Provider Demographics
NPI:1275024564
Name:DANG, MICHELLE QUYNH
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:QUYNH
Last Name:DANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:QUYNH
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9550 WARNER AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2843
Mailing Address - Country:US
Mailing Address - Phone:714-336-7536
Mailing Address - Fax:714-369-2641
Practice Address - Street 1:9550 WARNER AVE STE 224
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2843
Practice Address - Country:US
Practice Address - Phone:714-336-7536
Practice Address - Fax:714-369-2641
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor