Provider Demographics
NPI:1013046507
Name:HAI V DANG M D INC
Entity Type:Organization
Organization Name:HAI V DANG M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAI
Authorized Official - Middle Name:V
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-349-3355
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0005
Mailing Address - Country:US
Mailing Address - Phone:662-349-3355
Mailing Address - Fax:662-349-8815
Practice Address - Street 1:7640 CLARINGTON CV
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5652
Practice Address - Country:US
Practice Address - Phone:662-349-3355
Practice Address - Fax:662-349-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13499174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04409851Medicaid
MS04409851Medicaid