1699764944 NPI number — DR. SON N DANG MD

Table of content: SHAWNA REDD (NPI 1285087171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699764944 NPI number — DR. SON N DANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANG
Provider First Name:
SON
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699764944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2606 WALES AVE NW
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MASSILLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44646-2340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-834-4735
Provider Business Mailing Address Fax Number:
330-834-4736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2606 WALES AVE NW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MASSILLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44646-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-834-4735
Provider Business Practice Location Address Fax Number:
330-834-4736
Provider Enumeration Date:
10/19/2005

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: 207Q00000X , with the licence number:  35071045 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 043700096 . This is a "PHCS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 331940002 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2034828 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2836702 . This is a "AETNA SELECT CHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 868623302 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 90305 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000230399 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 515 . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5078576 . This is a "AETNA MC & EC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: QG03984 . This is a "HOMETOWN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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