Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E4039 | CA |
NPI | 1316011703 |
---|---|
Provider Name | Dr. Trieu Long Vo |
First Address | Sylmar, CA 91342 |
Second Address | Sylmar, CA 91342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 26/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E40390 | (05) | CA |
P00148920 | MEDICARE RAILROAD (01) | CA |
U64813 | (02) |