1366738742 NPI number — THERESA PHUONGLOAN DANG M.D.

Table of content: THERESA PHUONGLOAN DANG M.D. (NPI 1366738742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366738742 NPI number — THERESA PHUONGLOAN DANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANG
Provider First Name:
THERESA
Provider Middle Name:
PHUONGLOAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1366738742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 RUSSELL PALMER RD
Provider Second Line Business Mailing Address:
STE 151
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77339-1689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-540-7500
Provider Business Mailing Address Fax Number:
281-540-7502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 RUSSELL PALMER RD
Provider Second Line Business Practice Location Address:
STE 151
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77339-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-540-7500
Provider Business Practice Location Address Fax Number:
281-540-7502
Provider Enumeration Date:
06/23/2011

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: 207L00000X , with the licence number:  P0030 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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