Provider Demographics
NPI:1881927887
Name:JANG, YOUNG SOO I (DMD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:SOO
Last Name:JANG
Suffix:I
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 1:7300 OLD YORK RD
Mailing Address - Street 2:211
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3037
Mailing Address - Country:US
Mailing Address - Phone:215-782-1606
Mailing Address - Fax:215-782-1605
Practice Address - Street 1:7300 OLD YORK RD
Practice Address - Street 2:211
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3037
Practice Address - Country:US
Practice Address - Phone:215-782-1606
Practice Address - Fax:215-782-1605
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030832L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice