MEDICARE: THAI DUC DANG MD

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	207RN0300X	Nephrology Physician	N1296	TX
2	207R00000X	Internal Medicine Physician	N1296	TX
3	208M00000X	Hospitalist Physician	N1296	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578841425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAI DUC DANG MD

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:	HR/CREDENTIALING SERVICES
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST
Second Line	:	19TH FLOOR
City	:	HOUSTON
State	:	TX
Zip	:	77030-2312
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	03/12/2026

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Directions to “ THAI DUC DANG MD” Practice Location

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