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General NPI Number Information
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NPI Number | 1083842470
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Entity Type | Individual
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Provider Name | JEKYUNG JANG MT-BC
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Gender | Female
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 1760 E PECOS RD SUITE 307
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City | GILBERT
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State | AZ
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Zip | 85295-3200
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Country | US
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Telephone | 602-635-7524
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Fax | 602-635-4297
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Provider Business Mailing Address
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Address Line | 1817 N DOBSON RD APT. 1063
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City | CHANDLER
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State | AZ
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Zip | 85224-8705
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Country | US
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Telephone | 970-372-8498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 08896
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License Number State | WY
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