1013065473 NPI number — NGON HOANG DINH DO A PROFESSIONAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013065473 NPI number — NGON HOANG DINH DO A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NGON HOANG DINH DO A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1013065473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3674
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95156-3674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-279-6700
Provider Business Mailing Address Fax Number:
408-279-6760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 JOSE FIGUERES AVE STE 290
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95116-1587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-251-9700
Provider Business Practice Location Address Fax Number:
408-251-9799
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DINH
Authorized Official First Name:
NGON
Authorized Official Middle Name:
HOANG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
408-279-6700

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X , with the licence number:  20A6290 , 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)

  • Identifier: 00AX62900 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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