Provider Demographics
NPI:1144240896
Name:DANG, MINH N (OD)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:N
Last Name:DANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 N 1ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2405
Mailing Address - Country:US
Mailing Address - Phone:408-244-2000
Mailing Address - Fax:
Practice Address - Street 1:3571 N 1ST ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2405
Practice Address - Country:US
Practice Address - Phone:408-424-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10074T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD010074Medicaid
CASD010074Medicare ID - Type Unspecified
CASD010074Medicaid