Provider Demographics
NPI:1437118650
Name:BE, VIET ANH (MD)
Entity Type:Individual
Prefix:
First Name:VIET
Middle Name:ANH
Last Name:BE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12580 STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1098
Mailing Address - Country:US
Mailing Address - Phone:714-210-5665
Mailing Address - Fax:714-839-4137
Practice Address - Street 1:16169 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1305
Practice Address - Country:US
Practice Address - Phone:714-210-5665
Practice Address - Fax:714-839-4137
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G487530Medicaid
CAA92847Medicare UPIN
CA00G487530Medicaid