Provider Demographics
NPI:1114278439
Name:JANG, JAEPHIL (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JAEPHIL
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26931 CIRCLE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1055
Mailing Address - Country:US
Mailing Address - Phone:213-841-1790
Mailing Address - Fax:
Practice Address - Street 1:26931 CIRCLE VERDE DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-1055
Practice Address - Country:US
Practice Address - Phone:213-841-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist