Provider Demographics
NPI:1588847503
Name:JANG, WOOHYUN VERONICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:WOOHYUN
Middle Name:VERONICA
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 1:14220 FRANKLIN AVE
Mailing Address - Street 2:#LD
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2640
Mailing Address - Country:US
Mailing Address - Phone:718-762-2022
Mailing Address - Fax:718-762-2022
Practice Address - Street 1:14220 FRANKLIN AVE
Practice Address - Street 2:#LD
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2640
Practice Address - Country:US
Practice Address - Phone:718-762-2022
Practice Address - Fax:718-762-2022
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0433031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01384454Medicaid