Healthcare Provider Details

I. General information

NPI: 1205542875
Provider Name (Legal Business Name): S JANG DDS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4363 GOLDEN CENTER DR # B
PLACERVILLE CA
95667-6260
US

IV. Provider business mailing address

2260 E BIDWELL ST # 365
FOLSOM CA
95630-3555
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-4224
  • Fax:
Mailing address:
  • Phone:
  • 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: BUSINESS MANAGER
Credential:
Phone: 916-781-6550