Healthcare Provider Details

I. General information

NPI: 1437658614
Provider Name (Legal Business Name): S.Y.Y JANG DDS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W TEXAS ST STE 2C
FAIRFIELD CA
94533-4462
US

IV. Provider business mailing address

2260 E BIDWELL ST # 229
FOLSOM CA
95630-3555
US

V. Phone/Fax

Practice location:
  • Phone: 916-221-3116
  • Fax:
Mailing address:
  • Phone: 916-781-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

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