898
Name:JENG, JINFAE (NP)
Entity type:Individual
Prefix:
First Name:JINFAE
Middle Name:
Last Name:JENG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N AVENIDA ALIPAZ
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2201
Mailing Address - Country:US
Mailing Address - Phone:909-837-0776
Mailing Address - Fax:
Practice Address - Street 1:119 N AVENIDA ALIPAZ
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2201
Practice Address - Country:US
Practice Address - Phone:909-837-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily