Provider Demographics
NPI:1043231632
Name:DOAN, DOMINIQUE GIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:GIA
Last Name:DOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DOMINIQUE
Other - Middle Name:GIA
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:323 W VALLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3726
Mailing Address - Country:US
Mailing Address - Phone:626-300-0005
Mailing Address - Fax:626-300-9264
Practice Address - Street 1:323 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3726
Practice Address - Country:US
Practice Address - Phone:626-300-0005
Practice Address - Fax:626-300-9264
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38598207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA385980Medicaid
CAF12660Medicare UPIN