Healthcare Provider Details

I. General information

NPI: 1376699918
Provider Name (Legal Business Name): HUNG DINH DOAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7761 GARDEN GROVE BLVD
GARDEN GROVE CA
92841-4200
US

IV. Provider business mailing address

5970 S CENTRAL AVE
LOS ANGELES CA
90001-1150
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-8888
  • Fax: 714-901-7580
Mailing address:
  • Phone: 323-724-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA45781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: