Provider Demographics
NPI:1164547543
Name:JANG, ANNA SUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:SUN
Last Name:JANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:SUN
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:21648 N GERALDINE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3334
Mailing Address - Country:US
Mailing Address - Phone:623-388-1924
Mailing Address - Fax:602-978-9252
Practice Address - Street 1:4025 W BELL RD STE 14
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2749
Practice Address - Country:US
Practice Address - Phone:602-978-3500
Practice Address - Fax:602-978-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice