Provider Demographics
NPI:1952350647
Name:VO, CAU VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAU
Middle Name:VAN
Last Name:VO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14024 MAGNOLIA ST
Mailing Address - Street 2:104
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4766
Mailing Address - Country:US
Mailing Address - Phone:714-898-1375
Mailing Address - Fax:714-898-2105
Practice Address - Street 1:14024 MAGNOLIA ST
Practice Address - Street 2:104
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4766
Practice Address - Country:US
Practice Address - Phone:714-898-1375
Practice Address - Fax:714-898-2105
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A436800Medicaid
CAF16316Medicare UPIN
CAA43680Medicare ID - Type Unspecified