Provider Demographics
NPI:1316478597
Name:DINH, BAC NGOC (LMT)
Entity type:Individual
Prefix:
First Name:BAC
Middle Name:NGOC
Last Name:DINH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 BEXLEY TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1618
Mailing Address - Country:US
Mailing Address - Phone:240-396-7083
Mailing Address - Fax:
Practice Address - Street 1:12717 BEXLEY TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1618
Practice Address - Country:US
Practice Address - Phone:240-396-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02601171100000X
MDM05762225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist