Provider Demographics
NPI:1124272679
Name:DO, TAI ANH (MD)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:ANH
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10902 TYLER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2019
Mailing Address - Country:US
Mailing Address - Phone:856-952-2680
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BRANCH CLINIC SAN DIEGO 2450 CRAVEN ST #33000
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5191
Practice Address - Country:US
Practice Address - Phone:619-556-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1839092083B0002X, 2083C0008X, 2083P0901X, 2083X0100X
VA01012462022083B0002X, 2083C0008X, 2083P0901X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine