Individual
ALEXANDER KISAM JHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4534 PRECISSI LN STE A, STOCKTON, CA 95207-6213
(209) 957-8940
(209) 957-7990
Mailing address
4141 POPPLETON WAY, CARMICHAEL, CA 95608-1981
(916) 205-7074
(916) 944-4126
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
42664
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013553
DELTA CARE PMI
CA
01
—
42664
CALIFORNIA LICENSE
CA
01
—
B42664-02
HEALTHY FAMILY PROGRAM
CA
01
—
G93605-01
DENTI-CAL PROVIDER NUMBER
CA
Enumeration date
03/08/2007
Last updated
09/09/2015
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