Healthcare Provider Details

I. General information

NPI: 1124272679
Provider Name (Legal Business Name): TAI ANH DO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL BRANCH CLINIC SAN DIEGO 2450 CRAVEN ST #33000
SAN DIEGO CA
92136-5191
US

IV. Provider business mailing address

10902 TYLER WAY
SAN DIEGO CA
92129-2019
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8115
  • Fax:
Mailing address:
  • Phone: 856-952-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number183909
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101246202
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101246202
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number183909
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number183909
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number0101246202
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number183909
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number0101246202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: