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General NPI Number Information
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NPI Number | 1255474946
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Entity Type | Organization
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Legal Business Name | E. JANG DENTAL CORPORATION
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 7138 WILLOW ST
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4306
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Country | US
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Telephone | 707-823-5308
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Fax | 707-823-5256
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Provider Business Mailing Address
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Address Line | 7138 WILLOW ST
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4306
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Country | US
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Telephone | 707-823-5308
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Fax | 707-823-5256
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EUN SUB JANG
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Credential | DDS
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Telephone | 707-823-5308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48468
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License Number State | CA
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