Healthcare Provider Details

I. General information

NPI: 1386215226
Provider Name (Legal Business Name): JENNY HYEJI JANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 BEELER ST UNIT 140
DENVER CO
80238-4341
US

IV. Provider business mailing address

347 4TH ST UNIT B
PALISADES PARK NJ
07650-2220
US

V. Phone/Fax

Practice location:
  • Phone: 347-604-4357
  • Fax:
Mailing address:
  • Phone: 347-604-4357
  • Fax:

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 TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02880200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN.00206737
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: