Provider Demographics
NPI:1841374675
Name:DANG, CHUC VAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHUC
Middle Name:VAN
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 1:15035 E 14TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1901
Mailing Address - Country:US
Mailing Address - Phone:510-317-9990
Mailing Address - Fax:
Practice Address - Street 1:15035 E 14TH ST
Practice Address - Street 2:STE A
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1901
Practice Address - Country:US
Practice Address - Phone:510-317-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42462208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G424620Medicaid
CA00G424620Medicare ID - Type Unspecified
CA00G424620Medicaid