Healthcare Provider Details

I. General information

NPI: 1275513939
Provider Name (Legal Business Name): PETER D DANG DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15038 IMPERIAL HIGHWAY
LA MIRADA CA
90638
US

IV. Provider business mailing address

15038 IMPERIAL HIGHWAY
LA MIRADA CA
90638
US

V. Phone/Fax

Practice location:
  • Phone: 562-947-8200
  • Fax: 562-947-8233
Mailing address:
  • Phone: 562-947-8200
  • Fax: 562-947-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4378
License Number StateCA

VIII. Authorized Official

Name: DR. PETER DAI DANG
Title or Position: PRESIDENT
Credential: DPM
Phone: 562-947-8200