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General NPI Number Information
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NPI Number | 1396239745
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Entity Type | Individual
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Provider Name | SOO JI JANG AUD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 2100 W 3RD ST STE 111
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City | LOS ANGELES
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State | CA
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Zip | 90057-1999
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Country | US
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Telephone | 213-483-9930
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | ARTESIA
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State | CA
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Zip | 90702-0312
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Country | US
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Telephone | 562-483-9473
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU3299
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License Number State | CA
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