Healthcare Provider Details

I. General information

NPI: 1215517370
Provider Name (Legal Business Name): JOHNNY VAN DANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 ANNAPOLIS RD STE 100
ODENTON MD
21113-1622
US

IV. Provider business mailing address

1130 ANNAPOLIS RD STE 100
ODENTON MD
21113-1622
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-2255
  • Fax:
Mailing address:
  • Phone: 410-672-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberH0103263
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: