Provider Demographics
NPI:1073800157
Name:JANG, MARY I (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:JANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:IN
Other - Middle Name:K
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1251 HEULU ST
Mailing Address - Street 2:#306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3084
Mailing Address - Country:US
Mailing Address - Phone:808-386-7230
Mailing Address - Fax:
Practice Address - Street 1:1451 S KING ST
Practice Address - Street 2:SUITE 402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2506
Practice Address - Country:US
Practice Address - Phone:808-941-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN1042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily