Provider Demographics
NPI:1194851493
Name:DANG, THIEM (MD)
Entity Type:Individual
Prefix:DR
First Name:THIEM
Middle Name:
Last Name:DANG
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 1:1221 AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5533
Mailing Address - Country:US
Mailing Address - Phone:504-364-1844
Mailing Address - Fax:
Practice Address - Street 1:1221 AMELIA ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5533
Practice Address - Country:US
Practice Address - Phone:504-364-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339229Medicaid
LA721107862OtherTAX ID
LAB61462Medicare UPIN
LA5L742Medicare ID - Type Unspecified