Provider Demographics
NPI:1588110043
Name:CJ C JANG
Entity type:Organization
Organization Name:CJ C JANG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CJ
Authorized Official - Middle Name:CHANG-TAE
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-858-6070
Mailing Address - Street 1:7901 SKANSIE AVE
Mailing Address - Street 2:STE 245
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8349
Mailing Address - Country:US
Mailing Address - Phone:253-858-6070
Mailing Address - Fax:253-858-6081
Practice Address - Street 1:7901 SKANSIE AVE
Practice Address - Street 2:STE 245
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8349
Practice Address - Country:US
Practice Address - Phone:253-858-6070
Practice Address - Fax:253-858-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment