Provider Demographics
NPI:1659172450
Name:DANG, JUSTIN LE (PA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LE
Last Name:DANG
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FOLSOM BLVD APT 428
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4649
Mailing Address - Country:US
Mailing Address - Phone:415-939-5344
Mailing Address - Fax:
Practice Address - Street 1:6400 FOLSOM BLVD APT 428
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-4649
Practice Address - Country:US
Practice Address - Phone:415-939-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program