Provider Demographics
NPI:1922455575
Name:ADRIENNE NGOC LAN VAN, DDS, INC.
Entity Type:Organization
Organization Name:ADRIENNE NGOC LAN VAN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-298-8187
Mailing Address - Street 1:2114 SENTER RD
Mailing Address - Street 2:STE 14
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2608
Mailing Address - Country:US
Mailing Address - Phone:408-298-8187
Mailing Address - Fax:
Practice Address - Street 1:2114 SENTER RD
Practice Address - Street 2:STE 14
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2608
Practice Address - Country:US
Practice Address - Phone:408-298-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADRIENNE NGOC LAN VAN, DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40506305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG8955401Medicare PIN