Provider Demographics
NPI:1063582997
Name:KING JANG & STRAFACE MDS
Entity type:Organization
Organization Name:KING JANG & STRAFACE MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-372-7374
Mailing Address - Street 1:757 PACIFIC ST
Mailing Address - Street 2:D2 D3
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2819
Mailing Address - Country:US
Mailing Address - Phone:831-372-7374
Mailing Address - Fax:
Practice Address - Street 1:757 PACIFIC ST
Practice Address - Street 2:D2 D3
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2819
Practice Address - Country:US
Practice Address - Phone:831-372-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
YYY49877YMedicare ID - Type Unspecified