MEDICARE: DR. TRACH PHUONG DANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	A51333	CA

General Provider Information

NPI Number	:	1215959796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACH PHUONG DANG M.D.

Provider Business Mailing Address
First Line	:	2114 SENTER RD STE 24
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-2608
Country	:	US
Telephone Number	:	408-293-2188
Fax Number	:	408-292-5367

Provider Business Practice Location Address
First Line	:	2114 SENTER RD STE 24
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-2608
Country	:	US
Telephone Number	:	408-293-2188
Fax Number	:	408-292-5367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/09/2007

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