Provider Demographics
NPI:1710599253
Name:VO, NATHAN NGUYEN ANH
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:NGUYEN ANH
Last Name:VO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1648
Mailing Address - Country:US
Mailing Address - Phone:562-353-3448
Mailing Address - Fax:
Practice Address - Street 1:60 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1648
Practice Address - Country:US
Practice Address - Phone:562-353-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46538390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program