Provider Demographics
NPI:1114103124
Name:TA, TUAN V (MD)
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:V
Last Name:TA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2321 E 4TH STREET
Mailing Address - Street 2:SUITE C #637
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:714-664-0045
Mailing Address - Fax:714-664-0049
Practice Address - Street 1:999 N TUSTIN AVE STE 109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6501
Practice Address - Country:US
Practice Address - Phone:714-664-0045
Practice Address - Fax:714-664-0049
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2021-06-24
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Provider Licenses
StateLicense IDTaxonomies
CAA99653207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114103124Medicaid