Individual provider Active NPI

Jane L Lang, DDS

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1639299175
Registry record updated Jan 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019027084 Issued in IL
Practice address
4801 W Peterson Ave
Suite #212
Chicago, IL 60646-5713
Phone
(773) 481-5906
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019027084 IL Primary

Addresses

Primary practice location

4801 W Peterson Ave
Suite #212
Chicago, IL 60646-5713

Mailing address

4801 W Peterson Ave
Suite #212
Chicago, IL 60646-5713
Phone (773) 481-5906

Other identifiers 1

IdentifierTypeStateIssuer
9184160MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20170105002122 IL Order and Referring Only - DentistPractitioner - Dentist 7113208109

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019027084ILMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421884800000",
    "number": "1639299175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE",
            "address_2": "SUITE #212",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465713",
            "telephone_number": "773-481-5906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE",
            "address_2": "SUITE #212",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465713",
            "telephone_number": "773-481-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANG",
        "first_name": "JANE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2015-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9184160",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.