Provider Demographics
NPI:1033308432
Name:JANG, DONG KYU (L AC)
Entity Type:Individual
Prefix:
First Name:DONG KYU
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4318
Mailing Address - Country:US
Mailing Address - Phone:972-444-0660
Mailing Address - Fax:972-444-0660
Practice Address - Street 1:8350 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 177
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4318
Practice Address - Country:US
Practice Address - Phone:972-444-0660
Practice Address - Fax:972-444-0660
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11058171100000X
TX01085171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01085OtherACUPUNCTURE LICENSE