Healthcare Provider Details

I. General information

NPI: 1184361834
Provider Name (Legal Business Name): MICHAEL C. JANG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DEL SOL DR APT 748
SAN DIEGO CA
92108-2960
US

IV. Provider business mailing address

201 DEL SOL DR APT 748
SAN DIEGO CA
92108-2960
US

V. Phone/Fax

Practice location:
  • Phone: 408-429-4910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL C JANG
Title or Position: PRESIDENT
Credential: MD
Phone: 408-429-4910