Healthcare Provider Details

I. General information

NPI: 1184119174
Provider Name (Legal Business Name): NAM NGOC DINH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 DANIELS ST
MANTECA CA
95337-6706
US

IV. Provider business mailing address

1611 E 15TH ST
OAKLAND CA
94606-4525
US

V. Phone/Fax

Practice location:
  • Phone: 209-456-5610
  • Fax:
Mailing address:
  • Phone: 510-984-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-107965
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: