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General NPI Number Information
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NPI Number | 1962269324
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Entity Type | Individual
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Provider Name | GYUHA JANG
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Gender | Male
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 188 LONGWOOD AVE
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City | BOSTON
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State | MA
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Zip | 02115-5888
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Country | US
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Telephone | 617-432-1434
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Fax | 617-432-4258
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Provider Business Mailing Address
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Address Line | 26460 FIELDSTONE DR
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City | NOVI
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State | MI
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Zip | 48374-2153
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Country | US
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Telephone | 248-595-9767
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN10000148
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License Number State | MA
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