Healthcare Provider Details

I. General information

NPI: 1720334279
Provider Name (Legal Business Name): LUYEN V. TA, M.D., INC/TUONG-VI TA, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 9TH STREET SUITE A
OAKLAND CA
94607
US

IV. Provider business mailing address

341 9TH STREET SUITE A
OAKLAND CA
94607
US

V. Phone/Fax

Practice location:
  • Phone: 510-836-1095
  • Fax: 510-836-1096
Mailing address:
  • Phone: 510-836-1095
  • Fax: 510-836-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA37356
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA37356
License Number StateCA

VIII. Authorized Official

Name: DR. TUONG-VI TA
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 510-836-1095