Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E3686 | CA |
NPI | 1073577458 |
---|---|
Provider Name | Thu Kim Van |
First Address | Garden Grove, CA 92840-4881 |
Second Address | Garden Grove, CA 92840-4881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GRE000290 | (05) | CA |
T96072 | (02) | CA |