Provider Demographics
NPI:1073648861
Name:SANG, IRENE NORA (OD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:NORA
Last Name:SANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:729 MISSION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3072
Mailing Address - Country:US
Mailing Address - Phone:626-441-5300
Mailing Address - Fax:626-441-2880
Practice Address - Street 1:729 MISSION ST STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3072
Practice Address - Country:US
Practice Address - Phone:626-441-5300
Practice Address - Fax:626-441-2880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8021T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2535OtherDAVIS VISION
CA03072OtherMEDICAL EYE SERVICES
CA8021OtherFACEY MEDICAL GROUP
CA03072OtherMEDICAL EYE SERVICES
T70246Medicare UPIN