Individual provider Active NPI

An Quoc Dang, M.D.

  • Nephrology Physician
  • Garden Grove, CA
National Provider Identifier
1952302564
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A65421 Issued in CA
Practice address
13872 Harbor Blvd
Unit 1C
Garden Grove, CA 92843-4000
Phone
(714) 531-5201
Fax
(714) 775-2849
NPI assigned
Aug 4, 2005
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A65421 CA Primary

Addresses

Primary practice location

13872 Harbor Blvd
Unit 1C
Garden Grove, CA 92843-4000

Mailing address

13872 Harbor Blvd
Unit 1C
Garden Grove, CA 92843-4000
Phone (714) 531-5201

Other identifiers 2

IdentifierTypeStateIssuer
A65421OtherCAMEDICAL LICENSE
00A654210MedicaidCA

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
I20120106000208 CA Practitioner - NephrologyPractitioner - Internal Medicine 0941474043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of California, Geffen School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

13872 Harbor Blvd
Suite 1C
Garden Grove, CA 92843-4000
Phone (714) 531-5791

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A65421CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phu Van Dang, MD & Pauline Suong Thi Dang, MD, a Prof Medical Corp Nephrology CurrentSince Aug 1, 2002 Accepting new patients
Orange Coast Memorial Medical Center PastSince Aug 1, 2002 Accepting new patients

Locations

13872 Harbor Blvd
Ste 1C
Garden Grove, CA 92843
Phone (714) 531-5201

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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 6

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": "1123113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1952302564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13872 HARBOR BLVD",
            "address_2": "UNIT 1C",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928434000",
            "telephone_number": "714-531-5201",
            "fax_number": "714-775-2849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13872 HARBOR BLVD",
            "address_2": "UNIT 1C",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928434000",
            "telephone_number": "714-531-5201",
            "fax_number": "714-775-2849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANG",
        "first_name": "AN",
        "middle_name": "QUOC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A65421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "A65421",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A654210",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.