Provider Demographics
NPI:1417032020
Name:TADANG, VICTOR VIET (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:VIET
Last Name:TADANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9872 CHAPMAN AVE.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2718
Mailing Address - Country:US
Mailing Address - Phone:714-539-8438
Mailing Address - Fax:
Practice Address - Street 1:9872 CHAPMAN AVE.
Practice Address - Street 2:SUITE 106
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2718
Practice Address - Country:US
Practice Address - Phone:714-539-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB31152OtherDENTI-CAL PROVIDER