Healthcare Provider Details

I. General information

NPI: 1205226875
Provider Name (Legal Business Name): S. JANG DDS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 E BIDWELL ST # 110
FOLSOM CA
95630-3463
US

IV. Provider business mailing address

2260 E BIDWELL ST # 351
FOLSOM CA
95630-3463
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-4224
  • Fax: 916-984-4248
Mailing address:
  • Phone: 916-781-6550
  • Fax: 916-984-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number57611
License Number StateCA

VIII. Authorized Official

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