Provider Demographics
NPI:1205536869
Name:DANG, DUNG JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:DUNG
Middle Name:JENNIFER
Last Name:DANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8700 CENTRAL MALL DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8058
Mailing Address - Country:US
Mailing Address - Phone:409-722-6141
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTRAL MALL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8058
Practice Address - Country:US
Practice Address - Phone:409-205-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10864TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist