Provider Demographics
NPI:1982179537
Name:JANG, HANSUNG (LAC)
Entity Type:Individual
Prefix:MR
First Name:HANSUNG
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:HANSUNG
Other - Middle Name:
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1862 E FIR AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2727
Mailing Address - Country:US
Mailing Address - Phone:559-904-1181
Mailing Address - Fax:
Practice Address - Street 1:200 W BULLARD AVE STE B1
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0857
Practice Address - Country:US
Practice Address - Phone:559-904-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18199171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist