Provider Demographics
NPI:1750807822
Name:JANG, DEBBIE (DMD)
Entity type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 COLUMBIA ST APT 1002
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3470
Mailing Address - Country:US
Mailing Address - Phone:702-956-1738
Mailing Address - Fax:
Practice Address - Street 1:2484 VISTA WAY STE B
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5682
Practice Address - Country:US
Practice Address - Phone:760-439-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6950122300000X
NY0617501223X0400X
CA1074241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist