Provider Demographics
NPI:1891763470
Name:DANG, KEVIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:H
Last Name:DANG
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 3098
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3098
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:25395 HANCOCK AVE
Practice Address - Street 2:STE100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9019
Practice Address - Country:US
Practice Address - Phone:951-696-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70939207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709390Medicaid
CA00A709393Medicare PIN
CAA70939Medicare PIN
CAH72396Medicare UPIN
CAWA70939AMedicare PIN
CA00A709392Medicare PIN