Provider Demographics
NPI:1265625933
Name:DENNIS BANG, M.D. INC.
Entity type:Organization
Organization Name:DENNIS BANG, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-360-7999
Mailing Address - Street 1:99 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2222
Mailing Address - Country:US
Mailing Address - Phone:310-360-7999
Mailing Address - Fax:310-360-7970
Practice Address - Street 1:99 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-360-7999
Practice Address - Fax:310-360-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60220208200000X, 2082S0099X, 2082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602200Medicaid
CA4651925OtherCIGNA
CA00A602200OtherBLUE SHIELD OF CA
CA00A602200Medicaid