Provider Demographics
NPI:1184030413
Name:JANG, EMMELINE (OD)
Entity Type:Individual
Prefix:
First Name:EMMELINE
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7197 VILLAGE PKWY
Mailing Address - Street 2:STE D
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2411
Mailing Address - Country:US
Mailing Address - Phone:925-828-9511
Mailing Address - Fax:
Practice Address - Street 1:103 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3902
Practice Address - Country:US
Practice Address - Phone:718-358-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33897152W00000X
NYTUV008182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist