Provider Demographics
NPI:1851313761
Name:D'JANG, DOUGLAS R (PA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:D'JANG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 PORT OF TACOMA RD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98421-3707
Mailing Address - Country:US
Mailing Address - Phone:253-274-5521
Mailing Address - Fax:206-763-5241
Practice Address - Street 1:1930 PORT OF TACOMA RD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98421-3707
Practice Address - Country:US
Practice Address - Phone:253-274-5521
Practice Address - Fax:206-763-5241
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
WAPA10003479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2009627Medicaid