Healthcare Provider Details

I. General information

NPI: 1104440163
Provider Name (Legal Business Name): JASON GIANG MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17782 COWAN STE A
IRVINE CA
92614-6041
US

IV. Provider business mailing address

17782 COWAN STE A
IRVINE CA
92614-6041
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-7118
  • Fax: 949-579-9102
Mailing address:
  • Phone: 949-722-7118
  • Fax: 949-579-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96963
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number96963
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: