Individual provider Active NPI

Marvin Tieu Dang, DO

  • Sports Medicine (Family Medicine) Physician
  • San Clemente, CA
National Provider Identifier
1720577687
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
20A23024 Issued in CA
Practice address
993 Avenida Pico Ste 130
San Clemente, CA 92673-3908
Phone
(949) 557-0410
NPI assigned
May 7, 2018
Last updated
Oct 20, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A23024 CA
Sports Medicine (Family Medicine) Physician 207QS0010X 20A23024 CA Primary

Addresses

Primary practice location

993 Avenida Pico Ste 130
San Clemente, CA 92673-3908

Mailing address

580 Anton Blvd Unit 454
Costa Mesa, CA 92626-7048

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220825002954 NY Practitioner - Family PracticePractitioner - Sports Medicine 6709124373 Reassigns benefits to 1 organization
I20250120000376 CA Practitioner - Family PracticePractitioner - Sports Medicine 6709124373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hoag ClinicGroup PAC ID 3274872064, 447 clinicians

Practice addresses (Care Compare)

993 Avenido Pico
San Clemente, CA 92673
Phone (949) 557-0820

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A23024CAMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Sep 1, 2022 Accepting new patients
New York University CurrentSince Sep 1, 2022 Accepting new patients
Hoag Clinic CurrentSince May 1, 2025 Accepting new patients
Hoag Hospital Past Accepting new patients

Locations

26672 Portola Pkwy
Ste 114
Foothill Ranch, CA 92610
Phone (949) 557-0773

1 Hoag Dr
Bldg 31
Newport Beach, CA 92663
Phone (949) 650-3350

1031 Avenida Pico
Ste 204
San Clemente, CA 92673
Phone (949) 829-5533

186 Joralemon St
Brooklyn Heights, NY 11201
Phone (718) 852-1400

550 1st Ave
New York, NY 10016
Phone (212) 263-3293

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10944/brand/3/csg/1/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: mdang136357@nyumc.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1720577687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 ANTON BLVD UNIT 454",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926267048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "993 AVENIDA PICO STE 130",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926733908",
            "telephone_number": "949-557-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANG",
        "first_name": "MARVIN",
        "middle_name": "TIEU",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-07",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A23024",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "20A23024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.