Provider Demographics
NPI:1851480479
Name:JANG, M. CATARINA (OD)
Entity Type:Individual
Prefix:DR
First Name:M. CATARINA
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CATARINA
Other - Middle Name:M
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:703 PIER AVE
Mailing Address - Street 2:STE C
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3958
Mailing Address - Country:US
Mailing Address - Phone:917-796-4024
Mailing Address - Fax:
Practice Address - Street 1:703 PIER AVE
Practice Address - Street 2:STE C
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3958
Practice Address - Country:US
Practice Address - Phone:917-796-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005981152WC0802X
CA13814T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02144085Medicaid
NY02144085Medicaid
NYU74693Medicare UPIN