Provider Demographics
NPI:1487236857
Name:JANG, ESTHER
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 DEAN MARTIN DR UNIT 3016
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4246
Mailing Address - Country:US
Mailing Address - Phone:628-226-7402
Mailing Address - Fax:
Practice Address - Street 1:4471 DEAN MARTIN DR UNIT 3106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4246
Practice Address - Country:US
Practice Address - Phone:628-226-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-3891223X0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics