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General NPI Number Information
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NPI Number | 1811688211
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Entity Type | Individual
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Provider Name | JENNIFER DANG OD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 7855 KEW AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8801
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Country | US
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Telephone | 909-463-5732
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Fax |
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Provider Business Mailing Address
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Address Line | 10511 KETCH AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92843-5162
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Country | US
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Telephone | 714-489-1787
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 35441
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License Number State | CA
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