Provider Demographics
NPI:1891136933
Name:GOLEPANG, JAYFERSON MICQUEL ANG (MD)
Entity Type:Individual
Prefix:
First Name:JAYFERSON MICQUEL
Middle Name:ANG
Last Name:GOLEPANG
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 1:82 CLARKSVILLE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8210
Mailing Address - Country:US
Mailing Address - Phone:916-983-8868
Mailing Address - Fax:
Practice Address - Street 1:82 CLARKSVILLE RD STE 120
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8210
Practice Address - Country:US
Practice Address - Phone:916-983-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine