Provider Demographics
NPI:1720017148
Name:DOAN, VIEN D (DO)
Entity Type:Individual
Prefix:DR
First Name:VIEN
Middle Name:D
Last Name:DOAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4343 MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3517
Mailing Address - Country:US
Mailing Address - Phone:951-784-7406
Mailing Address - Fax:951-784-7409
Practice Address - Street 1:4343 MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3517
Practice Address - Country:US
Practice Address - Phone:951-784-7406
Practice Address - Fax:951-784-7409
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08909Medicare UPIN
020A52760Medicare ID - Type Unspecified