Healthcare Provider Details

I. General information

NPI: 1447526835
Provider Name (Legal Business Name): BRYAN VO, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3651
US

IV. Provider business mailing address

24411 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3651
US

V. Phone/Fax

Practice location:
  • Phone: 949-452-3733
  • Fax:
Mailing address:
  • Phone: 949-452-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA96744
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA96744
License Number StateCA

VIII. Authorized Official

Name: BRYAN VO
Title or Position: PRESIDENT
Credential: MD
Phone: 949-452-3733