Provider Demographics
NPI:1467775866
Name:DINH XUAN DAM M.D. CORPORATION
Entity Type:Organization
Organization Name:DINH XUAN DAM M.D. CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-923-8080
Mailing Address - Street 1:200 N JACKSON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1601
Mailing Address - Country:US
Mailing Address - Phone:408-923-8080
Mailing Address - Fax:408-923-8549
Practice Address - Street 1:200 N JACKSON AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1601
Practice Address - Country:US
Practice Address - Phone:408-923-8080
Practice Address - Fax:408-923-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A773200Medicaid
CAH77833Medicare UPIN
CA00A773200Medicaid