Provider Demographics
NPI:1952302564
Name:DANG, AN QUOC (MD)
Entity Type:Individual
Prefix:DR
First Name:AN
Middle Name:QUOC
Last Name:DANG
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 1:13872 HARBOR BLVD
Mailing Address - Street 2:UNIT 1C
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4000
Mailing Address - Country:US
Mailing Address - Phone:714-531-5201
Mailing Address - Fax:714-775-2849
Practice Address - Street 1:13872 HARBOR BLVD
Practice Address - Street 2:UNIT 1C
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4000
Practice Address - Country:US
Practice Address - Phone:714-531-5201
Practice Address - Fax:714-775-2849
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65421207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65421OtherMEDICAL LICENSE
CA00A654210Medicaid
CABD5781883OtherDEA REGISTRATION
CAA65421OtherMEDICAL LICENSE
CA00A654210Medicaid