Provider Demographics
NPI:1780017632
Name:JANG, ELISHA BONNY ENG (NP, GNP-BC)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:BONNY ENG
Last Name:JANG
Suffix:
Gender:F
Credentials:NP, GNP-BC
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:BONNY
Other - Last Name:ENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, GNP-BC
Mailing Address - Street 1:299 STOCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2763
Mailing Address - Country:US
Mailing Address - Phone:408-535-4600
Mailing Address - Fax:408-535-4661
Practice Address - Street 1:299 STOCKTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2763
Practice Address - Country:US
Practice Address - Phone:408-535-4600
Practice Address - Fax:408-535-4661
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23355363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology