Provider Demographics
NPI:1235231333
Name:DANG, MINH NGOC (MD)
Entity Type:Individual
Prefix:MR
First Name:MINH
Middle Name:NGOC
Last Name:DANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12302 GARDEN GROVE BOULEVARD
Mailing Address - Street 2:STE #7
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1835
Mailing Address - Country:US
Mailing Address - Phone:714-537-4343
Mailing Address - Fax:714-537-5543
Practice Address - Street 1:12302 GARDEN GROVE BOULEVARD
Practice Address - Street 2:STE #7
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1835
Practice Address - Country:US
Practice Address - Phone:714-537-4343
Practice Address - Fax:714-537-5543
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32864208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A328641Medicaid
A32864Medicare ID - Type Unspecified
A84399Medicare UPIN