Provider Demographics
NPI:1588962823
Name:JANG, DONGSUK (LAC)
Entity type:Individual
Prefix:
First Name:DONGSUK
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E RAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1669
Mailing Address - Country:US
Mailing Address - Phone:480-855-1734
Mailing Address - Fax:480-841-6571
Practice Address - Street 1:1025 E RAY RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1669
Practice Address - Country:US
Practice Address - Phone:480-855-1734
Practice Address - Fax:480-841-6571
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC010742171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist