MEDICARE: PHUC DANG, MD CORPORATION

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	207XS0106X	Orthopaedic Hand Surgery Physician	A117592	CA

General Provider Information

NPI Number	:	1477906717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHUC DANG, MD CORPORATION

Provider Business Mailing Address
First Line	:	300 OLD RIVER RD
Second Line	:	SUITE 200
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-9503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 MISSION DR APT A
Second Line	:	SUITE 200
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4217
Country	:	US
Telephone Number	:	714-442-5052
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PHUC N DANG
Credential	:
Telephone Number	:	714-442-5052

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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