Provider Demographics
NPI:1457316150
Name:DANG, PHUC CAO (MD)
Entity Type:Individual
Prefix:
First Name:PHUC
Middle Name:CAO
Last Name:DANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95151-1850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1692 TULLY RD
Practice Address - Street 2:SUITE #10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2549
Practice Address - Country:US
Practice Address - Phone:408-531-8572
Practice Address - Fax:408-531-8574
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A677990Medicaid
CA00A677990Medicaid
H08518Medicare UPIN