Healthcare Provider Details

I. General information

NPI: 1609011998
Provider Name (Legal Business Name): JANE G. WHANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 MAIN ST
HARTFORD CT
06120-2357
US

IV. Provider business mailing address

1516 RUTLAND WAY
HANOVER MD
21076-1729
US

V. Phone/Fax

Practice location:
  • Phone: 860-970-0928
  • Fax:
Mailing address:
  • Phone: 201-232-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number009951
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22D102391800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number009951
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14767
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number009951
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: