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General NPI Number Information
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NPI Number | 1386101665
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Entity Type | Individual
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Provider Name | BENI THI DANG PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 691 MURPHY RD., STE 107
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City | MEDFORD
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State | OR
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Zip | 97504-4311
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Country | US
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Telephone | 541-789-5121
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Fax | 541-789-5122
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Provider Business Mailing Address
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Address Line | 2825 E BARNETT RD MSS
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City | MEDFORD
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State | OR
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Zip | 97504-8332
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Country | US
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Telephone | 541-789-4207
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Fax | 541-789-4806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA192053
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA192053
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License Number State | OR
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