Provider Demographics
NPI:1790039709
Name:JANG, GRAY DEUKSHIN (OMD , LAC)
Entity type:Individual
Prefix:DR
First Name:GRAY
Middle Name:DEUKSHIN
Last Name:JANG
Suffix:
Gender:M
Credentials:OMD , LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3111
Mailing Address - Country:US
Mailing Address - Phone:626-202-7787
Mailing Address - Fax:
Practice Address - Street 1:2727 WEST 6TH STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:626-202-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11847171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist