Individual
KWANG M JANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7464 N CLARK ST, CHICAGO, IL 60626-1620
(773) 381-8700
(773) 381-8701
Mailing address
7464 N CLARK ST, CHICAGO, IL 60626-1620
(773) 381-8700
(773) 381-8701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036132637
IL
207R00000X
Internal Medicine Physician
125056216
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036132637
IL PERMANENT LICENSE
IL
01
—
125056216
IL STATE LICENSE # 125056216
IL
Enumeration date
08/28/2009
Last updated
09/25/2013
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