Provider Demographics
NPI:1275730186
Name:JANG, ALLISON YOUNGAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:YOUNGAH
Last Name:JANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WESTERVELT AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2546
Mailing Address - Country:US
Mailing Address - Phone:734-709-7722
Mailing Address - Fax:
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:734-709-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019646122300000X
NJ22DI02553200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1275730186Medicaid
MI5198971Medicaid
MI5198990Medicaid