Provider Demographics
NPI:1477536332
Name:VO, VIVIAN VAN (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:VAN
Last Name:VO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W YOSEMITE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4587
Mailing Address - Country:US
Mailing Address - Phone:559-674-5477
Mailing Address - Fax:559-674-3189
Practice Address - Street 1:816 W YOSEMITE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4587
Practice Address - Country:US
Practice Address - Phone:559-674-5477
Practice Address - Fax:559-674-3189
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51152OtherDENTIST LICENSE
CA51152OtherDENTIST LICENSE