Individual provider Active NPI

Phuc Cao Dang, MD

  • Internal Medicine Physician
  • San Jose, CA
National Provider Identifier
1457316150
Registry record updated Sep 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A67799 Issued in CA
Practice address
1692 Tully Rd
Suite #10
San Jose, CA 95122-2549
Phone
(408) 531-8572
Fax
(408) 531-8574
NPI assigned
Apr 18, 2006
Last updated
Sep 25, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A67799 CA Primary

Addresses

Primary practice location

1692 Tully Rd
Suite #10
San Jose, CA 95122-2549

Mailing address

PO Box 21850
San Jose, CA 95151-1850

Other identifiers 1

IdentifierTypeStateIssuer
00A677990MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100826000995 CA Practitioner - Internal Medicine 8729102884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hanh My Nguyen, MD, Inc.Group PAC ID 2769506880, 2 clinicians

Practice addresses (Care Compare)

1692 Tully Rd
Suite 10
San Jose, CA 95122-2550
Phone (408) 531-8572

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A67799CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hanh My Nguyen, MD, Inc. Internal Medicine CurrentSince Mar 19, 1999 Accepting new patients

Locations

1692 Tully Rd
Ste 10
San Jose, CA 95122
Phone (408) 531-8572

1879 Lundy Ave
Ste 166
San Jose, CA 95131
Phone (408) 531-8572

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1457316150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21850",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951511850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1692 TULLY RD",
            "address_2": "SUITE #10",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951222549",
            "telephone_number": "408-531-8572",
            "fax_number": "408-531-8574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANG",
        "first_name": "PHUC",
        "middle_name": "CAO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A67799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A677990",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.