Provider Demographics
NPI:1336144005
Name:VANG, DANIEL YOOJYIM (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:YOOJYIM
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:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7443
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:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7443
Practice Address - Country:US
Practice Address - Phone:985-893-3524
Practice Address - Fax:985-893-9877
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM200001213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1479829Medicaid
LAP00267274OtherRAILROAD MEDICARE PTAN
LA1479829Medicaid
LAP00267274OtherRAILROAD MEDICARE PTAN