Provider Demographics
NPI:1508274648
Name:DANG, LAN N
Entity Type:Individual
Prefix:MRS
First Name:LAN
Middle Name:N
Last Name:DANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 GLENVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3991
Mailing Address - Country:US
Mailing Address - Phone:530-410-5590
Mailing Address - Fax:
Practice Address - Street 1:1919 DAVIS ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1231
Practice Address - Country:US
Practice Address - Phone:510-569-9000
Practice Address - Fax:510-569-5441
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH55068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist