Provider Demographics
NPI:1750306718
Name:JANG, CATHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:J
Last Name:JANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 COWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6325
Mailing Address - Country:US
Mailing Address - Phone:530-757-4116
Mailing Address - Fax:
Practice Address - Street 1:1321 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5131
Practice Address - Country:US
Practice Address - Phone:530-666-1631
Practice Address - Fax:530-661-2410
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81225207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA812250OtherBLUE SHIELD
CAP00052547OtherRR MEDICARE
CA00A812250Medicaid
H91685Medicare UPIN
CA00A812250Medicaid