Healthcare Provider Details

I. General information

NPI: 1578614103
Provider Name (Legal Business Name): DENNIS J BANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 S HARVARD BLVD
LOS ANGELES CA
90005-2513
US

IV. Provider business mailing address

691 S HARVARD BLVD
LOS ANGELES CA
90005-2513
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-5388
  • Fax: 475-313-1265
Mailing address:
  • Phone: 213-235-5388
  • Fax: 475-313-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA60220
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA60220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: