Healthcare Provider Details

I. General information

NPI: 1740924539
Provider Name (Legal Business Name): JONATHAN JANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 S ALEXANDER ST
PLANT CITY FL
33563
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1187
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 813-752-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN29707
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: