Healthcare Provider Details

I. General information

NPI: 1639691579
Provider Name (Legal Business Name): JEE HOON JANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 MADERA RD
SIMI VALLEY CA
93065-3053
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-5722
  • Fax: 805-915-4141
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA173800
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZC0008X
TaxonomyClinical Informatics (Pathology) Physician
License NumberA173800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: