Provider Demographics
NPI:1477906717
Name:PHUC DANG, MD CORPORATION
Entity Type:Organization
Organization Name:PHUC DANG, MD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHUC
Authorized Official - Middle Name:N
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-442-5052
Mailing Address - Street 1:300 OLD RIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1006 MISSION DR APT A
Practice Address - Street 2:SUITE 200
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4217
Practice Address - Country:US
Practice Address - Phone:714-442-5052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117592207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty