MEDICARE: MR. JONATHAN 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	106H00000X	Marriage & Family Therapist	120325	CA

General Provider Information

NPI Number	:	1710451711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN DANG

Provider Business Mailing Address
First Line	:	10439 SCHMIDT RD
Second Line	:
City	:	SOUTH EL MONTE
State	:	CA
Zip	:	91733-2161
Country	:	US
Telephone Number	:	626-371-3916
Fax Number	:

Provider Business Practice Location Address
First Line	:	4929 WILSHIRE BLVD STE 245
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3859
Country	:	US
Telephone Number	:	323-743-1122
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	02/28/2022

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