Tyd Executive Medical Clinic

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

G44887 Issued in CA

Legal business name

TYD EXECUTIVE MEDICAL CLINIC

Practice address

411 N Central Ave Ste 305
Glendale, CA 91203-2020

Phone

(818) 500-0205

Fax

(818) 500-1348

NPI assigned

Jan 5, 2012

Organization subpart

No

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

Authorized official

Name

Tze Yu Dang, M.D

Title

Physician

Phone

(818) 500-0205

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1942570130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 N CENTRAL AVE STE 305",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032020",
            "telephone_number": "818-500-0205",
            "fax_number": "818-500-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 N CENTRAL AVE STE 305",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032020",
            "telephone_number": "818-500-0205",
            "fax_number": "818-500-1348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYD EXECUTIVE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "DANG",
        "authorized_official_first_name": "TZE",
        "authorized_official_middle_name": "YU",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "818-500-0205",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "G44887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "G44887",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G44887",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Glendale, CA
• Providers in Glendale, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.