Provider Demographics
NPI:1992172696
Name:DANG, THUY THI NGOC (PA-C)
Entity type:Individual
Prefix:
First Name:THUY
Middle Name:THI NGOC
Last Name:DANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:309
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5018
Mailing Address - Country:US
Mailing Address - Phone:562-869-1201
Mailing Address - Fax:562-869-1281
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:309
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5018
Practice Address - Country:US
Practice Address - Phone:562-869-1201
Practice Address - Fax:562-869-1281
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA552706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant