Provider Demographics
NPI:1962692483
Name:WANG, JENNY H (DO)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:H
Last Name:WANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 NE HOYT ST STE 625
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2990
Mailing Address - Country:US
Mailing Address - Phone:503-731-2900
Mailing Address - Fax:
Practice Address - Street 1:5050 NE HOYT ST STE 625
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2990
Practice Address - Country:US
Practice Address - Phone:503-731-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340108702085R0202X
MI51010173742085R0202X
ORDO2183872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34010870OtherOHIO MEDICAL LICENSE