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General NPI Number Information
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NPI Number | 1659038503
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Entity Type | Organization
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Legal Business Name | JAE Y JANG DMD LLC
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 9601 BLACKWELL RD STE 310
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City | ROCKVILLE
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State | MD
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Zip | 20850-3472
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Country | US
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Telephone | 240-428-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 7710 WOODMONT AVE APT 1208
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City | BETHESDA
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State | MD
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Zip | 20814-6090
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAE YEON JANG
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Credential | DMD
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Telephone | 240-428-7311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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