Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 62978 | CA |
NPI | 1053748608 |
---|---|
Provider Name | Dr. Vincent D Van |
First Address | San Jose, CA 95132-1540 |
Second Address | San Jose, CA 95132-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2013 |
Last Update Date | 27/09/2013 |