Provider Demographics
NPI:1376503169
Name:DANG, KEVIN HUY (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HUY
Last Name:DANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 PHOENIX AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6013
Mailing Address - Country:US
Mailing Address - Phone:479-434-4668
Mailing Address - Fax:
Practice Address - Street 1:4189 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6013
Practice Address - Country:US
Practice Address - Phone:479-434-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143673722Medicaid
AR143673722Medicaid
AR49587Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER