Healthcare Provider Details

I. General information

NPI: 1477796845
Provider Name (Legal Business Name): KENNETH H JAHNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 HAVEN AVE SUITE 200
RANCHO CUCAMONGA CA
91730-5149
US

IV. Provider business mailing address

1901 W LUGONIA AVE SUITE 230
REDLANDS CA
92374-9703
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-1600
  • Fax: 909-557-1732
Mailing address:
  • Phone: 909-557-1600
  • Fax: 909-557-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA116022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: