Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A415350 | CA |
NPI | 1003822503 |
---|---|
Provider Name | Phuong Duc Dang |
First Address | Oakland, CA 94606 |
Second Address | Oakland, CA 94606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A415350 | (05) | CA |
A29401 | (02) |