Provider Demographics
NPI:1467572230
Name:JANG, KENNY YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:YOUNG
Last Name:JANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 W. ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92933
Mailing Address - Country:US
Mailing Address - Phone:714-626-0288
Mailing Address - Fax:714-626-0298
Practice Address - Street 1:1657 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4535
Practice Address - Country:US
Practice Address - Phone:714-626-0288
Practice Address - Fax:714-626-0298
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist