Provider Demographics
NPI:1316366719
Name:JANG, KIMBERLY (DDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:50 HAVEN AVE
Mailing Address - Street 2:MAILBOX B9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2652
Mailing Address - Country:US
Mailing Address - Phone:216-215-1175
Mailing Address - Fax:
Practice Address - Street 1:16111 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program