Provider Demographics
NPI:1881912061
Name:TAOLIN C JEN MD PA
Entity type:Organization
Organization Name:TAOLIN C JEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAOLIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-387-9033
Mailing Address - Street 1:3 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 614
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4776
Mailing Address - Country:US
Mailing Address - Phone:904-387-9033
Mailing Address - Fax:904-387-9561
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 614
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4776
Practice Address - Country:US
Practice Address - Phone:904-387-9033
Practice Address - Fax:904-387-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP93000013252261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care