Provider Demographics
NPI:1851280135
Name:JANG, JISOO (PA-S)
Entity type:Individual
Prefix:
First Name:JISOO
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7361 CALHOUN PL STE 600
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2788
Mailing Address - Country:US
Mailing Address - Phone:301-942-7600
Mailing Address - Fax:
Practice Address - Street 1:14995 SHADY GROVE RD STE 500
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:301-942-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110011070207RR0500X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology