Provider Demographics
NPI:1851473557
Name:VO, JOHN DAI (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAI
Last Name:VO
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 1:355 E 21ST ST
Mailing Address - Street 2:STE D
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4851
Mailing Address - Country:US
Mailing Address - Phone:909-882-8455
Mailing Address - Fax:909-882-8050
Practice Address - Street 1:355 E 21ST ST
Practice Address - Street 2:STE D
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4851
Practice Address - Country:US
Practice Address - Phone:909-882-8455
Practice Address - Fax:909-882-8050
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA43167208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A431671Medicaid