Organization Active NPI

Dinh Xuan Dam M.D. Corporation

  • Internal Medicine Physician
  • San Jose, CA
National Provider Identifier
1467775866
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A77320 Issued in CA
Legal business name
DINH XUAN DAM M.D. CORPORATION
Practice address
200 N Jackson Ave Ste C
San Jose, CA 95116-1601
Phone
(408) 923-8080
Fax
(408) 923-8549
NPI assigned
Mar 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Authorized official

Name
Mrs. Kim K Chu
Title
Office Manager
Phone
(408) 923-8080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X A77320 CA Primary

Addresses

Primary practice location

200 N Jackson Ave Ste C
San Jose, CA 95116-1601

Mailing address

200 N Jackson Ave Ste C
San Jose, CA 95116-1601
Phone (408) 923-8080

Other identifiers 1

IdentifierTypeStateIssuer
00A773200MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101028000062 CA Part B Supplier - Clinic/Group Practice 8325232952 Receives reassigned benefits from 1 practitioner
Practice locations: San Jose, CA

National Provider Directory

National Provider Directory

Locations

200 N Jackson Ave
Ste C
San Jose, CA 95116
Phone (408) 923-8080

200 N Jackson Ave
San Jose, CA 95116

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1268352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715904000000",
    "number": "1467775866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N JACKSON AVE STE C",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161601",
            "telephone_number": "408-923-8080",
            "fax_number": "408-923-8549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N JACKSON AVE STE C",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161601",
            "telephone_number": "408-923-8080",
            "fax_number": "408-923-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DINH XUAN DAM M.D. CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-12",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "CHU",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "408-923-8080",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A77320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A773200",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.