Provider Demographics
NPI:1033347604
Name:DANG, QUYEN NGOC BAO (MD)
Entity Type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:NGOC BAO
Last Name:DANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 W. 15TH ST.
Mailing Address - Street 2:STE A
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7790
Mailing Address - Country:US
Mailing Address - Phone:972-379-2416
Mailing Address - Fax:972-867-1018
Practice Address - Street 1:3809 W. 15TH ST.
Practice Address - Street 2:STE A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7790
Practice Address - Country:US
Practice Address - Phone:972-379-2416
Practice Address - Fax:972-867-1018
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP6803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302247YK00Medicare PIN