Provider Demographics
NPI:1457424806
Name:JANG, CJ CHANG-TAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CJ
Middle Name:CHANG-TAE
Last Name:JANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 SKANSIE AVE
Mailing Address - Street 2:SUITE #245
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8349
Mailing Address - Country:US
Mailing Address - Phone:253-858-6070
Mailing Address - Fax:
Practice Address - Street 1:7901 SKANSIE AVE
Practice Address - Street 2:SUITE #245
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8349
Practice Address - Country:US
Practice Address - Phone:253-858-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist