1306025234 NPI number — STEPHEN M. DANG

Table of content: (NPI 1306025234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306025234 NPI number — STEPHEN M. DANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN M. DANG
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306025234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1315 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALHAMBRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91801-4163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-281-1536
Provider Business Mailing Address Fax Number:
626-281-1607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALHAMBRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91801-4163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-281-1536
Provider Business Practice Location Address Fax Number:
626-281-1607
Provider Enumeration Date:
10/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANG
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
626-281-1536

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  32056 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1265450522 . This is a "NPI SOLE PRACTIONER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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