Provider Demographics
NPI:1710396908
Name:KENNETH JANG DDS, INC.
Entity Type:Organization
Organization Name:KENNETH JANG DDS, INC.
Other - Org Name:LA CONTENTA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-553-8390
Mailing Address - Street 1:8228 CRYSTAL WALK CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8081
Mailing Address - Country:US
Mailing Address - Phone:909-553-8390
Mailing Address - Fax:
Practice Address - Street 1:1919 VISTA DEL LAGO DR
Practice Address - Street 2:#11
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-9294
Practice Address - Country:US
Practice Address - Phone:209-772-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty