Provider Demographics
NPI:1316936891
Name:HUANG, JENNIE CHEN SHANG (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:CHEN SHANG
Last Name:HUANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2284
Mailing Address - Country:US
Mailing Address - Phone:206-267-4390
Mailing Address - Fax:206-267-4391
Practice Address - Street 1:1600 7TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2284
Practice Address - Country:US
Practice Address - Phone:206-267-4390
Practice Address - Fax:206-267-4391
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60723572207Q00000X
CAA82377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A823770OtherBLUE SHIELD
CA00A823770Medicaid
I12853Medicare UPIN
CA00A823770Medicaid