Provider Demographics
NPI:1740775816
Name:URGENT CARE CLINIC OF NORTHERN CA INC
Entity Type:Organization
Organization Name:URGENT CARE CLINIC OF NORTHERN CA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-828-6470
Mailing Address - Street 1:999 STORY ROAD, SUITE 9021
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4604
Mailing Address - Country:US
Mailing Address - Phone:408-982-5301
Mailing Address - Fax:408-982-5797
Practice Address - Street 1:999 STORY ROAD, SUITE 9021
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-982-5301
Practice Address - Fax:408-982-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care