Provider Demographics
NPI:1902256464
Name:JANG BOO CHI MD PC
Entity Type:Organization
Organization Name:JANG BOO CHI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JANG
Authorized Official - Middle Name:BOO
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-252-6890
Mailing Address - Street 1:143 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1852
Mailing Address - Country:US
Mailing Address - Phone:315-252-6890
Mailing Address - Fax:
Practice Address - Street 1:143 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1852
Practice Address - Country:US
Practice Address - Phone:315-252-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty