Provider Demographics
NPI:1750624375
Name:JANG, KRISTINE HANNI (DO)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:HANNI
Last Name:JANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF MEDICINE
Mailing Address - Street 2:HSC LEVEL 16, 020 SUNY STONY BROOK
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8160
Mailing Address - Country:US
Mailing Address - Phone:631-444-7411
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:DEPARTMENT OF MEDICINE
Practice Address - Street 2:HSC LEVEL 16, 020 SUNY STONY BROOK
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program