Healthcare Provider Details

I. General information

NPI: 1376913244
Provider Name (Legal Business Name): MR. VI VAN NHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2015
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9353 VALLEY BLVD
ROSEMEAD CA
91770-1934
US

IV. Provider business mailing address

818 S 1ST ST # A
ALHAMBRA CA
91801-4305
US

V. Phone/Fax

Practice location:
  • Phone: 626-283-0877
  • Fax:
Mailing address:
  • Phone: 626-283-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW109882
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW109882
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: