Healthcare Provider Details

I. General information

NPI: 1710842281
Provider Name (Legal Business Name): JIMMY M DANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAINT GEORGES AVE STE 202
RAHWAY NJ
07065-2713
US

IV. Provider business mailing address

1600 SAINT GEORGES AVE STE 202
RAHWAY NJ
07065-2713
US

V. Phone/Fax

Practice location:
  • Phone: 732-499-0111
  • Fax:
Mailing address:
  • Phone: 732-499-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number26NJ15480300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: