Healthcare Provider Details

I. General information

NPI: 1790882678
Provider Name (Legal Business Name): DAVID J. LANG M.D., INC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 SAN MIGUEL DR 206
NEWPORT BEACH CA
92660-7812
US

IV. Provider business mailing address

359 SAN MIGUEL DR 206
NEWPORT BEACH CA
92660-7812
US

V. Phone/Fax

Practice location:
  • Phone: 949-706-2751
  • Fax: 949-706-2761
Mailing address:
  • Phone: 949-706-2751
  • Fax: 949-706-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberG50878
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: