Provider Demographics
NPI:1477613115
Name:JANG, LAUREEN LINDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREEN
Middle Name:LINDA
Last Name:JANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:LAUREEN
Other - Middle Name:J
Other - Last Name:HORI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NA
Mailing Address - Street 1:20 CRESTVIEW COURT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-2139
Mailing Address - Country:US
Mailing Address - Phone:925-947-1485
Mailing Address - Fax:
Practice Address - Street 1:SAN QUENTIN
Practice Address - Street 2:
Practice Address - City:SAN QUENTIN
Practice Address - State:CA
Practice Address - Zip Code:94964
Practice Address - Country:US
Practice Address - Phone:415-454-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice