Provider Demographics
NPI:1164403994
Name:DANG, THANH K (MD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:K
Last Name:DANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THANG
Other - Middle Name:K
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 CURVE CREST BLVD W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6040
Practice Address - Country:US
Practice Address - Phone:651-439-1234
Practice Address - Fax:651-275-3325
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN379612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116641OtherFIRST HEALTH PLAN
130017755OtherRR MEDICARE
785177OtherST CLOUD HOSPITAL
785177OtherARAZ GRP AMERICA'S PPO
1016683OtherPREFERRED ONE
1507269OtherMEDICA HEALTH PLANS
HP26416OtherHEALTH PARTNERS
122798OtherU CARE
206518500OtherMEDICAL ASSISTANCE
09 15 1998OtherMMSI
45Q89DAOtherBLUE CROSS BLUE SHIELD
09 15 1998OtherMMSI
130017755OtherRR MEDICARE