Provider Demographics
NPI:1740462860
Name:DZUNG D DANG DPM PA
Entity type:Organization
Organization Name:DZUNG D DANG DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DZUNG
Authorized Official - Middle Name:D
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-935-0020
Mailing Address - Street 1:1111 GESSNER DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6041
Mailing Address - Country:US
Mailing Address - Phone:713-935-0020
Mailing Address - Fax:713-935-0130
Practice Address - Street 1:1111 GESSNER DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6041
Practice Address - Country:US
Practice Address - Phone:713-935-0020
Practice Address - Fax:713-935-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5342TG152W00000X
TX2083P0011X
208D00000X
TX1173213ES0103X
TXF0611090363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092799802Medicaid
TX092799802Medicaid
4657300001Medicare NSC
00W290Medicare PIN