Provider Demographics
NPI:1538112685
Name:MASSILLON FAMILY CARE INC
Entity Type:Organization
Organization Name:MASSILLON FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SON
Authorized Official - Middle Name:N
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-834-4735
Mailing Address - Street 1:2606 WALES AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2340
Mailing Address - Country:US
Mailing Address - Phone:330-834-4735
Mailing Address - Fax:330-834-4736
Practice Address - Street 1:2606 WALES AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2340
Practice Address - Country:US
Practice Address - Phone:330-834-4735
Practice Address - Fax:330-834-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2565522Medicaid
MA9326131Medicare PIN