Provider Demographics
NPI:1871569335
Name:GE, NENGJIE JAYNE (MD)
Entity type:Individual
Prefix:
First Name:NENGJIE
Middle Name:JAYNE
Last Name:GE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NENGJIE
Other - Middle Name:JAYNE
Other - Last Name:GE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3711
Mailing Address - Country:US
Mailing Address - Phone:949-753-8118
Mailing Address - Fax:949-753-8113
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-753-8118
Practice Address - Fax:949-753-8113
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70942207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16972OtherMEDICARE GROUP NUMBER
CAW16972Medicare PIN
CAG96027Medicare UPIN
CAA70942Medicare ID - Type Unspecified
CA5300390001Medicare NSC