Provider Demographics
NPI:1790966992
Name:JANG, EDWARD M (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:JANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7872 WALKER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1748
Mailing Address - Country:US
Mailing Address - Phone:714-880-3801
Mailing Address - Fax:714-522-7328
Practice Address - Street 1:7872 WALKER ST STE 100
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1748
Practice Address - Country:US
Practice Address - Phone:714-880-3801
Practice Address - Fax:714-522-7328
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110154851OtherCHAMPUS
CA00A321030Medicaid
CA00A321030Medicaid
CAWA32103JMedicare PIN
CAA84311Medicare UPIN