Provider Demographics
NPI:1568737450
Name:DANG, VICKY
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
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 1:215 DEININGER CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1707
Mailing Address - Country:US
Mailing Address - Phone:951-493-2368
Mailing Address - Fax:888-545-4615
Practice Address - Street 1:215 DEININGER CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1707
Practice Address - Country:US
Practice Address - Phone:951-493-2368
Practice Address - Fax:888-545-4615
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist