Provider Demographics
NPI:1154501302
Name:DANG, LINH PHUONG (DC)
Entity Type:Individual
Prefix:DR
First Name:LINH
Middle Name:PHUONG
Last Name:DANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PHUONG
Other - Middle Name:LINH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4445 FAULKNER DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5813
Mailing Address - Country:US
Mailing Address - Phone:510-557-1570
Mailing Address - Fax:510-818-1616
Practice Address - Street 1:4445 FAULKNER DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5813
Practice Address - Country:US
Practice Address - Phone:510-557-1570
Practice Address - Fax:510-818-1616
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor