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General NPI Number Information
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NPI Number | 1710396908
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Entity Type | Organization
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Legal Business Name | KENNETH JANG DDS, INC.
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 1919 VISTA DEL LAGO DR #11
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City | VALLEY SPRINGS
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State | CA
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Zip | 95252-9294
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Country | US
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Telephone | 209-772-0375
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Fax |
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Provider Business Mailing Address
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Address Line | 8228 CRYSTAL WALK CIR
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City | ELK GROVE
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State | CA
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Zip | 95758-8081
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Country | US
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Telephone | 909-553-8390
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH JANG
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Credential | D.D.S.
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Telephone | 909-553-8390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60901
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License Number State | CA
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