1760658900 NPI number — MR. THIEN HIEU VAN M.D.

Table of content: MR. THIEN HIEU VAN M.D. (NPI 1760658900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760658900 NPI number — MR. THIEN HIEU VAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN
Provider First Name:
THIEN
Provider Middle Name:
HIEU
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760658900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11301 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
VHA (VA GREATER LOS ANGELES HEALTHCARE SYSTEM)
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90073-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-478-3711
Provider Business Mailing Address Fax Number:
661-632-1886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 WESTWIND DR RM 318
Provider Second Line Business Practice Location Address:
VA CBOC BAKERSFIELD PRIMARY CARE
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-3028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-632-1800
Provider Business Practice Location Address Fax Number:
661-632-1886
Provider Enumeration Date:
05/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301091205 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)