Provider Demographics
NPI:1265775662
Name:DANG, KHOA AN
Entity type:Individual
Prefix:MR
First Name:KHOA
Middle Name:AN
Last Name:DANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 8TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6526
Mailing Address - Country:US
Mailing Address - Phone:510-917-0627
Mailing Address - Fax:510-474-1715
Practice Address - Street 1:310 8TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6526
Practice Address - Country:US
Practice Address - Phone:510-917-0627
Practice Address - Fax:510-474-1715
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator