Provider Demographics
NPI:1962508325
Name:DO, DAT THANH (MD)
Entity Type:Individual
Prefix:
First Name:DAT
Middle Name:THANH
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1540 FLORIDA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4430
Mailing Address - Country:US
Mailing Address - Phone:209-577-5557
Mailing Address - Fax:209-579-7246
Practice Address - Street 1:1540 FLORIDA AVE STE 100
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4430
Practice Address - Country:US
Practice Address - Phone:209-577-5557
Practice Address - Fax:209-579-7246
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76728207R00000X, 207RI0011X
TXM1639207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199673801Medicaid
TX8BW903OtherBCBS
TX199673802OtherCSHCN
TX199673801Medicaid
TX8L6315Medicare PIN