MEDICARE: DR. KIM BAO DANG D.D.S

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	1223G0001X	General Practice Dentistry	35706	CA

General Provider Information

NPI Number	:	1184637266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM BAO DANG D.D.S

Provider Business Mailing Address
First Line	:	6688 CRESTWOOD DR
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94552-5233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 VAN NESS AVE
Second Line	:	SUITE 203
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3023
Country	:	US
Telephone Number	:	415-885-0900
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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