Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G059426 | CA |
NPI | 1003857525 |
---|---|
Provider Name | Cheryl Lee Jang |
First Address | South Pasadena, CA 91030-4110 |
Second Address | Glendale, CA 91206-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 12/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E02885 | (02) | CA |