Provider Demographics
NPI:1669420097
Name:JANG, STEVEN WANGSOO (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WANGSOO
Last Name:JANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:WANGSOO
Other - Middle Name:
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:17410 HIGHWAY 99
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3632
Mailing Address - Country:US
Mailing Address - Phone:425-742-3777
Mailing Address - Fax:425-742-8695
Practice Address - Street 1:17410 HIGHWAY 99
Practice Address - Street 2:SUITE 110
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3632
Practice Address - Country:US
Practice Address - Phone:425-742-3777
Practice Address - Fax:425-742-8695
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032191Medicaid
WA100000125710OtherREGENCE BLUESHIELD
WAMJ1246835OtherDEA REGISTRATION NO.
WAMJ1246835OtherDEA REGISTRATION NO.
WA2032191Medicaid