MEDICARE: MICHAEL DANG

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	183500000X	Pharmacist	61246	CA

General Provider Information

NPI Number	:	1528491818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DANG

Provider Business Mailing Address
First Line	:	17332 APEL LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4662
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3029 HARBOR BLVD
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2504
Country	:	US
Telephone Number	:	714-434-7485
Fax Number	:	714-434-2862

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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