Provider Demographics
NPI:1790040228
Name:CHIANG, JACK C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:C
Last Name:CHIANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 BARRANCA PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4672
Mailing Address - Country:US
Mailing Address - Phone:949-857-1366
Mailing Address - Fax:949-857-2248
Practice Address - Street 1:4920 BARRANCA PKWY STE C
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4672
Practice Address - Country:US
Practice Address - Phone:949-857-1366
Practice Address - Fax:949-857-2248
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1035711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice