Kenny Young Jang, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

46613 Issued in CA

Practice address

1657 W Orangethorpe Ave
Fullerton, CA 92833-4535

Phone

(714) 626-0288

Fax

(714) 626-0298

NPI assigned

Mar 29, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kenny Jang, DDS

  • Dentist
  • Fullerton, CA
  • NPI 1184964033
  NPD (past) Authorized official
• Bryan H Chung DMD Ms Inc

  • Dentist
  • Fullerton, CA
  • NPI 1033840582
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1467572230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1657 W. ORANGETHORPE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92933",
            "telephone_number": "714-626-0288",
            "fax_number": "714-626-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1657 W ORANGETHORPE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334535",
            "telephone_number": "714-626-0288",
            "fax_number": "714-626-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANG",
        "first_name": "KENNY",
        "middle_name": "YOUNG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "46613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Chou DDS Dental Group of Fullerton Inc
• James N Berbos Dba Fullerton Eye Center Optical
• James Park DDS, Inc.
• Kristen James
• Maggie Jan
• Nicole Grace Jang
• Sarah Wonhee Jang
• Seokwon Jang, DDS
• Sojung Jang, DDS
• Destiny Jara, MS, OTR/L

• All providers in Fullerton, CA
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.