Provider Demographics
NPI:1962544569
Name:JUANG, JENNIFER AN-JENG (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AN-JENG
Last Name:JUANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:AN-JENG
Other - Last Name:JUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 1834
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0075
Mailing Address - Country:US
Mailing Address - Phone:206-251-3831
Mailing Address - Fax:
Practice Address - Street 1:4538 KLAHANIE DR SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-5812
Practice Address - Country:US
Practice Address - Phone:425-392-9982
Practice Address - Fax:815-301-5473
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAJU1418OtherREGENCE BLUE SHIELD
WAAB13904Medicare ID - Type Unspecified
WAJU1418OtherREGENCE BLUE SHIELD
8852088Medicare PIN