1316140882 NPI number — HUNG DANG DO

Table of content: HUNG DANG DO (NPI 1316140882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316140882 NPI number — HUNG DANG DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANG
Provider First Name:
HUNG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1316140882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 S LAKE PARK AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
HOBART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46342-6791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-942-6122
Provider Business Mailing Address Fax Number:
219-947-6045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 S LAKE PARK AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-6971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-942-6122
Provider Business Practice Location Address Fax Number:
219-947-6045
Provider Enumeration Date:
06/11/2007

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: 208600000X , with the licence number:  5101015915 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 02003347A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: OS10124 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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