Provider Demographics
NPI:1629058441
Name:DANG, MINH NGOC O (MD)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:NGOC O
Last Name:DANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 STONERIDGE DR
Mailing Address - Street 2:150
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3204
Mailing Address - Country:US
Mailing Address - Phone:925-251-9012
Mailing Address - Fax:925-251-9013
Practice Address - Street 1:6155 STONERIDGE DR
Practice Address - Street 2:150
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3204
Practice Address - Country:US
Practice Address - Phone:925-251-9012
Practice Address - Fax:925-251-9013
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61331174400000X
CAA061331207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A613311Medicare PIN
CAA061331Medicare ID - Type Unspecified
CAG72215Medicare UPIN