Provider Demographics
NPI:1538993423
Name:JANG, SEUNG JIN (DMD)
Entity type:Individual
Prefix:DR
First Name:SEUNG JIN
Middle Name:
Last Name:JANG
Suffix:
Gender:
Credentials:DMD
Other - Prefix:DR
Other - First Name:JAMES SEUNG JIN
Other - Middle Name:
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1804 LENNOX FLATS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1480
Mailing Address - Country:US
Mailing Address - Phone:352-318-7754
Mailing Address - Fax:
Practice Address - Street 1:511 E 3RD ST STE 260
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-2072
Practice Address - Country:US
Practice Address - Phone:484-526-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027665122300000X
FLDN29165122300000X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist