Provider Demographics
NPI:1841306719
Name:JANG, JOHN J (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:JANG
Suffix:
Gender:M
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:PO BOX 12972
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0033
Mailing Address - Country:US
Mailing Address - Phone:623-388-1926
Mailing Address - Fax:
Practice Address - Street 1:1851 W HAVASU WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5474
Practice Address - Country:US
Practice Address - Phone:623-388-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist