Provider Demographics
NPI:1689793267
Name:VONDOEPP, CHRISTIAN ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ERNEST
Last Name:VONDOEPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:327 NORTH SAN MATEO DRIVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2585
Mailing Address - Country:US
Mailing Address - Phone:650-342-0334
Mailing Address - Fax:415-665-4738
Practice Address - Street 1:327 NORTH SAN MATEO DRIVE
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2585
Practice Address - Country:US
Practice Address - Phone:650-342-0334
Practice Address - Fax:415-665-4738
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2549OtherNEVADA LICENSE
CA000G83480Medicaid
AV2028668OtherDEA
CA000G83480Medicaid
CA000G83480Medicare ID - Type Unspecified