Individual provider Active NPI

Jung Ho Jang, DC, LAC

  • Chiropractor
  • Lynnwood, WA
National Provider Identifier
1710037874
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00034706 Issued in WA
Practice address
2122 164TH St SW
Ste 203
Lynnwood, WA 98087-7811
Phone
(425) 245-7122
Fax
(888) 741-1274
NPI assigned
Jan 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC60506236 WA
Chiropractor 111N00000X CH00034706 WA Primary

Addresses

Primary practice location

2122 164TH St SW
Ste 203
Lynnwood, WA 98087-7811

Mailing address

2122 164TH St SW
Ste 203
Lynnwood, WA 98087-7811
Phone (425) 245-7122

Other practice location 1

7404 Evergreen Way Ste A
Everett, WA 98203-5683
Phone (425) 382-2188

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070806000472 WA Practitioner - Chiropractic 8224129226 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2122 164TH St SW
Suite 203
Lynnwood, WA 98087-7811
Phone (425) 245-7122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AC60506236WAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
First Choice Health Center,Inc. Chiropractor CurrentSince Sep 6, 2016 Accepting new patients
First Choice Health Center Chiropractor Current Accepting new patients
Zimmerman Chiropractic PS Chiropractor Past Accepting new patients
MC3 Enterprises LLC Chiropractor PastSince Jun 7, 2020 Accepting new patients

Locations

7404 Evergreen Way
Ste A
Everett, WA 98203
Phone (425) 382-2188

3333 184th St SW
Ste R
Lynnwood, WA 98037
Phone (425) 467-0150

2122 164th St SW
Ste 203
Lynnwood, WA 98087
Phone (425) 245-7122

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1710037874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 164TH ST SW",
            "address_2": "STE 203",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980877811",
            "telephone_number": "425-245-7122",
            "fax_number": "888-741-1274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 164TH ST SW",
            "address_2": "STE 203",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980877811",
            "telephone_number": "425-245-7122",
            "fax_number": "888-741-1274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7404 Evergreen Way Ste A",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982035683",
            "country_code": "US",
            "telephone_number": "425-382-2188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JANG",
        "first_name": "JUNG HO",
        "credential": "DC, LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "WA",
            "license": "AC60506236",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.