Healthcare Provider Details

I. General information

NPI: 1750772828
Provider Name (Legal Business Name): S. JANG DDS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9184 E STOCKTON BLVD STE B
ELK GROVE CA
95624-9510
US

IV. Provider business mailing address

2260 E BIDWELL ST # 358
FOLSOM CA
95630-3463
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-4224
  • Fax: 916-984-4248
Mailing address:
  • Phone: 916-984-4224
  • Fax: 916-984-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number57611
License Number StateCA

VIII. Authorized Official

Name: MEGAN POOLE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 916-781-6550