Healthcare Provider Details

I. General information

NPI: 1629603659
Provider Name (Legal Business Name): LINH LAI RDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 STORY RD STE 1079
SAN JOSE CA
95122-2670
US

IV. Provider business mailing address

1111 STORY RD STE 1079
SAN JOSE CA
95122-2670
US

V. Phone/Fax

Practice location:
  • Phone: 408-288-5037
  • Fax: 408-288-9265
Mailing address:
  • Phone: 408-288-5037
  • Fax: 408-288-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSL5355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: