Provider Demographics
NPI:1366762916
Name:JANG, INSOON (RPH)
Entity type:Individual
Prefix:
First Name:INSOON
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11496 N VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-4195
Mailing Address - Country:US
Mailing Address - Phone:805-646-6697
Mailing Address - Fax:805-646-0627
Practice Address - Street 1:11496 N VENTURA AVE
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-4195
Practice Address - Country:US
Practice Address - Phone:805-646-6697
Practice Address - Fax:805-646-0627
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist