MEDICARE: DANHJOHN TAI 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	207Q00000X	Family Medicine Physician	J4068	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

General Provider Information

NPI Number	:	1932106341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANHJOHN TAI DANG MD

Provider Business Mailing Address
First Line	:	110 W HENDERSON ST
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-4906
Country	:	US
Telephone Number	:	817-760-4201
Fax Number	:	817-760-4202

Provider Business Practice Location Address
First Line	:	110 W HENDERSON ST
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-4906
Country	:	US
Telephone Number	:	817-760-4201
Fax Number	:	817-760-4202

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/21/2022

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