Basic Information
| Provider Information | |||||||||
| NPI: | 1689753105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANG | ||||||||
| FirstName: | HUY | ||||||||
| MiddleName: | NGOC | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 708790 | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840708790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668692395 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 AUSTIN AVE NW | ||||||||
| Address2: | |||||||||
| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446463554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308487943 | ||||||||
| FaxNumber: | 3308487944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 11/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0201X | 35.088581 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 000000497135 | 01 | OH | BC/BS OF OHIO | OTHER | P00409914 | 01 | OH | RR MEDICARE | OTHER |