Provider Demographics
NPI:1265960280
Name:JANG, JANET (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040A JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS-MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98432
Mailing Address - Country:US
Mailing Address - Phone:253-968-0257
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5001
Practice Address - Country:US
Practice Address - Phone:253-968-0257
Practice Address - Fax:253-968-5294
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 171000000X
NE312012080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherMEDICARE UPIN