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General NPI Number Information
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NPI Number | 1346736816
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Entity Type | Organization
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Legal Business Name | QUOC DANG DO LLC
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Dates
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Enumeration Date | 07/07/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 3475 SHERIDAN ST STE 201
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3659
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Country | US
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Telephone | 786-209-3451
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Fax | 786-431-2509
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Provider Business Mailing Address
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Address Line | 1521 ALTON RD STE 729
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3301
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Country | US
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Telephone | 786-209-3451
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Fax | 786-431-2509
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MR. QUOC BAO NHU DANG
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Credential | D.O.
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Telephone | 786-832-4487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS14038
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License Number State | FL
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