Provider Demographics
NPI:1326447012
Name:HEALTONES MEDICAL CLINIC
Entity Type:Organization
Organization Name:HEALTONES MEDICAL CLINIC
Other - Org Name:HEALTONES MEDICAL CLINIC INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-426-4135
Mailing Address - Street 1:2179 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1346
Mailing Address - Country:US
Mailing Address - Phone:408-426-4135
Mailing Address - Fax:408-258-2269
Practice Address - Street 1:2179 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1346
Practice Address - Country:US
Practice Address - Phone:408-426-4135
Practice Address - Fax:408-258-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31014207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGB296AMedicare UPIN