Individual
DAT DOAN TO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-5700
(951) 486-5705
Mailing address
PO BOX 7270, MORENO VALLEY, CA 92552-7270
(951) 486-5700
(951) 486-5705
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A93559
CA
Other
Enumeration date
07/17/2007
Last updated
07/17/2007
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