Basic Information
| Provider Information | |||||||||
| NPI: | 1881012615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIN | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 S PARK ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537151507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084173886 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3102 MERITER WAY | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537195833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084178300 | ||||||||
| FaxNumber: | 6084178801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2014 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD187563 | OR | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 35129256 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 73355 | WI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.