Healthcare Provider Details

I. General information

NPI: 1588862528
Provider Name (Legal Business Name): KRISTEL LYNN DANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 BARRANCA PKWY., STE. 200
IRVINE CA
92604
US

IV. Provider business mailing address

4050 BARRANCA PKWY., STE. 200
IRVINE CA
92604
US

V. Phone/Fax

Practice location:
  • Phone: 949-559-1911
  • Fax: 949-559-4071
Mailing address:
  • Phone: 949-559-1911
  • Fax: 949-559-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17763
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number17763
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number676160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: