Provider Demographics
NPI:1508323460
Name:EDWARD JANG DDS INC
Entity Type:Organization
Organization Name:EDWARD JANG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-724-8555
Mailing Address - Street 1:2000 APPIAN WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2525
Mailing Address - Country:US
Mailing Address - Phone:510-724-8555
Mailing Address - Fax:510-724-3555
Practice Address - Street 1:2000 APPIAN WAY STE 201
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2525
Practice Address - Country:US
Practice Address - Phone:510-724-8555
Practice Address - Fax:510-724-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental