Provider Demographics
NPI:1003231986
Name:BANG, JORGEN (HIS)
Entity Type:Individual
Prefix:
First Name:JORGEN
Middle Name:
Last Name:BANG
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 E BROADWAY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6132
Mailing Address - Country:US
Mailing Address - Phone:509-924-3459
Mailing Address - Fax:509-934-3692
Practice Address - Street 1:12211 E BROADWAY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6132
Practice Address - Country:US
Practice Address - Phone:509-924-3459
Practice Address - Fax:509-934-3692
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60334513237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist