Healthcare Provider Details

I. General information

NPI: 1255562641
Provider Name (Legal Business Name): BAN DUC DOAN MD INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 WESTMINSTER AVE STE 206
GARDEN GROVE CA
92844-2751
US

IV. Provider business mailing address

9191 WESTMINSTER AVE STE 206
GARDEN GROVE CA
92844-2751
US

V. Phone/Fax

Practice location:
  • Phone: 714-899-2000
  • Fax: 714-583-6336
Mailing address:
  • Phone: 714-899-2000
  • Fax: 714-583-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA43454
License Number StateCA

VIII. Authorized Official

Name: DR. BAN DUC DOAN
Title or Position: M.D.
Credential: M.D
Phone: 714-899-2000