Provider Demographics
NPI:1912070251
Name:YSD & J DMD PC
Entity Type:Organization
Organization Name:YSD & J DMD PC
Other - Org Name:DR JANG'S DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESITENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:S
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-205-1661
Mailing Address - Street 1:1135 W. CHELTENHAM AVE.
Mailing Address - Street 2:103
Mailing Address - City:MELROSE PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027
Mailing Address - Country:US
Mailing Address - Phone:215-782-1606
Mailing Address - Fax:215-782-1605
Practice Address - Street 1:1135 W CHELTENHAM AVE
Practice Address - Street 2:103
Practice Address - City:MELROSE PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3008
Practice Address - Country:US
Practice Address - Phone:215-782-1606
Practice Address - Fax:215-782-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030832L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty