Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 008202 | GA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A159626 | CA |
NPI | 1760872188 |
---|---|
Provider Name | Kim Ann Vo Dang |
First Address | La Mesa, CA 91942-3033 |
Second Address | La Mesa, CA 91942-3033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2015 |
Last Update Date | 31/07/2019 |