Provider Demographics
NPI:1336638618
Name:JANG, HYUN SOO (MD)
Entity Type:Individual
Prefix:DR
First Name:HYUN SOO
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1251
Mailing Address - Country:US
Mailing Address - Phone:541-756-2584
Mailing Address - Fax:541-756-5783
Practice Address - Street 1:3585 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1251
Practice Address - Country:US
Practice Address - Phone:541-756-2584
Practice Address - Fax:541-756-5783
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR76660207W00000X
ORMD209427207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORFJ1568419OtherDEA