Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 86035 | CA |
NPI | 1346786944 |
---|---|
Provider Name | Daye Jang |
First Address | Garden Grove, CA 92841 |
Second Address | Garden Grove, CA 92841-2718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2017 |
Last Update Date | 17/03/2018 |