Provider Demographics
NPI:1548276454
Name:DANG, VIET VAN (MD)
Entity type:Individual
Prefix:DR
First Name:VIET
Middle Name:VAN
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 1:10301 BOLSA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6784
Mailing Address - Country:US
Mailing Address - Phone:714-775-0898
Mailing Address - Fax:715-775-4208
Practice Address - Street 1:10301 BOLSA AVE STE 104
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6784
Practice Address - Country:US
Practice Address - Phone:714-775-0898
Practice Address - Fax:715-775-4208
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G488290Medicaid
CAG48829Medicare ID - Type Unspecified
CAA92852Medicare UPIN