Provider Demographics
NPI:1578614103
Name:BANG, DENNIS J (MD)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:BANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2222
Mailing Address - Country:US
Mailing Address - Phone:310-360-7999
Mailing Address - Fax:310-360-7970
Practice Address - Street 1:99 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-360-7999
Practice Address - Fax:310-360-7970
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA602202086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602200OtherBLUE SHIELD OF CA
CA4651925OtherCIGNA
CA00A602200Medicaid
CAW16157Medicare ID - Type UnspecifiedMEDICARE
CA00A602200OtherBLUE SHIELD OF CA
CA00A602200Medicaid