Provider Demographics
NPI:1659822443
Name:JANG, HYEJU (ANP-BC)
Entity Type:Individual
Prefix:
First Name:HYEJU
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12910 S SENECA RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2170
Mailing Address - Country:US
Mailing Address - Phone:708-586-2530
Mailing Address - Fax:708-448-5505
Practice Address - Street 1:12910 S SENECA RD
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2170
Practice Address - Country:US
Practice Address - Phone:708-586-2530
Practice Address - Fax:708-448-5505
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014349363LA2200X
CA95003935363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health