Provider Demographics
NPI:1972178937
Name:ANGELA FANG DENTAL CORPORATION
Entity Type:Organization
Organization Name:ANGELA FANG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-619-1778
Mailing Address - Street 1:24971 SAUSALITO ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5627
Mailing Address - Country:US
Mailing Address - Phone:310-619-1778
Mailing Address - Fax:
Practice Address - Street 1:31161 NIGUEL RD STE K
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4102
Practice Address - Country:US
Practice Address - Phone:949-443-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental