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General NPI Number Information
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NPI Number | 1932943354
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Entity Type | Organization
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Legal Business Name | S JANG DDS INCORPORATED
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 5756 PACIFIC AVE STE 75
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City | STOCKTON
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State | CA
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Zip | 95207-5156
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Country | US
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Telephone | 916-221-3116
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Fax |
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Provider Business Mailing Address
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Address Line | 400 PLAZA DR # 120-369
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City | FOLSOM
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State | CA
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Zip | 95630-4744
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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 | ADMIN
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Name | MEGAN CASTILLO
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Credential |
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Telephone | 916-781-6550
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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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