Individual provider · NPI-1

Jason Bahng, DPM

Podiatrist, Foot & Ankle Surgery · Roseville, CA

NPI number1649835562
StatusActive
Last updated in NPPESNov 6, 2024

Details

NPI
1649835562
Entity type
Individual (NPI-1)
Name
Jason Bahng
Credential
DPM
Sex
Male
Sole proprietor
No
Enumeration date
May 6, 2019
Certification date
Nov 6, 2024
Last updated
Nov 6, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
213ES0103X Podiatrist, Foot & Ankle SurgeryE6087CAYes
213ES0103X Podiatrist, Foot & Ankle SurgeryT49-2021TX
213ES0103X Podiatrist, Foot & Ankle Surgery3160TX

Practice location

1650 Lead Hill Blvd Ste 100
Roseville, CA 95661-3072

Phone 832-376-8600

Mailing address

1650 Lead Hill Blvd Ste 100
Roseville, CA 95661-3072

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