=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760934038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL H JANG DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2016
-----------------------------------------------------
Last Update Date | 11/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14711 PRINCETON AVE UNIT-12
-----------------------------------------------------
City | MOORPARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93021-1457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-529-4821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24979 CONSTITUTION AVE UNIT-528
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91381-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-894-6894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | DR. PAUL HO JIN JANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 909-894-6894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 64115
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------