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General NPI Number Information
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NPI Number | 1720334279
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Entity Type | Organization
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Legal Business Name | LUYEN V. TA, M.D., INC/TUONG-VI TA, M.D.
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 341 9TH STREET SUITE A
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City | OAKLAND
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State | CA
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Zip | 94607
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Country | US
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Telephone | 510-836-1095
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Fax | 510-836-1096
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Provider Business Mailing Address
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Address Line | 341 9TH STREET SUITE A
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City | OAKLAND
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State | CA
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Zip | 94607
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Country | US
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Telephone | 510-836-1095
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Fax | 510-836-1096
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TUONG-VI TA
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Credential | M.D.,
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Telephone | 510-836-1095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A37356
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A37356
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License Number State | CA
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