Provider Demographics
NPI:1104481340
Name:TRACH P. DANG M.D., INC
Entity type:Organization
Organization Name:TRACH P. DANG M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:THANH
Authorized Official - Middle Name:NGUYET
Authorized Official - Last Name:LA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-829-0655
Mailing Address - Street 1:2114 SENTER RD STE 24
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2608
Mailing Address - Country:US
Mailing Address - Phone:408-293-2188
Mailing Address - Fax:408-292-5367
Practice Address - Street 1:2114 SENTER RD STE 24
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2608
Practice Address - Country:US
Practice Address - Phone:408-293-2188
Practice Address - Fax:408-292-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care