Healthcare Provider Details

I. General information

NPI: 1932272614
Provider Name (Legal Business Name): PHONG T DANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900A GARDEN GROVE BLVD STE #122
GARDEN GROVE CA
92843-2023
US

IV. Provider business mailing address

PO BOX 775
GARDEN GROVE CA
92842-0775
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-0342
  • Fax: 714-636-0391
Mailing address:
  • Phone: 714-636-0342
  • Fax: 714-636-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG78903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: