Provider Demographics
NPI:1033277264
Name:VO, COLLEEN PHUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:PHUONG
Last Name:VO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 S. SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4001
Mailing Address - Country:US
Mailing Address - Phone:310-846-0172
Mailing Address - Fax:310-348-9074
Practice Address - Street 1:8611 S. SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4001
Practice Address - Country:US
Practice Address - Phone:310-846-0172
Practice Address - Fax:310-348-9074
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist