Provider Demographics
NPI:1548729692
Name:DUAN, JENNIFER X
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:X
Last Name:DUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:XINYUE
Other - Middle Name:
Other - Last Name:DUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5114 MEDICAL DR APT 2309
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3875
Mailing Address - Country:US
Mailing Address - Phone:918-876-2579
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program