Healthcare Provider Details

I. General information

NPI: 1760872188
Provider Name (Legal Business Name): KIM ANN VO DANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2015
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR STE 500
LA MESA CA
91942-3033
US

IV. Provider business mailing address

8851 CENTER DR STE 500
LA MESA CA
91942-3033
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-5757
  • Fax:
Mailing address:
  • Phone: 619-740-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number008202
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA159626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: