=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558651000
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BINH DANG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2011
-----------------------------------------------------
Last Update Date | 06/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 W 7TH ST
-----------------------------------------------------
City | SAN PEDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90732-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-514-5401
-----------------------------------------------------
Fax | 310-514-4330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21311 MADRONA AVE STE 101
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-5970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A123574
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------