1083778054 NPI number — ANGELA MICHIKO DANGTRAN PHARM. D.

Table of content: ANGELA MICHIKO DANGTRAN PHARM. D. (NPI 1083778054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083778054 NPI number — ANGELA MICHIKO DANGTRAN PHARM. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANGTRAN
Provider First Name:
ANGELA
Provider Middle Name:
MICHIKO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083778054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4469 SOLANO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94533-6608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-400-3958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94596-5318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-295-4655
Provider Business Practice Location Address Fax Number:
925-295-4661
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  57588 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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