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General NPI Number Information
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NPI Number | 1972170405
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Entity Type | Individual
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Provider Name | KAYLA ASHLEY JANG DMD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 27045 E UNIVERSITY DR STE 2A
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City | AUBREY
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State | TX
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Zip | 76227-2746
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Country | US
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Telephone | 469-277-1787
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 NEWPORT DR
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City | ROLLING MEADOWS
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State | IL
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Zip | 60008-3801
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Country | US
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Telephone | 224-636-2223
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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 | 019.033262
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 39453
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License Number State | TX
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