MEDICARE: DR. THU PHUONG HO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A100210	CA
2	2080P0205X	Pediatric Endocrinology Physician	A100210	CA

General Provider Information

NPI Number	:	1245437433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THU PHUONG HO M.D.

Provider Business Mailing Address
First Line	:	2690 S WHITE RD STE 50
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-2075
Country	:	US
Telephone Number	:	408-223-7000
Fax Number	:	408-223-7001

Provider Business Practice Location Address
First Line	:	2690 S WHITE RD STE 50
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-2075
Country	:	US
Telephone Number	:	408-223-7000
Fax Number	:	408-223-7001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	05/14/2015

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