1982179537 NPI number — MR. HANSUNG JANG LA.C

Table of content: MR. HANSUNG JANG LA.C (NPI 1982179537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982179537 NPI number — MR. HANSUNG JANG LA.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANG
Provider First Name:
HANSUNG
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LA.C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JANG
Provider Other First Name:
HANSUNG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982179537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1862 E FIR AVE APT 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-2727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-904-1181
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W BULLARD AVE STE B1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93612-0857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-904-1181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  18199 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)