Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | 60208875 | WA |
Y | 207YP0228X | Pediatric Otolaryngology | A120391 | CA |
NPI | 1861658718 |
---|---|
Provider Name | Dr. David Dang Tieu |
First Address | Los Angeles, CA 90027-5814 |
Second Address | Los Angeles, CA 90027-5814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60208875 | WASHINGTON STATE DEPARTMENT OF HEALTH (01) | WA |
A120391 | MEDICAL BOARD OF CALIFORNIA (01) | CA |