Provider Demographics
NPI:1396830071
Name:BANG, JENNIFER K (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:BANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4235 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5047
Mailing Address - Country:US
Mailing Address - Phone:214-750-5100
Mailing Address - Fax:214-750-4500
Practice Address - Street 1:4235 W NORTHWEST HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-5047
Practice Address - Country:US
Practice Address - Phone:214-750-5100
Practice Address - Fax:214-750-4500
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AD156OtherBC/BS
TX186633703Medicaid
TX186633703Medicaid