Provider Demographics
NPI:1083842470
Name:JANG, JEKYUNG (MT-BC)
Entity Type:Individual
Prefix:
First Name:JEKYUNG
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 N DOBSON RD
Mailing Address - Street 2:APT. 1063
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8705
Mailing Address - Country:US
Mailing Address - Phone:970-372-8498
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD
Practice Address - Street 2:SUITE 307
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3200
Practice Address - Country:US
Practice Address - Phone:602-635-7524
Practice Address - Fax:602-635-4297
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY08896225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist