Provider Demographics
NPI:1124032792
Name:CAI, DUNG VAN (MD)
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:VAN
Last Name:CAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 MERIDIAN AV
Mailing Address - Street 2:#5
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126
Mailing Address - Country:US
Mailing Address - Phone:408-294-5115
Mailing Address - Fax:408-294-0274
Practice Address - Street 1:259 MERIDIAN AV
Practice Address - Street 2:#5
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126
Practice Address - Country:US
Practice Address - Phone:408-294-5115
Practice Address - Fax:408-294-0274
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36652207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A3665219Medicaid
A28151Medicare UPIN
CA00A3665219Medicaid