Provider Demographics
NPI:1174815815
Name:NGUYEN, VON TA (MD)
Entity Type:Individual
Prefix:
First Name:VON
Middle Name:TA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VON
Other - Middle Name:A
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ALSO KNOWN AS
Mailing Address - Street 1:700 PRESIDIO AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2903
Mailing Address - Country:US
Mailing Address - Phone:916-220-1566
Mailing Address - Fax:
Practice Address - Street 1:2333 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1925
Practice Address - Country:US
Practice Address - Phone:415-600-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115066207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology