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1790137545 NPI number — ADRIANNA MIRIM JANG DMD

NPI Number: 1790137545
Health Care Provider/Practitioner: ADRIANNA MIRIM JANG DMD

Information about “1790137545” NPI (ADRIANNA MIRIM JANG DMD) exists in 1790137545 in HTML format HTML  |  1790137545 in plain Text format TXT  |  1790137545 in PDF (Portable Document Format) PDF  |  1790137545 in an XML format XML  formats.

NPI Number : 1790137545 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790137545",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JANG",
    "FirstName": "ADRIANNA",
    "MiddleName": "MIRIM",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JANG",
    "OtherFirstName": "MI",
    "OtherMiddleName": "RIM",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DMD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10288 77TH ST",
    "SecondLineMailingAddress": "SUITE 300",
    "MailingAddressCityName": "PLEASANT PRAIRIE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53158-1133",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "262-697-4222",
    "MailingAddressFaxNumber": "262-697-4370",
    "FirstLinePracticeLocationAddress": "10288 77TH ST",
    "SecondLinePracticeLocationAddress": "SUITE 300",
    "PracticeLocationAddressCityName": "PLEASANT PRAIRIE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53158-1133",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-697-4222",
    "PracticeLocationAddressFaxNumber": "262-697-4370",
    "EnumerationDate": "07/05/2016",
    "LastUpdateDate": "07/23/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "1001392",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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