Provider Demographics
NPI:1760550784
Name:TU, AN DANG (DDS)
Entity Type:Individual
Prefix:
First Name:AN
Middle Name:DANG
Last Name:TU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:DANG
Other - Last Name:TU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9872 CHAPMAN AVE
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2737
Mailing Address - Country:US
Mailing Address - Phone:714-590-1718
Mailing Address - Fax:714-590-9851
Practice Address - Street 1:9872 CHAPMAN AVE
Practice Address - Street 2:SUITE # 106
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2737
Practice Address - Country:US
Practice Address - Phone:714-590-1718
Practice Address - Fax:714-590-9851
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38142OtherDELTA DENTAL HEALTHY FAMI
CAB3814201Medicaid
CA899474OtherUNITED CONCORDIA