Provider Demographics
NPI:1134149867
Name:DO, BANG KINH (DDS)
Entity type:Individual
Prefix:DR
First Name:BANG
Middle Name:KINH
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 EL CAJON BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1168
Mailing Address - Country:US
Mailing Address - Phone:619-280-0337
Mailing Address - Fax:619-280-0347
Practice Address - Street 1:4090 EL CAJON BLVD STE F
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1168
Practice Address - Country:US
Practice Address - Phone:619-280-0337
Practice Address - Fax:619-280-0347
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist