Healthcare Provider Details

I. General information

NPI: 1982463121
Provider Name (Legal Business Name): DAT HOANGGIA CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAT HOANG-GIA CNS

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1290
US

IV. Provider business mailing address

3801 MIRANDA AVE
PALO ALTO CA
94304
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 999-999-9999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number5121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: