MEDICARE: KHAM VANG 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	60807	CA

General Provider Information

NPI Number	:	1245511096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHAM VANG D.D.S

Provider Business Mailing Address
First Line	:	PO BOX AD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95992-1396
Country	:	US
Telephone Number	:	530-751-3769
Fax Number	:	530-751-1237

Provider Business Practice Location Address
First Line	:	236 W EAST AVE STE H
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-7239
Country	:	US
Telephone Number	:	530-342-6065
Fax Number	:	530-343-7769

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	10/10/2012

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Directions to “ KHAM VANG D.D.S” Practice Location

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