Provider Demographics
NPI:1255474946
Name:E. JANG DENTAL CORPORATION
Entity Type:Organization
Organization Name:E. JANG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUN
Authorized Official - Middle Name:SUB
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-823-5308
Mailing Address - Street 1:7138 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4306
Mailing Address - Country:US
Mailing Address - Phone:707-823-5308
Mailing Address - Fax:707-823-5256
Practice Address - Street 1:7138 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4306
Practice Address - Country:US
Practice Address - Phone:707-823-5308
Practice Address - Fax:707-823-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty