Organization
TYD EXECUTIVE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TZE YU DANG M.D (PHYSICIAN)
(818) 500-0205
Entity
Organization
Contact information
Practice address
411 N CENTRAL AVE STE 305, GLENDALE, CA 91203-2020
(818) 500-0205
(818) 500-1348
Mailing address
411 N CENTRAL AVE STE 305, GLENDALE, CA 91203-2020
(818) 500-0205
(818) 500-1348
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G44887
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G44887
—
CA
01
—
G44887
MEDICAID
CA
Enumeration date
01/05/2012
Last updated
04/24/2014
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