Provider Demographics
NPI:1356328900
Name:DANG, HIEP DINH (DO)
Entity Type:Individual
Prefix:
First Name:HIEP
Middle Name:DINH
Last Name:DANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14160 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4657
Mailing Address - Country:US
Mailing Address - Phone:714-590-9697
Mailing Address - Fax:
Practice Address - Street 1:14160 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4657
Practice Address - Country:US
Practice Address - Phone:714-590-9697
Practice Address - Fax:714-590-8770
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH16798Medicare UPIN