1740794437 NPI number — MR. DUNG XUAN DINH P.A.

Table of content: MR. DUNG XUAN DINH P.A. (NPI 1740794437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740794437 NPI number — MR. DUNG XUAN DINH P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINH
Provider First Name:
DUNG
Provider Middle Name:
XUAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

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:
1740794437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1569 LEXANN AVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95121-1794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-270-4267
Provider Business Mailing Address Fax Number:
408-270-3594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1569 LEXANN AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95121-1794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-270-4267
Provider Business Practice Location Address Fax Number:
408-270-3594
Provider Enumeration Date:
11/17/2017

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: 363A00000X , with the licence number:  PA15212 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: 1042295 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100169561 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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