Individual provider Active NPI

Gray Deukshin Jang, O.M.D , L.AC.

  • Acupuncturist
  • San Jacinto, CA
National Provider Identifier
1790039709
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
11847 Issued in CA
Practice address
1695 S San Jacinto Ave Ste a-D&F
San Jacinto, CA 92583-5103
Phone
(951) 330-3100
Fax
(951) 350-1050
NPI assigned
Oct 30, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 11847 CA Primary

Addresses

Primary practice location

1695 S San Jacinto Ave Ste a-D&F
San Jacinto, CA 92583-5103

Mailing address

1695 S San Jacinto Ave Ste a-D&F
San Jacinto, CA 92583-5103
Phone (951) 330-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
South Baylo University Acupuncturist Past Accepting new patients
Tobias Moeller-Bertram MD Corporation Past Accepting new patients

Organizations & group practices 2

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": "1351555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1790039709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 S SAN JACINTO AVE STE A-D&F",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835103",
            "telephone_number": "951-330-3100",
            "fax_number": "951-350-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 S SAN JACINTO AVE STE A-D&F",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835103",
            "telephone_number": "951-330-3100",
            "fax_number": "951-350-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANG",
        "first_name": "GRAY",
        "middle_name": "DEUKSHIN",
        "name_prefix": "Dr.",
        "credential": "O.M.D , L.AC.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-30",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "11847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jacinto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.