Healthcare Provider Details

I. General information

NPI: 1235648536
Provider Name (Legal Business Name): MRS. NGA TUYET DANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 THE ALAMEDA
SAN JOSE CA
95126-1136
US

IV. Provider business mailing address

1802 CLUB DR
GILROY CA
95020-3010
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-259-2273
Mailing address:
  • Phone: 408-460-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number784274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: