Healthcare Provider Details

I. General information

NPI: 1215445291
Provider Name (Legal Business Name): VALLEY ADVANTAGE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 QUIMBY ROAD SUITE 160
SAN JOSE CA
95122-1337
US

IV. Provider business mailing address

4945 PALEMETTO DUNES CT
SAN JOSE CA
95138-2131
US

V. Phone/Fax

Practice location:
  • Phone: 408-550-2750
  • Fax: 408-550-2755
Mailing address:
  • Phone: 408-258-5083
  • Fax: 408-258-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. TAM HOANG NGUYEN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 408-258-5083