Provider Demographics
NPI:1447286570
Name:KHANH V. DANG, MD, LLC
Entity type:Organization
Organization Name:KHANH V. DANG, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-5088
Mailing Address - Street 1:1151 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2775
Mailing Address - Country:US
Mailing Address - Phone:614-451-5088
Mailing Address - Fax:614-451-4185
Practice Address - Street 1:1151 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2775
Practice Address - Country:US
Practice Address - Phone:614-451-5088
Practice Address - Fax:614-451-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271923Medicaid
OH0407186OtherUHC
OH280764512006OtherMEDICAL MUTUAL
OH000000249487OtherANTHEM
OH5717134OtherAETNA
OH0271923Medicaid
OH9327021Medicare PIN