Provider Demographics
NPI:1053564203
Name:MUGO, JEAN WANGECHI (MD)
Entity type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:WANGECHI
Last Name:MUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:WANGECHI
Other - Last Name:MUGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9205 215TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1232
Mailing Address - Country:US
Mailing Address - Phone:516-263-0078
Mailing Address - Fax:347-426-5348
Practice Address - Street 1:7925 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2128
Practice Address - Country:US
Practice Address - Phone:718-264-5030
Practice Address - Fax:718-264-5027
Is Sole Proprietor?:No
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program