Provider Demographics
NPI:1588762058
Name:LIAN JEN DO PA
Entity type:Organization
Organization Name:LIAN JEN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:941-627-9768
Mailing Address - Street 1:3089 TAMIAMI TRAIL
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-627-9768
Mailing Address - Fax:941-627-2785
Practice Address - Street 1:3089 TAMIAMI TRAIL
Practice Address - Street 2:SUITE B
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-627-9768
Practice Address - Fax:941-627-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS09374208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49234OtherBCBS
FLG09374Medicare UPIN
FL49234OtherBCBS