Healthcare Provider Details

I. General information

NPI: 1609670264
Provider Name (Legal Business Name): DO HYEON JANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31646 DUNLAP BLVD
YUCAIPA CA
92399-1689
US

IV. Provider business mailing address

8530 HAVEN AVE APT 3302
RANCHO CUCAMONGA CA
91730-9134
US

V. Phone/Fax

Practice location:
  • Phone: 909-794-4909
  • Fax:
Mailing address:
  • Phone: 216-801-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8105
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: