Basic Information
Provider Information
NPI: 1659480051
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZENG
FirstName: WENJIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1111 N LEE AVE STE 305
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731032620
CountryCode: US
TelephoneNumber: 4058120361
FaxNumber: 4059423873
Practice Location
Address1: 1000 N LEE AVE
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731021036
CountryCode: US
TelephoneNumber: 4052726406
FaxNumber: 4052726075
Other Information
ProviderEnumerationDate: 08/30/2006
LastUpdateDate: 09/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X28748OKY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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