Provider Demographics
NPI:1225649957
Name:DANG, ANH NGOC
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:NGOC
Last Name:DANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 E 13TH ST APT 245
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3352
Mailing Address - Country:US
Mailing Address - Phone:951-488-8057
Mailing Address - Fax:
Practice Address - Street 1:531 E 13TH ST APT 245
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3352
Practice Address - Country:US
Practice Address - Phone:951-488-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program