Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 106947 | CA |
NPI | 1053863761 |
---|---|
Provider Name | Cong Vo |
First Address | Tustin, CA 92780-6738 |
Second Address | Bakersfield, CA 93301-5032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2016 |
Last Update Date | 15/09/2021 |