Provider Demographics
NPI:1477648012
Name:JANG, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:JANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MEDICAL CTR. BLVD.
Mailing Address - Street 2:PEDIATRIC ER
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1554
Mailing Address - Fax:504-349-1579
Practice Address - Street 1:1101 MEDICAL CTR. BLVD.
Practice Address - Street 2:PEDIATRIC ER
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-1554
Practice Address - Fax:504-349-1579
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC28497208000000X
LA025790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1047040Medicaid
FL278312600Medicaid
FL278312600Medicaid