Provider Demographics
NPI:1851464606
Name:HO, MYLIEN (MD)
Entity Type:Individual
Prefix:
First Name:MYLIEN
Middle Name:
Last Name:HO
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 1:5555 RESERVOIR DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5148
Mailing Address - Country:US
Mailing Address - Phone:619-286-5858
Mailing Address - Fax:619-286-1474
Practice Address - Street 1:5555 RESERVOIR DR STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5148
Practice Address - Country:US
Practice Address - Phone:619-286-5858
Practice Address - Fax:619-286-1474
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA482150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist