MEDICARE: JENNIFER DANG OD

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	152W00000X	Optometrist	35441	CA

General Provider Information

NPI Number	:	1811688211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DANG OD

Provider Business Mailing Address
First Line	:	10511 KETCH AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-5162
Country	:	US
Telephone Number	:	714-489-1787
Fax Number	:

Provider Business Practice Location Address
First Line	:	7855 KEW AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-8801
Country	:	US
Telephone Number	:	909-463-5732
Fax Number	:

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

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	05/24/2023

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