Healthcare Provider Details

I. General information

NPI: 1477906717
Provider Name (Legal Business Name): PHUC DANG, MD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 MISSION DR APT A SUITE 200
COSTA MESA CA
92626-4217
US

IV. Provider business mailing address

300 OLD RIVER RD SUITE 200
BAKERSFIELD CA
93311-9503
US

V. Phone/Fax

Practice location:
  • Phone: 714-442-5052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA117592
License Number StateCA

VIII. Authorized Official

Name: PHUC N DANG
Title or Position: PRESIDENT
Credential:
Phone: 714-442-5052