Healthcare Provider Details

I. General information

NPI: 1700700655
Provider Name (Legal Business Name): DYLAN JANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 IVY ST APT 1
PITTSBURGH PA
15232-2469
US

IV. Provider business mailing address

703 IVY ST APT 1
PITTSBURGH PA
15232-2469
US

V. Phone/Fax

Practice location:
  • Phone: 703-415-6393
  • Fax:
Mailing address:
  • Phone: 703-415-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN790441
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: