Provider Demographics
NPI:1437670957
Name:JANG, YOON JI (DDS)
Entity Type:Individual
Prefix:
First Name:YOON JI
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 LEXINGTON ST, STE 204
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02466
Mailing Address - Country:US
Mailing Address - Phone:617-244-5020
Mailing Address - Fax:617-630-1778
Practice Address - Street 1:73 LEXINGTON ST, STE 204
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02466
Practice Address - Country:US
Practice Address - Phone:617-244-5020
Practice Address - Fax:617-630-1778
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18576831223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice