Provider Demographics
NPI:1225228091
Name:KAO N. VANG, D.M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KAO N. VANG, D.M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAO
Authorized Official - Middle Name:NHIAWA
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-225-9098
Mailing Address - Street 1:4304 E ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-2600
Mailing Address - Country:US
Mailing Address - Phone:559-225-9098
Mailing Address - Fax:
Practice Address - Street 1:4304 E ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-2600
Practice Address - Country:US
Practice Address - Phone:559-225-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA157871712Medicaid