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General NPI Number Information
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NPI Number | 1932687241
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Entity Type | Organization
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Legal Business Name | SILHOUETTE MEDICAL GROUP
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 101 E VINEYARD AVE STE 107
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City | LIVERMORE
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State | CA
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Zip | 94550-6877
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Country | US
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Telephone | 925-579-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E VINEYARD AVE STE 107
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City | LIVERMORE
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State | CA
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Zip | 94550-6877
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Country | US
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Telephone | 925-579-2510
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. TAM NGUYEN
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Credential | MD
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Telephone | 408-504-0966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State | CA
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