Provider Demographics
NPI:1477677888
Name:DANGTRAN, ERICK K
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:K
Last Name:DANGTRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1048
Mailing Address - Country:US
Mailing Address - Phone:408-494-1577
Mailing Address - Fax:408-292-3640
Practice Address - Street 1:614 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1048
Practice Address - Country:US
Practice Address - Phone:408-494-1561
Practice Address - Fax:408-292-3640
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health