MEDICARE: DR. LISA H DANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD.207237	LA
2	207W00000X	Ophthalmology Physician	A154089	CA

General Provider Information

NPI Number	:	1083938096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA H DANG M.D.

Provider Business Mailing Address
First Line	:	100 E CALIFORNIA BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3205
Country	:	US
Telephone Number	:	8-898-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 N ROBERTSON BLVD STE 102
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1767
Country	:	US
Telephone Number	:	310-385-3540
Fax Number	:	310-385-3521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	12/02/2021

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