Provider Demographics
NPI:1972170405
Name:JANG, KAYLA ASHLEY (DMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ASHLEY
Last Name:JANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3801
Mailing Address - Country:US
Mailing Address - Phone:224-636-2223
Mailing Address - Fax:
Practice Address - Street 1:27045 E UNIVERSITY DR STE 2A
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-2746
Practice Address - Country:US
Practice Address - Phone:469-277-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0332621223G0001X
TX394531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice