Provider Demographics
NPI:1124663455
Name:PHYSICIAN AT HOME INC
Entity type:Organization
Organization Name:PHYSICIAN AT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VU
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-496-4207
Mailing Address - Street 1:5907 CERRITOS AVE UNIT 2325
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-8716
Mailing Address - Country:US
Mailing Address - Phone:714-799-5858
Mailing Address - Fax:714-799-7272
Practice Address - Street 1:7923 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4225
Practice Address - Country:US
Practice Address - Phone:714-596-0368
Practice Address - Fax:714-591-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA138753OtherLICENSE