Provider Demographics
NPI:1881764637
Name:DANG, DIEP KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:DIEP
Middle Name:KIM
Last Name:DANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 AVENIDA DEL MAR #B
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672
Mailing Address - Country:US
Mailing Address - Phone:949-366-9055
Mailing Address - Fax:949-366-2025
Practice Address - Street 1:210 AVENIDA DEL MAR #B
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:949-366-9055
Practice Address - Fax:949-366-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2013-08-26
Deactivation Date:2006-11-09
Deactivation Code:
Reactivation Date:2006-11-13
Provider Licenses
StateLicense IDTaxonomies
CA37809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA83780901OtherDENTICAL