Provider Demographics
NPI:1790712164
Name:VO, MICHAEL HUNG (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HUNG
Last Name:VO
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 1:15405 CALLE ROSA RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2959
Mailing Address - Country:US
Mailing Address - Phone:408-219-7514
Mailing Address - Fax:
Practice Address - Street 1:1025 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1329
Practice Address - Country:US
Practice Address - Phone:310-354-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG791182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG791180Medicaid
CAF71170Medicare UPIN
CAG791180Medicaid