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1548605983

NPI Code Detail

MEDICARE: DR. DAN L. PONG MD

MEDICARE: DR. DAN L. PONG MD

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	2085R0202X	Diagnostic Radiology Physician	R4455	TX
2	2085N0700X	Neuroradiology Physician	R4455	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548605983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN L. PONG MD

Provider Business Mailing Address
First Line	:	1820 PRESTON PARK BLVD STE 2400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3716
Country	:	US
Telephone Number	:	972-867-7862
Fax Number	:	972-612-1623

Provider Business Practice Location Address
First Line	:	1820 PRESTON PARK BLVD STE 2400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3716
Country	:	US
Telephone Number	:	972-867-7862
Fax Number	:	972-612-1623

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	05/21/2026

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Directions to “ DR. DAN L. PONG MD” Practice Location

Language	Start Address	Practice Location

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