Healthcare Provider Details

I. General information

NPI: 1477261089
Provider Name (Legal Business Name): DA SOM JANG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 CHICAGO AVE
EVANSTON IL
60201-4727
US

IV. Provider business mailing address

3023 N CLARK ST STE 593
CHICAGO IL
60657-5200
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-6503
  • Fax:
Mailing address:
  • Phone: 312-926-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209026698
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041457288
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: