Provider Demographics
NPI:1295391704
Name:DANG, JENNIFER THANH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THANH
Last Name:DANG
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9061 WILLIAMSON CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5007
Mailing Address - Country:US
Mailing Address - Phone:916-804-7534
Mailing Address - Fax:
Practice Address - Street 1:9061 WILLIAMSON CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-5007
Practice Address - Country:US
Practice Address - Phone:916-804-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant