Provider Demographics
NPI:1790917631
Name:DAN, DANH THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANH
Middle Name:THANH
Last Name:DAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12688 CHAPMAN AVE
Mailing Address - Street 2:SUITE 3116
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4041
Mailing Address - Country:US
Mailing Address - Phone:714-697-9347
Mailing Address - Fax:714-829-1388
Practice Address - Street 1:12688 CHAPMAN AVE
Practice Address - Street 2:SUITE 3116
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4041
Practice Address - Country:US
Practice Address - Phone:714-697-9347
Practice Address - Fax:714-829-1388
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112628207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine