Basic Information
Provider Information
NPI: 1821714601
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VO
FirstName: DAVID TUAN
MiddleName: DUC
NamePrefix:  
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2400 MOORPARK AVE STE 300
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951282680
CountryCode: US
TelephoneNumber: 4089752730
FaxNumber:  
Practice Location
Address1: 2400 MOORPARK AVE STE 300
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951282680
CountryCode: US
TelephoneNumber: 4089752730
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/13/2022
LastUpdateDate: 10/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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