Provider Demographics
NPI:1609800960
Name:DINH, MICHELLE PHUONG (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PHUONG
Last Name:DINH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:PHUONG
Other - Last Name:DINH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5880 SANTA TERESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4117
Mailing Address - Country:US
Mailing Address - Phone:408-227-7309
Mailing Address - Fax:
Practice Address - Street 1:195 E VIRGINIA ST
Practice Address - Street 2:FAMILY PRACTICE DEPT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5844
Practice Address - Country:US
Practice Address - Phone:408-918-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine