Provider Demographics
NPI:1932106341
Name:DANG, DANHJOHN TAI (MD)
Entity Type:Individual
Prefix:
First Name:DANHJOHN
Middle Name:TAI
Last Name:DANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:TAI
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 W HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4906
Mailing Address - Country:US
Mailing Address - Phone:817-760-4201
Mailing Address - Fax:817-760-4202
Practice Address - Street 1:110 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4906
Practice Address - Country:US
Practice Address - Phone:817-760-4201
Practice Address - Fax:817-760-4202
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136833406Medicaid
TX84M875Medicare PIN
TX136833406Medicaid