Provider Demographics
NPI:1639230550
Name:LANG, RONALD P (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:P
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-0107
Mailing Address - Country:US
Mailing Address - Phone:323-525-1118
Mailing Address - Fax:818-303-1306
Practice Address - Street 1:8737 BEVERLY BLVD
Practice Address - Street 2:SUITE # 203
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1828
Practice Address - Country:US
Practice Address - Phone:323-525-1111
Practice Address - Fax:323-525-1100
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42331207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G423310Medicaid
CAWG42331AMedicare PIN
CA00G423310Medicaid
CAWG42331BMedicare PIN