MEDICARE: KODY DANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA65287	CA
2	363A00000X	Physician Assistant	PA65287	CA

General Provider Information

NPI Number	:	1518703420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KODY DANG

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:	424-522-7100
Fax Number	:	424-522-7234

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2006
Country	:	US
Telephone Number	:	424-522-7234
Fax Number	:	424-522-7234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	02/03/2026

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Directions to “ KODY DANG ” Practice Location

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