Healthcare Provider Details

I. General information

NPI: 1639979487
Provider Name (Legal Business Name): JASMINE ANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22015 AVALON BLVD
CARSON CA
90745-3355
US

IV. Provider business mailing address

19546 ROGAN CT
ROWLAND HEIGHTS CA
91748-3255
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-7584
  • Fax:
Mailing address:
  • Phone: 909-859-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: