Provider Demographics
NPI:1295932457
Name:DANG, KIM ANH THI (P-AC)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ANH THI
Last Name:DANG
Suffix:
Gender:F
Credentials:P-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:STE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:
Practice Address - Street 1:257 HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27887
Practice Address - Country:US
Practice Address - Phone:252-410-0001
Practice Address - Fax:252-410-0003
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002978363A00000X
NC0010-01841363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85002978OtherPHYSICIAN ASST-LICENSED
NC0010-01841OtherPHYSICIAN ASSISTANT LICENCE NUMBAER