Provider Demographics
NPI:1740932854
Name:JANG, DANIELLE HANNA (LAC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:HANNA
Last Name:JANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28426 KLONDIKE DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1165
Mailing Address - Country:US
Mailing Address - Phone:949-237-2103
Mailing Address - Fax:949-377-3712
Practice Address - Street 1:4482 BARRANCA PKWY STE 248
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4770
Practice Address - Country:US
Practice Address - Phone:949-237-2103
Practice Address - Fax:949-377-3712
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist