Provider Demographics
NPI:1104003185
Name:VIET VAN DANG,M.D. INC.
Entity type:Organization
Organization Name:VIET VAN DANG,M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-775-0898
Mailing Address - Street 1:10301 BOLSA AVE
Mailing Address - Street 2:104
Mailing Address - City:WESTMINSTER
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:92683
Mailing Address - Country:UM
Mailing Address - Phone:714-775-0898
Mailing Address - Fax:714-775-4208
Practice Address - Street 1:10301 BOLSA AVE
Practice Address - Street 2:104
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:714-775-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48829207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G488290Medicaid
CAG48829Medicare PIN
CAA92852Medicare UPIN