Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | DPM200001 | LA |
NPI | 1336144005 |
---|---|
Provider Name | Dr. Daniel Yoojyim Vang |
First Address | Covington, LA 70433-7443 |
Second Address | Covington, LA 70433-7443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 28/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1479829 | (05) | LA |
P00267274 | RAILROAD MEDICARE PTAN (01) | LA |
V05199 | (02) | LA |