Provider Demographics
NPI:1538838438
Name:HO, TIEN DANG (RT)
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:DANG
Last Name:HO
Suffix:
Gender:M
Credentials:RT
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Mailing Address - Street 1:3648 HEATHCOT CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1442
Mailing Address - Country:US
Mailing Address - Phone:669-350-3331
Mailing Address - Fax:669-201-0296
Practice Address - Street 1:3648 HEATHCOT CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1442
Practice Address - Country:US
Practice Address - Phone:669-350-3331
Practice Address - Fax:669-201-0296
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-14
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Provider Licenses
StateLicense IDTaxonomies
CARHF00109759247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87-1986948Medicaid