Active NPI
Douglas R D'Jang, PA
- Physician Assistant
- Tacoma, WA
National Provider Identifier
1851313761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10003479
- Practice address
- 1930 Port of Tacoma Rd
Tacoma, WA 98421-3707 - Phone
- (253) 274-5521
- Fax
- (206) 763-5241
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | |||
| Physician Assistant | 363A00000X | PA10003479 | WA | Primary |
Addresses
Primary practice location
1930 Port of Tacoma Rd
Tacoma, WA 98421-3707
Mailing address
1930 Port of Tacoma Rd
Tacoma, WA 98421-3707
Phone (253) 274-5521
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2009627 | Medicaid | WA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ddjang44445@fhsce.catholichealth.net | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10003479 | WA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606867200000",
"number": "1851313761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 PORT OF TACOMA RD",
"city": "TACOMA",
"state": "WA",
"postal_code": "984213707",
"telephone_number": "253-274-5521",
"fax_number": "206-763-5241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1930 PORT OF TACOMA RD",
"city": "TACOMA",
"state": "WA",
"postal_code": "984213707",
"telephone_number": "253-274-5521",
"fax_number": "206-763-5241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "D'JANG",
"first_name": "DOUGLAS",
"middle_name": "R",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2020-12-02",
"certification_date": "2020-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10003479",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2009627",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ddjang44445@fhsce.catholichealth.net",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1930 Port Of Tacoma Rd",
"city": "Tacoma",
"state": "WA",
"country_code": "US",
"postal_code": "984213707",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; 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.