Provider Demographics
NPI:1518936616
Name:DAM, DINH X (MD)
Entity Type:Individual
Prefix:DR
First Name:DINH
Middle Name:X
Last Name:DAM
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 1:200 N JACKSON AVE
Mailing Address - Street 2:SUITE C
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
Practice Address - Street 2:SUITE C
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A773200Medicaid
CAH77833Medicare UPIN
CA00A773202Medicare ID - Type Unspecified
CA00A773200Medicaid