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General NPI Number Information
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NPI Number | 1760949671
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Entity Type | Individual
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Provider Name | JAE AN
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Gender | Male
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 65 JEFFERSON AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201-2474
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Country | US
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Telephone | 908-469-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 65 JEFFERSON AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201-2474
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Country | US
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Telephone | 908-469-9100
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02811400
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License Number State | NJ
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