Provider Demographics
NPI:1669673976
Name:DANG, TUNG PHUOC (DC)
Entity Type:Individual
Prefix:DR
First Name:TUNG
Middle Name:PHUOC
Last Name:DANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 RIDGECROSSING LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1972
Mailing Address - Country:US
Mailing Address - Phone:832-640-8580
Mailing Address - Fax:713-781-0188
Practice Address - Street 1:6250 WESTPARK DR
Practice Address - Street 2:STE 319
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7322
Practice Address - Country:US
Practice Address - Phone:713-781-0040
Practice Address - Fax:713-781-0188
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609-386Medicare ID - Type Unspecified