BOLSA-WARD MEDICAL CLINIC, INC.
NPI 1093918872
Internal Medicine - Nephrology in Garden Grove, CA
About Bolsa-ward Medical Clinic, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BOLSA-WARD MEDICAL CLINIC, INC. (NPI 1093918872) is a healthcare organization registered as a nephrology in Garden Grove, California and active in the NPI registry since June 2007. The organization lists Phu Van Dang, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Bolsa-ward Medical Clinic, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Bolsa-Ward Medical Clinic, Inc., which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp's NPI number?
The NPI number for Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp is 1093918872. It was assigned to this organization in the NPPES registry on June 7, 2007. The provider is doing business as Bolsa-Ward Medical Clinic, Inc..
Where is Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp located?
Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp is located at 13872 Harbor Blvd Unit 1C, Garden Grove, CA 92843. The listed phone number is (714) 531-5201.
What is Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp's specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.
Is Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp enrolled in Medicare?
Yes. Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp is registered in the Medicare PECOS enrollment system.
When is Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nephrology) reassigns their Medicare billing to Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Phu Van Dang, MD & Pauline Suong Thi Dang, MD, A Prof Medical Corp was last updated on May 20, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Bolsa-Ward Medical Clinic, Inc. · NPI 1093918872
Nephrology organization in Garden Grove, California. Organization record, active in the CMS NPPES registry since June 7, 2007.
## Identity
- **NPI:** 1093918872 (Entity type: Organization)
- **Enumerated:** June 7, 2007
- **Primary specialty:** Internal Medicine - Nephrology · taxonomy 207RN0300X
- **Legal business name:** Phu Van Dang, Md & Pauline Suong Thi Dang, Md, A Prof Medical Corp
- **Organization subpart:** No
- **Authorized official:** Phu Dang, PRESIDENT
## Practice location
- **Address:** 13872 HARBOR BLVD, UNIT 1C, Garden Grove, CA 92843-4000
- **Phone:** (714) 531-5201 · **Fax:** (714) 775-2849
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Nephrology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 20, 2014
- **Other identifiers:** Medicare ID-Type Unspecified W13435 (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1093918872) · Data from the CMS NPPES public registry.