Healthcare Provider Details

I. General information

NPI: 1295360659
Provider Name (Legal Business Name): ANDREW QUAN DONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 J ST STE 200
SACRAMENTO CA
95816-5551
US

IV. Provider business mailing address

3800 J ST STE 200
SACRAMENTO CA
95816-5551
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-8900
  • Fax: 916-454-4359
Mailing address:
  • Phone: 916-453-8900
  • Fax: 916-454-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: