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General NPI Number Information
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NPI Number | 1710451711
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Entity Type | Individual
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Provider Name | MR. JONATHAN DANG
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Gender | Male
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 4929 WILSHIRE BLVD STE 245
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City | LOS ANGELES
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State | CA
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Zip | 90010-3859
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Country | US
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Telephone | 323-743-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 10439 SCHMIDT RD
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City | SOUTH EL MONTE
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State | CA
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Zip | 91733-2161
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Country | US
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Telephone | 626-371-3916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 120325
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License Number State | CA
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