Provider Demographics
NPI:1215550728
Name:VO, TRUNG MINH (RD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:MINH
Last Name:VO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 MONTGOMERY DR APT 1-209
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2903
Mailing Address - Country:US
Mailing Address - Phone:408-460-3421
Mailing Address - Fax:
Practice Address - Street 1:1450 S WHITE RD
Practice Address - Street 2:UNIT 30
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127
Practice Address - Country:US
Practice Address - Phone:408-610-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86069586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered