Healthcare Provider Details

I. General information

NPI: 1851280135
Provider Name (Legal Business Name): JISOO JANG PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

14995 SHADY GROVE RD STE 500
ROCKVILLE MD
20850-8726
US

IV. Provider business mailing address

7361 CALHOUN PL STE 600
ROCKVILLE MD
20855-2788
US

V. Phone/Fax

Practice location:
  • Phone: 301-942-7600
  • Fax:
Mailing address:
  • Phone: 301-942-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0110011070
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: