Provider Demographics
NPI:1083660302
Name:VANG, DAVID YWJPHEEJ (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:YWJPHEEJ
Last Name:VANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W 21ST AVE
Mailing Address - Street 2:AMBULATORY FOOT CLINIC
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-893-3524
Mailing Address - Fax:985-893-9877
Practice Address - Street 1:1010 W 21ST AVE
Practice Address - Street 2:AMBULATORY FOOT CLINIC
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-893-3524
Practice Address - Fax:985-893-9877
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200006213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369683Medicaid
LAP00442320OtherRAILROAD MEDICARE PTAN
LAP00442320OtherRAILROAD MEDICARE PTAN
LA4K107CP84Medicare PIN