MEDICARE: DA SOM JANG DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	041457288	IL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209026698	IL

General Provider Information

NPI Number	:	1477261089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DA SOM JANG DNP

Provider Business Mailing Address
First Line	:	3023 N CLARK ST STE 593
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5200
Country	:	US
Telephone Number	:	312-926-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 CHICAGO AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4727
Country	:	US
Telephone Number	:	847-328-6503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2022
Last Update Date	:	12/17/2025

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