Healthcare Provider Details

I. General information

NPI: 1780455188
Provider Name (Legal Business Name): TED JANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BRUNSWICK ST
SAN FRANCISCO CA
94112-4202
US

IV. Provider business mailing address

635 BRUNSWICK ST
SAN FRANCISCO CA
94112-4202
US

V. Phone/Fax

Practice location:
  • Phone: 415-337-4065
  • Fax:
Mailing address:
  • Phone: 415-337-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: