Individual provider Active NPI

Peter Vincent Phillip Dangvu, M.D.

  • Family Medicine Physician
  • Laguna Woods, CA
National Provider Identifier
1063453330
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A63928 Issued in CA
Practice address
24268 El Toro Road
Laguna Woods, CA 92637
Phone
(657) 241-8455
Fax
(657) 295-2116
NPI assigned
Jun 9, 2006
Last updated
May 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A63928 CA Primary

Addresses

Primary practice location

24268 El Toro Road
Laguna Woods, CA 92637

Mailing address

24268 El Toro Road
Laguna Woods, CA 92637
Phone (657) 241-8455

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040702001287 CA Practitioner - Family Practice 0840277190 Reassigns benefits to 2 organizations
Practice locations: Huntington Beach, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Pennsylvania, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Department of State HospitalsGroup PAC ID 9638174238, 275 clinicians

Practice addresses (Care Compare)

11401 Bloomfield Ave
Norwalk, CA 90650-2015
Phone (916) 651-8811

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A63928CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals Current Accepting new patients
Department of State Hospitals CurrentSince May 16, 2023 Accepting new patients
Memorialcare Medical Foundation Family Medicine CurrentSince Jun 1, 2022 Accepting new patients
Department of State Hospitals CurrentSince May 16, 2023 Accepting new patients
Providence Medical Foundation Family Medicine Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

24268 El Toro Rd
Laguna Woods, CA 92637
Phone (657) 241-8455

11401 Bloomfield Ave
Norwalk, CA 90650
Phone (562) 863-7011

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1063453330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24268 EL TORO ROAD",
            "city": "LAGUNA WOODS",
            "state": "CA",
            "postal_code": "92637",
            "telephone_number": "657-241-8455",
            "fax_number": "657-295-2116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24268 EL TORO ROAD",
            "city": "LAGUNA WOODS",
            "state": "CA",
            "postal_code": "92637",
            "telephone_number": "657-241-8455",
            "fax_number": "657-295-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANGVU",
        "first_name": "PETER",
        "middle_name": "VINCENT PHILLIP",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A63928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Laguna Woods, CA

Sources for this page

Verify at the official NPI Registry.