Provider Demographics
NPI:1477510568
Name:VAN, THU HOA VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:THU HOA
Middle Name:VICTORIA
Last Name:VAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15606 BROOKHURST ST
Mailing Address - Street 2:STE B
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7582
Mailing Address - Country:US
Mailing Address - Phone:714-531-0000
Mailing Address - Fax:714-531-1006
Practice Address - Street 1:15606 BROOKHURST ST STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-531-0000
Practice Address - Fax:714-531-1006
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81299208D00000X
MS208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126018Medicaid
MS00126018Medicaid